Treatment patterns, outcomes and clinical characteristics in advanced renal cell carcinoma: a real-world US study

Lay abstract In patients with advanced/late-stage renal cell carcinoma (aRCC), a type of kidney cancer that has spread to other parts of the body, the chance of recovery from the disease over time is low. A number of new treatments have become available in recent years, including types of drugs like tyrosine kinase inhibitors (TKIs) and immuno-oncology (IO) therapies. We wanted to know how these drugs are used in clinical practice. We carried out a survey asking various questions such as the age and gender of patients, how long they had aRCC, how they were treated and what their symptoms were. The survey showed that despite being available as treatments, these new drugs were not routinely used as recommended by recently published clinical guidelines. Patients, whose chances of recovering from aRCC were low, were more likely to be given TKIs instead of the new IO/TKI and IO/IO combinations now recommended (resulting in a less than 10% chance that the disease would totally disappear). As healthcare practitioners learn more about these new treatments, it is expected that their use will increase, leading to improved outcomes. Aim:Assessing treatment patterns, outcomes and clinical characteristics in advanced renal cell carcinoma clinical practice.Materials & methods:A US cross-sectional physician survey conducted February-September 2019.Results:Surveyed physicians reported first-line treatment of 445 patients involving tyrosine kinase inhibitor monotherapy (51.0%), immuno-oncology (IO/IO combination) therapy (25.8%) or other regimens (23.1%). A total of 60.9% had physician-assessed IMDC risk. Of these 61.9, 50.9 and 27.6% of patients with favorable, intermediate and poor risk, respectively, received tyrosine kinase inhibitor monotherapy. A total of 16.7, 26.9 and 34.5% of patients with favorable, intermediate or poor risk received IO/IO combination therapy. Complete/partial responses (similar to 35% patients) remained comparable across first-line treatments.Conclusion:Guideline-recommended therapies are not widely prescribed. Many patients experienced poor clinical outcomes highlighting a need for more effective treatments.