ASCO GU 2018: Analysis of an Online Tool to Explore Evolving Practice Patterns in Renal Cell Carcinoma

San Francisco, CA ( Dr. Won Kim from UCSF presented a group analysis of an online tool to explore evolving practice patterns among patients with renal cell carcinoma (RCC). The complex and rapidly evolving treatment landscape for advanced RCC poses challenges for healthcare providers, particularly those in community settings, to make treatment decisions. To better understand current RCC treatment patterns, the objective of this study was to analyze patient cases entered by health care providers in an online tool developed by five experienced RCC oncologists from leading academic institutions.

The tool used in this study was developed in 2016 and updated in 2017 to include over 500 case variations based on key factors defined by the experts. Health care providers enter patient information and their intended treatment plan. The tool then provides expert treatment recommendations for the patient case entered, followed by a survey to determine if the recommendations changed the health care provider’s treatment plan. The analysis for this study compared intended treatment of health care providers vs expert recommendations for 1027 cases entered into the tool (2016, n = 470; 2017, n = 557). Pearson chi-squared and Fischer’s Exact tests were used for analyses.

The authors found that there was substantial treatment variation between health care providers and experts. In the first-line setting, 65% of health care providers vs 81% of experts selected sunitinib or pazopanib in both 2016 and 2017 (p = 0.0014). After disease progression on a first-line TKI, experts selected nivolumab as second-line treatment more often than health care providers (98% vs 26% in 2016, p < 0.0001; 89% vs 37% in 2017, p < 0.0001). There were significant changes in practice patterns from 2016 to 2017 for both experts and health care providers in patients who received two prior lines of treatment. After disease progression on a first-line TKI and then nivolumab, experts recommended cabozantinib as the TKI of choice in 76% of cases in 2017 vs 40% in 2016. After disease progression on a first-line TKI and then either axitinib or everolimus, experts selected nivolumab more often than health care providers (84% vs 30%, respectively; p = 0.002) in 2016. However, expert and health care provider treatment plans were not significantly different in 2017 (100% vs 70%, respectively; p = 0.08). Among the survey respondents, 46% of health care providers who differed from experts in their treatment selection indicated that the tool changed their intended treatment.

The authors concluded that practice patterns between experts and health care providers differed substantially in patients with treatment-refractory RCC. Given that expert recommendations often changed the treatment plan of health care providers, the potential of an online tool to improve clinical outcomes and standardize treatment in patients with advanced RCC warrants further investigation.

Presented by: Won Kim, MD University of California San Francisco, San Francisco, CA

Co-Authors: Kristen Rosenthal, Thomas E. Hutson, Robert J. Motzer, Elizabeth R. Plimack, Kevin Obholz, Angelique Vinther, Brian I. Rini; University of California San Francisco, San Francisco, CA; Clinical Care Options, LLC, Reston, VA; Baylor Sammons Cancer Center-Texas Oncology, Dallas, TX; Memorial Sloan Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic Taussig Cancer Insitute, Cleveland, OH

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA