Real-world effectiveness in previously untreated, advanced/metastatic renal cell carcinoma - a systematic literature review update

To review published real-world evidence (RWE) studies to evaluate the treatment effectiveness in patients with previously untreated, advanced or metastatic renal cell carcinoma (aRCC). An update to an existing systematic literature review (SLR) was carried out by two independent reviewers. MEDLINE (in-Process), Embase, Cochrane databases, trial registries, and conference proceedings were searched from May 2017 to January 2020 to identify RWE publications on previously untreated aRCC patients. In total, 143 relevant publications were identified through the SLR update. Studies were conducted in either a prospective (n=40) or retrospective (n=103, e.g. data from databases, registries or retrospective analyses) setting and were carried out in several countries, most frequently (with >10 publications each) in the US, Japan, Italy, and Germany. First-line treatment with sunitinib or pazopanib were most commonly investigated (>40 publications) and recently, RWE data has become available for immuno-oncology (IO) therapies such as nivolumab plus ipilimumab or immune-checkpoint inhibitors in general. Median progression-free survival (mPFS) and median overall survival (mOS) were presented according to IMDC or MSKCC risk status (favorable, intermediate, or poor); or without any risk status stratification. For patients with a favorable risk status, mPFS and mOS ranged from 2.9–39.6 months and 12–133 months, respectively. mPFS and mOS ranged from 2.3–24.6 months and 8.7–40.8 months, respectively, in intermediate risk patients and 2.3–9 months and 4.1–23.7 months, respectively, in poor risk patients. mPFS and mOS for patients that were not stratified according to risk status ranged from 2.6–39.7 months and 0.6–79.1 months, respectively. There is still a considerable unmet need for improved survival in patients with aRCC in the real-world setting, according to this SLR update assessing recent real-world effectiveness data. Currently there are only a few studies available that evaluate newer treatments and combinations thereof.