ABSTRACT
Objectives: Scant research exists on evolving real world treatment patterns given new immuno-oncology (IO) combination regimens added to the National Comprehensive Cancer Network (NCCN) guidelines for advanced renal cell carcinoma (aRCC). This study describes real-world (RW) treatment patterns in a large US claims database toward understanding new standards of care in aRCC treatment. Methods: Using Optum Clinformatics Claims data, patients ≥18 with ≥ 2 RCC diagnoses 30-days apart, who subsequently start first-line (1L) aRCC treatment (study index date) during April 2018 to March 2019 were all followed-for 9 months. Patients had ≥2 secondary malignancy codes in the 12 months prior/30 days post-index date and 9-months of continuous enrollment pre- and post-index. Results: Study identified 415 1L aRCC patients. The most common 1L regimen was monotherapy tyrosine kinase inhibitors (mono TKIs) representing 43.13% (N=179). Combination IO (combo IO), monotherapy IO (mono IO), IO + TKI, and Other, represented 28.43% (N=118), 25.30% (N=105), 0.96% (N=4) and 3.13% (N=13) respectively. Combo IO patients were younger, mean age 66.58, compared to mono TKI and mono IO patients, mean age 70.15 (p=0.003) and 72.72 (p<0.001), respectively. Mean days of continuous therapy for mono TKI patients was 152.17, compared to combo IO 171.64 (p=0.034) and mono IO 173.22 (p=0.028). Mono TKI users went on to second-line treatment more often, 41% vs combo IO 12.38% (p=0.0005) and vs mono IO 33.05% (p=0.158). Conclusions: RW claims data provide insight into how physicians and patients adapt to new treatment guidelines. The prevalence of 1L IO monotherapy was an interesting finding given it is not indicated for first line treatment. Ongoing monitoring of real-world treatment patterns of new and evolving regimens, as well as oral versus injectable preferences, will be especially important in the face of the COVID-19 pandemic as we track the impact of health services interruptions.