Comparative analysis of profiles of second-line stage IV renal cell carcinoma patients by first-line to second-line treatment sequencing in the United States.

Abstract

e16110 Background: Treatment of metastatic renal cell carcinoma (RCC) is evolving. With new agents, 2nd line (2L) therapies becoming frontline (1L) options, and growing research on outcomes, optimal treatment sequencing is increasingly complex. Methods: Real world data from Ipsos Global Oncology Monitor©: geographically representative physicians in US reported on 1,120 stage IV RCC anti-cancer drug-treated patients seen in consultation from 10/2017–9/2018, providing patient demographics, current and historic treatment data. Analysis of 1L to 2L treatment algorithm was conducted for current 2L patients. Patient profiles of 2 most frequent algorithms [TKI-TKI (n = 298) and TKI-CKI (n = 443)] were compared using inferential statistics. Results: Patients treated with 1L TKI and 2L CKI (TKI-CKI) vs. those treated with 1L TKI and 2L TKI (TKI-TKI) are older (mean: 65.8 vs 62.7; p < 0.05), have metastases in ≥ 2 sites (52% vs 36%; p < 0.01) and maintained 1L treatment for longer (mean: 10.0 vs 8.8 months; p < 0.05). 2L CKI patients were more likely to have achieved CR, VGPR or PR from 1L TKI (60% vs. 50%; p < 0.05) and less likely to have distant progression (19% vs. 26%; p < 0.05) or discontinued 1L TKI due to toxicities (9% vs. 16%; p < 0.01). 2L CKIs are more likely prescribed due to new clinical data (20% vs 12%; p < 0.05) and biomarker results (7% vs 2%; p < 0.05); 2L TKIs are prescribed more for convenience (10% vs 4%; p < 0.01). Physicians prescribed 2L CKIs more frequently with intent to extend life (53% vs 40%; p < 0.01) than palliative intent (47% vs 60%; p < 0.05). TKI-CKI patients were more involved in 2L treatment choice (17% vs 8%; p < 0.01) and physicians stated higher satisfaction with their current CKI (36% vs 26%; p < 0.01) relative to TKI-TKI patients.Conclusions: TKI-CKI patients are likely to have a more progressed disease, but also to have had a more positive outcome from 1L TKI, suggesting a therapeutic strategy driven by clinical attributes. New clinical data reinforce prescribing CKIs to extend life rather than for palliative purposes. When prescribing CKIs, patient involvement is higher (possibly due to mode of administration requiring more commitment) and physicians are more satisfied with results (despite these patients being older and with more metastases).