title: First-line sunitinib versus pazopanib in metastatic renal cell carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium.
abstract: Sunitinib (SU) and pazopanib (PZ) are standards of care for first-line treatment of metastatic renal cell carcinoma (mRCC). However, how the efficacy of these drugs translates into effectiveness on a population-based level is unknown.
  
  
  
  We used the International mRCC Database Consortium (IMDC) to assess overall survival (OS), progression-free survival (PFS), response rate (RR) and performed proportional hazard regression adjusting for IMDC prognostic groups. Second-line OS (OS2) and second-line PFS (PFS2) were also evaluated.
  
  
  
  We obtained data from 7438 patients with mRCC treated with either first-line SU (n = 6519) or PZ (n = 919) with an overall median follow-up of 40.4 months (95% confidence interval [CI] 39.2-42.1). There were no significant differences in IMDC prognostic groups (p = 0.36). There was no OS difference between SU and PZ (22.3 versus 22.6 months, respectively, p = 0.65). When adjusted for IMDC criteria, the hazard ratio (HR) of death for PZ versus SU was 1.03 (95% CI 0.92-1.17, p = 0.58). There was no PFS difference between SU and PZ (8.4 versus 8.3 months, respectively, p = 0.17). When adjusted for IMDC criteria, the HR for PFS for PZ versus SU was 1.08 (95% CI 0.981-1.19, p = 0.12). There was no difference in RR between SU and PZ (30% versus 28%, respectively, p = 0.15). We also found no difference in any second-line treatment between either post-SU or post-PZ groups for OS2 (13.1 versus 11 months, p = 0.27) and PFS2 (3.7 versus 5.0 months, p = 0.07).
  
  
  
  We confirmed in real-world practice that SU and PZ have similar efficacy in the first-line setting for mRCC and do not affect outcomes with subsequent second-line treatment.
authors.affiliation: Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada; Hospital Medica Sur, Mexico City, Mexico.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Ruiz-Morales
authors.affiliation: Department of Oncology, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Swierkowski
authors.affiliation: Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada.
authors.forename: J Connor
authors.initials: JC
authors.lastname: Wells
authors.affiliation: Department of Oncology, Casa di Cura Pederzoli, Peschiera Del Garda, Italy.
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Fraccon
authors.affiliation: Department of Medical Oncology, Ospedale Santa Maria della Misericordia, Rovigo, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Pasini
authors.affiliation: Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Frede
authors.initials: F
authors.lastname: Donskov
authors.affiliation: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Georg A
authors.initials: GA
authors.lastname: Bjarnason
authors.affiliation: Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Hao-Wen
authors.initials: HW
authors.lastname: Sim
authors.affiliation: Department of Health Quality, Medical University of Lodz, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Sliwczynsk
authors.affiliation: Institute of Statistics and Demography, Warsaw School of Economics, Warsaw, Poland.
authors.forename: Aneta
authors.initials: A
authors.lastname: Ptak-Chmielewska
authors.affiliation: National Health Fund, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Teter
authors.affiliation: Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Benoit
authors.initials: B
authors.lastname: Beuselinck
authors.affiliation: Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Wood
authors.affiliation: Department of Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yuasa
authors.affiliation: Monash University Eastern Health Clinical School, Australia.
authors.forename: Carmel
authors.initials: C
authors.lastname: Pezaro
authors.affiliation: Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Brian I
authors.initials: BI
authors.lastname: Rini
authors.affiliation: Department of Oncology, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Szczylik
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada. Electronic address: daniel.heng@albertahealthservices.ca.
authors.forename: Daniel Y C
authors.initials: DY
authors.lastname: Heng
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D006801:Humans; D007191:Indazoles; D007211:Indoles / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D011758:Pyrroles / Q000627:therapeutic use*; D012189:Retrospective Studies; D013449:Sulfonamides / Q000627:therapeutic use*; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007191:Indazoles; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; C516667:pazopanib; D000077210:Sunitinib
keywords: Carcinoma; Pazopanib; Renal cell; Sunitinib; Vascular endothelial growth factor receptor