Patients with metastatic renal cell carcinoma (mRCC) have poor prognoses, although some targeted therapies have shown clinical benefit. Axitinib is a potent and selective second-generation VEGFR inhibitor with demonstrated activity as a second-line treatment in phase II studies. A phase III study—the AXIS trial—is underway to compare the efficacy and safety of axitinib with sorafenib, a first-generation VEGFR inhibitor. Updated efficacy results for this trial have now been published by Robert Motzer and colleagues.

The trial enrolled 723 patients with mRCC who had progressive disease after failure of one first-line systemic regimen. Patients were randomly allocated to receive axitinib (5 mg twice daily) or sorafenib (400 mg twice daily). At the cut-off date of 1 November 2011, overall survival of 20.1 months was reported with axitinib and 19.2 months with sorafenib, and progression-free survival (PFS) was 8.3 months with axitinib and 5.7 months with sorafenib. Although overall survival did not differ between the groups, PFS was the primary end point for the study and it was longer in patients treated with axitinib.

Patient-reported outcomes from this trial have also been described by David Cella and colleagues. No major differences in the on-treatment quality of life was seen between patients receiving sorafenib and axitinib. However, quality of life worsened after both treatments ended, probably due to tumour progression. As treatment duration was longer with axitinib than sorafenib, the time to worsening of quality of life can be dealyed for longer in patients using axitinib. Taken together, these results indicate that axitinib is an option for second-line treatment of mRCC.