ASCO Reading Room | Disparities in Uptake of New FDA-Approved Therapies for Metastatic Clear Cell Renal Cell Carcinoma

Background

Several new treatments for metastatic clear cell renal cell carcinoma (mRCC) have been approved over the past decade. Real-world data on access to these new treatments and their impact on health disparities are limited. This study assessed real-world access to new treatments as well as racial and social disparities for patients with mRCC and their impact on clinical outcomes.

Methods

The Flatiron Health longitudinal database was queried for adult patients with mccRCC who received systemic therapies from January 2011 to December 2022 with at least two documented clinic visits. Patients younger than 45 years were excluded. Data were collected on age, sex, race, ethnicity, ECOG status, practice type, stage, smoking status, socioeconomic status (SES) defined by the Yost index, insurance status, overall survival (OS), and first 14 treatments received. Patients were classified as receiving new therapy if they received a first-line regimen for mccRCC during predefined time windows beginning on the date of FDA approval of their first-line regimen through 6 months later or when the next new drug was approved, whichever was later. The chi-square test was used to assess variables by race. Univariate Cox proportional hazards models were used for overall survival analysis. R version 4.3.0 was used for programming.

Results

7,113 patients were included. 68.8% of the cohort were white, 7.1% black, 1.4% Asian, 12.7% other, and 10.1% had missing data. Older age and receiving care in a community practice setting were associated with worse OS (CI 1.45–1.81 and CI 0.70–0.81, respectively), whereas SES was not (CI 0.81–1.01 for the highest group versus the lowest group). Black race was associated with a 24% increased risk of mortality compared with white race (CI 1.11–1.39, P=0.0003), and this was more pronounced in patients under 65 years of age (CI 1.17-1.63, P= 0.0001). 31.4% of patients received at least one new treatment during the study period, and there was no difference by race. Receipt of a new treatment was not statistically associated with an improvement in overall survival (P=0.1660).

Conclusions

This is the first study in the immunotherapy era to highlight poorer overall survival in black patients with mCRC. Access to care at an academic center was associated with improved overall survival. Access to new therapies did not differ across racial groups in the United States using real-world data.

Read an interview about the study here and an expert commentary on it here.