Bladder Cancer Update & Renal Cell Cancer Update, 2017 (Video Program)Optimal sequencing of VEGF TKIs for RCC
2:46 minutes.
TRANSCRIPTION:
DR LOVE: Globally right now, how do you decide which TKI to start with and, if you’re going to use a second- or third- or fourth-line TKI, kind of how you’re going to sequence them? DR MOTZER: In the first line, I think the 2 major contenders for treatment are pazopanib and sunitinib. And there are advocates for each. Based on the COMPARZ trial, which was a comparison of sunitinib to pazopanib, a noninferiority trial, I generally use pazopanib in patients who are not on a clinical trial. And so that’s been my first-line choice. What I’ve found is that the major side effect or issue or problem with pazopanib is the hepatic toxicity, the elevation of liver function tests, which occur usually by 8 to 12 weeks. And so when patients develop the liver function test abnormality, it is problematic. It’s disappointing to the patient. And normally I stop pazopanib and switch to axitinib. But what I’ve found is, for the other remaining patients, probably the 80% of patients who don’t have any liver problem then, over time I think they do feel better than if they’re on sunitinib. And I think reasons for that are the lack of blood count suppression, less fatigue and less incidence of hand-foot syndrome. Now, I think — but there is a certain confidence that many feel with regard to efficacy from sunitinib. It’s been well entrenched. It’s been here for 10 years. People have a lot of experience with it. They’re more used to using it and modifying toxicity. And also, many claim that the 2-week-on, 1-week-off schedule is a better, more-tolerated schedule. So I really think that either one of those are very good choices in first-line therapy. And it’s really the doctor and the patient’s choice. DR LOVE: Is there any reason to believe that it is more effective than pazopanib, or is it generally accepted to be equal, just a question of toxicity? DR MOTZER: There has been this view voiced by some that it’s more effective, that we see more responses and so forth. But, I mean, that large trial, the COMPARZ trial, it didn’t show any difference in response rate, didn’t show a meaningful difference in progression-free survival, and probably most meaningful, the overall survival was exactly the same between the 2 drugs. |