title: Patterns of care among patients receiving sequential targeted therapies for advanced renal cell carcinoma: A retrospective chart review in the USA.
abstract: To assess real-world treatment patterns of targeted therapies after failure of first-line tyrosine kinase inhibitors in patients with advanced renal cell carcinoma.
  
  
  
  A large, retrospective review of medical charts of patients with advanced renal cell carcinoma in the USA was carried out. Descriptive statistics were used to summarize physicians' and patients' characteristics, treatment sequences, and reasons for treatment choices. P-values were calculated using χ2-tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. A descriptive comparison was carried out between current results and those of a previous treatment pattern study conducted in 2012 to identify changes in treatment patterns over time.
  
  
  
  Sunitinib and everolimus remained the most commonly-used first and second targeted therapies, respectively. Among patients who continued to a third targeted therapy, everolimus and axitinib were the most commonly-used treatments after second targeted therapy with a tyrosine kinase inhibitor and a mammalian target of rapamycin inhibitor, respectively. The use of pazopanib as first targeted therapy, and of axitinib and sorafenib as second targeted therapies, increased over time. Efficacy, treatment guidelines and a different mechanism of action were the main reasons given by physicians for choosing among second targeted therapies after failure of a first tyrosine kinase inhibitor.
  
  
  
  The results of the present study document patterns of care during a period of rapid and ongoing therapeutic advancement in advanced renal cell carcinoma. Sequencing of therapies warrants ongoing analysis in light of new agents entering the advanced renal cell carcinoma treatment landscape.
authors.affiliation: City of Hope Comprehensive Cancer Center, Duarte, California, USA.
authors.forename: Sumanta K
authors.initials: SK
authors.lastname: Pal
authors.affiliation: Analysis Group, Boston, Massachusetts, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Signorovitch
authors.affiliation: Analysis Group, Boston, Massachusetts, USA.
authors.forename: Nanxin
authors.initials: N
authors.lastname: Li
authors.affiliation: Analysis Group, Boston, Massachusetts, USA.
authors.forename: Miriam L
authors.initials: ML
authors.lastname: Zichlin
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA.
authors.forename: Zhimei
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA.
authors.forename: Sameer R
authors.initials: SR
authors.lastname: Ghate
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA.
authors.forename: Jose Ricardo
authors.initials: JR
authors.lastname: Perez
authors.affiliation: US Oncology Research, Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Vogelzang
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000077784:Axitinib / Q000494:pharmacology / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000628:therapy*; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D000068338:Everolimus / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007191:Indazoles; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D009392:Nephrectomy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D047428:Protein Kinase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D011743:Pyrimidines / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use; D000077210:Sunitinib / Q000494:pharmacology / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007191:Indazoles; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; C516667:pazopanib; D000068338:Everolimus; D000077784:Axitinib; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D000077210:Sunitinib
keywords: advanced renal cell carcinoma; mammalian target of rapamycin inhibitors; targeted therapy; treatment patterns; tyrosine kinase inhibitors