Real-World Survival Outcomes and Prognostic Factors Among Patients Receiving First Targeted Therapy for Advanced Renal Cell Carcinoma: A SEER–Medicare Database Analysis

Pal, Sumanta K.; Ghate, Sameer; Li, Nanxin; Swallow, Elyse; Peeples, Miranda; Zichlin, Miriam L.; Perez, Jose Ricardo; Agarwal, Neeraj; Vogelzang, Nicholas J.

doi:10.1016/j.clgc.2016.12.005

Cited by 57 publications

(65 citation statements)

References 47 publications

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“…Our report from 24 VHA medical centers across the country complements and expands upon other retrospective analyses of real‐world utilization of renal cell carcinoma therapies . To our knowledge, this analysis is the first to quantify the gains in overall survival that are likely attributable to guarantee or immortal time (about 44 days).…”

Section: Discussionmentioning

confidence: 82%

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Use of targeted therapies for advanced renal cell carcinoma in the Veterans Health Administration

et al. 2019

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Background The objective of this study is to describe the use of targeted therapies for the treatment of advanced renal cell carcinoma (RCC) and overall survival (OS) among patients in clinical practice in the Veterans Health Administration (VHA). Methods A retrospective cohort of 286 patients from 24 VHA Medical Centers diagnosed with advanced clear cell RCC between Fiscal Year (FY) 2010 and FY2014 was followed through September 30, 2016. Among patients who received targeted therapy, we described the medications taken, duration of therapy, and overall survival. We also assessed the effect of the first therapy received on overall survival using Cox Proportional Hazards models. Results There were 66 patients who did not receive therapy for their advanced RCC. Of the 220 treated patients, the mean (sd) number of medications received was 1.9 (1.1). The medications most commonly used first were sunitinib (61.8%), pazopanib (17.3%), and temsirolimus (10.9%). The median duration of first‐line therapy was 86 days (interquartile range [IQR] 42, 210). Median total duration of therapy was 159 days (IQR 58, 397). 62.3% of patients had ≥ 1 dose of therapy held or reduced, mainly due to an adverse drug event (ADE). Median survival from the start of treatment to death was 1.08 years (IQR 0.80, 1.31). Finally, receipt of temsirolimus vs sunitinib (HR 1.95 [95%CI 1.09,3.47]) as the first targeted therapy was independently associated with an increased hazard of death. Conclusion Our analysis of targeted therapies for advanced RCC in VHA suggests duration of treatment is shorter in a real‐world setting than in clinical trials, and dose reductions and ADEs are more common.

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Section: Discussionmentioning

confidence: 82%

“…In contrast with prior observational studies, we provide an estimate of immortal time. Figure shows the difference in overall survival between patients who receive no therapy and patients who receive at least one targeted therapy.…”

Section: Discussionmentioning

confidence: 99%

Use of targeted therapies for advanced renal cell carcinoma in the Veterans Health Administration

et al. 2019

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“…Although the recent progress of screening has led to an increase in the rate of patients being diagnosed with RCC in an early stage, which is curable by treatment with radical surgery, metastases are shown in approximately 15% of RCC patients at initial presentation . In the treatment for mRCC, therapeutic strategies have been dramatically changing and the prognostic outcome of mRCC has been improved through the induction of many options including targeted agents or ICIs . Therefore, the identification of biomarkers for the evaluation and prediction of the effects of therapeutic options and prognosis of mRCC patients in the new era is a very important issue.…”

Section: Introductionmentioning

confidence: 99%

“…1 In the treatment for mRCC, therapeutic strategies have been dramatically changing and the prognostic outcome of mRCC has been improved through the induction of many options including targeted agents or ICIs. 2 Therefore, the identification of biomarkers for the evaluation and prediction of the effects of therapeutic options and prognosis of mRCC patients in the new era is a very important issue. Taking these backgrounds into consideration, organizing the conventional clinical parameters believed to be required to identify more useful biomarkers to establish novel therapeutic strategies for RCC based on them.…”

Section: Introductionmentioning

confidence: 99%

Current status of prognostic factors in patients with metastatic renal cell carcinoma

et al. 2019

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In recent years, the induction of novel agents, including molecular‐targeted agents and immune checkpoint inhibitors, have dramatically changed therapeutic options and their outcomes for metastatic renal cell carcinoma. Several prognostic models based on the data of patients with metastatic renal cell carcinoma treated with targeted agents or cytokine therapy have been useful in real clinical practice. Serum or peripheral blood markers related to inflammatory response have been reported to be associated with their prognosis or therapeutic efficacy. In addition to them, investigation for novel predictive factors that represent the efficacy of agents, the risk of adverse events and the prognosis are required for the advance of therapeutic strategies. The present review discusses the conventional prognostic models and clinical factors, and recent advances of the identification of some of the most promising molecules as novel biomarkers for metastatic renal cell carcinoma.

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“…Recent advances in systemic therapy have led to improved prognosis of mRCC. 1 ICIs are approved for a wide range of malignancies, but predicting the prognosis or therapeutic efficacy of an ICI for mRCC remains difficult. CRP is one of the most representative proteins in the acute phase of inflammatory response.…”

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confidence: 99%

C‐reactive protein can be used to predict the therapeutic effects of nivolumab in patients with metastatic renal cell carcinoma

et al. 2019

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Real-World Survival Outcomes and Prognostic Factors Among Patients Receiving First Targeted Therapy for Advanced Renal Cell Carcinoma: A SEER–Medicare Database Analysis

Cited by 57 publications

References 47 publications

Use of targeted therapies for advanced renal cell carcinoma in the Veterans Health Administration

Use of targeted therapies for advanced renal cell carcinoma in the Veterans Health Administration

Current status of prognostic factors in patients with metastatic renal cell carcinoma

C‐reactive protein can be used to predict the therapeutic effects of nivolumab in patients with metastatic renal cell carcinoma

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