title: Trends of Systemic Therapy Use for Renal Cell Carcinoma in the United States.
abstract: OBJECTIVE
  To assess the utilization of immunotherapy after the advent of tyrosine-kinase inhibitors and mammalian target of rapamycin inhibitors for metastatic renal cell carcinoma (RCC) in the United States, as well as to better understand the variables associated with the implementation of these systemic therapies.
  
  
  METHODS
  The National Cancer Data Base Participant User File for Renal Cancer was queried. Patients diagnosed with metastatic RCC were identified. From that group, patients who received either immunotherapy or chemotherapy (single or multiagent), given as a first-course therapy from 1998 to 2011 were selected. Multivariate analysis was used to assess patient, disease, and provider factors associated with immunotherapy or chemotherapy overall usage between 2003 and 2011.
  
  
  RESULTS
  A total of 25,186 patients diagnosed with metastatic RCC were identified; 3107 received immunotherapy and 8640 received chemotherapy. The use of immunotherapy decreased from 30.3% in 1998 to 3.8% in 2011. The use of chemotherapy increased from 16.2% in 1998 to 54.0% in 2011. The most dramatic period of change was from 2004 to 2006. Independent negative predictors of receiving immunotherapy included progressive years of diagnosis (P <.0001), increasing age (P <.0001), female gender (P = .001), and African American race (P = .04).
  
  
  CONCLUSIONS
  There has been a significant decrease in the use of immunotherapy for metastatic RCC in the United States since the introduction of targeted chemotherapeutic agents in the past decade.
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: Elizabeth.Ferry@UHhospitals.org.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Ferry
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Minnillo
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Maurice
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH; Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Department of Urology, Glickman Urological and Kidney Institute, Cleveland, OH; Cleveland Clinic, Cleveland, OH.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000628:therapy*; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000706:statistics & numerical data* / Q000639:trends*; D007680:Kidney Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014481:United States