Abstract 680P
Background
Second-line (2L) treatment options for advanced renal cell carcinoma (aRCC) include the tyrosine kinase inhibitors (TKI) cabozantinib and axitinib. We characterized real-world (RW) use of cabozantinib (most recently approved TKI) and axitinib (most commonly used 2L TKI) for aRCC in England.
Methods
This was a retrospective cohort study using the Cancer Analysis System (CAS). Patients were ≥ 18 yrs, had renal cell carcinoma (RCC; ICD-10 code C64 or C65), initiated ≥ 2L cabozantinib or axitinib following prior VEGF therapy, had aRCC at diagnosis, or initiated aRCC therapy during the study (Jan 1, 2011–Jan 31, 2020). We described treatment patterns and sequences in patients who received ≥ 2L cabozantinib (prior axitinib excluded) or axitinib (prior cabozantinib excluded). Duration of therapy (DoT) and overall survival (OS) were also assessed. Inverse probability weighting (IPW) was used to reduce between-cohort differences and compare OS.
Results
At study initiation, 77 305 patients in CAS had an RCC diagnosis; 440 were eligible for the cabozantinib cohort, 1045 for the axitinib cohort (median age, 62.5 vs 63.0 yrs; 76.4% vs 70.2% male; 58.6% vs 53.2% aRCC at diagnosis; 18.2% vs 20.4% ECOG PS 0–1). In the cabozantinib cohort, the most common treatment sequences were 1L sunitinib (n = 186) or pazopanib (n = 178) → 2L cabozantinib (n = 377) → 3L nivolumab (n = 68); 7 patients received 3L axitinib. For the axitinib cohort they were 1L pazopanib (n = 500) or sunitinib (n = 422) → 2L axitinib (n = 919) → 3L nivolumab (n = 171) or cabozantinib (n = 49). In the cabozantinib cohort, 27.7% of patients received ≥ 3L therapy vs 34.4% in the axitinib cohort. DoT, OS and the IPW OS comparison are shown in the table. Table: 680P
| Median (IQR), months | Unweighted analysis | IPW analysisa | |||
| ≥ 2L cabozantinib (n = 404) | ≥ 2L axitinib (n = 1045) | ≥ 2L cabozantinib (n = 816) | ≥ 2L axitinib (n = 1483) | p value | |
| DoT | 5.52 (2.73–11.74) | 4.60 (1.45–12.36) | – | – | – |
| OS | 11.41 (5.65–27.32) | 9.60 (4.54–20.32) | 11.24 (5.65–27.98) | 10.39 (4.70–22.03) | 0.0034 |
aPropensity score matching (IPW) was used to reduce baseline differences between the cohorts.IPW, inverse probability weighting; DoT, duration of therapy; OS, overall survival.
Conclusions
This study demonstrates the potential of CAS to generate RW data to complement (and compare vs) randomized controlled trials. There was a signal for prolonged RW OS with 2L cabozantinib (vs axitinib) in patients with aRCC in England who had received prior VEGF therapy.
Clinical trial identification
Study number: CLIN-60000-450 | IPN60000.
Editorial acknowledgement
Alison Chisholm of Oxford PharmaGenesis, Oxford, UK, provided medical writing and editorial support, which was sponsored by Ipsen.
Legal entity responsible for the study
Ipsen.
Funding
Ipsen.
Disclosure
J.E. Brown: Financial Interests, Institutional, Research Grant: Amgen; Financial Interests, Personal, Advisory Board: Amgen; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Advisory Board: BMS; Financial Interests, Personal, Advisory Board: Daiicho-Sankyo; Financial Interests, Personal, Advisory Board: Ipsen; Financial Interests, Personal, Advisory Board: Sandoz; Financial Interests, Personal, Advisory Board: MSD. B. Harrow: Financial Interests, Personal, Full or part-time Employment, At the time of the study: Ipsen. A. Marciniak: Financial Interests, Institutional, Project Lead, Consulting: Ipsen; Financial Interests, Institutional, Project Lead, Consulting: Theramex; Financial Interests, Personal, Stocks/Shares: Pfizer; Financial Interests, Personal, Stocks/Shares: Amgen; Financial Interests, Personal, Stocks/Shares: Allergan. C. McCarthy: Financial Interests, Personal, Stocks/Shares: Sanofi; Financial Interests, Personal, Project Lead, Consulting: Ipsen; Financial Interests, Personal, Project Lead, Consulting: Inversago. A. Protheroe: Financial Interests, Personal, Advisory Board: Astellas; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: Ipsen; Financial Interests, Personal, Advisory Board: Merck; Financial Interests, Personal, Invited Speaker: Eisai; Financial Interests, Personal, Advisory Board: MSD; Financial Interests, Personal, Advisory Board: BMS. All other authors have declared no conflicts of interest.