The burden of illness in metastatic renal cell carcinoma (mRCC) patients after two targeted therapies: A review of the literature.

Abstract

e15043 Background: MRCC poses a substantial burden in terms of morbidity, mortality, impaired quality of life (QoL), and costs. Despite the emergence of targeted therapies (VEGF-TKIs and mTORs) in this setting, considerable unmet medical needs remain. Methods: A comprehensive literature search was performed to systematically review available data on the burden of mRCC. Included articles focused on the efficacy, toxicity, guidelines, therapy sequencing, and overall disease burden of mRCC patients who have failed multiple targeted therapies. Of the 933 articles mRCC articles identified, 83 met the criteria for data extraction. Results: An extensive amount of literature is published on targeted therapies in the treatment of patients with mRCC. Recently approved therapies report improved outcomes in 1st and 2nd line treatment; however, there are minimal data on the efficacy and safety of treatments following failure of 2 sequential targeted therapies. Specifically, two studies report OS in 2nd line failures: one prospective study of capecitabine as 3rd line treatment (OS: 7.2 months [CI: 4.6-8.8]) and one retrospective single arm study of 3rd line sorafenib use after failure of both VEGF-TKIs and mTORs (OS: 7 months [range: 6-10]). Consequently, of the six current practice guidelines, none recommend a specific treatment for patients who fail 2 targeted therapies. As highlighted in over 20 articles on therapy sequencing, the treatment population failing 2 targeted therapies represents an extremely heterogeneous group with a variety of prior therapies, for whom data are lacking. QoL and economic data focusing on patients in this setting were not identified. However, based upon evaluations in 1st and 2nd line patients, treatment toxicity and disease progression are expected to have a negative impact on QoL while increasing costs due to the associated need for additional treatment, hospitalizations, and other management. Conclusions: Despite significant advances in the treatment options for patients with mRCC, many patients inevitably progress and are left with few options. There is substantial unmet need for safe and effective 3rd line treatment options that can provide clinical benefit.