ASPEN: everolimus versus sunitinib in metastatic non-clear cell renal cell carcinoma
In the first randomised trial dedicated to non-clear cell kidney cancers, sunitinib delayed progression more than everolimus overall, though chromophobe tumours appeared to fare better on everolimus.
Overview
Randomised phase 2 trial of 108 patients with metastatic papillary, chromophobe or unclassified renal cell carcinoma randomised to sunitinib or everolimus.
Median progression-free survival was 8.3 months with sunitinib against 5.6 months with everolimus (hazard ratio 1.41 for everolimus); in the small chromophobe subgroup everolimus gave longer progression-free survival (11.4 versus 5.5 months), while papillary tumours did better with sunitinib.
- Median progression-free survival 8.3 months (sunitinib) vs 5.6 months (everolimus).
- Chromophobe subgroup: 11.4 months with everolimus vs 5.5 months with sunitinib.
VEGF-directed therapy is the default for non-clear cell disease, with everolimus considered in chromophobe tumours; cabozantinib later became preferred for papillary disease.
- Small heterogeneous trial; subgroup findings are hypothesis-generating.
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