Real-World Patterns and Predictors of Oral Anticancer Agent Use Among Patients With Metastatic RCC

Findings from a recent study on patterns and predictors of oral anticancer agent use in patients with metastatic renal cell carcinoma (mRCC) found that adherence was low, especially in those with multiple comorbidities and high frailty (JCO Oncol Pract. 2021; OP2001082. doi:10.1200/OP.20.01082).

“Availability of targeted oral anticancer agents has transformed care for patients with mRCC,” wrote Stephanie Wheeler, PhD, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC and colleagues, adding, “Our objective was to identify patterns and predictors of oral anticancer agent use within 12 months after mRCC was detected to understand real-world adoption of oral anticancer agents.”

Dr Wheeler and colleagues examined patterns of use in 5 oral therapies among 713 patients with mRCC who were selected from a novel, North Carolina cancer registry-linked multiplayer claims data resource. Patients selected for this study were diagnosed with mRCC between 2006 and 2015, with claims through 2016, who had 12 months of continuous enrollment before metastatic index date.

Unadjusted and adjusted risk ratios for associations between patient characteristics and oral anti-cancer agent use were calculated through Log-Poisson models.  A sensitivity analyses estimated risk differences in oral anti-cancer agent use.

Results revealed low (37%) oral anticancer agent use during the first year after metastatic index date. Both publicly and privately insured patients had demonstrated low use, as well as shifting patterns of use consistent with regulatory approvals over time.

Patients between the ages of 70 and 74 years were half as likely (0.34 to 0.78) as those between 18 and 49 years to use oral anticancer agents, while patients age 80 years and older were 71% less likely (0.17 to 0.50).  

Risk ratios were 0.73 in patients with two comorbidities. Patients with 3 or more comorbidities had a risk ratio of 0.68. Patients with comorbidities were less likely to receive oral anticancer agents than those with no comorbidities. Higher frailty was associated with lower oral anticancer agent use, with a risk ratio of 0.67.

“These findings suggest a need to better understand the system-level and provider-level drivers of oral anticancer underuse, as well as oral anticancer agent adherence and associated survival,” concluded Dr Wheeler and colleagues.—Marta Rybczynski