Department of Urology, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48105-2967, USA.
Urology. 2011 Apr;77(4):825-830.e1. doi: 10.1016/j.urology.2010.11.003. Epub 2011 Jan 22.
To characterize the contemporary use of oral-targeted therapies (ie, sunitinib, sorafenib) among patients with renal cell carcinoma (RCC) and to assess the factors associated with short-term and sequential treatment.
We used an administrative claims database of privately insured patients to evaluate oral-targeted therapy use among patients with RCC from 2006 to 2007. After identifying patients with RCC who had received sunitinib and/or sorafenib, we determined the prevalence of patients treated with short-term and/or sequential therapy. We performed bivariate and multivariate analyses to estimate the associations between the patient characteristics and receipt of short-term and/or sequential treatment regimens.
We identified 938 patients with RCC who had initially been treated with sunitinib (n = 554) or sorafenib (n = 384). In this group, 36% and 23% of patients had received short-term or sequential therapy, respectively. Most patients (61%) who had received sequential therapy had undergone short-term treatment with ≥1 drugs, with second-line sorafenib more likely to be given as short-term therapy than sunitinib (63% vs 34%, P < .001). Short-term therapy was more common in female patients (odds ratio 1.53, 95% confidence interval 1.12-2.09) and patients in the Southern United States (odds ratio 1.71, 95% confidence interval 1.05-2.80). Sequential therapy was more common among patients receiving sorafenib first (odds ratio 2.30, 95% confidence interval 1.64-3.21).
Short-term and sequential oral targeted therapy use was relatively prevalent among patients with RCC. For patients treated with sunitinib and sorafenib, the patterns of short-term use varied by the sequence of medications, suggesting differences in the effectiveness or tolerability of each regimen. These findings highlight the need for future studies to characterize the "real-world" clinical outcomes and economic effect associated with these treatment courses.
描述肾细胞癌（RCC）患者中口服靶向治疗（即舒尼替尼、索拉非尼）的当代应用情况，并评估与短期和序贯治疗相关的因素。
我们使用私人保险患者的行政索赔数据库，评估了 2006 年至 2007 年期间接受 RCC 治疗的患者使用口服靶向治疗的情况。在确定接受舒尼替尼和/或索拉非尼治疗的 RCC 患者后，我们确定了接受短期和/或序贯治疗的患者的流行率。我们进行了双变量和多变量分析，以估计患者特征与接受短期和/或序贯治疗方案之间的关联。
我们确定了 938 名最初接受舒尼替尼（n=554）或索拉非尼（n=384）治疗的 RCC 患者。在这组患者中，分别有 36%和 23%的患者接受了短期或序贯治疗。大多数接受序贯治疗的患者（61%）接受了≥1 种药物的短期治疗，二线索拉非尼比舒尼替尼更有可能作为短期治疗（63%比 34%，P<0.001）。女性患者（比值比 1.53，95%置信区间 1.12-2.09）和美国南部地区的患者（比值比 1.71，95%置信区间 1.05-2.80）接受短期治疗的可能性更大。首先接受索拉非尼治疗的患者接受序贯治疗的可能性更高（比值比 2.30，95%置信区间 1.64-3.21）。
RCC 患者短期和序贯口服靶向治疗的应用相对普遍。对于接受舒尼替尼和索拉非尼治疗的患者，短期使用模式因药物顺序而异，表明每种方案的有效性或耐受性存在差异。这些发现强调了未来研究需要描述与这些治疗方案相关的“真实世界”临床结果和经济影响。
