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JAMA Oncol. 2017 Apr 1;3(4):501-508. doi: 10.1001/jamaoncol.2016.5202.

Alternating Treatment With Pazopanib and Everolimus vs Continuous Pazopanib to Delay Disease Progression in Patients With Metastatic Clear Cell Renal Cell Cancer: The ROPETAR Randomized Clinical Trial.

Author information

1
University Medical Center Utrecht, Department of Medical Oncology, Utrecht, the Netherlands.
2
Franciscus Gasthuis, Department of Medical Oncology, Rotterdam, the Netherlands.
3
Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, the Netherlands.
4
Amphia Hospital, Department of Medical Oncology, Breda, the Netherlands.
5
Maxima Medical Center, Department of Medical Oncology, Eindhoven, the Netherlands.
6
St Antonius Hospital, Department of Medical Oncology, Nieuwegein, the Netherlands.
7
Medical Center Leeuwarden, Department of Medical Oncology, Leeuwarden, the Netherlands.
8
Zuyderland Medical Center, Department of Medical Oncology, Heerlen, the Netherlands.
9
Maastricht University Medical Center, Department of Medical Oncology, Maastricht, the Netherlands.
10
Elisabeth Tweesteden Hospital, Department of Medical Oncology, Tilburg, the Netherlands.
11
University Medical Center Utrecht, Department of Medical Oncology, Utrecht, the Netherlands3Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, the Netherlands.
12
Isala Clinics, Department of Medical Oncology, Zwolle, the Netherlands.
13
Haga Hospital, Department of Medical Oncology, Den Haag, the Netherlands.
14
Zuyderland Medical Center, Department of Medical Oncology, Sittard-Geleen, the Netherlands.
15
Academic Medical Center, Department of Medical Oncology, Amsterdam, the Netherlands.
16
Netherlands Cancer Institute, Department of Biometrics, Amsterdam, the Netherlands.
17
Netherlands Cancer Institute, Department of Medical Oncology, Amsterdam, the Netherlands.
18
University Medical Center Utrecht, Department of Medical Oncology, Utrecht, the Netherlands16Netherlands Cancer Institute, Department of Medical Oncology, Amsterdam, the Netherlands.

Abstract

Importance:

To our knowledge, this is the first randomized clinical trial evaluating an alternating treatment regimen in an attempt to delay disease progression in clear cell renal cell carcinoma.

Objective:

To test our hypothesis that an 8-week rotating treatment schedule with pazopanib and everolimus delays disease progression, exhibits more favorable toxic effects, and improves quality of life when compared with continuous treatment with pazopanib.

Design, Setting, and Participants:

This was an open-label, randomized (1:1) study (ROPETAR trial). In total, 101 patients with treatment-naive progressive metastatic clear cell renal cell carcinoma were enrolled between September 2012 and April 2014 from 17 large peripheral or academic hospitals in The Netherlands and followed for at least one year.

Interventions:

First-line treatment consisted of either an 8-week alternating treatment schedule of pazopanib 800 mg/d and everolimus 10 mg/d (rotating arm) or continuous pazopanib 800 mg/d (control arm) until progression. After progression, patients made a final rotation to either pazopanib or everolimus monotherapy (rotating arm) or initiated everolimus (control arm).

Main Outcome and Measures:

The primary end point was survival until first progression or death. Secondary end points included time to second progression or death, toxic effects, and quality of life.

Results:

A total of 52 patients were randomized to the rotating arm (median [range] age, 65 [44-87] years) and 49 patients to the control arm (median [range] age, 67 [38-82] years). Memorial Sloan Kettering Cancer Center risk category was favorable in 26% of patients, intermediate in 58%, and poor in 15%. Baseline characteristics and risk categories were well balanced between arms. One-year PFS1 for rotating treatment was 45% (95% CI, 33-60) and 32% (95% CI, 21-49) for pazopanib (control). Median time until first progression or death for rotating treatment was 7.4 months (95% CI, 5.6-18.4) and 9.4 months (95% CI, 6.6-11.9) for pazopanib (control) (P = .37). Mucositis, anorexia, and dizziness were more prevalent in the rotating arm during first-line treatment. No difference in quality of life was observed.

Conclusions and Relevance:

Rotating treatment did not result in prolonged progression-free-survival, fewer toxic effects, or improved quality of life. First-line treatment with a vascular endothelial growth factor inhibitor remains the optimal approach in metastatic clear cell renal cell carcinoma.

Trial Registration:

clinicaltrials.gov Identifier: NCT01408004.

PMID:
27918762
DOI:
10.1001/jamaoncol.2016.5202
[Indexed for MEDLINE]

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