Oncologists appear to prefer an immunotherapy (IO)/IO combination compared with an IO/tyrosine kinase inhibitor (TKI) combination for the first-line treatment of intermediate-/poor-risk metastatic renal cell carcinoma, according to research presented at the International Kidney Cancer Symposium (IKCS) 2021.
The investigators aimed to understand how oncologists decide between IO/IO and IO/TKI treatment options via survey. They sent a 10 question electronic survey focused on a patient scenario to 294 academic/disease-focused and general oncologists in the United States.
The scenario was described as follows: “A 60 y/o M presents with hematuria. CT A/P showed an 8-cm mass in the L kidney, multiple enlarged retroperitoneal LNs and bilateral pulmonary nodules. Brain MRI is negative for brain mets. Bx of the kidney mass showed clear cell RCC. Past medical hx includes only diabetes. Karnofsky Performance Status is 70%. Labs are normal except for a Ca level of 10.8. What is the initial treatment you would prescribe for this patient?” (Options: IO/IO and IO/TKI).
Overall, 105 providers responded, a response rate of 36%. Among those, 61% chose IO/IO and 39% chose IO/TKI. Respondents were 78% academic/disease-focused oncologists and 22% general oncologists. Academic/disease-focused oncologists were significantly more likely to choose IO/IO compared with general oncologists (68% vs 35%; P =.004).
The investigators also aimed to determine what factors drive physician decision-making. The perceived main issue with IO/TKI among oncologists who chose IO/IO in the survey were long-term toxicities (31%), short-term toxicities (28%), less effectiveness (28%), and less convenience (8%). The perceived main issue with IO/IO among oncologists who chose IO/TKI in the survey were short-term toxicities (43%), less effectiveness (28%), long-term toxicities (15%), and risk of death (10%). Overall, 88% of providers supported a phase 3 trial comparing IO/IO vs IO/TKI.
Limitations of the study included the small sample size, which was predominantly composed of academic/disease-focused oncologists.
“There was a significant association between type of practice and choice of therapy; academic/disease-focused oncologists were more likely to choose IO/IO,” concluded the investigators. “We plan to perform a larger study to better understand preferences of general oncologists and better evaluate decision-making with more choices.”
Chablani PV, Karrison T, Stadler W. Evaluation of provider preferences in first-Line metastatic renal cell carcinoma. Presented at IKCS 2021; November 5-6, 2021. Abstract N31.