Prescribing Preferences in the First-Line Treatment for Patients With Metastatic Renal Cell Carcinoma in the United States

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Abstract

Micro-Abstract

This study was undertaken to determine, among the various agents available for the first-line treatment of metastatic renal cell cancer, which are the most preferred by US prescribers and why. Our study included 109 board-certified or board-eligible cancer specialists within a diverse mix of practice types. The tyrosine kinase inhibitors of vascular endothelial growth factor, sunitinib and pazopanib, were the most preferred agents. A perception of better tolerability drove treatment decisions for pazopanib, and perceptions regarding efficacy outcomes drove initial sunitinib preference.

Background:

Despite existing guidelines for first-line treatment of metastatic renal cell carcinoma (mRCC), prescribing preferences in the United States have not been fully examined. The objectives of this study were to characterize US physicians' preferences and factors influencing first-line mRCC treatment.

Materials and Methods:

A Web-based study presented physicians with hypothetical mRCC patient cases and recorded initial therapy preference and rationale. Descriptive statistics were used to characterize preferred treatment; logistic regression was used to determine patient characteristics associated with therapy changes. Analyses were conducted on pooled responses across cases. Model results were summarized using odds ratios (ORs), 95% confidence intervals, and P values for the covariates.

Results:

One hundred nine physicians participated in the study; 96 (88.1%) chose a tyrosine kinase inhibitor as their preferred first-line mRCC treatment (62 [56.9%], sunitinib; 31 [28.4%], pazopanib). Perceived superior overall survival and progression-free survival were top reasons physicians chose sunitinib; enhanced tolerability and efficacy similar to sunitinib were top reasons physicians chose pazopanib. Initial sunitinib prescribers were more likely to change therapy in the presence of comorbid conditions (OR, 2.915; P = .0068), poor Eastern Cooperative Oncology Group performance status (OR, 2.368; P = .0106), or poor prognostic risk (OR, 3.884; P = .0224). This was not seen for initial pazopanib prescribers.

Conclusion:

Sunitinib and pazopanib were the most preferred agents for first-line mRCC treatment. Sunitinib preference was driven by perceptions of efficacy, and pazopanib was preferred for its perceived tolerability and efficacy similar to sunitinib. With varying clinical scenarios, initial pazopanib prescribers were more likely to maintain pazopanib and alter dosing; sunitinib prescribers were more likely to switch therapy.

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