A randomised, double-blind phase III study of pazopanib in patients with advanced and/or metastatic renal cell carcinoma: final overall survival results and safety update. Academic Article uri icon

Overview

abstract

  • BACKGROUND: In this randomised phase III study (VEG105192; NCT00334282), pazopanib previously demonstrated statistically and clinically meaningful improvement of progression-free survival versus placebo in patients with advanced/metastatic renal cell carcinoma (mRCC). Final overall survival (OS) and updated safety results are now reported. METHODS: Treatment-naive or cytokine-pretreated mRCC patients (n=435) stratified and randomised (2:1) to pazopanib 800 mg daily or placebo, were treated until disease progression, death or unacceptable toxicity. Upon progression, placebo patients could receive pazopanib through an open-label study. Final OS in the intent-to-treat population was analysed using a stratified log-rank test. Rank-preserving structural failure time (RPSFT) and inverse probability of censoring weighted (IPCW) analyses were performed post-hoc to adjust for crossover. FINDINGS: The difference in final OS between pazopanib- and placebo-treated patients was not statistically significant (22.9 versus 20.5 months, respectively; hazard ratio [HR]=0.91; 95% confidence interval [CI], 0.71-1.16; one-sided P=.224). Early and frequent crossover from placebo to pazopanib and prolonged duration of crossover treatment confounded the OS analysis. In IPCW analyses, pazopanib decreased mortality (HR=0.504; 95% CI, 0.315-0.762; two-sided P=.002). Similar, albeit non-significant, results were obtained in RPSFT analyses (HR=0.43; 95% CI, 0.215-1.388; two-sided P=.172). Since the last cutoff, cumulative exposure to pazopanib increased by 30%. The pazopanib safety profile showed no new safety signals or changes in the type, frequency and severity of adverse events. INTERPRETATION: Although no significant difference in OS was observed in this study, extensive crossover from placebo to pazopanib confounded final OS analysis. Post-hoc analyses adjusting for crossover suggest OS benefit with pazopanib treatment for mRCC patients.

authors

  • Sternberg, Cora
  • Hawkins, Robert E
  • Wagstaff, John
  • Salman, Pamela
  • Mardiak, Jozef
  • Barrios, Carlos H
  • Zarba, Juan J
  • Gladkov, Oleg A
  • Lee, Eunsik
  • Szczylik, Cezary
  • McCann, Lauren
  • Rubin, Stephen D
  • Chen, Mei
  • Davis, Ian D

publication date

  • January 12, 2013

Research

keywords

  • Carcinoma, Renal Cell
  • Kidney Neoplasms
  • Pyrimidines
  • Sulfonamides

Identity

Scopus Document Identifier

  • 84875690904

Digital Object Identifier (DOI)

  • 10.1016/j.ejca.2012.12.010

PubMed ID

  • 23321547

Additional Document Info

volume

  • 49

issue

  • 6