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Patterns and Predictors of Oral Anticancer Agent Use for Metastatic RCC

March 19, 2021

Stephanie Wheeler, PhD MPH, The University of North Carolina at Chapel Hill, Chapel Hill, NC discusses results from a study on patterns and predictors of oral anticancer agent utilization in metastatic renal cell carcinoma (mRCC).

These results were presented at the virtual 2021 ASCO Genitourinary Cancers Symposium.


Hello. My name is Stephanie Wheeler. I'm here to tell you about a study that we conducted in collaboration with Duke University and the UNC CIPHR resource, which is part of the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill.

We're focused in the study on patterns and predictors of oral anticancer agent utilization in metastatic renal cell carcinoma. We know that metastatic renal cell carcinoma survival is extremely low, as you can see in this graph here, and that newly approved oral anticancer agents can improve survival.

That said, the real‑world utilization of these agents remain unknown. Because patients who are facing renal cell carcinoma also may have complex healthcare needs in terms of their other chronic conditions, it's important to understand to what extent these medications are being used in these populations and how that relates to outcomes.

Our goal was to identify patterns and predictors of OAA use within the first year after metastatic disease was detected. We used a unique data resource that's available in North Carolina, that links our state cancer registry to multi‑payer claims data from private insurance plans, Medicare, and Medicaid.

We focused on populations of patients who had an algorithm‑detected metastatic renal cell carcinoma between the years of 2006 and 2015. Some of the cohort characteristics are available here on the right‑hand side of the screen.

In terms of our results over this time period, we observed that about a third of patients initiated an OAA during this time period and that there was really no trend in terms of the overall use of OAAs over this time period, despite the introduction of several new agents over this period of time.

You can see that while specific drugs may have decreased a little bit and newer drugs, such as axitinib, increased over this period of time, but there was really no statistically different trend in the overall utilization.

We also noted that lower OAA use was associated with older age, greater frailty as detected in the claims data, and having two or more comorbid conditions. Also, we observed lower OAA use among patients who were stage 1 versus stage 4.

As we think about what these results mean in terms of the patterns of OAA utilization in this patient population, it's unclear what the clinical judgment was for determining differential use.

It may be that lower OAA utilization represents more appropriate judgment in treating patients who are medically complex. Future research, given that, should investigate what some of those multilevel drivers are of OAA initiation and also what the adherence differentials may look like over time.

I think it's important to note, the patient‑level characteristics that we observed that were associated with low OAA use, such as older age, higher comorbidity burden, and higher frailty, we would expect that those things should potentially clinically meaningfully affect whether or not a person begins OAAs and that may also reflect patient preferences as opposed to simply just provider decision‑making.

I also think it's important to note that characteristics that may reflect disparities or discrimination in treatment, including race, ethnicity, rurality, and insurance type, in this study were not associated with OAA initiation in adjusted analyses. This may be reassuring but should be confirmed in other studies, given that these groups have historically faced worse cancer outcomes.

Thank you for your attention. We look forward to engaging with reviewers and folks who are interested in this study. This study was presented at the ASCO GU Cancer Symposium. Thank you.

Wheeler SB, Spees L, Jackson BE, et al. Patterns and predictors of oral anticancer agent utilization in diverse metastatic renal cell carcinoma patients. Presented at: the virtual 2021 ASCO Genitourinary Cancers Symposium; February 11-13, 2021. Abstract 279.

Dr Wheeler reports no relevant financial relationships.

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