Comparison of axitinib and sunitinib as first-line therapies for metastatic renal cell carcinoma: a real-world multicenter analysis
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We aimed to compare oncological outcomes and safety of axitinib and sunitinib in patients with treatment-naïve metastatic renal cell carcinoma (mRCC). We retrospectively evaluated 169 patients with mRCC who were treated with axitinib or sunitinib as the first-line therapy in five hospitals between October 2008 and August 2018. Oncological outcomes and safety were compared between axitinib (n = 68) and sunitinib (n = 101) groups. Inverse probability of treatment weighted (IPTW)-adjusted Cox regression analysis was performed to evaluate effects of first-line therapies on progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Patients in the axitinib group were significantly older (66 vs. 72 years) than those in the sunitinib group. Median relative dose intensity was significantly higher in the axitinib group (94 ± 62%) than in the sunitinib group (65 ± 20%; P = 0.001). Objective response rate was significantly higher in the axitinib group (21%) than in the sunitinib group (10%; P = 0.042). IPTW-adjusted Cox regression analysis revealed significant differences in CSS and OS but not in PFS between the two groups. Safety in terms of grade ≥ 3 adverse events was significantly different between the axitinib (34%) and sunitinib (55%) groups (P = 0.006). Compared with sunitinib, axitinib significantly prolonged CSS and OS and showed a safer profile as the first-line therapy for treatment-naïve mRCC.
KeywordsAxitinib Sunitinib Metastatic renal cell carcinoma First-line therapy Safety Efficacy
Metastatic renal cell carcinoma
Tyrosine kinase inhibitors
Vascular endothelial growth factor
- ECOG PS
Eastern Cooperative Oncology Group performance status
International Metastatic Renal Cell Carcinoma Database Consortium
Inverse probability of treatment weighted
- 95% CI
95% confidence interval
Relative dose intensity
Mammalian target of rapamycin inhibitor
The authors would like to thank Takuma Narita, Teppei Okamoto, Itsuto Hamano, Hirotaka Horiguchi, Masaaki Oikawa, Daisuke Noro, Kazuhisa Hagiwara, Yuki Fujita, Yukie Nishizawa, and Satomi Sakamoto for their invaluable support in data collection. The authors would also like to thank Enago (http://www.enago.jp) for English language review.
This work was supported by a Grant-in-Aid for Scientific Research (Nos. 17K11118, 17K11119, 17K16768, 17K16770, 17K167711, 18K16681, 18K16682, 18K16717, 18K16718, 18K16719, and 18K09157) from the Japan Society for the Promotion of Science.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest.
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