38: Real-world Treatment Patterns and Clinical Outcomes Among patients with Metastatic Renal Cell Carcinoma (mRCC) Post Immune-oncology (IO) and Tyrosine Kinase Inhibitors (TKIs)

Background: With rapidly evolving treatment landscape for mRCC treatments, we aimed to describe real-world treatment patterns and clinical outcomes of subsequent line of treatment (LOT) in mRCC patients (pts) who received a prior IO and TKI therapy

Methods: Using data from The US Oncology Network electronic health record database, iKnowMed, we included adult mRCC pts receiving a subsequent LOT (index date) after receiving IO and TKI in combination or sequence between 01/01/2018 and 09/30/2020 and followed them until 04/30/2022. Overall survival (OS) and real-world progression-free survival (rwPFS) from index date were described using Kaplan-Meier analysis.

Results: We identified 239 mRCC pts who met the eligibility requirements. Median age was 67 (range: 58, 73) years, 73.6% were male,63.6% had an ECOG performance status of 0-1 and 61.5% had intermediate/poor IMDC risk score. Of 239 pts, 29 (12.1%) received subsequent therapy at LOT2, 167 (69.8%) at LOT3 and 43 (18.0%) at LOT4. Overall, TKI monotherapy/TKI+non-IO (71.5%) was the most common subsequent treatment used after receiving IO and TKI, including cabozantinib (38.5%) and axitinib (10.5%). Median OS for LOT2, LOT3, and LOT4 was 18.0, 17.0, and 26.9 months, respectively (p=0.84). There was no meaningful difference in OS across treatment classes (p=0.40). There was no meaningful difference in rwPFS across LOTs (p=0.88) or treatment classes (p=0.19) (Table).

Conclusions: In mRCC pts treated with IO and TKI in combination/sequence, majority received a subsequent therapy at LOT3 with a preference for TKI based treatments overall. There was no meaningful difference in OS and rwPFS among pts treated subsequently with IO monotherapy or IO+IO, TKI monotherapy/TKI+non-IO or mTOR. There is need for considering treatments with newer mode of action (non-IO/non-TKI) in this population.