PISCES: Metastatic RCC Patients Preferred Pazopanib to Sunitinib

Chemical structure of pazopanib

A study of patient preference revealed that patients who participated in a crossover trial of pazopanib and sunitinib for metastatic renal cell carcinoma preferred treatment with pazopanib.

The PISCES study, conducted by Bernard Escudier, MD, of Institut Gustave Roussy, Villejuif, France, and colleagues, enrolled 169 patients with metastatic renal cell carcinoma and randomly assigned them to 800-mg pazopanib for 10 weeks followed by a 2-week washout and then crossover to 50-mg sunitinib per day for 10 weeks, or the reverse sequence.

Escudier and colleagues were looking to determine if there was a patient preference for one of the drugs. This was assessed using a questionnaire at the end of the two treatment periods. In order to meet inclusion criteria for the study patients had to have received both treatments, had no disease progression prior to crossover, and had to complete the preference questionnaire. Results were published in the Journal of Clinical Oncology.

A similar proportion of patients assigned to sunitinib-pazopanib compared with pazopanib-sunitinib completed the questionnaire. One-hundred fourteen patients met the inclusion criteria and were used for the final primary analysis.

Seventy percent of patients reported preferring pazopanib compared with 22% preferring sunitinib (P < .001); 8% reported no preference.

“There was a period effect, in that a greater proportion of patients preferred the treatment in period 1 (54%) vs period 2 (38%) vs no preference (8%),” the researchers wrote. “Despite this period effect, patients in the sunitinib-pazopanib arm preferred pazopanib approximately twice as often as sunitinib (62% vs 32%, respectively).”

After adjusting for the period effect, the researchers found that there was still a 49.3% difference in patient preference for pazopanib compared with sunitinib.

Among the reasons that patients reported preferring pazopanib were less fatigue and a better overall quality of life. The most cited reason for a sunitinib preference was less diarrhea.

The study also showed that physician and patient preference were in line. Sixty-one percent of physicians preferred to continue their patients on pazopanib compared with 22% on sunitinib.

“The study by Escudier et al now provides more thorough data and complements the findings of the study by Motzer et al: that pazopanib boasts a better safety and quality-of-life profile,” wrote Marc B. Garnick, MD, of Beth Israel Deaconess Medical Center, in an accompanying editorial. “Taken together, the results of these two studies seem to demonstrate that pazopanib is preferred by both patients and physicians.”

However, Garnick also pointed out several weaknesses with the study including the small sample size of 160 patients of whom only two-thirds were included in the final analysis. In addition, fatigue, which is one of the “most important adverse events leading to patient preference,” is difficult to measure and compare.

“For example, the incidence of any grade of fatigue in the study by Motzer et al was 55% for pazopanib and 63% for sunitinib; asthenia was not even listed,” he wrote. “In the study by Escudier et al, the numbers for fatigue and asthenia for pazopanib are 29% and 16%, and for sunitinib, 30% and 24%.”

Finally, Garnick noted that although patient preference is important, efficacy should still be the most important factor when considering drug choice.

“It is of note that in both the study by Motzer et al and that by Escudier et al, sunitinib fared better than pazopanib in terms of several efficacy parameters,” Garnick wrote. “Median progression-free survival was 8.4 months for pazopanib and 9.5 months for sunitinib, and in the study by Escudier et al, albeit smaller and of shorter duration, there was a 20% progressive disease rate in period 1 for pazopanib vs 11% for sunitinib. Although not statistically significant, patient preferences could potentially have been influenced by disclosure of such data to study participants.”