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. 2023 May 2;7(3):pkad036.
doi: 10.1093/jncics/pkad036.

Disparities in immune and targeted therapy utilization for older US patients with metastatic renal cell carcinoma

Ryan D Chow  1 , Jessica B Long  2 , Sirad Hassan  2 , Stephanie B Wheeler  3   4 , Lisa P Spees  3   4 , Michael S Leapman  2   5 , Michael E Hurwitz  6 , Hannah D McManus  7 , Cary P Gross  2   6 , Michaela A Dinan  2   8
Affiliations

Disparities in immune and targeted therapy utilization for older US patients with metastatic renal cell carcinoma

Ryan D Chow et al. JNCI Cancer Spectr. .

Abstract

Disparities in metastatic renal cell carcinoma (mRCC) outcomes persist in the era of oral anticancer agents (OAAs) and immunotherapies (IOs). We examined variation in the utilization of mRCC systemic therapies among US Medicare beneficiaries from 2015 to 2019. Logistic regression models evaluated the association between therapy receipt and demographic covariates including patient race, ethnicity, and sex. In total, 15 407 patients met study criteria. After multivariable adjustment, non-Hispanic Black race and ethnicity was associated with reduced IO (adjusted relative risk ratio [aRRR] = 0.76, 95% confidence interval [CI] = 0.61 to 0.95; P = .015) and OAA receipt (aRRR = 0.76, 95% CI = 0.64 to 0.90; P = .002) compared with non-Hispanic White race and ethnicity. Female sex was associated with reduced IO (aRRR = 0.73, 95% CI = 0.66 to 0.81; P < .001) and OAA receipt (aRRR = 0.74, 95% CI = 0.68 to 0.81; P < .001) compared with male sex. Thus, disparities by race, ethnicity, and sex were observed in mRCC systemic therapy utilization for Medicare beneficiaries from 2015 to 2019.

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Conflict of interest statement

Dr Wheeler reported receiving grants from Pfizer outside of the submitted work. Dr Spees reported receiving grants from AstraZeneca/Merck outside of the submitted work. Dr Hurwitz serves on advisory boards for Bristol Myers Squibb, Nektar Therapeutics, Janssen Pharmaceuticals, Exelixis, and CRISPR Therapeutics and receives research funding outside of the submitted work from Achilles, Apexigen, Astellas, AstraZeneca, Bayer, Bristol Myer Squibb, Clovis, Corvus, Eli Lilly, Endocyte, Genentech, Genmab, GSK, Innocrin, Iovance, KSQ Therapeutics, MedImmune, Merck, Nektar Therapeutics, Novartis, Pfizer, Progenics, Roche Laboratories, Sanofi Aventis, SQZ Biotech, Seattle Genetics. Dr McManus reports receiving grants from Pfizer outside of the submitted work. Dr Gross reports receiving grants from AstraZeneca, Genentech, and Johnson & Johnson outside of the submitted work. Dr Dinan reports receiving grants from AstraZeneca outside of the submitted work. All other authors had no potential conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
The evolution of initial systemic treatment for mRCC from 2015 to 2019 across racial and ethnic groups. A) Trends in initial systemic treatment from 2015 to 2019, categorizing patients by receipt of any systemic therapy, immunotherapy (IO), or oral anticancer agents (OAA). Data are expressed as unadjusted percentages of patients diagnosed with mRCC in a given year. B-D) Trends in utilization of any systemic therapy (B), IO (C), and OAA (D) from 2015 to 2019, stratified by racial and ethnic group. Because of small sample sizes, multiple races and ethnicities were combined for visualization, as indicated. Data are expressed as unadjusted percentages of patients diagnosed with mRCC in a given year. AINAO = American Indian, Native Alaskan, or all other; API = Asian and Pacific Islander; mRCC = metastatic RCC.
Figure 2.
Figure 2.
Factors associated with receipt of systemic therapy for metastatic RCC. A-C). Forest plots detailing the association between several demographic characteristics and receipt of any systemic therapy (A), IOs (B), or OAAs (C). Estimates for panel A are from a multivariable regression model with receipt of any systemic therapy as the outcome and the indicated covariates as predictors, expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Estimates for panels B-C are similarly derived from a multinomial regression model with the specific first-line systemic treatment received as the outcome, expressed as relative risk ratios (aRRRs). AINAO = American Indian, Native Alaskan, and all other; IO = inhibitor immunotherapy; LIS = low-income subsidy; OAA = oral anticancer agent.
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