Renal Cell Carcinoma · Medical · Metastatic · Patient Preference / QoL · 2026-09-18

PISCES

Among patients receiving two VEGF-TKIs with broadly similar efficacy, which treatment is preferred by patients when HRQoL and toxicity are considered?

Population

169 patients with metastatic RCC randomized to a double-blind crossover; 114 met the prespecified primary-analysis criteria.

Intervention

Pazopanib 800 mg/day for 10 weeks, washout, then sunitinib 50 mg/day 4 weeks on/2 weeks off.

Comparator

Reverse sequence: sunitinib followed by pazopanib.

Sample size / primary endpoint

169 randomized; 114 in primary preference analysis; Patient preference after both treatment periods

Absolute Effect

Primary efficacy result

Patient preference: pazopanib 70% vs sunitinib 22%; 8% no preference

Two 10-week treatment periods with a 2-week washout.

No OS comparison was designed or powered; efficacy was treated as broadly comparable based on prior randomized evidence.

No valid PFS NNT/NNH should be derived from this preference trial.

NNT / NNH

NNT: not applicable; the primary endpoint was preference, not an event-rate treatment benefit.

NNH: not quantifiable; safety was assessed descriptively and informed preference.

Treatment burden and toxicity

Less fatigue and better overall QoL were major reasons for preferring pazopanib; diarrhea was the most cited reason for preferring sunitinib.

Quality of life: QoL domains related to fatigue and hand/foot or mouth/throat soreness favored pazopanib.

Subgroups / clinically important modifiers

Preference results were consistent in sensitivity analyses, including intent-to-treat analyses.

Limitations and maturity

Crossover design excludes patients who progressed before crossover from the primary preference analysis and is not designed to compare survival.

Clinical interpretation

When efficacy is similar, toxicity and QoL can materially change patient preference; PISCES provides evidence for shared decision-making rather than a survival ranking.

PISCES is valuable because it quantifies a dimension often invisible in conventional efficacy trials: which treatment patients actually prefer after experiencing both toxicity profiles.

Primary / authoritative sources

PISCES primary publication (PubMed)