Impact on clinical practice of the implementation of guidelines for the toxicity management of targeted therapies in kidney cancer. The protect-2 study

Abstract

BackgroundThe impact of such recommendations after their implementation of guidelines has not usually been evaluated. Herein, we assessed the impact and compliance with the Spanish Oncology Genitourinary Group (SOGUG) Guidelines for toxicity management of targeted therapies in metastatic renal cell carcinoma (mRCC) in daily clinical practice.MethodsData on 407 mRCC patients who initiated first-line targeted therapy during the year before and the year after publication and implementation of the SOGUG guideline program were available from 34 Spanish Hospitals. Adherence to SOGUG Guidelines was assessed in every cycle.ResultsAdverse event (AE) management was consistent with the Guidelines as a whole for 28.7 % out of 966 post-implementation cycles compared with 23.1 % out of 892 pre-implementation cycles (p = 0.006). Analysis of adherence by AE in non-compliant cycles showed significant changes in appropriate management of hypertension (33 % pre-implementation vs. 44.5 % post-implementation cycles; p < 0.0001), diarrhea (74.0 % vs. 80.5 %; p = 0.011) and dyslipemia (25.0 % vs. 44.6 %; p < 0.001).ConclusionsSlight but significant improvements in AE management were detected following the implementation of SOGUG recommendations. However, room for improvement in the management of AEs due to targeted agents still remains and could be the focus for further programs in this direction.

Trends in the surgical management of stage 1 renal cell carcinoma: findings from a population‐based study

“…The evidence regarding the impact of the publication of clinical guidelines on practice is mixed, with some studies finding a positive impact [15,24,25], some showing only a small impact [26,27], and others showing no impact [28]. As we do not have data regarding the surgical management of small RCC tumours prior to 2009, we do not know whether use of NSS to treat T1a tumours was increasing during the 2000s, suggesting the increase we found between 2009 and 2013 was simply a continuation of this trend; however, Patel et al [17] showed that use of NSS for all RCC tumours was relatively stable between 2005 and 2008 at 20% in the Australian state of New South Wales.…”

Real-World Data from a Metastatic Renal Cell Carcinoma Community-Academic Registry: Comparative Outcomes of Progression Free Survival and Overall Survival

“…One specific study of sunitinib therapy indicated that patients who maintain dose intensity (higher drug exposure) had better survival [14]. As we have learned more of about these agents, it is clear that managing side effects with appropriate follow up, supportive care, and dose modifications as appropriate may be of crucial importance to help maximize efficacy [16]. It should also be noted that there were numerically more nephrectomies done in the ACAD population.…”

LSD1 inhibition suppresses the growth of clear cell renal cell carcinoma via upregulating P21 signaling

“…However, few patients achieve complete remission and a significant number of responsive patients develop resistance over time. Although there have been several studies to find biomarkers in RCC patients7., 8., it remains imperative to identify targets for new therapeutic approaches 9 .…”