Patterns of care among patients receiving sequential targeted therapies for advanced renal cell carcinoma: A retrospective chart review in the USA

Abstract

Objectives: To assess real-world treatment patterns of targeted therapies after failure of first-line tyrosine kinase inhibitors in patients with advanced renal cell carcinoma. Methods: A large, retrospective review of medical charts of patients with advanced renal cell carcinoma in the USA was carried out. Descriptive statistics were used to summarize physicians' and patients' characteristics, treatment sequences, and reasons for treatment choices. P-values were calculated using v 2 -tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. A descriptive comparison was carried out between current results and those of a previous treatment pattern study conducted in 2012 to identify changes in treatment patterns over time. Results: Sunitinib and everolimus remained the most commonly-used first and second targeted therapies, respectively. Among patients who continued to a third targeted therapy, everolimus and axitinib were the most commonly-used treatments after second targeted therapy with a tyrosine kinase inhibitor and a mammalian target of rapamycin inhibitor, respectively. The use of pazopanib as first targeted therapy, and of axitinib and sorafenib as second targeted therapies, increased over time. Efficacy, treatment guidelines and a different mechanism of action were the main reasons given by physicians for choosing among second targeted therapies after failure of a first tyrosine kinase inhibitor. Conclusions:The results of the present study document patterns of care during a period of rapid and ongoing therapeutic advancement in advanced renal cell carcinoma. Sequencing of therapies warrants ongoing analysis in light of new agents entering the advanced renal cell carcinoma treatment landscape.

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: A population-based analysis

“…With improvements in progression-free survival in the range of 3-8 months, [6,7,16] they have become a cornerstone of therapy for metastatic RCC [1,2,17,18]. However, with that success, there has been a significant effort to utilize these therapies in the adjuvant setting for high-risk localized or locally advanced RCC.…”

“…The use of TTs for these patients has steadily increased since 2006, though they remain underutilized [17,18,[21][22][23][24]. Their use provided cancerspecific survival benefit in the entire cM1 cohort and in the clear-cell subset (Supplementary Table 2B and 2C), and the primary benefit appears to be within the first 20 months (Figure 2A).…”

“…Additionally, we are unable to identify the specific TT utilized, and traditional chemotherapeutic agents may potentially be included in the TT analysis; however, as RCC has been known to be chemo-resistant, the incidence is likely to be low during the TT era. Prior studies have demonstrated very low rates of chemotherapy use prior to the introduction of targeted therapies [17,18,21]. Lastly, as it relates to the chemotherapy variable, prior comparison to SEER-Medicare datasets have demonstrated 65-80% sensitivity, but very high specificity [28].…”

Sequential Treatment with Pazopanib and Everolimus in Metastatic Renal Cell Carcinoma

“…Among risk factors that could influence OS, the presence of metastases in lung and liver had a negative impact in the second line treatment with everolimus. Pal et al recently accounted for negative prognostic factors the presence of higher tumor grade and lung, bone, or liver metastasis in patients with mRCC treated with angiogenesis inhibitors (Pal et al, 2017b). …”

Editorial Comment from Dr Kamel and Dr Bissada to Patterns of care among patients receiving sequential targeted therapies for advanced renal cell carcinoma: A retrospective chart review in the USA

“…1 Indeed, kidney cancer continues to be the most significant cause of potential years of life lost from genitourinary malignancy in the USA. 2 Also, kidney cancer is poorly responsive to both traditional chemotherapy regimens and radiation therapy.…”