CN2 TREATMENT PATTERNS, SURVIVAL, AND HEALTHCARE RESOURCE USE FOR LOCALLY ADVANCED OR METASTATIC RENAL CELL CARCINOMA IN ENGLAND: RESULTS OF A LONGITUDINAL OBSERVATIONAL COHORT STUDY

Recent approval of immune checkpoint inhibitor (ICI) and tyrosine kinase inhibitor (TKI) combination therapies has altered the first-line (1L) standard of care for patients with advanced renal cell carcinoma (aRCC). The objective of this study was to evaluate treatment patterns, outcomes, and healthcare resource use (HRU) among patients with newly diagnosed aRCC in England. This cohort study included patients aged ≥18 years diagnosed with primary stage III or IV aRCC between January 2013 and June 2017 in the National Cancer Registration and Analysis Service, a population-level cancer registry in England, with follow-up until March 2018. A total of 14,629 patients with aRCC (mean age 68.3 years [SD: 12.3], 65.6% male, and 83.4% with clear cell tumor histology) were included. The baseline mean modified Deyo-Charlson Comorbidity Index score was 2.8 (SD: 1.7). There were 8,130 deaths (55.6%) during follow-up, resulting in a median survival of 21.6 months from diagnosis and 24-month survival of 48.4% (95% CI: 47.5%-49.2%). During follow-up, 51.5% underwent ≥1 surgical resection, and 13.7% received radiation therapy. Overall, 3,549 patients (24.3%) received systemic therapy: 13.0% of patients with stage III disease and 30.0% with stage IV. Among patients receiving 1L therapy, 1,379 (38.9%) also received 2L, 491 (13.8%) 3L, and 173 (4.9%) ≥4L. Targeted therapies were the most frequently (>80%) administered agents across all lines; ICIs were the second most common agents, ranging from 1.7% for 1L to 31.8% for ≥4L (overall: 8.6%). Mean (SD) HRU per patient per year was as follows: outpatient visits, 19.8 (28.1); hospital admissions, 4.8 (10.1); emergency department visits, 2.0 (4.4). This observational study describes clinical management and outcomes for patients with aRCC in England before the introduction of ICI/TKI combinations in the 1L setting. Systemic therapy use was limited, highlighting the need for additional treatment options in this elderly population with significant comorbidities.