Renal Cell Carcinoma · Medical · First-line metastatic

COMPARZ

In previously untreated metastatic clear-cell RCC, is pazopanib non-inferior to sunitinib for progression-free survival?

Population1,110 eligible patients with metastatic RCC randomized in 14 countries.InterventionPazopanib 800 mg daily.ComparatorSunitinib 50 mg daily, 4 weeks on/2 weeks off.Primary endpointProgression-free survival by independent review.

Absolute Effect

Median PFS

8.4 vs 9.5 months

Pazopanib versus sunitinib; HR 1.05 (95% CI 0.90–1.22), meeting the prespecified non-inferiority criterion.

Interpretation

Non-inferior PFS

The 1.1-month difference in medians should not be interpreted as a superiority or inferiority claim.

Quality of life / toxicity

Pazopanib and sunitinib had different toxicity and symptom profiles. Pazopanib produced more liver-enzyme abnormalities, whereas sunitinib produced more fatigue, hand-foot syndrome and related symptoms. Patient-reported global health/QoL favoured pazopanib during treatment.

Clinical interpretation

COMPARZ is a non-inferiority trial: pazopanib provided similar PFS with a different toxicity profile.

The correct evidence translation is equivalence within the prespecified margin, not “pazopanib is better” or “sunitinib is better.”

NNT / NNH

NNT is not appropriate for a non-inferiority PFS comparison based on median times. A fixed-time NNH should be calculated only for a specific patient-important adverse event.

Limitations

The trial predates current immune-checkpoint inhibitor combinations and modern targeted sequencing. Its contemporary value is mainly comparative evidence about pazopanib versus sunitinib.

Primary / authoritative source

COMPARZ primary report — NEJM