Patients with metastatic renal cell carcinoma (RCC) who are older than 80 years at diagnosis were less likely to be treated with oral anticancer agents than younger patients with the disease, according to results of a retrospective study presented at the 2020 American Society of Clinical Oncology (ASCO) Quality Care Symposium, a virtual conference.1

Oral small molecule receptor tyrosine kinase inhibitors (TKIs), such as sunitinib, pazopanib, and axitinib, as well as the mTOR inhibitor, everolimus, have become standard-of-care approaches for the treatment of patients with metastatic RCC.  

The incorporation of TKIs into the first-line treatment regimens of patients with metastatic RCC has been associated with longer survival times compared with more traditional approaches, such as interferon-alfa therapy.2 However, there is evidence suggesting that outcomes are worse for Black patients compared with White patients.3


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A primary aim of this study was to investigate patient-related factors that influence use of emerging oral targeted therapy in patients aged 65 years or older with metastatic RCC enrolled in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. A second study objective was to evaluate the costs, to Medicare and to the patient, related to the use of oral targeted therapy in this setting.

This study included only those patients (2792) with prescription drug coverage. It focused on the use of oral anticancer agents within 12 months of diagnosis and was limited to the period between 2007 and 2015.

By 2015, 37% of study participants were undergoing treatment with an oral anticancer agent, most frequently sunitinib or pazopanib.

A key finding on multivariable analysis was that patient-specific factors independently associated with reduced likelihood of receiving an oral targeted therapy were age older than 80 years at diagnosis (relative risk [RR], 0.50; 95% CI, 0.42-60 compared with those aged 65 to 70 years), being unmarried (RR, 0.85; 95% CI, 0.73-0.96 compared with married), and residing in the southern area of the United States (RR, 0.83; 95% CI, 0.70-0.98 compared with Western part of the country).

Neither race/ethnicity nor socioeconomic status as determined by zip code were significantly associated with the use of oral targeted therapy in this setting.

Regarding these findings, the study authors noted that “future research is warranted to investigate if such differences in [oral anticancer agent] use lead to differences in survival.”

An assessment of health care expenditures for this patient population showed that those receiving oral anticancer therapy had total, cancer-related, and inpatient admission costs that were higher by 36%, 47%, and 8%, respectively, compared with those not receiving this type of treatment.

Although inflation-adjusted, Medicare-related costs for a 1-month supply of the first prescription of oral anticancer therapy increased from a mean of $3864 in 2007 to a mean of $7482 in 2015, mean, inflation-adjusted, patient-related out-of-pocket costs decreased from $2409 in 2007 to $1477 in 2015.

With respect to the latter finding, the study authors commented that “patients are not bearing the burden of rising costs for these agents; however, out-of-pocket costs are still high, with more than half of patients paying [more than] $1000 out-of-pocket for a 30-day supply.”

Disclosures: Multiple authors declared affiliation with industry. Please refer to the original abstract for a full list of disclosures.

References

1. Wilson LE, Spees L, Pritchard J, et al. Disparities in utilization of oral anticancer agents and related costs in elderly patients with metastatic renal cell carcinoma in the United States. J Clin Oncol. 2020;38:(suppl 29):Abstr 106.

2. Motzer RJ, Hutson TE, Tomczak P, et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. 2009;27(22):3584-3590. doi:10.1200/JCO.2008.20.1293.

3. Bosse D, Xie W, Lin X, et al. Outcomes in black and white patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors: Insights from two large cohorts.JCO Global Oncol. 2020;6:293-306. doi: 10.1200/JGO.19.00380