Abstract
ABSTRACTBackground:Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center.Materials and Methods:Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model.Results:Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047).Conclusion:Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.
Highlights
Kidney cancer is the third most common urologic malignancy, with 10.688 new cases estimated for 2018 in Brazil [1], with increasing incidence trends [2]
Patients Characteristics Between January 2007 and 2018, 171 eligible metastatic renal cell carcinoma (mRCC) patients were treated at A.C. Camargo Cancer Center (ACCCC) with Tyrosine kinase inhibitors (TKI) as the first-line treatment
There was an imbalance in the proportion of nephrectomies (p=0.003) and metastasectomies (p=0.5) performed, with Public Health System (PHS) patients having fewer of these procedures than private health systems (PrS) patients
Summary
Kidney cancer is the third most common urologic malignancy, with 10.688 new cases estimated for 2018 in Brazil [1], with increasing incidence trends [2]. The introduction of targeted therapies, such as tyrosine kinase inhibitors (TKI), and recently immunotherapy, has led to significant survival benefits for metastatic renal cell carcinoma (mRCC) patients treated in the first- [4,5,6] and second-line [7,8,9] settings, with extensive evidence from randomized clinical trials and meta-analyses [10]. In Brazil, there are no approved second and further lines of treatment for mRCC in the Public Health System (PHS). The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center. Conclusion: Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access
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