RCC benefit independent of sorafenib, sunitinib sequence order

By Shreeya Nanda, Senior medwireNews Reporter

Sequential treatment with sorafenib followed by sunitinib is not superior to sunitinib followed by sorafenib in patients with advanced or metastatic renal cell carcinoma (RCC), suggests research published in European Urology.

“Both drugs provided overall clinical benefit, regardless of treatment sequence”, note Christian Eichelberg (University of Regensburg, Germany) and team.

In the SWITCH phase III trial, patients with previously untreated advanced or metastatic disease were randomly assigned to either receive sorafenib followed by sunitinib (n=182) or vice versa (n=183).

After an average follow-up of 10.3 months, the primary endpoint of total progression-free survival (PFS), defined as time from randomisation to progression or death during second-line therapy, did not vary significantly between the sorafenib first and sunitinib first groups, at a median of 12.5 versus 14.9 months.

The groups were also similar with respect to median first-line PFS, defined as time to progression or death during first-line treatment, but patients who received sorafenib first had a significantly longer median second-line PFS, defined as time to progression or death during second-line treatment, than those given sunitinib first, at 5.4 versus 2.8 months.

Median overall survival was comparable, at 31.5 months for the sorafenib first group and 30.2 months for those treated with sunitinib first.

Interestingly, significantly more participants in the sorafenib first arm received protocol defined second-line treatment compared with the sunitinib first arm, at 57% versus 42%.

“This is consistent with data from other studies suggesting that patients receiving sorafenib early in the treatment sequence are more likely to receive subsequent therapies than those receiving first-line sunitinib”, say the researchers.

Overall, the incidence of adverse events was comparable between the groups, the team reports, but significantly fewer patients withdrew from first-line treatment as a result of toxicity in the sorafenib first than in the sunitinib first group (19 vs 30%).

Diarrhoea, fatigue and hypertension were the most common adverse events during first-line treatment with sorafenib and sunitinib, with patients treated with first-line sorafenib also experiencing hand–foot skin reaction and those given first-line sunitinib also reporting nausea.

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