Meeting
2024 ASCO Genitourinary Cancers Symposium
Evolving metastatic renal cell carcinoma (mRCC) treatment landscape in the post vascular endothelial growth factor (VEGF) and immune checkpoint inhibitor (IO) setting.
Authors
Neil J. Shah
Memorial Sloan Kettering Cancer Center, New York, NY
Neil J. Shah , Rituparna Bhattacharya , Ning Ning , Reshma Shinde , Jordana Schmier , Malinda Tan , Traci LeMasters , Murali Sundaram , Rodolfo F. Perini , Robert J. Motzer
Organizations
Memorial Sloan Kettering Cancer Center, New York, NY, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, Rahway, NJ, Open Health, Hingham, MA, OPEN Health, Hingham, MA, Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, North Wales, PA, Merck and Co Inc Global Human Health Business Development, North Wales, PA
Research Funding
his abstract was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.
Background: IO and VEGF based therapies have transformed the front-line treatment paradigm for patients with mRCC. This study's objective is to describe treatment patterns and clinical outcomes among mRCC patients in the post IO and VEGF setting. Methods: Adult patients diagnosed with mRCC between Jan 2015 - Dec 2022 and received IO and VEGF (in combination or sequence) in the first three lines of therapy after mRCC diagnosis were identified from Optum’s de-identified Clinformatics® Data Mart Database, a large retrospective claims database. Index date was defined as the date of the first (index) treatment in the post IO and VEGF setting. Patients were required to have continuous enrollment of 6 months prior to index date. Patients were categorized into 3 cohorts based on lines of index treatment (2L, 3L, 4L). Treatment patterns were described and real world (rw) time on treatment (ToT), time to next treatment (TTNT), and overall survival (OS) were estimated by Kaplan Meier analysis. Results: A total of 664 patients were included (2L:186, 3L:429, 4L:49). 37% received IO and VEGF in combination prior to index line of therapy. Median age at mRCC diagnosis was 67.0 years, with 72.7% male and 68.1% White; 11.6% died and 7.4% disenrolled during index treatment. Post IO and VEGF, cabozantinib was the most used therapy across 3 cohorts (2L: 43.5%, 3L: 35.2%, 4L: 30.6%) (Table). Median rwToT and rwTTNT for 2L, 3L, and 4L cohorts were 4.4, 5.0, and 5.6 months and 10.7, 11.7, and 9.5 months, respectively. Median OS from mRCC diagnosis was similar across the 3 cohorts (2L: 41.6, 3L: 38.7, 4L: 40.6 months); median OS from index date decreased with advancement in LOT (2L: 20.6, 3L: 14.1, 4L: 10.3 months). Conclusions: Our study is one of the largest and comprehensive study giving a unique perspective into evolving treatment patterns and outcomes for mRCC patients in the post IO and VEGF setting. Post IO+VEGF, the most common treatments were tyrosine kinase inhibitor-based treatments, and the median ToT was less than 6 months. Hence, novel treatments are needed to improve clinical outcomes for mRCC patients in the post IO and VEGF setting.
| Outcomes, Median in Months (95% Confidence Interval) | 2L Cohort (n=186) | 3L Cohort (n=429) | 4L Cohort (n=49) |
|---|---|---|---|
| Time on Tx | 4.4 (3.4-5.3) | 5.0 (4.4-6.0) | 5.6 (2.1-8.3) |
| Time to next Tx | 10.7 (8.6-20.6) | 11.7 (10.4-14.8) | 9.5 (6.4-14.2) |
| OS from mRCC diagnosis | 41.6 (30.6-64.0) | 38.7 (35.5-42.6) | 40.6 (36.0-48.8) |
| OS from index date | 20.6 (14.6-NE) | 14.1 (11.5-16.0) | 10.3 (8.8-16.7) |
| Most used Tx for index Tx, n (%) | |||
| Cabozantinib | 81 (43.5%) | 151 (35.2%) | 15 (30.6%) |
| Everolimus + lenvatinib | 20 (10.8%) | 71 (16.6%) | 7 (14.2%) |
| Ipilimumab + nivolumab | 21 (11.3%) | 9 (2.1%) | 0 (0%) |
| Axitinib | 5 (2.7%) | 34 (7.9%) | 6 (12.2%) |
NE, not estimable; OS, overall survival; Tx, treatment.
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Abstract Details
Session Type
Poster Session
Session Title
Poster Session C: Renal Cell Cancer; Adrenal, Penile, and Testicular Cancers
Track
Renal Cell Cancer,Adrenal Cancer,Penile Cancer,Testicular Cancer
Sub Track
Quality of Care/Quality Improvement and Real-World Evidence
Citation
J Clin Oncol 42, 2024 (suppl 4; abstr 406)
DOI
10.1200/JCO.2024.42.4_suppl.406
Abstract #
406
Poster Bd #
G9
Abstract Disclosures
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