Sunitinib vs Pazopanib vs Cabozantinib — for Kidney Cancer

Neither is clearly superior on tumour control — the COMPARZ trial, which compared them head to head in a large randomised study, showed they performed similarly. The meaningful difference is in side effects: pazopanib causes less fatigue and less hand-foot syndrome, while sunitinib carries a lower risk of liver enzyme elevation. Your oncologist will choose based on your health, your other medications, and which side effects would be harder for you to manage day to day.

In intermediate-to-poor-risk kidney cancer, the CABOSUN trial showed cabozantinib extended progression-free survival compared with sunitinib, and NCCN guidance now prefers cabozantinib in that group. In good-risk disease, there is no clear evidence it offers the same advantage. So the answer depends on your risk category — cabozantinib is not universally more effective, but it is the preferred first choice for a specific group of patients, and your oncologist can tell you which group you fall into.

Sunitinib and one of its breakdown products are yellow-orange in colour, and enough accumulates in the skin to produce a visible tint — particularly on fair skin. This is not a sign of liver damage, which causes a different kind of jaundice that also yellows the whites of the eyes. Yellow skin alone on sunitinib is an expected and harmless effect. If you are unsure whether what you are seeing is drug colouring or something else, describe it to your team rather than worrying alone.

It depends on which drug you are taking. Pazopanib must be taken on an empty stomach — food significantly increases how much the drug is absorbed, which can cause toxicity. Cabozantinib should also be taken away from food for the same reason. Sunitinib can be taken with or without food. Your pharmacist will confirm the exact instructions for your drug and formulation, and following those instructions consistently matters more than people often realise.

Tell your oncologist or nurse as soon as you notice redness, tingling or soreness on your palms or soles — do not wait for blisters to appear. Mild reactions are usually managed with moisturising cream, padding, avoiding friction on the skin, and sometimes a dose reduction. More severe reactions may need the drug to be paused. Reporting early keeps the options wider: a small dose adjustment often resolves it enough to continue, while waiting until it is severe may require stopping the drug.

Yes. All three are CDSCO-approved for kidney cancer and available in India. Sunitinib and pazopanib are both available as generics, which makes them substantially more affordable than the original branded versions. Cabozantinib remains available only as a branded drug and is considerably more expensive. At CION, these medications are prescribed by your oncologist and dispensed through a pharmacy. If cost is a significant concern, ask your team about patient assistance programmes offered by the manufacturers.