First-line treatment of metastatic renal cell carcinoma after COMPARZ and PISCES

In patients with metastatic renal cell carcinoma and favourable or intermediate risk, sunitinib, pazopanib, and bevacizumab along with interferon have been recommended with identical evidence level I, recommendation grade A. In clinical practice, most physicians and patients are likely to favour an oral treatment (i.e., sunitinib or pazopanib). Choosing between those two tyrosine kinase inhibitors may prove challenging. Two randomized trials have been conducted to facilitate treatment choices, COMPARZ, and PISCES. We discuss below the design of these trials, their results, their potential interpretation, and their clinical implications for selecting treatment.

Both trials were reported to meet the primary endpoint (i.e., noninferiority of pazopanib versus sunitinib) and patient's preference of pazopanib over sunitinib. However, several methodological aspects have raised doubts about the reliability of these conclusions. Pitfalls include the patients selected for the final analysis, discrepancies of results between the per protocol and intention-to-treat populations, the time points at which quality of life and disease were assessed.

A rigorous head-to-head comparison of pazopanib versus sunitinib is yet to be performed. Clinical considerations and physicans' experience, rather than the reported results of these trials, may continue to influence treatment choices.