Sunitinib versus Capecitabine for Patients with HER2-Negative Advanced Breast Cancer
Slides from a presentation at SABCS 2009 and transcribed comments from a recent interview with Adam M Brufsky, MD, PhD (12/23/09)
Presentation discussed in this issue:
Barrios C et al. Sunitinib vs capecitabine in patients with previously treated HER2-negative advanced breast cancer: A Phase III, randomized, open-label study. San Antonio Breast Cancer Symposium 2009;Abstract 46.
Go to previous Journal Club Go to next Journal Club
DR BRUFSKY: This presentation demonstrates that all multitargeted tyrosine kinase inhibitors are not created equal. The trial was designed not as an equivalence trial, but as a superiority trial, which is a bit surprising for a single-agent biological being compared to chemotherapy. The trial was stopped because it was not possible for sunitinib to be superior to capecitabine for treatment of HER2-negative, advanced breast cancer. In fact, sunitinib had almost no benefit.
The progression-free survival in the capecitabine arm was 4.2 months and in the sunitinib arm it was 2.8 months, which is the time between two CT scans in measurable disease. The patients’ disease progressed through their sunitinib treatment. This trial clearly demonstrates that there’s no benefit to sunitinib in this setting and this is not a drug that I would use. These anti-angiogenic drugs need to be used with caution because their benefit is not clear in different settings.
There’s one last sunitinib trial left, which is a comparison of sunitinib and capecitabine versus capecitabine alone. It is similar in design to the SOLTI trial, which evaluates the combination of sorafenib and capecitabine (see presentation 2 of this 5MJC issue). Those data will likely be presented at ASCO 2010. If that study is negative, I believe sunitinib is finished as a drug for metastatic breast cancer, unfortunately.
Dr Brufsky is Associate Professor of Medicine and Associate Division Chief of Hematology/Oncology at the University of Pittsburgh, Co-Director of the Comprehensive Breast Cancer Center and Associate Director for Clinical Investigation at the University of Pittsburgh Cancer Institute in Pittsburgh, Pennsylvania.