Characteristics, Treatment Patterns, and Survival of Patients With Locally Advanced or Metastatic Renal Cell Carcinoma in England: Results of a Nationwide Cohort Study

BACKGROUND: Combination therapies have revolutionized the first-line (1L) treatment of advanced clear cell renal cell carcinoma (RCC), with the approval of immuno-oncology (IO) and tyrosine kinase inhibitors (TKI).

OBJECTIVES: To describe characteristics, treatment patterns, and survival outcomes among patients with newly diagnosed aRCC in England.

METHODS: The cohort was identified using routine administrative data from the National Cancer Registration and Analysis Service. Patient-level linkage was used to extract national data on disease (National Cancer Registration Dataset); inpatient, outpatient, and diagnoses (Hospital Episode Statistics); anticancer radiotherapy (National Radiotherapy Dataset); and systemic anticancer treatments (Systemic Anti-Cancer Therapy Dataset). Adult patients were included following an incident primary diagnosis (index date) of stage III/IV RCC between January 2013 and December 2020. Follow-up period was index date to first of: death, loss to follow-up, or end of study (May 2022). Overall survival (OS) was estimated by Kaplan-Meier.

RESULTS: Among 25,918 patients, mean age was 68.1 years (SD, 12.3); 66% were male; and 84.1% had tumours with clear-cell histology. Mean modified Deyo-Charlson comorbidity index at baseline was 2.8 (SD, 1.7). During follow-up, 50.9% underwent ≥1 surgical resection, and 22.6% received radiation therapy. Only 8,443 patients (36.2%) received 1L treatment; of these, 4160 (49.3%) received 2L, 1,873 (21.8%) received 3L, and 743 (8.8%) received ≥4L. Among patients receiving systemic treatment, 82.4% had targeted treatments and 17.0% had IO in 1L. Median OS from diagnosis was 26.5 months (95% CI, 25.5-27.5), with 24-month survival 51.5% (95% CI, 50.8-52.1). Median OS from 1L initiation was 15.7 months (95% CI, 15.1-16.4), with 24-month survival 39.0% (95% CI, 38.0-40.0).

CONCLUSIONS: Characteristics of patients with RCC in this nationwide cohort study were consistent with other real-world studies. Systemic therapy use was limited, and OS outcomes were poor, highlighting the need for further research to understand the real-world impact of newer combination therapies.