PMID- 36874600
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230411
IS  - 2666-1683 (Electronic)
IS  - 2666-1691 (Print)
IS  - 2666-1683 (Linking)
VI  - 49
DP  - 2023 Mar
TI  - Real-world Treatment Patterns and Clinical Outcomes for Metastatic Renal Cell 
      Carcinoma in the Current Treatment Era.
PG  - 110-118
LID - 10.1016/j.euros.2022.12.015 [doi]
AB  - BACKGROUND: Immuno-oncology (IO) agents and tyrosine kinase inhibitors (TKIs) 
      have revolutionized the treatment paradigm for metastatic renal cell carcinoma 
      (mRCC). Data on real-world usage and outcomes are limited. OBJECTIVE: To examine 
      real-world treatment patterns and clinical outcomes for mRCC. DESIGN SETTING AND 
      PARTICIPANTS: This retrospective cohort study included 1538 patients with mRCC 
      who received first-line treatment with pembrolizumab + axitinib (P + A; n = 279, 
      18%), ipilimumab + nivolumab (I + N; n = 618, 40%), or TKI monotherapy (TKIm; 
      cabozantinib, sunitinib, pazopanib, or axitinib; n = 641, 42%) between January 1, 
      2018 and September 30, 2020 in US Oncology Network/non-network practices. OUTCOME 
      MEASUREMENTS AND STATISTICAL ANALYSIS: The relationship with outcomes, time on 
      treatment (ToT), time to next treatment (TTNT), and overall survival (OS) was 
      analyzed using multivariable Cox proportional-hazards models. RESULTS AND 
      LIMITATIONS: The median age of the cohort was 67 yr (interquartile range 
      59.5-74.4), 70% were male, 79% had clear cell RCC, and 87% had an intermediate or 
      poor International mRCC Database Consortium risk score. The median ToT was 13.6 
      for P + A versus 5.8 for I + N versus 3.4 mo for TKIm (p < 0.001) and the median 
      TTNT was 16.4 for P + A versus 8.3 for I + N versus 8.4 mo for TKIm (p < 0.001) . 
      Median OS was not reached for P + A, 27.6 mo for I + N, and 26.9 mo for TKIm 
      (p = 0.237). On adjusted multivariable analysis, treatment with P + A was 
      associated with better ToT (adjusted hazard ratio [aHR] 0.59, 95% confidence 
      interval [CI] 0.47-0.72 vs I + N; 0.37, 95% CI, 0.30-0.45 vs TKIm; p < 0.0001) 
      and better TTNT (aHR 0.61, 95% CI 0.49-0.77 vs I + N; 0.53, 95% CI 0.42-0.67 vs 
      TKIm; p < 0.0001). Limitations include the retrospective design and the limited 
      follow-up for characterization of survival. CONCLUSIONS: We noted substantial 
      uptake of IO-based therapies in the first-line community oncology setting since 
      their approval. In addition, the study provides insights into clinical 
      effectiveness, tolerability, and/or compliance of IO-based therapies. PATIENT 
      SUMMARY: We examined the use of immunotherapy for patients with metastatic kidney 
      cancer. The findings suggest rapid implementation of these new treatments by 
      oncologists working in the community setting, which is reassuring for patients 
      with this disease.
CI  - (c) 2023 Merck Sharp & Dohme LLC., a subsidiary Merck & Co., The Author(s).
FAU - Shah, Neil J
AU  - Shah NJ
AD  - Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 
      USA.
AD  - Department of Medicine, Weill Cornell Medical Center, New York, NY.
FAU - Sura, Sneha D
AU  - Sura SD
AD  - Ontada LLC, The Woodlands, TX, USA.
FAU - Shinde, Reshma
AU  - Shinde R
AD  - Merck & Co., Inc., Rahway, NJ, United States of America.
FAU - Shi, Junxin
AU  - Shi J
AD  - Ontada LLC, The Woodlands, TX, USA.
FAU - Singhal, Puneet K
AU  - Singhal PK
AD  - Merck & Co., Inc., Rahway, NJ, United States of America.
FAU - Robert, Nicholas J
AU  - Robert NJ
AD  - Ontada LLC, The Woodlands, TX, USA.
FAU - Vogelzang, Nicholas J
AU  - Vogelzang NJ
AD  - Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA.
FAU - Perini, Rodolfo F
AU  - Perini RF
AD  - Merck & Co., Inc., Rahway, NJ, United States of America.
FAU - Motzer, Robert J
AU  - Motzer RJ
AD  - Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 
      USA.
AD  - Department of Medicine, Weill Cornell Medical Center, New York, NY.
LA  - eng
GR  - P30 CA008748/CA/NCI NIH HHS/United States
PT  - Journal Article
DEP - 20230206
PL  - Netherlands
TA  - Eur Urol Open Sci
JT  - European urology open science
JID - 101771568
PMC - PMC9974999
OTO - NOTNLM
OT  - Immuno-oncology
OT  - Metastatic renal cell carcinoma
OT  - Overall survival
OT  - Time on treatment
OT  - Time to next treatment
EDAT- 2023/03/07 06:00
MHDA- 2023/03/07 06:01
PMCR- 2023/02/06
CRDT- 2023/03/06 03:58
PHST- 2022/12/22 00:00 [accepted]
PHST- 2023/03/06 03:58 [entrez]
PHST- 2023/03/07 06:00 [pubmed]
PHST- 2023/03/07 06:01 [medline]
PHST- 2023/02/06 00:00 [pmc-release]
AID - S2666-1683(23)00008-3 [pii]
AID - 10.1016/j.euros.2022.12.015 [doi]
PST - epublish
SO  - Eur Urol Open Sci. 2023 Feb 6;49:110-118. doi: 10.1016/j.euros.2022.12.015. 
      eCollection 2023 Mar.