Patterns of care for metastatic renal cell carcinoma in <scp>A</scp>ustralia

Day, Daphne; Kanjanapan, Yada; Kwan, Edmond M.; Yip, Desmond; Lawrentschuk, Nathan; Andrews, Miles C.; Davis, Ian D.; Azad, Arun; Rosenthal, Mark; Wong, Shirley; Johnstone, Alice; Gibbs, Peter

doi:10.1111/bju.13176

Cited by 12 publications

(20 citation statements)

References 13 publications

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“…In other retrospective series of de novo mRCC patients, mOS varies between 13 and 19 months . Patterns of care and survival outcomes in the full cohort ( n = 212) of this Australian study were previously reported . Notably, the mOS in the overall cohort was 29.1 months, consistent with survival data observed in the phase III studies …”

Section: Discussionsupporting

confidence: 86%

“…Our study was approved by the local institutional human research ethics committees. Patterns of care from this cohort have been previously reported …”

Section: Methodsmentioning

confidence: 90%

“…Our study initially identified 212 consecutive patients treated for mRCC between 2006 and 2012 . Overall, 72% ( n = 153) had a recorded nephrectomy.…”

Section: Resultsmentioning

confidence: 99%

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Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil‐to‐lymphocyte ratio in patients with metastatic renal cell carcinoma

Day

Kanjanapan

Kwan

et al. 2016

Internal Medicine Journal

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Section: Discussionsupporting

confidence: 86%

“…Our study was approved by the local institutional human research ethics committees. Patterns of care from this cohort have been previously reported …”

Section: Methodsmentioning

confidence: 90%

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Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil‐to‐lymphocyte ratio in patients with metastatic renal cell carcinoma

Day

Kanjanapan

Kwan

et al. 2016

Internal Medicine Journal

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“…The predominant sequence was TKI‐TKI ( n = 100, 58.8% of 170 patients who received second‐line therapy), followed by TKI‐mTORi ( n = 24, 14.1%) and mTORi‐TKI ( n = 20, 11.8%). Recent real‐world chart review studies carried out in the USA and Australia showed a different treatment sequence of first‐line TKI followed by mTORi (everolimus or temsirolimus) as the predominant second‐line therapy. The present study could be considered to represent the features of systemic mRCC treatment in Japan, as well as the prognosis from TKI treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Information on real‐world treatment patterns and outcomes is informative for clinical practice in this setting, but the information is limited . By studying treatment patterns and outcomes in patients with mRCC, to understand unmet needs, clinical outcomes and the burden of disease after progression from first‐line therapy might be understood.…”

Section: Introductionmentioning

confidence: 99%

Treatment patterns and outcomes in patients with unresectable or metastatic renal cell carcinoma in Japan

et al. 2018

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Objectives To clarify treatment patterns and outcomes for patients with unresectable or metastatic renal cell carcinoma in the molecular target therapy era in Japan. Methods A multicenter, retrospective medical chart review study was carried out. Patients diagnosed with unresectable or metastatic renal cell carcinoma between January 2012 and August 2015 were enrolled. Data extracted from medical records included treatment duration, grade ≥3 adverse events, reason for discontinuation for each targeted therapy and survival data until August 2016. Results Of 277 eligible patients, 266, 170 and 77 received first‐, second‐ and third‐line systemic treatment, respectively. Tyrosine kinase inhibitors were the most common first‐line therapy (72.2%), followed by mammalian target of rapamycin inhibitors (14.3%) and cytokines (13.5%). Among 170 patients who received second‐line treatment, tyrosine kinase inhibitor–tyrosine kinase inhibitor was the most common sequence (58.8%), followed by tyrosine kinase inhibitor–mammalian target of rapamycin inhibitor (14.1%) and cytokine–tyrosine kinase inhibitor (14.1%). With a median follow‐up period of 19.8 months, median overall survival was not reached at 48 months. Patients who discontinued first‐line tyrosine kinase inhibitors in <6 months showed poorer overall survival compared with patients who received first‐line tyrosine kinase inhibitors for ≥6 months. Conclusions The present analysis illustrates the contemporary treatment patterns and prognosis for patients with unresectable or metastatic renal cancer in a real‐world setting in Japan. Tyrosine kinase inhibitor–tyrosine kinase inhibitor represents the most commonly used sequence. Shorter treatment duration of first‐line tyrosine kinase inhibitors is associated with poorer prognosis, suggesting the need for better treatment options.

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Sunitinib for Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis of Real-World and Clinical Trials Data

et al. 2019

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Background Randomized controlled trials (RCTs) have stringent inclusion criteria and may not fully represent patients seen in everyday clinical practice. Real-world data (RWD) can provide supportive evidence for the effectiveness of medical interventions in more heterogeneous populations than RCTs. Sunitinib is a widely used first-line treatment for patients with metastatic renal cell carcinoma (mRCC). Objective This is the first comprehensive meta-analysis to evaluate the efficacy of sunitinib using the novel approach of combining RCTs and RWD. Methods RCTs and RWD studies published between 2000 and 2017 were identified from PubMed, Ovid, MEDLINE, and EMBASE. Eligible studies contained a cohort of ≥ 50 adult patients with mRCC receiving first-line sunitinib treatment. The meta-analysis combined RWD and RCT treatment groups, adjusting for data type (RCT or RWD). Recorded outcomes were median progression-free survival (mPFS), median overall survival (mOS), and objective response rate (ORR). Publication bias was assessed via review of funnel plots for each outcome measure. A random effects model to account for study heterogeneity was applied to each endpoint. Sensitivity analyses evaluated the robustness of the overall estimates. Results Of the 3611 studies identified through medical database searches, 22 (15 RWD studies, 7 RCTs) met eligibility criteria and were analyzed. mPFS (18 studies), mOS (19 studies), and ORR (15 studies) were reported for aggregate measures based on 4815, 5321, and 4183 patients, respectively. Reported mPFS (RWD, 7.5-11.0 months; RCTs, 5.6-15.1 months) and ORR data (RWD, 14.0-34.6%; RCTs, 18.8-46.9%) were consistent with the overall confidence estimates (95% confidence interval [CI]) of 9.3 (8.6-10.2) months and 27.9% (24.2-32.0), respectively. Reported mOS showed greater variation in RWD (6.8-33.2 months) compared with RCTs (21.8-31.5 months), with an overall confidence estimate (95% CI) of 23.0 (19.2-27.6) months. Inspection of funnel plots and sensitivity analyses indicated that there was no publication bias for any efficacy endpoint. Sensitivity analyses showed no evidence of lack of robustness for mPFS, mOS, or ORR. Interpretation of these results is limited by differences in trial design, cohort characteristics, and missing data. Conclusions This novel, comprehensive meta-analysis validates sunitinib as an effective first-line treatment for patients with mRCC in both RCTs and everyday clinical practice. The methodology provides a framework for future analyses combining data from RCTs and RWD.

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Patterns of care for metastatic renal cell carcinoma in Australia

Cited by 12 publications

References 13 publications

Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil‐to‐lymphocyte ratio in patients with metastatic renal cell carcinoma

Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil‐to‐lymphocyte ratio in patients with metastatic renal cell carcinoma

Treatment patterns and outcomes in patients with unresectable or metastatic renal cell carcinoma in Japan

Sunitinib for Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis of Real-World and Clinical Trials Data

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