Observational study on the evolution of systemic treatments for advanced renal cell carcinoma in Southwest Finland between 2010 and 2021

Abstract

<p>Background: Novel receptor tyrosine kinase inhibitors and immune checkpoint inhibitors have<br>been introduced to the treatment of advanced renal cell carcinoma (aRCC) during the past decade.<br>However, the adoption of novel treatments into clinical practice has been unknown in Finland.<br></p><p>Objectives: Our aim was to evaluate the use of systemic treatments and treatment outcomes<br>of aRCC patients in Southwest Finland during 2010–2021.<br></p><p>Design and Methods: Clinical characteristics, treatments for aRCC, healthcare resource<br>utilization, and overall survival (OS) were retrospectively obtained from electronic medical<br>records. Patients were stratified using the International Metastatic RCC Database Consortium<br>(IMDC) risk classification.<br></p><p>Results: In total, 1112 RCC patients were identified, 336 (30%) patients presented with aRCC,<br>and 57% of them (n = 191) had received systemic treatment. Pre-2018, sunitinib (79%) was<br>the most common first-line treatment, and pazopanib (17%), axitinib (17%), and cabozantinib<br>(5%) were frequently used in the second-line. Post-2018, sunitinib (52%), cabozantinib (31%),<br>and the combination of ipilimumab and nivolumab (10%) were most commonly used in the<br>first-line, and cabozantinib (23%) in the second-line. Median OS for patients with favorable,<br>intermediate, and poor risk were 61.9, 28.6, and 8.1 months, respectively. A total of 73%, 74%,<br>and 35% of the patients with favorable, intermediate, and poor risk had received second-line<br>systemic treatment. In poor-risk patients, the number of hospital inpatient days was twofold<br>higher compared to intermediate and fourfold higher compared to favorable-risk patients.<br></p><p>Conclusion: New treatment options were readily adopted into routine clinical practice after<br>becoming reimbursed in Finland. OS and the need for hospitalization depended significantly on<br>the IMDC risk category. Upfront combination treatments are warranted for poor-risk patients<br>as the proportion of patients receiving second-line treatment is low.<br></p>