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Lee D, Burns D, Wilson E. NICE's Pathways Pilot: Pursuing Good Decision Making in Difficult Circumstances. PHARMACOECONOMICS - OPEN 2024; 8:645-649. [PMID: 38613596 DOI: 10.1007/s41669-024-00490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Dawn Lee
- PenTAG, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Darren Burns
- PenTAG, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
- Delta Hat, Long Eaton, UK
| | - Ed Wilson
- PenTAG, University of Exeter Medical School, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
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Brown J, Harrow B, Marciniak A, McCarthy C, Houchard A, Cirneanu L, Protheroe A. Cabozantinib and Axitinib After Vascular Endothelial Growth Factor Therapy in Patients with Advanced Renal Cell Carcinoma: A Retrospective Cohort Study from England. Drugs Real World Outcomes 2024; 11:195-207. [PMID: 38265633 PMCID: PMC11176148 DOI: 10.1007/s40801-023-00415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The tyrosine kinase inhibitors cabozantinib and axitinib have been widely used in England to treat advanced renal cell carcinoma following prior vascular endothelial growth factor-targeted therapy, but data on real-world usage remain limited. Our objective was to describe the real-world treatment patterns and outcomes of patients with advanced renal cell carcinoma who received second-line or later-line (≥ 2L) cabozantinib or axitinib after vascular endothelial growth factor-targeted therapy in clinical practice in England. METHODS This retrospective cohort study used clinical practice data (collected 2011-20) from the English Cancer Analysis System database. Patient characteristics, treatment sequence and duration, and overall survival (time from initiation of cabozantinib/axitinib treatment to death) were evaluated. RESULTS Data from 1485 eligible adults with advanced renal cell carcinoma were analyzed: 440 received ≥ 2L cabozantinib (2L for 88.6% of them); 1045 received ≥ 2L axitinib (2L for 89.5%). The most common first-line treatments were sunitinib (2L cabozantinib subcohort, 48%; 2L axitinib subcohort, 46%) and pazopanib (46% and 54%, respectively); nivolumab was the most common third-line treatment (18% and 19%, respectively). Median (interquartile range) 2L therapy duration was 5.52 (2.73-11.74) months for cabozantinib and 4.60 (1.45-12.36) months for axitinib. Following adjustment for potential confounders using inverse probability weighting, overall survival (median [interquartile range]) was longer for ≥ 2L cabozantinib (11.2 [5.7-28.0] months) than for ≥ 2L axitinib (10.4 [4.7-22.0] months; log-rank p = 0.0034). CONCLUSIONS The Cancer Analysis System database is a valuable research resource providing extensive real-world clinical data. Real-world overall survival was longer with ≥ 2L cabozantinib than with axitinib. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04637204; registered November 2020.
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Affiliation(s)
- Janet Brown
- Division of Clinical Medicine, University of Sheffield, Western Bank, Sheffield, S10 2TN, UK.
| | | | | | | | | | | | - Andrew Protheroe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Zhuang TZ, Case K, Olsen TA, Brown JT, Carthon BC, Kucuk O, Goldman J, Harris W, Bilen MA, Nazha B. Metastatic Clear-Cell Renal Cell Carcinoma in the Era of Immune Checkpoint Inhibitors: Therapies and Ongoing Trials. Cancers (Basel) 2022; 14:2867. [PMID: 35740533 PMCID: PMC9220801 DOI: 10.3390/cancers14122867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) are now the bedrock for the treatment of metastatic renal cell carcinoma (RCC). Clear cell RCC (ccRCC) represents the most common subtype of this malignancy. Herein, we explore the therapeutic landscape of ccRCC by discussing the standard of care whose backbone consists of immune checkpoint inhibitors (ICI) and vascular endothelial growth factor inhibitors (VEGF). For ccRCC, pembrolizumab-axitinib, pembrolizumab-lenvatinib, and avelumab-axitinib or nivolumab-cabozantinib are now FDA-approved frontline options for all risk groups while nivolumab-ipilimumab is reserved for intermediate- and poor-risk groups. Monotherapy with pembrolizumab or nivolumab is a potential option for patients who are unable to take VEGFR-tyrosine kinase inhibitors. While outcomes have improved with the adoption of ICI therapies, many patients develop therapy-resistant disease, creating an unmet need for further investigation. The efficacy of novel therapies as well as novel combinations in the post-ICI era is unclear. This review summarizes the most significant clinical trials involving dual ICI/ICI and ICI/VEGFR therapies, in addition to other selected combination therapies that are likely to inform management in the near future.
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Affiliation(s)
- Tony Zibo Zhuang
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (T.Z.Z.); (K.C.); (T.A.O.)
| | - Katherine Case
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (T.Z.Z.); (K.C.); (T.A.O.)
| | - Timothy Anders Olsen
- School of Medicine, Emory University, Atlanta, GA 30322, USA; (T.Z.Z.); (K.C.); (T.A.O.)
| | - Jacqueline T. Brown
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA; (J.T.B.); (B.C.C.); (O.K.); (J.G.); (W.H.); (M.A.B.)
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bradley C. Carthon
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA; (J.T.B.); (B.C.C.); (O.K.); (J.G.); (W.H.); (M.A.B.)
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Omer Kucuk
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA; (J.T.B.); (B.C.C.); (O.K.); (J.G.); (W.H.); (M.A.B.)
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jamie Goldman
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA; (J.T.B.); (B.C.C.); (O.K.); (J.G.); (W.H.); (M.A.B.)
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Wayne Harris
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA; (J.T.B.); (B.C.C.); (O.K.); (J.G.); (W.H.); (M.A.B.)
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA; (J.T.B.); (B.C.C.); (O.K.); (J.G.); (W.H.); (M.A.B.)
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Bassel Nazha
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA; (J.T.B.); (B.C.C.); (O.K.); (J.G.); (W.H.); (M.A.B.)
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
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