title: Treatment patterns in metastatic renal cell carcinoma: a retrospective review of medical records from US community oncology practices.
abstract: BACKGROUND
  Vascular endothelial growth factor (VEGF) inhibitors, including targeted therapy with tyrosine kinase inhibitors (TKIs) and the angiogenesis inhibitor bevacizumab, and mammalian target of rapamycin (mTOR) inhibitors are now the standard of care for metastatic renal cell carcinoma (mRCC). However, real-world treatment patterns are not well characterized.
  
  
  OBJECTIVE
  To describe treatment patterns during the first, second, and third lines of targeted therapies for mRCC among community oncologists in the US.
  
  
  METHODS
  Participating physicians recruited from a nationwide panel each identified up to 15 adult mRCC patients who initiated a second therapy after January 2010. Information extracted from medical records included types of targeted therapies, reasons for treatment choices, patterns of treatment discontinuation, and dose adjustments.
  
  
  RESULTS
  Thirty-six physicians contributed charts from 433 mRCC patients. Seventy-seven percent of patients received a VEGF inhibitor as first targeted therapy; 23% received an mTOR inhibitor. Among first-line VEGF users, second-line treatments were 66% mTOR and 34% VEGF inhibitors. Among first-line mTOR users, second-line treatments were 94% VEGF and 6% mTOR inhibitors. Sunitinib followed by everolimus was the most commonly used treatment sequence. Estimated median duration for second targeted therapy was 8.6 months, and median overall survival (OS) and progression-free survival (PFS) were 27.4 and 10.8 months, respectively. Efficacy, treatment guidelines and mechanism of action were the most important considerations for treatment choice.
  
  
  CONCLUSIONS
  LIMITATIONS include no adjustment for baseline characteristics, possible difference between physician-defined progression and central review in the clinical trial setting, and limited data availability for axitinib during the study period.
  
  
  CONCLUSIONS
  In this large retrospective chart review among community oncologists, VEGF-mTOR-VEGF was the most common treatment sequence for mRCC. The most common drugs were sunitinib in the first line and everolimus in the second line.
authors.affiliation: MD Anderson Cancer Center , Houston, TX , USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
authors.forename: James E
authors.initials: JE
authors.lastname: Signorovitch
authors.forename: Peggy L
authors.initials: PL
authors.lastname: Lin
authors.forename: Zhimei
authors.initials: Z
authors.lastname: Liu
authors.forename: Ken
authors.initials: K
authors.lastname: Culver
authors.forename: Sumanta K
authors.initials: SK
authors.lastname: Pal
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Scott
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Vogelzang
mesh_terms: D000328:Adult; D000818:Animals; D000970:Antineoplastic Agents / Q000145:classification / Q000627:therapeutic use; D024221:Antineoplastic Protocols; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000473:pathology; D018572:Disease-Free Survival; D000068338:Everolimus; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077210:Sunitinib; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D042461:Vascular Endothelial Growth Factor A; D000068338:Everolimus; D011505:Protein-Tyrosine Kinases; D058570:TOR Serine-Threonine Kinases; D000077210:Sunitinib; D020123:Sirolimus
keywords: chart review; mammalian target of rapamycin; metastatic renal cell carcinoma; treatment patterns; vascular endothelial growth factor