• Robert J Motzer, Thomas E Hutson, Piotr Tomczak, M Dror Michaelson, Ronald M Bukowski, Olivier Rixe, Stéphane Oudard, Sylvie Negrier, Cezary Szczylik, Sindy T Kim, Isan Chen, Paul W Bycott, Charles M Baum, and Robert A Figlin.
• Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. motzerr@mskcc.org
• N. Engl. J. Med. 2007 Jan 11; 356 (2): 115124115-24.

BackgroundSince sunitinib malate has shown activity in two uncontrolled studies in patients with metastatic renal-cell carcinoma, a comparison of the drug with interferon alfa in a phase 3 trial is warranted.MethodsWe enrolled 750 patients with previously untreated, metastatic renal-cell carcinoma in a multicenter, randomized, phase 3 trial to receive either repeated 6-week cycles of sunitinib (at a dose of 50 mg given orally once daily for 4 weeks, followed by 2 weeks without treatment) or interferon alfa (at a dose of 9 MU given subcutaneously three times weekly). The primary end point was progression-free survival. Secondary end points included the objective response rate, overall survival, patient-reported outcomes, and safety.ResultsThe median progression-free survival was significantly longer in the sunitinib group (11 months) than in the interferon alfa group (5 months), corresponding to a hazard ratio of 0.42 (95% confidence interval, 0.32 to 0.54; P<0.001). Sunitinib was also associated with a higher objective response rate than was interferon alfa (31% vs. 6%, P<0.001). The proportion of patients with grade 3 or 4 treatment-related fatigue was significantly higher in the group treated with interferon alfa, whereas diarrhea was more frequent in the sunitinib group (P<0.05). Patients in the sunitinib group reported a significantly better quality of life than did patients in the interferon alfa group (P<0.001).ConclusionsProgression-free survival was longer and response rates were higher in patients with metastatic renal-cell cancer who received sunitinib than in those receiving interferon alfa (ClinicalTrials.gov numbers, NCT00098657 and NCT00083889 [ClinicalTrials.gov]).Copyright 2007 Massachusetts Medical Society.

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