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Background

Multiple new therapies for metastatic clear cell renal cell carcinoma (mccRCC) have been approved in the past decade. Real-world data on access to novel therapies and the impact on health-related disparities are limited. This study assessed real-world access to novel therapies along with racial and social disparities for mccRCC patients and their impact on clinical outcomes.

Methods

The longitudinal Flatiron Health database was queried for adult patients with mccRCC who received systemic treatments from Jan. 2011 to Dec. 2022 with at least two documented clinical visits. Patients < 45 years old were excluded. Data were collected on age, gender, race, ethnicity, ECOG status, practice type, stage, smoking status, socioeconomic status (SES) defined by the Yost Index, insurance status, overall survival (OS), and the first 14 treatments received. Patients were categorized as receiving a novel therapy if they received a first-line mccRCC regimen during prespecified time windows starting on their first-line FDA approval date until 6 months later or when the next novel drug was approved, whichever date came later. Chi square test was used to assess variables across race. Univariable Cox proportional hazard models were used for OS analysis. R version 4.3.0 was used for programming.

Results

7,113 patients were included. 68.8% of the cohort were white, 7.1% Black, 1.4% Asian, 12.7% other, and date on 10.1% were missing. Advanced age and receiving care in a community practice setting were associated with worse OS (CI 1.45-1.81 and CI 0.70-0.81, respectively), while SES was not (CI 0.81-1.01 for highest vs lowest group). Black race was associated with a 24% increased hazard of mortality compared with white race (CI 1.11-1.39, P=0.0003), and this was more pronounced in patients <65 years old (CI 1.17-1.63, P=0.0001). 31.4% of patients received at least one novel therapy during the study period, and there were no differences by race. Receipt of novel therapy was not statistically associated with improved OS (P=0.1660).

Conclusions

This is the first study in the immunotherapy era to highlight the worse OS of Black patients with mccRCC. Access to care at an academic center was associated with improved OS. Access to novel therapies did not differ between racial groups in the U.S. using real-world data.

Read an interview about the study here and expert commentary about it here.