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Patient’s preference (PISCES) crossover trial indicates that patients prefer pazopanib over sunitinib in metastatic RCC

Commentary from Professor Susanne Osanto

April 10th 2014

A crossover trial reported in the Journal of Clinical Oncology by Dr. Escudier et al suggests that patient-reported outcomes may help inform treatment choice in advanced/metastatic renal cell carcinoma (RCC), particularly between approved targeted therapies with similar efficacy. The authors found that patients with metastatic renal cell carcinoma preferred pazopanib vs. sunitinib treatment. 

This double-blind cross-over PISCES study evaluated patient preference for pazopanib or sunitinib and the influence of health-related quality of life (HRQoL) and safety factors on their stated preference. Patients with metastatic RCC were randomly assigned to
pazopanib 800 mg per day for 10 weeks, a 2-week washout, and then sunitinib 50 mg
per day (4 weeks on, 2 weeks off, 4 weeks on) for 10 weeks, or the reverse sequence. The primary end point, patient preference for a specific treatment, was assessed by questionnaire at the end of the two treatment periods. The study size was modest with 114 of the 169 randomly assigned patients meeting the prespecified modified intent-to-treat criteria for the primary analysis.

More patients preferred pazopanib (70%) over sunitinib (22%); 8% expressed no preference. Less fatigue and better overall quality of life were the main reasons for preferring pazopanib, with less diarrhea being the most cited reason for preferring sunitinib. Also physicians preferred pazopanib (61%) over sunitinib (22%); 17% expressed no preference. Adverse events were consistent with each drug's known profile.  

The study design was double blind, but in daily differences in specific toxicities related to either pazopanib or sunitinib may well have revealed which of the two TKIs patients were using.


Randomized, Controlled, Double-Blind, Cross-Over Trial Assessing Treatment Preference for Pazopanib Versus Sunitinib in Patients With Metastatic Renal Cell Carcinoma: PISCES Study

Escudier B, Porta C, Bono P, Powles T, Eisen T, Sternberg CN, Gschwend JE, De Giorgi U, Parikh O, Hawkins R, Sevin E, Négrier S, Khan S, Diaz J, Redhu S, Mehmud F, Cella D.

J Clin Oncol. 2014 Mar 31. [Epub ahead of print]