Dr Jeff Yorio, Texas Oncology, Austin, TX, discusses the findings from his study that examined the health care costs associated with adverse events in patients with metastatic renal cell carcinoma who have been treated with a VEGFR TKI.

Transcript: 

Dr Yorio:

I'm Dr Jeff Yorio and I'm with Texas Oncology in Central Austin.

Can you give some background about your study and what prompted you to undertake it?

Dr Yorio:

So we often think about the expensive cost of oncology drugs because they certainly are something that we're constantly having to deal with for our patients, especially patients with more advanced disease that need these type of medicines. And one thing we don't think a lot of is maybe some of the costs that those drugs eventually can also cause based on side effects. And also as we think about just the side effect burden that patients have, sometimes looking at maybe how expensive and how costly those medicines and their side effects might be might make us think about how we choose different medicines. In metastatic renal cell carcinoma, we've been fortunate to be inundated with a lot of different options and new medicines, which is a good thing and something we didn't necessarily have 10, 15 years ago. But these are maybe some different ways for us to think about how to choose our medicines.

Can you briefly describe how the study was conducted?

Dr Yorio:

We took an approach where we looked at our EMR data, which is across a system called iKnowMed, which looks at lots and lots of different clinics across the United States. And we looked for patients with advanced renal cell carcinoma that had been treated with VEGFR TKI therapies. And so then once we found patients that were treated with these type of therapies, we looked for ICD 10 codes in which they'd correlate with certain adverse events that we commonly know are associated with these therapies. And then we also looked at third party insurance claims kind of within 90 days of that adverse event to be able to try to figure out cost and how much these medicines and their side effects might have cost

What were the key findings regarding the management costs of VEGFR TKI-related adverse events in mRCC patients, and how did the different TKI regimens compare in terms of health care resource burden?

Dr Yorio:

I think some of the key takeaways are we're looking at kind of the main AEs we see with these drugs, hypertension, fatigue, renal failure, nausea, diarrhea, and trying to one, come up with how prevalent are these? And some of that data we know from just the different clinical trials that have been there, but of course we get some real world data in this type of study. And then how expensive or costly are those side effects to have? And so we looked at things like, let's say diarrhea, more expensive adverse events to get, and probably because there's a bigger cost associated with that, whether that be having to need more patient visits, IV fluids, other medicines we have to use for that. Getting hypertension was another significant cost probably because you have to get put on other medicines that also cost money. So those are the different things we found and looked at.

And sort of interesting what we found is of course the different TKIs and different lines of therapies had different problems associated with them that were more common. And we looked at Tivozanib, we looked at cabozantinib, we looked at axitinib, we looked at lenvatinib and everolimus and then sunitinib. And again, these are drugs that are getting used kind of in the third line, fourth line type of treatments. And what we saw was... So some drugs had more expensive adverse events associated with them. So diarrhea again is one of those that had a much higher cost adverse event. And the combination of lenvatinib and everolimus, that was more prevalent. So that likely drove up some of its cost. Some of the big skin reactions we see with sunitinib as well as the diarrhea and mucositis were higher and associated with sunitinib, and that drove up those costs. Tivozanib was higher with hypertension, but overall tended to be a less expensive regimen as far as the AE cost burden. So those were some of our findings overall.

Did anything about the findings surprise you?

Dr Yorio:

I think it's just interesting to see how much different adverse events might actually be and how costly they are. So I mean, I think we often see diarrhea as a big problem with these drugs, really thinking, oh gosh, this actually costs patients a lot of money in the end, just the money burden that racks up just having that adverse event. So that was kind of surprising as well as maybe some of the others we saw. And then in looking at drugs, maybe not too surprising. We all know sunitinib was probably a more toxic TKI than some of the others, but certainly that bore with just having a higher cost burden associated with its adverse events.

Looking ahead, what potential impact do you hope your findings will have on the cost-effectiveness of adverse event management in patients with mRCC?

Dr Yorio:

I think it's just another way to, when you're choosing between these different TKIs, it's another piece of information to think about. And so really thinking about drugs that are not only maybe have a little less side effects or maybe if those side effects end up being more costly to patients, ultimately that may translate into better quality of life for them. They're not having to be in clinic as much or going to the hospital as much because they're not having these more severe AEs. So I think the regiments like tivozanib by itself, axitinib by itself was a little less as well, maybe are more tolerable than what we saw with things like that combination of lenvatinib and everolimus.

So those are always things that I think people can take into account as they start to choose between these different medicines and what might be most appropriate. And I also think it's an interesting way to look at other similar issues in oncology. I think, again, we think so much about the cost of medicines themselves, but we don't think about the downstream cost that are associated with those medicines and all the other side effects that go with it. And I think in some ways you can use that to think about maybe how their quality of life of those patients are doing as well.

Is there anything else you would like to add/any final thoughts?

Dr Yorio:

I think it's a good food for thought on how we think about choosing these different regimens and hopefully we'll continue to see other studies kind of along these lines just because it's always interesting to see real world data and also how healthcare dollars are affected in these patients.