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

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).

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

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.

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).

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.