Skip to main content
Journal cover image

Quality-adjusted survival with first-line cabozantinib or sunitinib for advanced renal cell carcinoma in the CABOSUN randomized clinical trial (Alliance).

Publication ,  Journal Article
Chen, RC; Choueiri, TK; Feuilly, M; Meng, J; Lister, J; Marteau, F; Falchook, AD; Morris, MJ; George, DJ; Feldman, DR
Published in: Cancer
December 15, 2020

BACKGROUND: Cabozantinib Versus Sunitinib as Initial Targeted Therapy for Patients With Metastatic Renal Cell Carcinoma of Poor or Intermediate Risk: The Alliance A031203 CABOSUN Trial (CABOSUN) was a randomized, open-label, phase 2 trial evaluating first-line cabozantinib versus sunitinib in patients with advanced renal cell carcinoma (aRCC). This post hoc analysis evaluated quality-adjusted survival using Quality-adjusted Time Without Symptoms of disease or Toxicity of treatment (Q-TWiST). METHODS: Survival plots for cabozantinib and sunitinib (650-day follow-up) were partitioned into 3 health states: time spent before disease progression without toxicity (TWiST; toxicity based on National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0] grade 3/4 adverse events), time spent before disease progression with toxicity (TOX; durations of adverse events based on published literature), and time after disease recurrence (relapse) or progression to death (REL). Q-TWiST was the sum of the mean time spent in each state, with each state weighted to reflect patient preferences (from 0 [worst] to 1 [best]) using utility scores. TWiST was always weighted as 1. Overall survival and time to disease progression were based on all randomized patients (157 patients); TOX was based on all randomized and treated patients (150 patients). RESULTS: Across all utility combinations tested, Q-TWiST was found to be longer with cabozantinib versus sunitinib (range of differences, +24 days to +137 days). Q-TWiST differences that were found to be statistically significant (+92 days [95% confidence interval, 5-178 days] to +137 days [95% confidence interval, 60-214 days]) were of a clinically meaningful effect size (≥80 days), and were based on utility values that included those considered relevant for patients with aRCC (REL utility weight of 0.355, TOX utility weight of 0-1, and TWiST utility weight of 1). CONCLUSIONS: In patients with aRCC, first-line cabozantinib was found to provide longer quality-adjusted survival compared with sunitinib. These findings may help to inform clinical decision making. LAY SUMMARY: Cabozantinib and sunitinib are drugs that are used to treat patients with advanced kidney cancer. Clinical trials have shown that cabozantinib offers benefits over sunitinib, giving patients more time before their cancer progresses. It is important that this additional time before disease progression does not come at the expense of patients' quality of life, which can be affected by treatment side effects and/or ongoing cancer symptoms. Both quantity and quality of life are central to optimal treatment. In the current analysis of patients with advanced kidney cancer who were initiating treatment for the first time, cabozantinib provided more quality time before cancer progression compared with sunitinib.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

December 15, 2020

Volume

126

Issue

24

Start / End Page

5311 / 5318

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Sunitinib
  • Quality-Adjusted Life Years
  • Pyridines
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Kidney Neoplasms
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chen, R. C., Choueiri, T. K., Feuilly, M., Meng, J., Lister, J., Marteau, F., … Feldman, D. R. (2020). Quality-adjusted survival with first-line cabozantinib or sunitinib for advanced renal cell carcinoma in the CABOSUN randomized clinical trial (Alliance). Cancer, 126(24), 5311–5318. https://doi.org/10.1002/cncr.33169
Chen, Ronald C., Toni K. Choueiri, Marion Feuilly, Jie Meng, Johanna Lister, Florence Marteau, Aaron D. Falchook, Michael J. Morris, Daniel J. George, and Darren R. Feldman. “Quality-adjusted survival with first-line cabozantinib or sunitinib for advanced renal cell carcinoma in the CABOSUN randomized clinical trial (Alliance).Cancer 126, no. 24 (December 15, 2020): 5311–18. https://doi.org/10.1002/cncr.33169.
Chen RC, Choueiri TK, Feuilly M, Meng J, Lister J, Marteau F, et al. Quality-adjusted survival with first-line cabozantinib or sunitinib for advanced renal cell carcinoma in the CABOSUN randomized clinical trial (Alliance). Cancer. 2020 Dec 15;126(24):5311–8.
Chen, Ronald C., et al. “Quality-adjusted survival with first-line cabozantinib or sunitinib for advanced renal cell carcinoma in the CABOSUN randomized clinical trial (Alliance).Cancer, vol. 126, no. 24, Dec. 2020, pp. 5311–18. Pubmed, doi:10.1002/cncr.33169.
Chen RC, Choueiri TK, Feuilly M, Meng J, Lister J, Marteau F, Falchook AD, Morris MJ, George DJ, Feldman DR. Quality-adjusted survival with first-line cabozantinib or sunitinib for advanced renal cell carcinoma in the CABOSUN randomized clinical trial (Alliance). Cancer. 2020 Dec 15;126(24):5311–5318.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

December 15, 2020

Volume

126

Issue

24

Start / End Page

5311 / 5318

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Sunitinib
  • Quality-Adjusted Life Years
  • Pyridines
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Kidney Neoplasms
  • Humans