Real-world treatment patterns and clinical outcomes for metastatic renal cell carcinoma in the current treatment era Journal Article
| Authors: | Shah, N. J.; Sura, S. D.; Shinde, R.; Shi, J.; Singhal, P. K.; Robert, N. J.; Vogelzang, N. J.; Perini, R. F.; Motzer, R. J. |
| Article Title: | Real-world treatment patterns and clinical outcomes for metastatic renal cell carcinoma in the current treatment era |
| Abstract: | Background: Immuno-oncology (IO) agents and tyrosine kinase inhibitors (TKIs) have revolutionized the treatment paradigm for metastatic renal cell carcinoma (mRCC). Data on real-world usage and outcomes are limited. Objective: To examine real-world treatment patterns and clinical outcomes for mRCC. Design, setting, and participants: This retrospective cohort study included 1538 patients with mRCC who received first-line treatment with pembrolizumab + axitinib (P + A; n = 279, 18%), ipilimumab + nivolumab (I + N; n = 618, 40%), or TKI monotherapy (TKIm; cabozantinib, sunitinib, pazopanib, or axitinib; n = 641, 42%) between January 1, 2018 and September 30, 2020 in US Oncology Network/non-network practices. Outcome measurements and statistical analysis: The relationship with outcomes, time on treatment (ToT), time to next treatment (TTNT), and overall survival (OS) was analyzed using multivariable Cox proportional-hazards models. Results and limitations: The median age of the cohort was 67 yr (interquartile range 59.5–74.4), 70% were male, 79% had clear cell RCC, and 87% had an intermediate or poor International mRCC Database Consortium risk score. The median ToT was 13.6 for P + A versus 5.8 for I + N versus 3.4 mo for TKIm (p < 0.001) and the median TTNT was 16.4 for P + A versus 8.3 for I + N versus 8.4 mo for TKIm (p < 0.001). Median OS was not reached for P + A, 27.6 mo for I + N, and 26.9 mo for TKIm (p = 0.237). On adjusted multivariable analysis, treatment with P + A was associated with better ToT (adjusted hazard ratio [aHR] 0.59, 95% confidence interval [CI] 0.47–0.72 vs I + N; 0.37, 95% CI, 0.30–0.45 vs TKIm; p < 0.0001) and better TTNT (aHR 0.61, 95% CI 0.49–0.77 vs I + N; 0.53, 95% CI 0.42–0.67 vs TKIm; p < 0.0001). Limitations include the retrospective design and the limited follow-up for characterization of survival. Conclusions: We noted substantial uptake of IO-based therapies in the first-line community oncology setting since their approval. In addition, the study provides insights into clinical effectiveness, tolerability, and/or compliance of IO-based therapies. Patient summary: We examined the use of immunotherapy for patients with metastatic kidney cancer. The findings suggest rapid implementation of these new treatments by oncologists working in the community setting, which is reassuring for patients with this disease. © 2023 Merck Sharp & Dohme LLC., a subsidiary Merck & Co., The Author(s) |
| Keywords: | adult; cancer survival; controlled study; aged; major clinical study; overall survival; sunitinib; monotherapy; follow up; ipilimumab; cancer immunotherapy; cohort analysis; data base; retrospective study; risk assessment; protein tyrosine kinase inhibitor; scoring system; pazopanib; clinical effectiveness; axitinib; everolimus; clear cell renal cell carcinoma; metastatic renal cell carcinoma; clinical outcome; cabozantinib; combination drug therapy; nivolumab; time to treatment; immuno-oncology; lenvatinib; human; male; female; article; pembrolizumab; avelumab; time on treatment; time to next treatment |
| Journal Title: | European Urology Open Science |
| Volume: | 49 |
| ISSN: | 2666-1691 |
| Publisher: | Elsevier BV |
| Date Published: | 2023-03-01 |
| Start Page: | 110 |
| End Page: | 118 |
| Language: | English |
| DOI: | 10.1016/j.euros.2022.12.015 |
| PROVIDER: | scopus |
| PMCID: | PMC9974999 |
| PUBMED: | 36874600 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 March 2023 -- Source: Scopus |
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