title: Patterns of care for metastatic renal cell carcinoma in Australia.
abstract: OBJECTIVE
  To examine the patterns of care and outcomes for metastatic renal cell carcinoma (mRCC) in Australia, where there are limited reimbursed treatment options. In particular, we aim to explore prescribing patterns for first-line systemic treatment, the practice of an initial watchful-waiting approach, and the use of systemic treatments in elderly patients.
  
  
  METHODS
  Patients with mRCC undergoing treatment between 2006 and 2012 were identified from four academic hospitals in Victoria and Australian Capital Territory. Demographic, clinicopathological, treatment, and survival data were recorded by chart review. Descriptive statistics were used to report findings. Survival was estimated by the Kaplan-Meier method and compared using the log-rank test. The study was supported by a grant from Pfizer Australia.
  
  
  RESULTS
  Our study identified 212 patients with mRCC for analysis. Patients were predominantly of clear cell histology (75%), Eastern Cooperative Oncology Group performance status <2 (67%) and with favourable/intermediate Memorial Sloan-Kettering Cancer Center risk (68%). The median age at diagnosis was 61 years. In all, 163 (77%) patients received first-line systemic therapy, while 49 (23%) received best supportive care (BSC). The most frequently used first-line treatment was sunitinib (125 patients, 77%). Patients who received sunitinib had a median overall survival (OS) of 27.6 months. In all, 43% of patients who received sunitinib underwent a watchful-waiting period of >90 days before initiating treatment; these patients had a median OS of 56.3 months. Elderly patients (50 patients aged ≥70 years) were more likely to receive BSC alone than younger patients (46% vs 16%, P < 0.001). Of those who received systemic therapy, elderly patients were also more likely to have upfront dose reductions (30% vs 8%, P = 0.03).
  
  
  CONCLUSIONS
  Our study of patients with mRCC treated in Australian centres showed that sunitinib was the most commonly prescribed systemic treatment between 2006 and 2012, associated with survival outcomes similar to pivotal studies. We also found that an initial watchful-waiting approach is commonly adopted without apparent detriment to survival. And finally, we found that age has an impact on the prescribing of systemic therapy.
authors.affiliation: Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Daphne
authors.initials: D
authors.lastname: Day
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Canberra, Australia.
authors.forename: Yada
authors.initials: Y
authors.lastname: Kanjanapan
authors.affiliation: Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Edmond
authors.initials: E
authors.lastname: Kwan
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Canberra, Australia.
authors.forename: Desmond
authors.initials: D
authors.lastname: Yip
authors.affiliation: Department of Urology, Austin Health, Heidelberg, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
authors.affiliation: Department of Medical Oncology, Western Health, Footscray, Australia.
authors.forename: Miles
authors.initials: M
authors.lastname: Andrews
authors.affiliation: Monash University Eastern Health Clinical School, Box Hill, Australia.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Davis
authors.affiliation: Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Heidelberg, Australia.
authors.forename: Arun A
authors.initials: AA
authors.lastname: Azad
authors.affiliation: Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Rosenthal
authors.affiliation: Department of Medical Oncology, Western Health, Footscray, Australia.
authors.forename: Shirley
authors.initials: S
authors.lastname: Wong
authors.affiliation: Biogrid Australia, Melbourne, Australia.
authors.forename: Alice
authors.initials: A
authors.lastname: Johnstone
authors.affiliation: Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia.|Biogrid Australia, Melbourne, Australia.|Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.|The University of Melbourne, Melbourne, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Gibbs
authors.affiliation: Department of Medical Oncology, The Royal Melbourne Hospital, Melbourne, Australia.|Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.|The University of Melbourne, Melbourne, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Tran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019468:Disease Management; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: patterns of care; renal cell carcinoma; sunitinib