加拿大医疗体系中转移性肾细胞癌系统治疗的应用趋势。

Trends of Utilization of Systemic Therapies for Metastatic Renal Cell Carcinoma in the Canadian Health Care System.

机构信息

Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.

Department of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada.

出版信息

JCO Glob Oncol. 2023 Sep;9:e2300271. doi: 10.1200/GO.23.00271.

DOI:10.1200/GO.23.00271

PMID:37992270

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10681568/

Abstract

PURPOSE

Standard-of-care therapies for metastatic renal cell carcinoma (mRCC) have greatly evolved. However, the availability of emerging options in global health care systems can vary. We sought to describe the integration and usage of systemic therapies for mRCC in Canada since 2011.

METHODS

We included patients with mRCC enrolled in the Canadian Kidney Cancer Information System, a prospective cohort of patients from 14 Canadian academic centers, who received systemic therapy from January 1, 2011, to December 31, 2021. Patients were stratified by treatment era (cohort 1: 2011-2015, cohort 2: 2016-2021). Stacked bar charts were used to present treatment proportions; Sankey diagrams were used to show the evolution of treatment sequencing between the two cohorts.

RESULTS

Four thousand one hundred seven patients were diagnosed with mRCC, of whom 2,752 (67%) received systemic therapy. Among these patients, mean age was 64 years, 74% were male, 75% had clear cell histology, and International Metastatic RCC Database Consortium risk classification was favorable, intermediate, and poor in 16%, 56%, and 28%, respectively. Utilization of immune checkpoint inhibition (ICI)-based treatments has increased in Canada and reflects global and local patterns of approval and adoption. The use of therapies after doublet ICI has mostly shifted toward vascular endothelial growth factor-tyrosine kinase inhibitors (VEGF-TKIs) that were previously used in first line with subsequent treatments reflecting approved and available agents after previous VEGF-TKI. Clinical trial participation among patients who received systemic therapy was 18% in first, 21% in second, and 24% in third line.

CONCLUSION

In Canada's publicly funded health care system, availability of standard mRCC therapies broadly reflects access from government-funded clinical trials and compassionate access program sources. In an evolving therapeutic landscape, ongoing advocacy is required to continue to facilitate patient access to efficacious therapies.

摘要

目的

转移性肾细胞癌（mRCC）的标准治疗方法已经有了很大的发展。然而，在全球医疗保健系统中，新兴选择的可用性可能会有所不同。我们旨在描述自 2011 年以来加拿大转移性肾细胞癌系统治疗的整合和使用情况。

方法

我们纳入了在加拿大肾脏癌信息系统中登记的 mRCC 患者，该系统是一个来自 14 个加拿大学术中心的前瞻性队列患者，他们在 2011 年 1 月 1 日至 2021 年 12 月 31 日期间接受了系统治疗。患者根据治疗时期进行分层（队列 1：2011-2015 年，队列 2：2016-2021 年）。堆叠条形图用于展示治疗比例；Sankey 图用于展示两个队列之间治疗顺序的演变。

结果

4107 例患者被诊断为 mRCC，其中 2752 例（67%）接受了系统治疗。这些患者的平均年龄为 64 岁，74%为男性，75%为透明细胞组织学，国际转移性肾细胞癌数据库联盟风险分类分别为 16%、56%和 28%的预后良好、中等和较差。免疫检查点抑制剂（ICI）为基础的治疗在加拿大的应用有所增加，反映了全球和本地的批准和采用模式。在接受双 ICI 治疗后，治疗方案主要转向血管内皮生长因子-酪氨酸激酶抑制剂（VEGF-TKI），这些药物以前在一线治疗中使用，随后的治疗方案反映了以前 VEGF-TKI 治疗后批准和可用的药物。接受系统治疗的患者中，临床试验参与率在一线治疗中为 18%，二线治疗中为 21%，三线治疗中为 24%。