Sorafenib should not be used in the adjuvant setting in patients with resected renal cell carcinoma at intermediate or high risk of relapse, says the SORCE research team.

In addition, the multikinase inhibitors lenvatinib and sorafenib have both been recommended for the treatment of patients with locally advanced or metastatic differentiated thyroid cancers that have continued to progress despite surgery and radioactive iodine therapy.

REFLECT study findings indicate that lenvatinib offers non-inferior overall survival compared with the current standard of care, sorafenib, for the first-line treatment of patients with unresectable hepatocellular carcinoma.

After producing excessive toxicities and being unable to achieve full single agent dosages, this phase I study of a combination of sorafenib and tipifarnib in recurrent glioblastoma was stopped early, suggesting a need for other strategies. Nghiemphu PL et al. J Neurooncol 2017. doi:10.1007/s11060-017-2624-4

Adjuvant treatment with sunitinib or sorafenib does not prolong disease-free survival or overall survival in clear cell renal cell carcinoma patients classed as high risk, shows a post hoc analysis of the placebo-controlled ASSURE trial.

The most common multikinase inhibitor in the cohort was regorafenib, used in four patients, with cabozantinib, lenvatinib, sorafenib, and sunitinib used in one patient each.

They highlight the need for caution with cross-trial comparisons, but note that single-agent cabozantinib “appeared to be more active than platinum-gemcitabine chemotherapy” in this setting “and resulted in similar antitumor activity compared with the combination of platinum-based chemotherapy plus sorafenib.”

Brian Rini describes an analysis of the TIVO-3 advanced renal cell carcinoma trial suggesting that tivozanib offers better outcomes than sorafenib even in patients who have previously received axitinib.

The VEGFR–tyrosine kinase inhibitor (TKI) was evaluated in the phase 3 TIVO-3 trial, which showed a significant progression-free survival benefit with tivozanib versus sorafenib in the relapsed or refractory setting.

The patients received one or more VEGFR–TKIs (pazopanib, sunitinib, sorafenib, axitinib, regorafenib, vandetanib, lenvatinib, or cabozantinib) and factor Xa inhibitors (low molecular weight heparin [LMWH] including enoxaparin or the direct oral anticoagulants [DOACs] rivaroxaban or apixaban) between 2010 and 2018 whilst undergoing treatment for a variety of cancers, including renal cell carcinoma (48.8%), sarcoma (23.3%), and colorectal cancer (11.6%).

The phase III TIVO-3 trial has found that both progression-free survival and response are significantly better with tivozanib than sorafenib in patients with refractory metastatic renal cell carcinoma.

Adjuvant treatment with sunitinib may be associated with an increased mortality risk for older female patients with renal cell carcinoma, suggests a post-hoc analysis of the ASSURE trial that compared sunitinib and sorafenib with placebo.

The agent was shown to be noninferior to sorafenib in terms of overall survival (OS) in the phase III REFLECT trial ; the median OS durations were 13.6 months for the 478 participants randomly assigned to receive lenvatinib and 12.3 months for their 476 counterparts given sorafenib.

. --- Pembrolizumab has been approved for use alongside chemotherapy – specifically, carboplatin plus paclitaxel or nab-paclitaxel – for patients with previously untreated metastatic squamous NSCLC and as monotherapy for advanced hepatocellular carcinoma (HCC) patients who have previously received sorafenib.