Which Rx is Better for Advanced Kidney Cancer?

Votrient and Sutent offer similar survival benefits but different side effect profiles

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Along with the effectiveness of a cancer medication, physicians and patients want to know about its side effects. What’s the quality of a patient’s life while taking the medicine? Two kidney cancer medications are effective at treating cancer, but have markedly different side effect profiles.

A large phase III clinical trial found that pazopanib (Votrient) and sunitinib (Sutent) worked in delaying progression of advanced kidney cancer.

However, patients taking Votrient had a better quality of life and fewer serious side effects than those taking Sutent, the study found.

"Ask your oncologist about Rx side effects."

Toni Choueiri, MD, director of the Kidney Cancer Center at Dana-Farber/Brigham and Women’s Cancer Care, and Robert Motzer, MD, of Memorial Sloan-Kettering Cancer Center, were the lead investigators of this large international study.

Both Votrient and Sutent target specific molecules, including a molecule that helps cancer cells form blood vessels, which help the cancer live and grow.

Sutent was approved by the US Food and Drug Administration (FDA) in 2006 to treat advanced (has spread or metastasized) kidney cancer, and Votrient was approved for the same treatment in 2009.

For this study, a total of 1,100 patients were randomly assigned to receive 800 milligrams of Votrient daily or Sutent in six-week cycles (50 milligrams once a day for four weeks, followed by no treatment).

The researchers were primarily analyzing how long patients lived before the disease became worse (progression-free survival). The study was also examining overall survival, safety and health-related quality of life.

The median progression-free survival was similar for both medications — 8.4 months for the Votrient group and 9.5 months for those receiving Sutent.

Overall survival (time until death from any cause) was also about the same — 28.4 months for those taking Votrient and 29.3 months for patients taking Sutent.

The researchers found major differences in the side effects that patients experienced.

Those taking Sutent had higher rates of fatigue, hand and foot soreness, nausea and blood cell changes than patients taking Votrient.

Patients taking Votrient had higher levels of liver enzyme abnormalities, which led to the discontinuation of the medicine.

Quality of life measures during the first six months of treatment, including fatigue, along with mouth, throat, hands and feet soreness, favored Votrient.

The Votrient group also had fewer emergency room visits and phone consultations with providers.

The study authors suggest that these results may influence a change in the standard of care for advanced kidney cancer patients.

Dr. Choueiri, who is an associate professor of medicine at Harvard Medical School, said in a prepared statement, “If patients are going to live the same life span, why not use the one that’s better tolerated?”

Findings from this study were published in the August 22 issue of the New England Journal of Medicine.

The study was funded by GlaxoSmithKline Pharmaceuticals, the maker of Votrient.

Review Date: 
August 21, 2013
Last Updated:
December 31, 2013