# FIRSTMAPPP: sunitinib for metastatic progressive phaeochromocytomas and paragangliomas

Source: https://onco.cc/key-papers/paper-firstmappp-sunitinib-metastatic-ppgl-baudin-lancet-2024/  
OnCo record `paper-firstmappp-sunitinib-metastatic-ppgl-baudin-lancet-2024` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In the first randomised trial in these rare tumours, sunitinib kept 36 percent of patients free of progression at one year against 19 percent on placebo.

## Summary

Academic, multicentre, double-blind, placebo-controlled phase 2 trial at 14 European centres: 78 adults with progressive metastatic phaeochromocytoma or paraganglioma were randomised to sunitinib 37.5 mg daily or placebo. The primary endpoint was progression-free survival at 12 months.

14 of 39 sunitinib patients (36 percent) and 7 of 39 placebo patients (19 percent) were progression-free at 12 months, meeting the primary endpoint. Grade 3 or 4 asthenia (18 against 3 percent) and hypertension (13 against 10 percent) were the common toxicities; one death from rectal bleeding was drug-related.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: The Lancet
- Year: 2024
- DOI: 10.1016/S0140-6736(23)02554-0
- Authors: Baudin E, Goichot B, Berruti A, et al.
- Findings: Progression-free survival at 12 months 36 percent (90% CI 23 to 50) with sunitinib versus 19 percent (11 to 31) with placebo.; Grade 3 or 4 asthenia 18 versus 3 percent; hypertension 13 versus 10 percent; one drug-related death.
- What it means: Sunitinib has the highest level of evidence of any drug for progressive metastatic phaeochromocytoma and paraganglioma, alongside the later approval of belzutifan.
- Caveats: Small phase 2 with a single-arm-style primary endpoint; the placebo arm validated the design rather than providing a formal superiority test.

## Sources

- Lancet 2024: https://doi.org/10.1016/S0140-6736(23)02554-0
- PubMed: https://pubmed.ncbi.nlm.nih.gov/38402886/

## Connected records

- cancers: [Metastatic pheochromocytoma and paraganglioma](https://onco.cc/cancers/metastatic-ppgl/), [Pheochromocytoma and paraganglioma (PPGL)](https://onco.cc/cancers/pheochromocytoma-paraganglioma/)
- drugs: [Sunitinib](https://onco.cc/drugs/sunitinib/)
- trials: [FIRSTMAPPP](https://onco.cc/trials/firstmappp/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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