Immunotherapy-based combinations have overtaken tyrosine kinase inhibitor (TKI) monotherapy as the most-used first-line treatment for metastatic renal cell carcinoma (mRCC) in US oncology clinics, according to findings presented at IKCS North America 2022.
Investigators observed increased use of dual immunotherapy or immunotherapy plus a TKI in recent years, as the use of TKI monotherapy has decreased.
The investigators conducted this study using data from The US Oncology Network and non-network clinics that use the iKnowMed™ electronic health record system.
The study included 1538 patients who received first-line treatment for mRCC between January 1, 2018, and September 30, 2020. The patients’ median age was 67.1 years. Most were men, were White, had clear cell carcinoma, and had intermediate/poor-risk disease.
Patients received the following first-line treatments:
- Dual immunotherapy — ipilimumab plus nivolumab (n=641)
- Combination immunotherapy and TKI therapy — pembrolizumab plus axitinib or avelumab plus axitinib (n=279)
- TKI monotherapy — axitinib, cabozantinib, pazopanib, or sunitinib (n=618).
In the first half of 2018, 76.9% of patients received TKI monotherapy, and 23.1% received dual immunotherapy.
In the first half of 2019, 50.2% of patients received dual immunotherapy, 42.1% received TKI monotherapy, and 7.7% received immunotherapy plus a TKI.
In the third quarter of 2020, 41.9% of patients received dual immunotherapy, 31.3% received immunotherapy plus a TKI, and 26.9% received TKI monotherapy.
The investigators noted that second-line therapies were guided by therapies in the first line. Most patients received a TKI in the second line if they received immunotherapy in the first line, and immunotherapy in the second line if they received a TKI in the first line.
The most common second-line treatments were:
- Cabozantinib (48.6%) and pazopanib (12.1%) after dual immunotherapy
- Cabozantinib (50.9%) and ipilimumab plus nivolumab (22.6%) after combination immunotherapy-TKI
- Nivolumab (44.7%) and ipilimumab plus nivolumab (19.6%) after TKI monotherapy.
To determine the optimal sequencing of treatments after the first line, “a longer follow-up is needed,” the investigators noted.
Disclosures: The study authors did not provide disclosures.
Shah NJ, Sura S, Shinde R, et al. Real-world assessment of changing treatment patterns and sequence for patients with metastatic renal cell carcinoma in the first-line setting. Presented at IKCS North America 2022. November 4-5, 2022. Abstract 23.