More attention is being paid to the importance of patient preference as a factor in treatment selection. An innovative randomized, double-blind study in patients with metastatic kidney cancer demonstrates that quality of life and side effects drive patient preference.1 Results also suggest that physicians perceive quality-of-life differences between therapies as less important than patients do.
“We expected patients would prefer one drug over another, but we didn’t expect this great a difference,” said lead author Bernard J. Escudier, MD, Institut Gustave Roussy, Villejuif, France. “This is an excellent method to report the way patients are feeling about the side effects of drugs. Remember that low-grade toxicities may not seem bad to physicians, but toxicity over a long time can affect quality of life. Traditional adverse event reporting does not consider how patients feel when they take a drug over many months.”
Patients were treated with either pazopanib (Votrient) or sunitinib (Sutent), and they preferred pazopanib, in this study supported by GlaxoSmithKline (manufacturer of pazopanib). At the press conference where this study was discussed, experts said that they were assured that results were not biased because of the blinded study design.
The study included 169 patients randomly assigned to pazopanib for 10 weeks followed by a 2-week washout period and then sunitinib for 10 weeks, or vice versa. Pazopanib was preferred by 70% of patients, sunitinib was preferred by 22%, and 9% had no preference. When physicians were asked which drug they preferred, 60% preferred pazopanib, 21% preferred sunitinib, and 21% had no preference.
Improved quality of life and less fatigue were the most common reasons patients cited for preferring pazopanib over sunitinib. Additionally, fewer dose reductions were needed for patients taking pazopanib than for those taking sunitinib (13% vs 20%, respectively). Likewise, fewer treatment interruptions occurred in patients on pazopanib (6% vs 12%, respectively). ■
Disclosure: Dr. Escudier has served in a consulting or advisory role for AVEO, Bayer, GlaxoSmithKline, Novartis, and Pfizer.
1. Escudier BJ, Porta C, Bono P, et al: Patient preference between pazopanib and sunitinib: Results of a randomized, double-blind, placebo-controlled, cross-over study in patients with metastatic renal cell carcinoma—PISCES study, NCT 01064310. 2012 ASCO Annual Meeting. Abstract CRA4502. Presented June 2, 2012.