Purpose: The treatment landscape for metastatic renal cell carcinoma (mRCC) has evolved in recent years with the use of tyrosine kinase inhibitors (TKIs) and immuno-oncology (IO) therapies. This study examined patient characteristics, treatment patterns, health care resource utilization (HCRU), costs, and survival for individuals with mRCC who received either IO + IO or IO + TKI combinations as first-line (1L) regimens.
Methods: This retrospective cohort study used integrated claims and clinical data from a commercial health plan to study adults with mRCC who began 1L treatment between April 1, 2018, and January 31, 2023. Patient characteristics, 1L and second-line (2L) regimens, and HCRU were described. Costs were summarized per patient per month over time. Survival time was analyzed overall and partitioned into time on 1L, treatment-free survival, and survival after 2L.
Results: Patients receiving 1L IO + IO (n = 471) or IO + TKI (n = 353) regimens generally had similar baseline characteristics although among patients with risk data, 33% of IO-IO patients versus 23% of IO-TKI patients had poor risk scores. Treatment costs were higher for IO + IO in the first 3 months but lower in subsequent time intervals compared with IO + TKI. Total mean costs per patient were $720K in US dollars (USD) for IO + IO and $834K USD for IO + TKI over the course of 3 years. Medication costs represented 80% of total costs. IO + IO patients stayed on 1L therapy for a shorter duration, but cumulative survival time at 24 months was the same (63%) for both groups.
Conclusion: Patients receiving 1L IO + IO and IO + TKI regimens had similar baseline characteristics and comparable survival at 30 months. Although IO + IO was associated with higher treatment costs in the first 3 months, the subsequent monthly costs were lower compared with IO + TKI.