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A Prospective Multicenter Evaluation of Initial Treatment Choice in Metastatic Renal Cell Carcinoma Prior to the Immunotherapy Era: The MaRCC Registry Experience
Journal article   Open access   Peer reviewed

A Prospective Multicenter Evaluation of Initial Treatment Choice in Metastatic Renal Cell Carcinoma Prior to the Immunotherapy Era: The MaRCC Registry Experience

Brian A. Costello, Nrupen A. Bhavsar, Yousef Zakharia, Sumanta K. Pal, Ulka Vaishampayan, Heather Jim, Mayer N. Fishman, Ana M. Molina, Christos E. Kyriakopoulos, Che-Kai Tsao, …
Clinical genitourinary cancer, Vol.20(1), pp.1-10
02/01/2022
DOI: 10.1016/j.clgc.2021.07.002
PMCID: PMC10186183
PMID: 34364796
url
https://doi.org/10.1016/j.clgc.2021.07.002View
Published (Version of record) Open Access

Abstract

•This study examined real-world first-line treatment selection, treatment outcomes, and physician rationale regarding initial treatment selection in patients with metastatic renal cell carcinoma enrolled in the prospective Metastatic Renal Cell Carcinoma Registry.•Overall survival was longest in patients who participated in a clinical trial compared with those who received off-study pazopanib and sunitinib.•Factors underlying physician treatment selection revealed a relative de-emphasis on quality of life, toxicity, and patient preference compared with efficacy. The Metastatic Renal Cell Carcinoma (MaRCC) Registry provides prospective data on real-world treatment patterns and outcomes in patients with metastatic renal cell carcinoma (mRCC). Patients with mRCC and no prior systemic therapy were enrolled at academic and community sites. End of study data collection was in March 2019. Outcomes included overall survival (OS). A survey of treating physicians assessed reasons for treatment initiations and discontinuations. Overall, 376 patients with mRCC initiated first-line therapy; 171 (45.5%) received pazopanib, 75 (19.9%) sunitinib, and 74 (19.7%) participated in a clinical trial. Median (95% confidence interval) OS was longest in the clinical trial group (50.3 [35.8-not reached] months) versus pazopanib (39.0 [29.7-50.9] months) and sunitinib 26.2 [19.9-61.5] months). Non-clear cell RCC (21.5% of patients) was associated with worse median OS than clear cell RCC (18.0 vs. 47.3 months). Differences in baseline characteristics, treatment starting dose, and relative dose exposure among treatment groups suggest selection bias. Survey results revealed a de-emphasis on quality of life, toxicity, and patient preference compared with efficacy in treatment selection. The MaRCC Registry gives insights into real-world first-line treatment selection, outcomes, and physician rationale regarding initial treatment selection prior to the immunotherapy era. Differences in outcomes between clinical trial and off-study patients reflect the difficulty in translating trial results to real-world patients, and emphasize the need to broaden clinical trial eligibility. Physician emphasis on efficacy over quality of life and toxicity suggests more data and education are needed regarding these endpoints. The Metastatic Renal Cell Carcinoma Registry provides prospective data on real-world treatment patterns and outcomes in patients with metastatic renal cell carcinoma (mRCC). A total of 376 patients with mRCC and no prior systemic therapy were included in this study. This report describes initial real-world treatment patterns. Physician emphasis on efficacy over quality of life and toxicity suggests more data and education are needed.
 First-line cancer treatment Kidney cancer Real-world practice patterns Renal cell carcinoma Tyrosine kinase inhibitors

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