Patterns of treatment in first and subsequent lines in RCC in Spain. A real-world descriptive cross-sectional study

Advanced renal cell carcinoma (RCC) has had limited treatment options and poor prognosis. Initially, tyrosine kinase inhibitors (TKIs) increased progression-free survival (PFS) and allowed the identification of favorable (FP), intermediate (IP) and poor prognosis (PP) subgroups. While TKIs remain an option for FP patients, combinations of immune checkpoint inhibitors (IO) plus TKI in the overall population, or IO/IO in IP/PP patients, have improved overall survival (OS), and have become the standard of care. However, their adoption in clinical practice varies across countries.

We conducted a cross-sectional observational study using Oncology Dynamics™ database to assess treatment patterns in Spain.

A total of 1,587 metastatic RCC (mRCC) patients were registered, 900 in first-line treatment for clear cell mRCC (mccRCC). In 2022, among mccRCC FP patients treated by oncologists (N = 137), 92.7% received TKIs; while IP/PP patients (N = 298), 56.7% received TKIs, 27.5% antiPD1-antiCTLA4, and 13.8% antiPD1-TKI. In 2023, mccRCC FP patients (N = 124) received 94.4% TKIs; and IP/PP patients (N = 256) received 48.4% TKIs, 38.3% antiPD1-antiCTLA4, and 12.1% antiPD1-TKI.

During this period, the uptake of IO/IO and IO/TKI in clinical practice in Spain was lower than expected according to current recommendations.