Real-world treatment patterns and sequencing for metastatic renal cell carcinoma (mRCC): Results from the Flatiron database.

Abstract

286 Background: RCC accounts for ~80%‒90% of all kidney cancers worldwide. The mRCC treatment landscape is rapidly changing with the approval of new therapies; data describing real-world (RW) treatment patterns and sequencing are limited. This study investigates the characteristics, treatment patterns, and sequencing for mRCC patients in the RW (December 2015‒May 2020) and post-dual immuno-oncology therapy (IO-IO) approval in the United States (April 2018‒May 2020). Methods: Adults diagnosed with mRCC between December 2015 and May 2020 were selected from the Flatiron electronic medical record database for this retrospective study. The study cohort was required to have ≥ 1 month of medical data from the initial mRCC diagnosis date (index date). We used descriptive statistics to analyze baseline patient characteristics, treatment patterns, and sequencing. Results: Of 3,524 patients with mRCC (overall cohort, December 2015–May 2020), most were male (68.5%) and had clear cell histology (68.2%). The median age at metastatic diagnosis was 68 years (range, 23–85) and the median follow-up from index date was 328 days. Based on IMDC risk score, 75.8% of patients were categorized as intermediate/poor risk and 23.2% as favorable risk (1% missing). Systemic therapy for RCC was initiated in 79.1% (N = 2788) of patients. The most common treatments for first-line (1L) therapy were tyrosine kinase inhibitor (TKI) monotherapy (mono; 56.4%), IO-IO (19.1%), IO-TKI (9.5%), IO mono (6.9%), and others (8.1%). Second-line (2L) therapy was received by 1303 patients; treatment sequences are presented in the table below. Among patients who received IO-based therapy in the 1L (N = 990), 11% were retreated with IO on any subsequent line. When stratified by clear cell and non-clear cell histology, similar treatment patterns and sequences were observed. Among patients who initiated 1L treatment post-April 2018 (N = 1395), the most common treatments for 1L therapy were IO-IO (36.9%) and TKI mono (32.7%). Among patients who received 2L treatment after initiating 1L post-April 2018 (N = 486), TKI mono followed by IO mono, and IO-IO followed by TKI mono were the most prescribed sequences (Table). Conclusions: Following approval of IO-based therapies for 1L, RW treatment patterns for mRCC are evolving; IO-IO has become the most common 1L therapy received by all patients initiating treatment for mRCC. [Table: see text]

Real-world Treatment Patterns and Clinical Outcomes for Metastatic Renal Cell Carcinoma in the Current Treatment Era

“…Consistent with the study by Zakharia et al [17] , we observed a marked increase in the uptake of both pembrolizumab + axitinib and ipilimumab + nivolumab combinations since their respective FDA approval. In our study, consistent with the literature [18] , [19] , [20] , [21] , 2L therapies were guided by 1L therapies: patients received TKI monotherapy after IO-based 1L treatment, and received an IO-based therapy after TKI-based 1L treatment. Cabozantinib was the most common 2L therapy among patients receiving IO-based 1L therapy, and nivolumab was the most common 2L therapy among patients receiving 1L TKI monotherapy.…”

Real World Overall Survival of Patients With Metastatic Renal Cell Carcinoma Treated With Only Available Sunitinib and Pazopanib in First-Line Setting

“…The number of patients who are candidates for continuing treatment in Serbia is 35–40%. According to available data from the literature, the number of patients who continue treatment after the failure of the first-line TKI ranges between 26 and 63% in everyday practice ( 25 ).…”

Identifying homogeneous healthcare use profiles and treatment sequences by combining sequence pattern mining with care trajectory clustering in kidney cancer patients on oral anticancer drugs: A case study

“…Oral TKI monotherapy is still considered for patients unable to take or to tolerate checkpoint inhibitors, and for those displaying no response to immunotherapy. 1 Oral TKI treatment sequences in mRCC patients have been little studied 2 and may constitute prognostic hallmarks of disease progression. 3,4…”

“…Oral TKI monotherapy is still considered for patients unable to take or to tolerate checkpoint inhibitors, and for those displaying no response to immunotherapy. 1 Oral TKI treatment sequences in mRCC patients have been little studied 2 and may constitute prognostic hallmarks of disease progression. 3,4 The frequency and severity of adverse effects associated with TKI treatment remain high in comparison with intravenous chemotherapies, creating a major challenge in the ambulatory management of mRCC patients, whose healthcare pathways involve both hospital and community healthcare professionals.…”