Real-World Treatment Patterns and Clinical Outcomes Among Patients With Advanced Renal Cell Carcinoma

This real -world study of patients with renal cell carcinoma (RCC) compared clinical outcomes for patients treated with tyrosine kinase inhibitors (TKI), or an immunotherapy combination (IO +TKI or IO +IO). Medical record data was collected retrospectively for 498 patients across North America, Europe, and the UK. Immunotherapy (IO) combination was associated with longer progression-free survival (PFS) and time to next treatment (TTNT) than tyrosine kinase inhibitor (TKI) monotherapy. Among IO combinations, IO +TKI was associated with significantly improved progression-free survival (PFS) and TTNT compared to IO +IO. Background: Nearly 30% of new renal cell carcinoma (RCC) cases are diagnosed at an advanced or metastatic stage. Recent approvals of immunotherapies (IO) have significantly impacted patient care, but real -world outcomes of these treatments have not been widely evaluated. Methods: Eligible physicians abstracted demographic and clinical data from patient medical records for patients with advanced clear and non-clear cell RCC (aRCC) who initiated treatment between January 1, 2018, and December 31, 2020. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. A multivariate Cox regression model was developed to assess the impact of treatment category on clinical outcomes while controlling for International Metastatic RCC Database Consortium (IMDC) risk category, histology, and other patient characteristics. Results: A total of 498 patients were included (201 from US, 62 from Canada, 58 from UK, 59 from France, 58 from Germany, 60 from Spain). Of these, 250 received tyrosine kinase inhibitor (TKI) monotherapy, 197 received immunotherapy (IO) combination (119 IO + TKI, 78 IO + IO), and 32 received IO monotherapy as first -line treatment for aRCC; 19 patients received various other regimens. 16% of patients had a favorable IMDC risk score. Based on results of multivariable Cox regression, PFS (hazard ratio [HR] [95% confidence interval (CI)]: 0.50 [0.36-0.72]) ( P < .001) and time to next treatment (TTNT) were significantly longer (HR [95% CI]: 0.54 [0.39-0.73]) ( P < .001) for patients treated with IO combination versus TKI monotherapy. IO combination had a numerically reduced, but statistically insignificant, risk of death versus TKI monotherapy (HR: 0.66; P = .114). IO + TKI combination was associated with significantly longer PFS and reduced risk of progression (HR: 0.52; P = .04) versus IO + IO combination; similar results were observed for TTNT (HR: 0.57; P = .03). Conclusion: Our evaluation of realworld treatment outcomes in aRCC revealed that IO + TKI combination is associated with improved PFS and prolonged TTNT compared with TKI monotherapy and IO + IO combination.