“We have a lot of options for first-line therapy [in renal cell carcinoma] these days. The question is, what do we do with first-line failures?” said Daniel J. Canter, MD, formal discussant of the SWITCH trial at the Genitourinary Cancers Symposium. Dr. Canter is Vice Chairman of the Urologic Institute of Southeastern Pennsylvania and the Department of Urology of the Einstein Healthcare Network, and Associate Professor at the Fox Chase Cancer Center, Philadelphia. “How we select second-line therapies is an area of debate where there is room for improvement,” he noted.
“The SWITCH study showed us that switching from sorafenib to sunitinib or vice versa was well tolerated. It didn’t matter which drug was used first. This study was not practice-changing,” Dr. Canter said. “At present, most oncologists in the United States use sunitinib first-line, and only about 2% are using pazopanib [Votrient]. But this may change, and it may be reasonable to use pazopanib followed by sunitinib,” he added. “Globally, we need to figure out the best sequence.” ■
Disclosure: Dr. Canter reported no potential conflicts of interest.
The explosion of new therapies for metastatic renal cell carcinoma is a welcome advance, but studies have not yet defined optimal sequencing of the newer therapies. According to the phase III SWITCH trial, it matters little whether therapy for metastatic renal cell carcinoma begins with sorafenib...