Thirteen studies (853 patients, range nine to 260) were included in the review: two prospective studies, 10 retrospective studies and a retrospective review of the authors' patients. Results from the authors' own caseload were included in the review. Three studies included patients with prior anti-angiotherapy.
A longer period of progression-free survival was observed for patients who were treated with sorafenib as first-line treatment followed by sunitinib than for patients treated with sunitinib as first-line therapy followed by sorafenib (15.4 versus 12.1 months; pooled difference 3.3 months, 95% CI 1.45 to 5.12). There were no significant differences between treatment regimens in the time to disease progression after first-line treatment. For second-line treatment, sunitinib was associated with a longer period of progression-free survival than sorafenib (MD 2.66 months, 95% CI 1.02 to 4.3).
Sensitivity analyses with exclusion of five studies of patients with previous therapy and varying definitions of disease progression showed increases in progression-free survival with sorafenib as first-line treatment compared to sunitinib (MD 3.8 months, 95% CI 2.08 to 5.54). Age, gender and study design were not significantly associated with progression-free survival for any treatment regimen.