The following article features coverage from the ASCO Genitourinary Cancers Symposium 2022. Click here to read more of MPR‘s conference coverage.

When treating advanced renal cell carcinoma (aRCC), oncologists appear to prefer immune checkpoint inhibitor-based therapies regardless of PD-L1 status, according to findings presented at the 2022 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium.

The case-based study aimed to analyze the prescribing behaviors of community oncologists treating patients with aRCC based on their perceptions of results obtained from trials studying the various treatment regimens.

“In May 2021, medical oncologists experienced in treating aRCC were presented with key results from these trials and 2 clinical vignettes,” the authors explained. An audience response system was used to record preferences in treatment and reasons for decisions. Descriptive statistics were used to analyze responses.

A total of 103 oncologists participated in the study. Findings revealed that 76% of the participants would not order PD-L1 testing though 81% would use an ICI-based regimen for treatment. The analysis also found that, for a favorable risk aRCC patient, 65% of participants would prescribe ICI/tyrosine kinase inhibitor (TKI) therapy compared with 47% who would prescribe ICI/ICI therapy. Conversely, in poor risk aRCC patients, ICI/ICI therapy was more likely to be prescribed (52%) compared with ICI/TKI therapy (15%).

Findings analyzing ICI/TKI regimens also showed pembrolizumab/axitinib (PA) to be slightly preferred over nivolumab/cabozantinib (NC) for the both poor risk (21% vs 20%, respectively) and intermediate risk (30% vs 23%, respectively) patient cases. For favorable risk aRCC, PA was found to be significantly preferred over NC (46% vs 19%, respectively).

Results of the study also revealed that the majority of participants considered trials that attained primary or survival endpoints to be strong influencers for decision-making, while trial design, short follow-up, no overall survival data, and high rates of discontinuation were found to be major limitations.

“Providers typically will treat aRCC patients with ICI-based regimens regardless of PD-L1 status and are more likely to prescribe an ICI/TKI regimen for favorable risk and an ICI/ICI regimen for poor risk aRCC,” the study authors concluded. “Given the nonsignificant difference in preference for PA over NC, further research is needed to assess factors influencing providers’ decisions.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Garjra A, Jeune-Smith Y, Vaishampayan UN, Rupard S. Assessing physician prescribing behaviors in first-line (1L) advanced renal cell carcinoma (aRCC): A case-based study. Presented at: ASCO-GU 2022; February 17-19, 2022; Abstract 355.