Oral Anticancer Agent Use in Patients With Metastatic Renal Cell Carcinoma

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In a population-based cohort study reported in JCO Oncology Practice, Stephanie B. Wheeler, PhD, and colleagues found a low rate of oral anticancer agent use within 12 months after detection of metastatic disease in patients with renal cell carcinoma.

Stephanie B. Wheeler, PhD

Stephanie B. Wheeler, PhD

Study Details

The study used a novel, North Carolina cancer registry–linked multipayer claims data resource to assess patterns of use of five oral therapies—sorafenib, sunitinib, pazopanib, everolimus, and axitinib—within the 12 months after metastatic renal cell carcinoma detection from 2006 to 2015.

The metastatic index date was defined as the date of diagnosis for patients with stage IV disease, and the date of the first of two separate claims for a secondary malignant neoplasm at any time after initial diagnosis for patients with stage I to III disease. Patients were required to have 12 months of continuous insurance enrollment before and after the metastatic index date. 

Key Findings

Among the 713 patients included in the analysis, 262 (37%) used any oral agent during the 12 months after the metastatic index date. Patterns of use varied across years, with no consistent trend over time (P = .79), despite the increase in approval of agents during the study period. Use ranged from 28% in 2011 to 45% in 2012.

In adjusted models, factors significantly associated with oral agent use consisted of the following:

  • Increasing age at diagnosis: compared with those aged 18 to 49 years, risk ratios were 0.69 (P = .01) for those aged 50 to 64 years, 0.68 (P = .04) for those aged 65 to 69 years, 0.51 (P = .002) for those aged 70 to 74 years, and 0.29 (P < .0001) for those aged ≥ 80 years.
  • Number of comorbidities: compared to patients with no comorbidities, risk ratios were 0.73 (P = .03) for those with two and 0.68 (P = .01) for those with three or more.
  • Frailty: the risk ratio was 0.67 (P = .001) for those with frailty value above the median.
  • Stage at initial diagnosis: compared to patients with stage IV disease, risk ratios were 0.62 (P = .004) for stage I and 1.46 (P = .02) for stage II.
  • Poverty percentage in census tracts: the risk ratio was 1.31 (P = .02) for patients residing in areas with the lowest percentage of persons living below poverty level (highest quartile vs lowest 3 quartiles).

The investigators concluded, “These findings suggest a need to better understand the system-level and provider-level drivers of oral anticancer agent underuse, as well as oral anticancer agent adherence and associated survival.”

Dr. Wheeler, of Gillings School of Global Public Health, University of North Carolina at Chapel Hill, is the corresponding author for the JCO Oncology Practice article.

Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit

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