Chabrani Photovoltaic and so on. Abstract N31. Published in: International Kidney Cancer Symposium; November 5-6, 2021; Austin, Texas.
Chabrani Photovoltaic and so on. Abstract N31. Published in: International Kidney Cancer Symposium; November 5-6, 2021; Austin, Texas.
According to the research results published at the International Kidney Cancer Symposium, the type of practice may significantly influence the provider's choice of first-line treatment for metastatic renal cell carcinoma.
The results show that when representative patients with medium/low risk metastatic disease are given, oncologists practicing in an academic environment and disease-focused oncologists seem to be more likely to choose dual immunotherapy than general oncologists. Not an immunotherapy-tyrosine kinase inhibitor combination.
Dual immunotherapy using anti-CTLA-4 antibody ipilimumab (Yervoy, Bristol Myers Squibb) and anti-PD-1 antibody nivolumab (Opdivo, Bristol Myers Squibb) is approved for the first-line treatment of intermediate- or low-risk metastatic renal cell carcinoma .
Multiple immunotherapy-TKI options-including anti-PD-1 therapies pembrolizumab (Keytruda, Merck) and axitinib (Inlyta, Pfizer), a VEGF-targeted TKI-are approved for use in the same patient population.
Priyanka Chablani, MD, of the Department of Hematology and Oncology at the University of Chicago Medical Center, and colleagues aimed to assess the percentage of oncologists choosing a combination of dual immunotherapy and immunotherapy-TKI. They also assessed which factors motivated their decision-making, and whether the characteristics of the provider were relevant to their treatment choices.
The researchers created an electronic survey of 10 questions, focusing on a scenario involving a 60-year-old man with hematuria. The CT scan revealed an 8 cm mass in his left kidney and multiple enlarged lymph nodes and bilateral lung nodules in the retroperitoneum. A kidney biopsy revealed clear cell renal cell carcinoma. MRI of the brain showed no brain metastases.
The patient's Karnofsky physical status was 70%, the laboratory results were normal, but the calcium level was 10.8 mg/dL.
The survey asked whether oncologists would choose dual immunotherapy or immunotherapy-TKI as the initial treatment.
Chablani and colleagues sent the survey to 294 oncologists in the United States, of which 105 (36%) responded. Approximately three-quarters (78%) of the respondents are focused on academics or diseases, and 22% are general oncologists.
64 respondents (61%) said they would choose dual immunotherapy, and 41 respondents (39%) said they would choose the immunotherapy-TKI option.
Oncologists who focus on academic/disease tend to prefer dual immunotherapy (68% vs. 32%), while more general oncologists choose immunotherapy-TKI (65% vs. 35%; P = .004).
Oncologists who chose dual immunotherapy stated that they did so because of the following problems with the combination of immunotherapy and TKI: long-term toxicity (31%), short-term toxicity (28%), reduced effectiveness (28%), and convenience Decrease (8%).
Oncologists who chose the immunotherapy-TKI combination stated that they did so because of the following problems with dual immunotherapy: short-term toxicity (43%), reduced effectiveness (28%), long-term toxicity (15%), and risk of death (10%).
The majority (88%) of the interviewees stated that they are willing to allow patients to participate in a phase 3 trial that compares dual immunotherapy and immunotherapy-TKI regimens.
"Despite differences in suppliers, there is still a balance on this issue," Chablani and colleagues wrote. "We plan to conduct larger studies to better understand the preferences of general oncologists."
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