Overall survival (OS) in renal cell carcinoma (RCC) before and after the introduction of targeted therapies (TTs): A Norwegian population-based study (2000–2011).

Abstract

443 Background: The Renal Comparison study in Norway (RECON) is a retrospective non-interventional study of OS in all patients diagnosed with RCC and metastatic (m)RCC before and after the introduction of TTs. Methods: Using data from two national health registries, Cancer Registry of Norway (diagnosis and cause of death) and Norwegian Prescription Database (all dispensed drugs), we assessed OS in RCC and mRCC patients diagnosed during two periods after (2009–2011 and 2006–2008) and one period before (2000–2005 [RCC]; 2002–2005 [mRCC]) the introduction of TTs and factors influencing OS in mRCC. Multivariate analysis was performed using a Cox proportional hazards model, including estimation of adjusted HR. The regression model included the covariates age, gender, geographic region, nephrectomy status, diagnostic period and TT prescription. Results: In total, 2,176, 1,887, and 3,233 RCC patients were identified in 2009–2011, 2006–2008 and 2000–2005, respectively, of whom 2,160 (30%) had mRCC. From 2006 to 2011, TT use in mRCC patients significantly increased from 21% to 56% (p<0.01); sunitinib was the most frequent first-line treatment (93%). RCC patients diagnosed in 2009–2011 and 2006–2008 had a significant improvement in OS compared with patients diagnosed in 2000–2005 (median OS: not reached and 76 vs. 49 months, respectively; both p<0.001 [log-rank]). Similarly, a significant OS improvement was shown in mRCC patients diagnosed in 2009–2011 and 2006–2008 compared with 2002–2005 (median OS: 11.0 and 8.0 vs. 6.0 months, respectively; both p<0.001 [log-rank]; with adjusted HR [95% CI] of 0.77 [0.68–0.87] and 0.87 [0.78–0.98], respectively). Factors significantly associated with longer OS in mRCC were (HR, 95% CI): younger age (0.98, 0.98–0.99), female gender (0.88, 0.79–0.97), prior nephrectomy (0.49, 0.43–0.55) and TT prescription (0.58, 0.51–0.65). Significant regional variation was also shown. Conclusions: A significant OS improvement was shown in RCC and mRCC patients following the introduction of TTs. This advance has continued into the later TT era and, although multifactorial in origin, the contribution of TTs in mRCC is highly likely.