Trends of Systemic Therapy Use for Renal Cell Carcinoma in the United States

Ferry, Elizabeth; Minnillo, Brian J.; Maurice, Matthew J.; Abouassaly, Robert; Zhu, Hui

doi:10.1016/j.urology.2015.03.008

Cited by 10 publications

(13 citation statements)

References 19 publications

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“…Two randomized controlled trials provided conflicting evidence for its utility, [ 12 , 15 ] and consensus is still pending regarding the appropriateness in this setting. While other groups have assessed survival outcomes in the cytokine era, [ 19 – 21 ] we utilized the SEER database to evaluate trends of TT utilization, particularly in the non-metastatic setting, thereby adding some context for the discussion regarding the benefit of adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…For contrast, de novo metastatic RCC patients were evaluated first. The use of TTs for these patients has steadily increased since 2006, though they remain underutilized [ 17 , 18 , 21 – 24 ]. Their use provided cancer-specific survival benefit in the entire cM1 cohort and in the clear-cell subset ( Supplementary Table 2B and 2C ), and the primary benefit appears to be within the first 20 months (Figure 2A ).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, we are unable to identify the specific TT utilized, and traditional chemotherapeutic agents may potentially be included in the TT analysis; however, as RCC has been known to be chemo-resistant, the incidence is likely to be low during the TT era. Prior studies have demonstrated very low rates of chemotherapy use prior to the introduction of targeted therapies [ 17 , 18 , 21 ]. Lastly, as it relates to the chemotherapy variable, prior comparison to SEER-Medicare datasets have demonstrated 65-80% sensitivity, but very high specificity [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

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High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: a population-based analysis

et al. 2018

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ObjectiveTo utilize a population-based approach to address the role of adjuvant TT in the management of RCC.MethodsPatients with RCC (2006-2013) in the SEER database were stratified by metastatic disease at the time of diagnosis (cM0/cM1). cM0 patients following surgical excision were stratified into low and high-risk (ASSURE and S-TRAC criteria). Multivariable analyses performed to identify predictors of TT receipt; Fine and Gray competing risks analyses used to identify predictors of cancer-specific mortality (CSM). Subset analyses included patients with clear cell histology and high-risk cM0. Survival analyses were used to evaluate overall survival (OS) and cancer-specific survival (CSS) for all cohorts, stratified on TT receipt.Results79,926 patients included (71,682 cM0, 8,244 cM1); median follow-up for the entire cohort was 40.1 months. Of 31,453 patients with histologic grade data, 18,328 and 13,125 were low- and high-risk cM0, respectively. TT utilization in cM1 patients peaked at 50.6% and was associated with reduced CSM (HR 0.73, p<0.01). In contrast, TT utilization (presumed salvage therapy) never exceeded 2.2% in the entire cM0 cohort and 3.5% in the high-risk cM0 cohort. On competing risks analysis, TT receipt was associated with increased CSM in all cohorts.ConclusionWhen compared to the cM1 patients, TT receipt in cM0 patients does not provide any cancer-specific survival benefit, even in the small percentage of patients that eventually progress to metastatic disease. Competing risks mortality further limit any potential benefit in this population. Based on current evidence, adjuvant TT cannot be recommended for RCC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: a population-based analysis

et al. 2018

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show abstract

“…Two randomized controlled trials provided conflicting evidence for its utility, [12,15] and consensus is still pending regarding the appropriateness in this setting. While other groups have assessed survival outcomes in the cytokine era, [19][20][21] we utilized the SEER database to evaluate trends of TT utilization, particularly in the non-metastatic setting, thereby adding some context for the discussion regarding the benefit of adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The use of TTs for these patients has steadily increased since 2006, though they remain underutilized [17,18,[21][22][23][24]. Their use provided cancerspecific survival benefit in the entire cM1 cohort and in the clear-cell subset (Supplementary Table 2B and 2C), and the primary benefit appears to be within the first 20 months (Figure 2A).…”

Section: Discussionmentioning

confidence: 99%

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: A population-based analysis

Chandrasekar

Klaassen

Goldberg

et al. 2018

European Urology Supplements

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Objective: To utilize a population-based approach to address the role of adjuvant TT in the management of RCC.Methods: Patients with RCC (2006-2013) in the SEER database were stratified by metastatic disease at the time of diagnosis (cM0/cM1). cM0 patients following surgical excision were stratified into low and high-risk (ASSURE and S-TRAC criteria). Multivariable analyses performed to identify predictors of TT receipt; Fine and Gray competing risks analyses used to identify predictors of cancer-specific mortality (CSM). Subset analyses included patients with clear cell histology and high-risk cM0. Survival analyses were used to evaluate overall survival (OS) and cancer-specific survival (CSS) for all cohorts, stratified on TT receipt.Results: 79,926 patients included (71,682 cM0, 8,244 cM1); median follow-up for the entire cohort was 40.1 months. Of 31,453 patients with histologic grade data, 18,328 and 13,125 were low-and high-risk cM0, respectively. TT utilization in cM1 patients peaked at 50.6% and was associated with reduced CSM (HR 0.73, p<0.01). In contrast, TT utilization (presumed salvage therapy) never exceeded 2.2% in the entire cM0 cohort and 3.5% in the high-risk cM0 cohort. On competing risks analysis, TT receipt was associated with increased CSM in all cohorts.Conclusion: When compared to the cM1 patients, TT receipt in cM0 patients does not provide any cancer-specific survival benefit, even in the small percentage of patients that eventually progress to metastatic disease. Competing risks mortality further limit any potential benefit in this population. Based on current evidence, adjuvant TT cannot be recommended for RCC patients.

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Patient characteristics and treatments one year after diagnosis of renal cancer in 2015 according to the presence or absence of metastasis and a history of another tumour: A national observational study

et al. 2019

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Trends of Systemic Therapy Use for Renal Cell Carcinoma in the United States

Cited by 10 publications

References 19 publications

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: a population-based analysis

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: a population-based analysis

High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: A population-based analysis

Patient characteristics and treatments one year after diagnosis of renal cancer in 2015 according to the presence or absence of metastasis and a history of another tumour: A national observational study

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