First-line treatment of metastatic clear cell renal cell carcinoma: a decision-making analysis among experts

ESMO Open

article

S. Aeppli¹  M. Schmaus²  T. Eisen³  B. Escudier⁴  V. Grünwald⁵  J. Larkin⁶  D. McDermott⁷  J. Oldenburg⁸  C. Porta⁹  B.I. Rini^1,10  M. Schmidinger^1,11  C.N. Sternberg^1,12  C. Rothermundt¹  P.M. Putora^1,13 

[1] Division of Oncology and Haematology;Department of Radiotherapy and Radiation Oncology, University Medical Centre Hamburg Eppendorf;Department of Oncology, Cambridge University Hospitals National Health Service Foundation;Gustave Roussy;Interdisciplinary GU Oncology, Clinic for Urology and Clinic for Tumour Research, University Hospital Essen;The Royal Marsden Hospital;Beth Israel Deaconess Medical Centre;Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo;Department of Biomedical Sciences and Human Oncology, University of Bari ‘A. Moro’;Division of Hematology and Oncology, Vanderbilt University Medical Centre;Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Centre, Medical University of Vienna;Division of Hematology and Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine;Department of Radiation Oncology;Department of Radiation Oncology, University of Bern

关键词: decision-making;    immune checkpoint inhibitor;    clear cell renal cell carcinoma;    systemic treatment;    tyrosine kinase inhibitor;   

DOI  :  10.1016/j.esmoop.2020.100030

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background The treatment landscape of metastatic clear cell renal cell carcinoma (mccRCC) has been transformed by targeted therapies with tyrosine kinase inhibitors (TKI) and more recently by the incorporation of immune checkpoint inhibitors (ICI). Today, a spectrum of single agent TKI to TKI/ICI and ICI/ICI combinations can be considered and the choice of the best regimen is complex.Materials and methods We performed an updated decision-making analysis among 11 international kidney cancer experts. Each expert provided their treatment strategy and relevant decision criteria in the first line treatment of mccRCC. After the collection of all input a list of unified decision criteria was determined and compatible decision trees were created. We used a methodology based on diagnostic nodes, which allows for an automated cross-comparison of decision trees, to determine the most common treatment recommendations as well as deviations.Results Diverse parameters were considered relevant for treatment selection, various drugs and drug combinations were recommended by the experts. The parameters, chosen by the experts, were performance status, International Metastatic renal cell carcinoma Database Consortium (IMDC) risk group, PD-L1 status, zugzwang and contraindication to immunotherapy. The systemic therapies selected for first line treatment were sunitinib, pazopanib, tivozanib, cabozantinib, ipilimumab/nivolumab or pembrolizumab/axitinib.Conclusion A wide spectrum of treatment recommendations based on multiple decision criteria was demonstrated. Significant inter-expert variations were observed. This demonstrates how data from randomized trials are implemented differently when transferred into daily practice.

【 授权许可】

CC BY|CC BY-NC-ND