Key Take Home Messages
- •Over the past few years, multiple new options have emerged for the treatment of patients with intermediate/poor-risk metastatic metastatic renal cell carcinoma (RCC), specifically ipilimumab/nivolumab (IO/IO) and multiple immunotherapy/tyrosine kinase inhibitor (IO/TKI) combinations (e.g. pembrolizumab/axitinib, nivolumab/cabozantinib). There have been no validated biomarkers, or a phase III trial, to guide selection between IO/IO vs. IO/TKI.
- •We performed an electronic survey-based study to evaluate whether oncologists prefer IO/IO vs. IO/TKI for patients with intermediate/poor-risk metastatic RCC and what factors go into their decision-making.
- •We sent 294 surveys and received 105 responses (36% response rate). 61% of providers chose IO/IO, 39% chose IO/TKI. 78% of oncologists were academic or disease-focused, 22% were general. Academic/GU-focused oncologists were significantly more likely to choose IO/IO (56/82, 68%) compared to general oncologists (8/23, 35%), P = .004.
- •The majority of oncologists noted toxicity to play a role in their decision-making. Despite the significant treatment preference among academic/GU oncologists, the majority of respondents felt comfortable enrolling patients into a phase III trial comparing IO/IO vs. IO/TKI, demonstrating continued equipoise surrounding this question in the community.
Abstract
Introduction
Dual immunotherapy (ipilimumab/nivolumab, IO/IO) and immunotherapy/tyrosine kinase
inhibitor (IO/TKI) combinations (e.g. pembrolizumab/axitinib) are approved for the
first-line treatment of intermediate/poor risk metastatic renal cell carcinoma (RCC),
but there is limited comparative data between these two options. We sought to understand
how oncologists decide between IO/IO vs. IO/TKI.
Methods
We sent a 10-question electronic survey centered on a patient scenario of intermediate/poor
risk metastatic RCC to 294 academic/disease-focused and general oncologists in the
US.
Results
We received 105 responses (36% response rate): 61% (64) of providers chose IO/IO,
39% (41) chose IO/TKI. 78% (82) of oncologists were academic or disease-focused, 22%
(23) were general. Academic/disease-focused oncologists were significantly more likely
to choose IO/IO (56/82, 68%) than general oncologists (8/23, 35%), P = .004.
Among those who chose IO/IO, the perceived main issue with IO/TKI was: long-term toxicities
- 31% (20), short-term toxicities - 28% (18), less effective - 28% (18), less convenient
- 8% (5). Among those who chose IO/TKI, the perceived main issue with IO/IO was: short-term
toxicities - 43% (17), less effective - 28% (11), long-term toxicities - 15% (6),
and risk of death - 10% (4).
88% (92) of providers would be comfortable enrolling patients into a phase III trial
comparing IO/IO vs. IO/TKI. We found no associations between therapy chosen by a provider
and participation as PI in a trial of IO/IO or IO/TKI, or receipt of outside funding
from an IO/IO or IO/TKI company.
Conclusion
In response to a patient scenario of intermediate/poor risk metastatic RCC, 61% of
providers chose IO/IO, 39% chose IO/TKI. There was a significant association between
type of practice and choice of therapy, with academic/disease-focused oncologists
more likely to choose IO/IO. The majority of oncologists would be comfortable enrolling
patients into a phase III trial comparing IO/IO vs. IO/TKI.
Keywords
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References
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Study of cabozantinib in combination with nivolumab and ipilimumab in patients with previously untreated advanced or metastatic renal cell carcinoma (COSMIC-313). Available at: https://clinicaltrials.gov/ct2/show/NCT03937219. Accessed March 22, 2022.
Immunotherapy with nivolumab and ipilimumab followed by nivolumab or nivolumab with cabozantinib for patients with advanced kidney cancer, the PDIGREE study. Available at: https://clinicaltrials.gov/ct2/show/NCT03793166. Accessed March 22, 2022.
Article info
Publication history
Published online: June 11, 2022
Accepted:
June 7,
2022
Received:
May 11,
2022
Footnotes
Study has been presented at: International Kidney Cancer Symposium (IKCS), Austin, TX, 11/2021
Society for Immunotherapy for Cancer (SITC), Washington, DC, 11/2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
