Real-World Treatment Patterns Have Drastically Changed Over the Past 5 Years

2021 Year in Review - Renal-Cell Carcinoma

The treatment landscape for advanced renal-cell carcinoma (RCC) has evolved rapidly in recent years with the approval of new therapeutic options. However, few studies have evaluated real-world treatment patterns and sequencing.1

In a present real-world study, researchers evaluated records for adults diagnosed with advanced RCC between December 2015 and May 2020 from the Flatiron electronic medical record database. Enrolled patients had ≥1 months of medical data following diagnosis of advanced RCC. Baseline clinical and patient characteristics and treatments were evaluated for the entire study period as well as in the period following the approval of dual immune checkpoint inhibition in the United States (April 2018-May 2020).1

A total of 3524 patients with metastatic RCC were enrolled, among whom most were male (68.5%) and had clear-cell disease (68.2%). The median age at diagnosis was 68 years, and 75.8% of patients had intermediate- or poor-risk RCC. Median follow-up from date of diagnosis was 328 days.1

Systemic therapy was initiated in 79.1% of patients. In the whole study period, the most common first-line treatments were monotherapy with a tyrosine kinase inhibitor (TKI; 56.4%), dual checkpoint inhibition (19.1%), combination therapy with a TKI and immune checkpoint inhibitor (9.5%), monotherapy with a checkpoint inhibitor (6.9%), and other therapy (8.1%). Among patients treated after April 2018, the most common first-line treatments were dual immune checkpoint inhibition (36.9%) and TKI monotherapy (32.7%).1

A total of 1303 patients received second-line therapy during the study. In the full study period, the most common treatment sequence was TKI monotherapy to checkpoint inhibitor monotherapy (40.1%). In the post–April 2018 period, fewer patients received TKI monotherapy to checkpoint inhibitor monotherapy (22.8%) and more patients received dual immune checkpoint inhibition followed by TKI monotherapy (21.8%).1

The study investigators concluded that the approval of immunotherapeutics for advanced RCC in the first-line setting changed real-world treatment patterns for advanced RCC.1


  1. George S, Faccone J, Huo S, et al. Real-world treatment patterns and sequencing for metastatic renal cell carcinoma (mRCC): results from the Flatiron database. J Clin Oncol. 2021;39(6_suppl):Abstract 286.

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