{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:46:36Z","timestamp":1790837196315,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"24","license":[{"start":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T00:00:00Z","timestamp":1601942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014382","name":"Ipsen","doi-asserted-by":"publisher","award":["U10CA180821"],"award-info":[{"award-number":["U10CA180821"]}],"id":[{"id":"10.13039\/501100014382","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014382","name":"Ipsen","doi-asserted-by":"publisher","award":["U10CA180882"],"award-info":[{"award-number":["U10CA180882"]}],"id":[{"id":"10.13039\/501100014382","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014382","name":"Ipsen","doi-asserted-by":"publisher","award":["UG1CA189823"],"award-info":[{"award-number":["UG1CA189823"]}],"id":[{"id":"10.13039\/501100014382","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2020,12,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cabozantinib Versus Sunitinib as Initial Targeted Therapy for Patients With Metastatic Renal Cell Carcinoma of Poor or Intermediate Risk: The Alliance A031203 CABOSUN Trial (CABOSUN) was a randomized, open\u2010label, phase 2 trial evaluating first\u2010line cabozantinib versus sunitinib in patients with advanced renal cell carcinoma (aRCC). This post hoc analysis evaluated quality\u2010adjusted survival using Quality\u2010adjusted Time Without Symptoms of disease or Toxicity of treatment (Q\u2010TWiST).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Survival plots for cabozantinib and sunitinib (650\u2010day follow\u2010up) were partitioned into 3 health states: time spent before disease progression without toxicity (TWiST; toxicity based on National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0] grade 3\/4 adverse events), time spent before disease progression with toxicity (TOX; durations of adverse events based on published literature), and time after disease recurrence (relapse) or progression to death (REL). Q\u2010TWiST was the sum of the mean time spent in each state, with each state weighted to reflect patient preferences (from 0 [worst] to 1 [best]) using utility scores. TWiST was always weighted as 1. Overall survival and time to disease progression were based on all randomized patients (157 patients); TOX was based on all randomized and treated patients (150 patients).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Across all utility combinations tested, Q\u2010TWiST was found to be longer with cabozantinib versus sunitinib (range of differences, +24 days to +137 days). Q\u2010TWiST differences that were found to be statistically significant (+92 days [95% confidence interval, 5\u2010178 days] to +137 days [95% confidence interval, 60\u2010214 days]) were of a clinically meaningful effect size (\u226580 days), and were based on utility values that included those considered relevant for patients with aRCC (REL utility weight of 0.355, TOX utility weight of 0\u20101, and TWiST utility weight of 1).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with aRCC, first\u2010line cabozantinib was found to provide longer quality\u2010adjusted survival compared with sunitinib. These findings may help to inform clinical decision making.<\/jats:p><\/jats:sec><jats:sec><jats:title>Lay Summary<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Cabozantinib and sunitinib are drugs that are used to treat patients with advanced kidney cancer. Clinical trials have shown that cabozantinib offers benefits over sunitinib, giving patients more time before their cancer progresses.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>It is important that this additional time before disease progression does not come at the expense of patients' quality of life, which can be affected by treatment side effects and\/or ongoing cancer symptoms. Both quantity and quality of life are central to optimal treatment.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>In the current analysis of patients with advanced kidney cancer who were initiating treatment for the first time, cabozantinib provided more quality time before cancer progression compared with sunitinib.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.33169","type":"journal-article","created":{"date-parts":[[2020,10,6]],"date-time":"2020-10-06T17:04:27Z","timestamp":1602003867000},"page":"5311-5318","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Quality\u2010adjusted survival with first\u2010line cabozantinib or sunitinib for advanced renal cell carcinoma in the CABOSUN randomized clinical trial (Alliance)"],"prefix":"10.1002","volume":"126","author":[{"given":"Ronald C.","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Kansas Cancer Center Kansas City Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9201-3217","authenticated-orcid":false,"given":"Toni K.","family":"Choueiri","sequence":"additional","affiliation":[{"name":"Lank Center for Genitourinary Oncology Dana\u2010Farber Cancer Institute\/Brigham and Women's Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Feuilly","sequence":"additional","affiliation":[{"name":"Department of Oncology Ipsen Pharma SAS Boulogne\u2010Billancourt Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Meng","sequence":"additional","affiliation":[{"name":"Analytica Laser L\u00f6rrach Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Lister","sequence":"additional","affiliation":[{"name":"Analytica Laser L\u00f6rrach Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Marteau","sequence":"additional","affiliation":[{"name":"Department of Oncology Ipsen Pharma SAS Boulogne\u2010Billancourt Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron D.","family":"Falchook","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Cancer Institute Pembroke Pines Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Medicine Memorial Sloan Kettering Cancer Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"George","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Kansas Cancer Center Kansas City Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2424-4635","authenticated-orcid":false,"given":"Darren R.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Medicine Memorial Sloan Kettering Cancer Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.0922004"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-017-1704-4"},{"key":"e_1_2_9_4_1","first-page":"163","article-title":"Paraneoplastic syndromes in urologic malignancy: the many faces of renal cell carcinoma","volume":"4","author":"Palapattu GS","year":"2002","journal-title":"Rev Urol"},{"key":"e_1_2_9_5_1","unstructured":"MotzerRJ JonaschE AgarwalN et al.NCCN Guidelines Kidney Cancer Version 2. 2020. 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