title: Randomized, controlled, double-blind, cross-over trial assessing treatment preference for pazopanib versus sunitinib in patients with metastatic renal cell carcinoma: PISCES Study.
abstract: OBJECTIVE
  Patient-reported outcomes may help inform treatment choice in advanced/metastatic renal cell carcinoma (RCC), particularly between approved targeted therapies with similar efficacy. This double-blind cross-over study evaluated patient preference for pazopanib or sunitinib and the influence of health-related quality of life (HRQoL) and safety factors on their stated preference.
  
  
  METHODS
  Patients with metastatic RCC were randomly assigned to pazopanib 800 mg per day for 10 weeks, a 2-week washout, and then sunitinib 50 mg per day (4 weeks on, 2 weeks off, 4 weeks on) for 10 weeks, or the reverse sequence. The primary end point, patient preference for a specific treatment, was assessed by questionnaire at the end of the two treatment periods. Other end points and analyses included reasons for preference, physician preference, safety, and HRQoL.
  
  
  RESULTS
  Of 169 randomly assigned patients, 114 met the following prespecified modified intent-to-treat criteria for the primary analysis: exposure to both treatments, no disease progression before cross over, and completion of the preference questionnaire. Significantly more patients preferred pazopanib (70%) over sunitinib (22%); 8% expressed no preference (P < .001). All preplanned sensitivity analyses, including the intent-to-treat population, statistically favored pazopanib. Less fatigue and better overall quality of life were the main reasons for preferring pazopanib, with less diarrhea being the most cited reason for preferring sunitinib. Physicians also preferred pazopanib (61%) over sunitinib (22%); 17% expressed no preference. Adverse events were consistent with each drug's known profile. Pazopanib was superior to sunitinib in HRQoL measures evaluating fatigue, hand/foot soreness, and mouth/throat soreness.
  
  
  CONCLUSIONS
  This innovative cross-over trial demonstrated a significant patient preference for pazopanib over sunitinib, with HRQoL and safety as key influencing factors.
authors.affiliation: Bernard Escudier, Institut Gustave Roussy, Villejuif; Emmanuel Sevin, Centre François Baclesse, Caen; Sylvie Négrier, Leon Berard Cancer Center, Lyon, France; Camillo Porta, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Matteo, Pavia; Cora N. Sternberg, San Camillo Forlanini Hospital, Rome; Ugo De Giorgi, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy; Petri Bono, Helsinki University Central Hospital, Helsinki, Finland; Thomas Powles, Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, London; Tim Eisen, Cambridge University Health Partners, Cambridge; Omi Parikh, Royal Preston Hospital, Lancashire; Robert Hawkins, Christie Cancer Research UK, Manchester; Sadya Khan, Jose Diaz, and Faisal Mehmud, GlaxoSmithKline, Uxbridge, United Kingdom; Jürgen E. Gschwend, Klinikum Rechts der Isar der Technischen Universität München, Munich, Germany; Suman Redhu, GlaxoSmithKline, Collegeville, PA; and David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Camillo
authors.initials: C
authors.lastname: Porta
authors.forename: Petri
authors.initials: P
authors.lastname: Bono
authors.forename: Thomas
authors.initials: T
authors.lastname: Powles
authors.forename: Tim
authors.initials: T
authors.lastname: Eisen
authors.forename: Cora N
authors.initials: CN
authors.lastname: Sternberg
authors.forename: Jürgen E
authors.initials: JE
authors.lastname: Gschwend
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.forename: Omi
authors.initials: O
authors.lastname: Parikh
authors.forename: Robert
authors.initials: R
authors.lastname: Hawkins
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sevin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Négrier
authors.forename: Sadya
authors.initials: S
authors.lastname: Khan
authors.forename: Jose
authors.initials: J
authors.lastname: Diaz
authors.forename: Suman
authors.initials: S
authors.lastname: Redhu
authors.forename: Faisal
authors.initials: F
authors.lastname: Mehmud
authors.forename: David
authors.initials: D
authors.lastname: Cella
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007191:Indazoles; D007211:Indoles / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011743:Pyrimidines / Q000009:adverse effects*; D011758:Pyrroles / Q000009:adverse effects*; D011788:Quality of Life; D013449:Sulfonamides / Q000009:adverse effects*; D000077210:Sunitinib; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents; D007191:Indazoles; D007211:Indoles; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; C516667:pazopanib; D000077210:Sunitinib