Real-World Metastatic Renal Cell Carcinoma Treatment Patterns and Clinical Outcomes in The Netherlands

Abstract

The number of treatment options for patients with metastatic renal cell carcinoma (mRCC) has significantly grown in the last 15 years. Although randomized controlled trials are fundamental in investigating mRCC treatment efficacy, their external validity can be limited. Therefore, the efficacy of the different treatment options should also be evaluated in clinical practice. We performed a chart review of electronic health records using text mining software to study the current treatment patterns and outcomes. mRCC patients from two large hospitals in the Netherlands, starting treatment between January 2015 and May 2020, were included. Data were collected from electronic health records using a validated text mining tool. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan–Meier method. Most frequent first-line treatments were pazopanib (n = 70), sunitinib (n = 34), and nivolumab with ipilimumab (n = 28). The overall median PFS values for first-line treatment were 15.7 months (95% confidence interval [95%CI], 8.8–20.7), 16.3 months (95%CI, 9.3–not estimable [NE]) for pazopanib, and 6.9 months (95% CI, 4.4–NE) for sunitinib. The overall median OS values were 33.4 months (95%CI, 28.1–50.9 months), 39.3 months (95%CI, 29.5–NE) for pazopanib, and 28.1 months (95%CI, 7.0–NE) for sunitinib. For nivolumab with ipilimumab, median PFS and median OS were not reached. Of the patients who finished first- and second-line treatments, 64 and 62% received follow-up treatments, respectively. With most patients starting on pazopanib and sunitinib, these real-world treatment outcomes were most likely better than in pivotal trials, which may be due to extensive follow-up treatments.

Sunitinib for Metastatic Renal Cell Carcinoma: Real-World Data from the STAR-TOR Registry and Detailed Literature Review

“…We performed an explorative analysis according to histology which may explain the detrimental effect of non-clear cell histologies for this finding: clear cell a/mRCC patients yielded a PFS of 7.4 months compared to 5.0 months for all other histologies. These 7.4 months (7.7 months for 477 first-line ccRCCs) do not markedly differ from the results of other published real-world data [21][22][23][24]. Only Nikic et al [25] and Schmidinger et al [26] reported relevantly larger PFS of 10.4 and 14 months.…”

Sequential treatment of metastatic renal cell carcinoma patients after first-line vascular endothelial growth factor targeted therapy in a real-world setting: epidemiologic, noninterventional, retrospective–prospective cohort multicentre study

“…Sunitinib has shown a median PFS that was 6 months longer than that of interferon alpha (Motzer et al 2007). A real-world data study in the Netherlands showed a similar median PFS of 15.7 months with pazopanib monotherapy, sunitinib monotherapy, or nivolumab-ipilimumab combination (van Laar et al 2022).…”

Prognostic Factors in First-line Metastatic Renal Cell Carcinoma: How to Improve the Prognostic Ability of the IMDC and MSKCC Score?

“…Several reports have examined the prognostic role of clinical and biological characteristics of metastatic renal cell carcinoma [10][11][12][13][14][15] . For example, Xu Y et al showed that a poor performance status in metastatic RCC was significantly associated with inferior overall survival (pooled HR: 2.08, 95% CI: 1.78-2.45) and progression-free survival (pooled HR: 1.51, 95% CI: 1.20-1.91) [11] .…”

“…Several reports have examined the prognostic role of clinical and biological characteristics of metastatic renal cell carcinoma [10][11][12][13][14][15] . For example, Xu Y et al showed that a poor performance status in metastatic RCC was significantly associated with inferior overall survival (pooled HR: 2.08, 95% CI: 1.78-2.45) and progression-free survival (pooled HR: 1.51, 95% CI: 1.20-1.91) [11] . In addition, a meta-analysis including 19 studies identified performance status as the most decisive independent prognostic factor for survival in a multivariate analysis of 6780 patients with metastatic RCC [13] .…”