10.17863/CAM.58126
Hawkins, Robert
Fife, Kate
Hurst, Michael
Wang, Meng
Naicker, Niroshini
Nolasco, Sarah
Eisen, Tim
0000-0001-9663-4873
Matakidou, Athena
Gordon, Jason
Treatment patterns and health outcomes in metastatic renal cell carcinoma patients treated with targeted systemic therapies in the UK.
Springer Science and Business Media LLC
2020
Molecular targeted therapy
Renal Cancer
Survival analysis
Adolescent
Adult
Aged
Antineoplastic Agents
Axitinib
Carcinoma, Renal Cell
Everolimus
Female
Follow-Up Studies
Humans
Indazoles
Kaplan-Meier Estimate
Kidney Neoplasms
Longitudinal Studies
Male
Middle Aged
Molecular Targeted Therapy
Practice Patterns, Physicians'
Prognosis
Protein Kinase Inhibitors
Pyrimidines
Retrospective Studies
Sulfonamides
Sunitinib
Treatment Outcome
United Kingdom
Young Adult
Apollo - University of Cambridge Repository
University of Cambridge
013meh722
2020-10-02
2020-10-02
2020-07-17
eng
Article
https://www.repository.cam.ac.uk/handle/1810/311036
10.1186/s12885-020-07154-z
Attribution 4.0 International
open.access
BACKGROUND: Patients with metastatic renal cell carcinoma (mRCC) treated with targeted systemic therapies have demonstrated favourable outcomes in randomised controlled trials, however real-world evidence is limited. Thus, this study aimed to determine the effectiveness of targeted systemic therapies for patients with mRCC in routine clinical practice in the UK. METHODS: A retrospective, observational, longitudinal study based on chart review of newly diagnosed adult mRCC patients treated at two UK hospitals from 2008 to 2015 was conducted. Targeted systemic therapies recommended for use in mRCC patients were evaluated across first to third lines of therapy (1LOT-3LOT). Important exclusions were treatment with cytokine therapy and within non-standard of care clinical trials. Primary outcome measure was overall survival (OS); data were analysed descriptively and using Kaplan-Meyer analysis. RESULTS: 652 patients (65.3% male, 35.0% ≥70 years) were included. In 1LOT, 98.5% of patients received sunitinib or pazopanib. In 2LOT and 3LOT, 99.0 and 94.4% received axitinib or everolimus. Median OS was 12.9, 6.5 and 5.9 months at 1LOT, 2LOT and 3LOT respectively. Estimated OS at 1-year was 52.4% (95% CI: 48.6-56.4%) in 1LOT, 31.5% (25.2-39.5%) in 2LOT and 23.8% (10.1-55.9%) in 3LOT. Median OS from 1LOT in favourable, intermediate and poor MSKCC were 39.7, 15.8 and 6.1 months respectively. CONCLUSIONS: In this study, treatment was consistent with current National Institute for Health and Care Excellence (NICE) guidelines for mRCC patients. Although the study population favoured poorer prognosis patients, outcomes were more favourable than those for England at the same time. However, overall survival in this 'real-world' population remains poor and indicates significant unmet need for effective and safe treatment options to improve survival among mRCC patients.