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SWITCH trial: Similar progression-free and overall survival outcomes regardless of sorafenib-sunitinib sequence in mRCC

Commentary from Professor Susanne Osanto

10th April 2014

At the recent 2014 ASCO Genitourinary Cancers Symposium in San Francisco (January 30- February 1, 2014), Maurice Stephan Michel reported on the phase III randomized SWITCH trial, switching and sequencing sorafenib and sunitinib as first- and second-line treatment for advanced RCC. SWITCH was conducted in Germany, Austria, and the Netherlands and enrolled 365 patients unsuitable for cytokines who had not yet received systemic therapy. 

The primary endpoint of the study was whether sorafenib followed by sunitinib was superior compared to the sunitinib followed by sorafenib in terms of total progression-free survival (PFS).

Patients were randomized to receive open-label sorafenib followed by sunitinib (SO/SU) or sunitinib followed by sorafenib (SU/SO) in standard dosage. Primary endpoint was total PFS from randomization to event during 2nd line therapy. Therapy continued until progression or intolerability. The study was powered to detect a 47% increase in total PFS with SO/SU compared to SU/SO. 

Dr. Michel reported that “a median total PFS duration reaching 12.5 months in the sorafenib-sunitinib arm and 14.9 months in the sunitinib-sorafenib arm, yielding a hazard ratio of 1.01 and a p value for superiority of 0.54”. He also reported “similar overall survival data”.  
The study was reported not to meet its primary endpoint demonstrating superiority of sorafenib-sunitinib over sunitinib-sorafenib for total PFS measured over the two sequential therapies.


SWITCH: A randomized sequential open-label study to evaluate efficacy and safety of sorafenib (SO)/sunitinib (SU) versus SU/SO in the treatment of metastatic renal cell cancer (mRCC).

J Clin Oncol 32, 2014 (suppl 4; abstr 393)

Further reading

SWITCH: Survival Outcomes Similar Regardless of Sorafenib-Sunitinib Sequence in mRCC