# Efficacy of cabozantinib and sunitinib for the treatment of intermediate/poor risk renal cell carcinoma based upon UK real-world data

## TL;DR

A UK study found no significant difference in survival outcomes between cabozantinib and sunitinib for treating advanced kidney cancer, though cabozantinib showed a trend toward better short-term results.

## Contribution

This study provides real-world evidence comparing two first-line treatments for renal cell carcinoma in intermediate/poor risk patients using UK data.

## Key findings

- No significant difference in overall survival or progression-free survival between cabozantinib and sunitinib.
- Cabozantinib showed a trend toward improved progression-free survival but reduced overall survival, possibly due to fewer second-line treatment options.
- No prognostic factors were identified that significantly influenced treatment outcomes.

## Abstract

The purpose of this study was to explore the effectiveness of cabozantinib versus sunitinib for the treatment of first-line metastatic renal cell carcinoma in intermediate/poor risk patients.

Retrospective review of cases between 1 January 2018 and 30 June 2021 across 17 UK centres. Univariable and multivariable Cox proportional hazards modelling to identify prognostic factors. Inverse probability of treatment weighting, to estimate the causal effect of first-line treatment type.

Cabozantinib patients (n = 106) had poorer risk status, less prior nephrectomy, shorter time to therapy, and more clear cell histology than sunitinib patients (n = 218). More sunitinib patients received a second or third line of subsequent treatment (56% and 23% versus 43% and 13%). Though there was no significant difference between treatments in overall survival (OS) or progression-free survival (PFS) across models, the difference in PFS bordered on significant in a multipredictor analysis (benefit in favour of cabozantinib; P = 0.06). When the Kaplan–Meier curves were stratified by risk status (intermediate versus poor), patients had similar OS within the risk groups. PFS appeared to differ with poor risk patients performing better on cabozantinib. Inverse probability of treatment weighting analysis showed little difference from the unadjusted results: OS hazard ratio = 1.119 (95% confidence interval (CI) 0.823-1.521); PFS hazard ratio 0.825 (95% CI 0.636-1.070) for cabozantinib versus sunitinib.

Our results showed no significant difference in either OS or PFS between treatments. Cabozantinib trended towards improved PFS and reduced OS. Decision-making for tyrosine kinase inhibitor monotherapy should consider later-line treatment options. This analysis is of particular relevance as sunitinib is now off-patent meaning that the cost of a course of treatment has considerably reduced.

•No significant PFS/OS difference for sunitinib vs cabozantinib in 1L intermediate/poor risk RCC in large UK real-world cohort.•Trend towards improved PFS but reduced OS with cabozantinib, likely due to fewer 2nd-line options.•No prognostic factors identified which significantly impacted on the chance of outcomes differing between the two treatments.

No significant PFS/OS difference for sunitinib vs cabozantinib in 1L intermediate/poor risk RCC in large UK real-world cohort.

Trend towards improved PFS but reduced OS with cabozantinib, likely due to fewer 2nd-line options.

No prognostic factors identified which significantly impacted on the chance of outcomes differing between the two treatments.