title: Prescribing Preferences in the First-Line Treatment for Patients With Metastatic Renal Cell Carcinoma in the United States.
abstract: Despite existing guidelines for first-line treatment of metastatic renal cell carcinoma (mRCC), prescribing preferences in the United States have not been fully examined. The objectives of this study were to characterize US physicians' preferences and factors influencing first-line mRCC treatment.
  
  
  
  A Web-based study presented physicians with hypothetical mRCC patient cases and recorded initial therapy preference and rationale. Descriptive statistics were used to characterize preferred treatment; logistic regression was used to determine patient characteristics associated with therapy changes. Analyses were conducted on pooled responses across cases. Model results were summarized using odds ratios (ORs), 95% confidence intervals, and P values for the covariates.
  
  
  
  One hundred nine physicians participated in the study; 96 (88.1%) chose a tyrosine kinase inhibitor as their preferred first-line mRCC treatment (62 [56.9%], sunitinib; 31 [28.4%], pazopanib). Perceived superior overall survival and progression-free survival were top reasons physicians chose sunitinib; enhanced tolerability and efficacy similar to sunitinib were top reasons physicians chose pazopanib. Initial sunitinib prescribers were more likely to change therapy in the presence of comorbid conditions (OR, 2.915; P = .0068), poor Eastern Cooperative Oncology Group performance status (OR, 2.368; P = .0106), or poor prognostic risk (OR, 3.884; P = .0224). This was not seen for initial pazopanib prescribers.
  
  
  
  Sunitinib and pazopanib were the most preferred agents for first-line mRCC treatment. Sunitinib preference was driven by perceptions of efficacy, and pazopanib was preferred for its perceived tolerability and efficacy similar to sunitinib. With varying clinical scenarios, initial pazopanib prescribers were more likely to maintain pazopanib and alter dosing; sunitinib prescribers were more likely to switch therapy.
authors.affiliation: GlaxoSmithKline, Philadelphia, PA.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Hackshaw
authors.affiliation: GlaxoSmithKline, Philadelphia, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Holmes
authors.affiliation: Xcenda, LLC, Palm Harbor, FL. Electronic address: maria.lankford@xcenda.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Lankford
authors.affiliation: Xcenda, LLC, Palm Harbor, FL.
authors.forename: Michele
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Xcenda, LLC, Palm Harbor, FL.
authors.forename: Augustina
authors.initials: A
authors.lastname: Ogbonnaya
authors.affiliation: Xcenda, LLC, Palm Harbor, FL.
authors.forename: Michael
authors.initials: M
authors.lastname: Eaddy
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007191:Indazoles; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use; D000077210:Sunitinib; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D007191:Indazoles; D007211:Indoles; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; C516667:pazopanib; D000077210:Sunitinib
keywords: First-line mRCC treatment; Pazopanib; Sunitinib; TKI; mRCC prescribing preferences