Practice type influences oncologists’ therapy choice for metastatic renal cell carcinoma
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Practice type may significantly influence providers’ choice of first-line therapy for metastatic renal cell carcinoma, according to study results presented at International Kidney Cancer Symposium.
When given a representative patient scenario of intermediate/poor-risk metastatic disease, oncologists who practiced in academic settings and disease-focused oncologists appeared more likely than general oncologists to choose dual immunotherapy instead of an immunotherapy-tyrosine kinase inhibitor combination, results showed.
Dual immunotherapy with the anti-CTLA-4 antibody ipilimumab (Yervoy, Bristol Myers Squibb) and the anti-PD-1 antibody nivolumab (Opdivo, Bristol Myers Squibb) is approved for first-line treatment of intermediate- or poor-risk metastatic renal cell carcinoma.
Multiple immunotherapy-TKI options — including the anti-PD-1 therapy pembrolizumab (Keytruda, Merck) and axitinib (Inlyta, Pfizer), a VEGF-targeted TKI — are approved for the same patient population.
Priyanka Chablani, MD, of the division of hematology-oncology at University of Chicago Medical Center, and colleagues aimed to assess what percentage of oncologists chose dual immunotherapy vs. an immunotherapy-TKI combination. They also evaluated what factors drove their decision-making and whether provider characteristics correlated with their choice of therapy.
Researchers created a 10-question electronic survey that focused on a scenario involving a man aged 60 years with hematuria. CT scan revealed an 8-cm mass in his left kidney, with multiple enlarged retroperitoneal lymph nodes and bilateral pulmonary nodules. Kidney biopsy showed clear cell renal cell carcinoma. Brain MRI revealed no brain metastases.
The patient had a Karnofsky performance status of 70% and normal laboratory results except for a calcium level of 10.8 mg/dL.
The survey asked oncologists whether they would choose dual immunotherapy or an immunotherapy-TKI regimen as initial treatment.
Chablani and colleagues sent the survey to 294 oncologists in the United States, 105 (36%) of whom responded. About three-quarters (78%) of respondents were academic or disease focused and 22% were general oncologists.
Sixty-four respondents (61%) indicated they would choose dual immunotherapy and 41 (39%) indicated they would choose the immunotherapy-TKI regimen.
Academic/disease-focused oncologists favored the dual immunotherapy regimen (68% vs. 32%), whereas a higher percentage of general oncologists chose the immunotherapy-TKI regimen (65% vs. 35%; P = .004).
The oncologists who chose dual immunotherapy indicated they did so due to the following perceived issues with the immunotherapy-TKI combination: long-term toxicities (31%), short-term toxicities (28%), reduced effectiveness (28%) and reduced convenience (8%).
The oncologists who chose the immunotherapy-TKI combination indicated they did so due to the following perceived issues with dual immunotherapy: short-term toxicities (43%), reduced effectiveness (28%), long-term toxicities (15%) and risk for death (10%).
The majority (88%) of respondents indicated they would be comfortable enrolling their patients on a phase 3 trial designed to compare dual immunotherapy with the immunotherapy-TKI regimen.
“Despite provider differences, there is still equipoise around the issue,” Chablani and colleagues wrote. “We plan to perform a larger study to better understand preferences of general oncologists.”
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Chablani PV, et al. Abstract N31. Presented at: International Kidney Cancer Symposium; Nov. 5-6, 2021; Austin, Texas.
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