Treatment with sorafenib and sunitinib in renal cell cancer: a Swedish register-based study

Abstract

Sorafenib and sunitinib are used for renal cell carcinoma (RCC). The objective was to study the treatment duration and time to death in Swedish RCC patients on sorafenib or sunitinib as first-line or monotherapy or as sequential therapy. Patients with an RCC diagnosis were identified in the Swedish Cancer Register. Information on treatment with sorafenib and sunitinib was collected from the Swedish Prescribed Drug Register, and time of death from the Cause of Death Register. Outcome measures were duration of treatment and time to death on sorafenib or sunitinib as first-line or monotherapy and sequential therapy (sorafenib–sunitinib versus sunitinib–sorafenib). Poisson regression models were used to estimate hazard ratios (HR) with 95 % confidence intervals (CI). No difference was observed for sorafenib (n = 123 patients) versus sunitinib (n = 261 patients) in treatment duration (HR 1.00; CI 0.80–1.24) or risk for death (HR 1.30; CI 0.91–1.85) when used as first-line or monotherapy. The same applied for sequential therapy with sorafenib–sunitinib (n = 43 patients) versus sunitinib–sorafenib (n = 54 patients), HR 1.47 (CI 0.71–3.02) and HR 2.01 (CI 0.86–4.68), respectively. There was a difference between the two treatments in how the duration of first-line treatment influenced the duration of second-line treatment and time to death, in favor of starting with sorafenib. In conclusion, no difference was detected between sorafenib and sunitinib in the duration of treatment or time to death when used as first-line or monotherapy. The impact of the duration of first-line treatment differed between the two sequences, and the results indicated that sorafenib as first-line treatment is a favorable choice.Electronic supplementary materialThe online version of this article (doi:10.1007/s12032-012-0331-8) contains supplementary material, which is available to authorized users.

Sunitinib Versus Sorafenib as Initial Targeted Therapy for mCC-RCC With Favorable/Intermediate Risk: Multicenter Randomized Trial CROSS-J-RCC

“…13 Another singlearm trial assessing sorafenib as first-line treatment also found mPFS longer than 5.5 months with the treatment. 14,15 In the present study, the mPFS with first-line sorafenib was 7.0 months (95% CI, 6.3-7.7 months), comparable with previously reported results. Whether 1 of the clones in primary RCC develops into metastatic lesions has been a focus of intense debate, and the characteristics of primary RCC cells are not identical to those of the metastatic lesions.…”

Sorafenib versus sunitinib as first-line treatment agents in Chinese patients with metastatic renal cell carcinoma: the largest multicenter retrospective analysis of survival and prognostic factors

“…However the clinical benefits of OS and PFS were inferior compared with placebo [28]. In line with our findings, a Swedish register-based demonstrated no difference between sorafenib and sunitinib in the duration of treatment or time to death when used as first-line therapy, however, the impact of the duration of first-line treatment differed in sequential therapy, concluding sorafenib first line treatment as a favorable choice in mRCC [31]. Furthermore, comparison of the present mOS findings with sorafenib therapy with other Asian studies demonstrated mixed results, where the mOS was consistent with a Chinese study12 conducted by Yu et al [32], but were lower than the other Chinese [33, 34] and Korean studies [20].…”

SWITCH: A Randomised, Sequential, Open-label Study to Evaluate the Efficacy and Safety of Sorafenib-sunitinib Versus Sunitinib-sorafenib in the Treatment of Metastatic Renal Cell Cancer

“…Notably, patients in our study who did not progress to second-line therapy happened to have more advanced disease (less favourable MSKCC score and ECOG PS; more prior treatment) or poorer prognosis (fewer patients had undergone nephrectomy; more with nonclear-cell histologies) than those who did progress to second-line therapy. Furthermore, differences in the firstline AE profiles may impact patients' willingness or ability E U R O P E A N U R O L O G Y X X X ( 2 0 1 5 ) X X X -X X X to continue to second-line treatment, as has been shown elsewhere [28,29]. The most common reasons cited by investigators for not continuing to second-line treatment in SWITCH in the So-Su versus Su-So arms, respectively, were death (16% vs 19%), AEs (8% versus 17%), and withdrawn consent (9% vs 13%).…”