A look at 14 years of health care trends has revealed that the percentage of patients receiving treatment for metastatic renal cell carcinoma (mRCC) is growing as providers shift toward targeted therapeutic approaches.
The data come from a presentation at the recent American Urological Association 2016 annual meeting (May 6-10,2016; San Diego, CA), where Nawar Hanna, MD, Brigham and Women’s Hospital (Boston, MA), delivered the results of an analysis he and his colleagues conducted to review how health care practice has changed for mRCC before and after the start of the targeted treatment era.
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To do so, Dr Hanna and his team gathered practice data from 1998 to 2012 using the National Cancer Database. Of the 52,271 patients with mRCC identified, 24,549 patients (47%) did not receive any treatment. Among those who were treated, 14,137 patients (27.1%) received systemic therapy (ie immunotherapy or chemotherapy with single or multiple agents); 6787 patients (13%) received cytoreductive nephrectomy (CN) alone; and 6798 patients (13%) were treated with a combination of CN and systemic therapy.
From 1998 to 2005, the period before the start of the targeted therapy era, the number of patients undergoing CN doubled from 8% to 16%, and then leveled off during the targeted therapy era (2006-2012). However, the use of combination therapy continued to rise throughout the entire study period, growing from 5% in 1998 to 11% in 2005 to 18% in 2012. The use of systemic therapy fell sharply from 1998 to 2005 (30% vs 21%), but rebounded back to 33% in 2012.
Using multivariable logistic regression, researchers found that patients with papillary and chromophobe histology, higher Fuhram grade, T2 or T3 primary stage, and diagnosis within the targeted therapy era were more likely to be treated with CN. African Americans, older patients, those with more comorbidities, and patients treated at non-academic centers or without insurance were less likely to undergo CN.
Concluding the session, Dr Hanna noted that there is a clinical trial underway assessing the role of CN with targeted therapies. Whether CN should remain an integral part of treatment for patients with mRCC following the immunotherapy era will be contingent upon the results of this this trial and other research endeavors.
