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Comparison of axitinib and sunitinib as first-line therapies for metastatic renal cell carcinoma: a real-world multicenter analysis

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Abstract

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.

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Abbreviations

mRCC:

Metastatic renal cell carcinoma

TKIs:

Tyrosine kinase inhibitors

VEGF:

Vascular endothelial growth factor

ECOG PS:

Eastern Cooperative Oncology Group performance status

IMDC:

International Metastatic Renal Cell Carcinoma Database Consortium

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

PFS:

Progression-free survival

CSS:

Cancer-specific survival

OS:

Overall survival

IPTW:

Inverse probability of treatment weighted

HR:

Hazard ratio

95% CI:

95% confidence interval

IQR:

Interquartile range

RDI:

Relative dose intensity

mTORi:

Mammalian target of rapamycin inhibitor

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Acknowledgements

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.

Funding

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.

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Authors and Affiliations

  1. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan

    Sakae Konishi, Shingo Hatakeyama, Toshikazu Tanaka, Naoki Fujita, Yusuke Ishibashi, Hayato Yamamoto, Takahiro Yoneyama, Yasuhiro Hashimoto & Chikara Ohyama

  2. Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan

    Toshiaki Tanaka & Naoya Masumori

  3. Department of Urology, Graduate School of Medicine, University of Toyama, Toyama, Japan

    Yoshinori Ikehata & Hiroshi Kitamura

  4. Department of Urology, Mutsu General Hospital, Mutsu, Japan

    Kazuaki Yoshikawa

  5. Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan

    Toshiaki Kawaguchi

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  1. Sakae Konishi
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  2. Shingo Hatakeyama
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  3. Toshiaki Tanaka
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Correspondence to Shingo Hatakeyama.

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Konishi, S., Hatakeyama, S., Tanaka, T. et al. Comparison of axitinib and sunitinib as first-line therapies for metastatic renal cell carcinoma: a real-world multicenter analysis. Med Oncol 36, 6 (2019). https://doi.org/10.1007/s12032-018-1231-3

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