title: Pharmacoeconomic and clinical implications of sequential therapy for metastatic renal cell carcinoma patients in Central and Eastern Europe.
abstract: BACKGROUND
  The incidence and mortality rates of kidney cancer in the Central and Eastern European (CEE) region are among the highest in the world. Access to second and subsequent lines of metastatic renal cell carcinoma (mRCC) therapies is highly varied in the region. Despite the increasing body of evidence supporting the clinical benefit of multiple lines of treatment, access to treatment beyond first line is restricted in many of these countries.
  
  
  METHODS
  The adoption of targeted therapies for the first-line treatment of mRCC in the region was slow and faced many obstacles. In order to evaluate the current status of treatment beyond the first-line setting in the CEE region, this review examines the availability and reimbursement of mRCC drugs and clinical practice in institutions that treat patients with mRCC.
  
  
  CONCLUSIONS
  This review highlights the need to raise awareness among physicians, payers and regulators on clinical trial and cost-effectiveness data regarding the treatment of mRCC beyond the first line. The obstacles to mRCC drug access highlighted in this review need to be overcome to ensure that patients are receiving the best treatment available.
authors.affiliation: a University Hospital Split , Department of Oncology , Split , Croatia.
authors.forename: E
authors.initials: E
authors.lastname: Vrdoljak
authors.affiliation: b University of Szeged , Department of Oncotherapy , Szeged , Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Torday
authors.affiliation: c Central Clinical Hospital , Department of Oncology, Military Institute of Medicine , Warsaw , Poland.
authors.forename: C
authors.initials: C
authors.lastname: Szczylik
authors.affiliation: d NN Blokhin Russian Cancer Research Center , Biotherapy Department , Moscow , Russia.
authors.forename: G
authors.initials: G
authors.lastname: Kharkevich
authors.affiliation: e VKV American Hospital , Div. Medical Oncology , Istanbul , Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Bavbek
authors.affiliation: f Assaf Harofeh Centre Zerifin, Department of Oncology , Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel.
authors.forename: A
authors.initials: A
authors.lastname: Sella
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D005061:Europe, Eastern; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D012051:Reimbursement Mechanisms; D014421:Turkey
chemical_list: D000970:Antineoplastic Agents
keywords: axitinib; cytokines; everolimus; metastatic renal cell carcinoma; molecular-targeted agents; pazopanib; receptor tyrosine kinase inhibitors; sorafenib; sunitinib; temsirolimus