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Updated: Sep 10, 2025

A Syngeneic Mouse Model of Metastatic Renal Cell Carcinoma for Quantitative and Longitudinal Assessment of Preclinical Therapies
Published on: April 12, 2017
Structured Expert Elicitation to Inform Long-Term Survival Extrapolations in Advanced Renal Cell Carcinoma
Dawn Lee1, Zain Ahmad2, James M G Larkin3
1PenTAG, University of Exeter, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK. d.lee7@exeter.ac.uk.
Background:
In the absence of long-term data, structured expert elicitation gathers expert judgments and associated uncertainties to assess the clinical plausibility of long-term extrapolations.
Objective:
The objective of this study was to obtain expert estimates of expected long-term outcomes for advanced renal cell carcinoma treatments to inform cost-effectiveness analysis for National Institute for Health and Care Excellence (NICE)'s pathways pilot.
Methods:
Using materials from the structured expert elicitation resources (STEER) repository, aligned with the Medical Research Council (MRC) protocol, the exercise was planned and conducted. Aiming for 5-10 oncologists from diverse UK geographies and settings, experts estimated progression-free survival (PFS) at three landmark timepoints for 21 disease-risk-prior treatment combinations and overall survival for best supportive care. Within an 8-week timeframe, we piloted with one clinician, conducted online training, collected responses via an online survey using the roulette method and mathematically aggregated results through linear opinion pooling.
Results:
Nine experts participated (question response rate: 95%). For first-line intermediate/poor-risk patients, clinicians projected similar PFS for three immune oncology/tyrosine kinase inhibitor (TKI) combinations from 5 years onward and comparable PFS for two TKI monotherapies. Nivolumab + ipilimumab was anticipated to achieve the highest PFS amongst first-line therapies. Expert reasoning incorporated treatment class, clinical experience, and awareness of trial data optimism. Expert estimates were generally somewhat optimistic compared with observed UK real-world evidence and pessimistic compared with observed trial data.
Conclusions:
Structured expert elicitation is a pragmatic, efficient approach for informing long-term survival extrapolations in the context of a rapidly evolving treatment pathway. We demonstrated that expert elicitation is possible even for complex decision problems in a relatively short timeframe.
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