OBJECTIVES: To assess real-world treatment patterns and HRU among US mRCC patients from the HealthCore Integrated Research Database.

METHODS: In this retrospective study, adult patients with mRCC initiating first-line (1L) therapy between 31DEC2014-31MAR2019 were selected and stratified based on 1L regimen: tyrosine kinase inhibitors (TKI), immuno-oncology (IO), mammalian target of rapamycin (mTOR), or Other therapies. Treatment patterns were assessed descriptively. Time-to-end of 1L (discontinuation/switch) and incidence rates (IRs) of HRU (inpatient and hospice/long-term stays, outpatient, emergency department, and other ambulatory encounter visits) per-patient-per-month (PPPM) during 1L therapy were compared. Given the small sample size for mTOR and other therapies cohorts, outcome comparisons focused on TKI and IO cohorts.

RESULTS: Of the 997 patients identified (mean age: 61 years; male: 73%), 69.3%, 22.3%, 3.8%, and, 4.6% were treated with 1L TKI, IO, mTOR, and Other therapies, respectively. A sharp increase in 1L use of IO-based regimens was observed from 2017 (16.2%) to 2018 (39.4%) and 2019 (53.6%). Number of metastatic sites (1.71 vs. 1.46; p<0.05) and proportion of patients with lymph nodes metastases (39.2% vs. 29.4%; p<0.05) were higher among IO versus TKI patients. Median 1L duration was similar between TKI vs. IO (6.9 vs. 8.3 months, p=0.10). Outpatient visits not related to treatment administration (IRs PPPM: 2.57 vs. 2.99; p<0.05) and other ambulatory visits (IRs PPPM: 0.60 vs. 0.78; p<0.05) during 1L were lower in the IO compared to the TKI cohort. The incidence of other HRU was similar.

CONCLUSIONS: Among mRCC patients, a sharp increase in 1L use of IO-based regimens was observed starting in 2018, with TKI and IO representing an even split in Q1 2019. Although duration of 1L was similar in IO and TKI cohorts, patients in IO cohort had lower utilization of select HRU. Future research should evaluate the real-world impact of IO+TKI in 1L.