Efficacy of sequential therapies with sorafenib-sunitinib versus sunitinib-sorafenib in metastatic renal cell carcinoma: A systematic review and meta-analysis

Tingyu Wen, Hai Xiao _, Chao Luo, Li Huang and Meimei Xiong

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Oncotarget. 2017; 8:20441-20451. https://doi.org/10.18632/oncotarget.14671

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Tingyu Wen1, Hai Xiao2, Chao Luo3, Li Huang4 and Meimei Xiong5

1 College of Basic Medical Sciences, Gannan Medical University, Ganzhou, China

2 Department of Pathology, Gannan Medical University, Ganzhou, China

3 Department of Urology, People’s Hosptial of Pingxiang, Pingxiang, China

4 Department of Oncology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China

5 Department of Nephrology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China

Correspondence to:

Hai Xiao, email:

Keywords: renal cell carcinoma, sorafenib, sunitinib, targeted agents, meta-analysis

Received: November 10, 2016 Accepted: January 09, 2017 Published: January 15, 2017


The most efficient sequence of targeted agents for metastatic renal cell carcinoma patients has yet to be identified. Whether the sequence of sorafenib and sunitinib really matters is controversial and not answered clearly until now. This meta-analysis aims to estimate the efficacy of receptor tyrosine kinase inhibitors sorafenib-sunitinib and sunitinib-sorafenib for metastatic renal cell carcinoma, on the outcome of first-line progression-free survival, second-line progression-free survival, total progression-free survival and overall survival.

We searched PubMed, Embase, Cochrane Library and ClinicalTrails.gov for eligible studies. Data were analyzed using random or fixed effects model depending on the heterogeneity of the eligible studies. Heterogeneity across studies were analyzed using Q and I2 statistics.

Of 902 identified studies, ten were qualified in our analysis (N = 1732 patients). Sorafenib-sunitinib yielded no statistically significant benefit in first-line progression-free survival (fixed effects; HR = 0.95; 95%CI 0.75-1.21; p = 0.702), total progression-free survival (random effects; HR = 0.92; 95%CI 0.71-1.19; p = 0.531) and overall survival (fixed effects; HR = 0.89; 95%CI 0.72-1.09; p = 0.257), compared with sunitinib-sorafenib. Second-line progression-free survival was longer for sorafenib-sunitinib than sunitinib-sorafenib (fixed effects; HR = 0.55; 95%CI 0.44-0.68; p = 0.000).

Sequential therapies with sorafenib and sunitinib is well tolerated and efficient in mRCC. However, there are no evidence supported that sorafenib–sunitinib has the superiority to sunitinib-sorafenib in sequence. The ideal sequence of targeted agents requires further elucidation.

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