Trends of Utilization of Systemic Therapies for Metastatic Renal Cell Carcinoma in the Canadian Health Care System.

Autor:	Cardenas LM; Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada., Ghosh S; Department of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada., Finelli A; Division of Urology, University Health Network, Toronto, ON, Canada., Wood L; Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada., Kollmannsberger C; Department of Medical Oncology, BC Cancer Agency, Vancouver, BC, Canada., Basappa N; Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada., Graham J; Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, MB, Canada., Heng D; Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada., Bjarnason G; Department of Medical Oncology, Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, ON, Canada., Soulières D; Hematology-Oncology Department, CHUM-Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada., Bossé D; Medical Oncology Division, The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada., Castonguay V; Hematology-Oncology Department, Centre Hospitalier Universitaire Pavillon l'Hôtel-Dieu de Quebec, Quebec City, QC, Canada., Saleh R; Department of Medical Oncology, McGill University, Montreal, QC, Canada., Tanguay S; Division of Urology, McGill University and McGill University Health Centre, Montreal, QC, Canada., Bhindi B; Department of Surgery, Section of Urology, University of Calgary, Calgary, AB, Canada., Breau RH; Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada., Pouliot F; Department of Urology, CHU de Quebec, Université Laval, Quebec City, QC, Canada., Lalani AA; Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
Jazyk:	angličtina
Zdroj:	JCO global oncology [JCO Glob Oncol] 2023 Sep; Vol. 9, pp. e2300271.
DOI:	10.1200/GO.23.00271
Abstrakt:	Purpose: Standard-of-care therapies for metastatic renal cell carcinoma (mRCC) have greatly evolved. However, the availability of emerging options in global health care systems can vary. We sought to describe the integration and usage of systemic therapies for mRCC in Canada since 2011. Methods: We included patients with mRCC enrolled in the Canadian Kidney Cancer Information System, a prospective cohort of patients from 14 Canadian academic centers, who received systemic therapy from January 1, 2011, to December 31, 2021. Patients were stratified by treatment era (cohort 1: 2011-2015, cohort 2: 2016-2021). Stacked bar charts were used to present treatment proportions; Sankey diagrams were used to show the evolution of treatment sequencing between the two cohorts. Results: Four thousand one hundred seven patients were diagnosed with mRCC, of whom 2,752 (67%) received systemic therapy. Among these patients, mean age was 64 years, 74% were male, 75% had clear cell histology, and International Metastatic RCC Database Consortium risk classification was favorable, intermediate, and poor in 16%, 56%, and 28%, respectively. Utilization of immune checkpoint inhibition (ICI)-based treatments has increased in Canada and reflects global and local patterns of approval and adoption. The use of therapies after doublet ICI has mostly shifted toward vascular endothelial growth factor-tyrosine kinase inhibitors (VEGF-TKIs) that were previously used in first line with subsequent treatments reflecting approved and available agents after previous VEGF-TKI. Clinical trial participation among patients who received systemic therapy was 18% in first, 21% in second, and 24% in third line. Conclusion: In Canada's publicly funded health care system, availability of standard mRCC therapies broadly reflects access from government-funded clinical trials and compassionate access program sources. In an evolving therapeutic landscape, ongoing advocacy is required to continue to facilitate patient access to efficacious therapies.
Databáze:	MEDLINE
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