Real-World Treatment Patterns and Predictors of Treatment Allocation in Metastatic Non-Clear Cell Renal Cell...

Non-clear cell renal cell carcinoma (nccRCC) comprises heterogeneous cancers historically managed using evidence extrapolated from clear cell RCC. Current guidelines support histology-guided treatment, but real-world adoption of systemic strategies and cytoreductive nephrectomy remains incompletely characterized. We assessed temporal trends in systemic treatment and cytoreductive surgery and identified predictors of treatment allocation in metastatic nccRCC.

We used the National Cancer Database to identify adults diagnosed with metastatic nccRCC from 2016 to 2022. Patients were classified as receiving targeted therapy (TT) only, immunotherapy (IO) only, IO + TT, or no documented systemic therapy. Temporal trends were assessed using annual treatment proportions and estimated annual percentage change (EAPC). Multivariable logistic regression evaluated predictors of systemic treatment allocation and receipt of cytoreductive surgery.

Among 3677 patients, 30.9% received TT only, 19.3% IO only, 13.7% IO + TT, and 36.1% had no documented systemic therapy. Among treated patients, TT use decreased over time (EAPC -23.46%, 95% CI -25.80 to -21.05; P < .001), whereas IO only (EAPC +32.26%, 95% CI +6.21 to +64.71; P = .022) and IO + TT (EAPC +30.70%, 95% CI +25.00 to +36.66; P < .001) increased. Cytoreductive surgery declined (EAPC -8.89%, 95% CI -12.04 to 5.64; P = .001). Later year of diagnosis was associated with IO-based treatment, with differential use across histologic subtypes.

Between 2016 and 2022, treatment patterns for metastatic nccRCC in the US shifted from TT toward IO-based regimens, while cytoreductive surgery declined, reflecting evolving real-world management of this heterogeneous disease.