Evidence map›Paper›PMID 33460963›Full record

ArticleESMO open2021

First-line treatment of metastatic clear cell renal cell carcinoma: a decision-making analysis among experts.

S Aeppli, M Schmaus, T Eisen, B Escudier, V Grünwald, J Larkin, D McDermott, J Oldenburg, C Porta, B I Rini and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in ESMO open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.

0numbers the graph read from it
0cells of the map it votes in
26citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

26 citing papers in PubMed.

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  16. [Stereotactic body radiotherapy as "first-line treatment" for oligometastatic renal cell cancer].Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

S AeppliDivision of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland. Electronic address: Stefanie.aeppli@kssg.ch.
M SchmausDepartment of Radiotherapy and Radiation Oncology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.
T EisenDepartment of Oncology, Cambridge University Hospitals National Health Service Foundation, Cambridge, UK.
B EscudierGustave Roussy, Villejuif, France.
V GrünwaldInterdisciplinary GU Oncology, Clinic for Urology and Clinic for Tumour Research, University Hospital Essen, Essen, Germany.
J LarkinThe Royal Marsden Hospital, London, UK.
D McDermottBeth Israel Deaconess Medical Centre, Boston, USA.
J OldenburgDepartment of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway.
C PortaDepartment of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy.
B I RiniDivision of Hematology and Oncology, Vanderbilt University Medical Centre, Nashville, USA.
M SchmidingerDepartment of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Centre, Medical University of Vienna, Austria.
C N SternbergDivision of Hematology and Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, USA.
C RothermundtDivision of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
P M PutoraDepartment of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Bern, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe treatment landscape of metastatic clear cell renal cell carcinoma (mccRCC) has been transformed by targeted therapies with tyrosine kinase inhibitors (TKI) and more recently by the incorporation of immune checkpoint inhibitors (ICI). Today, a spectrum of single agent TKI to TKI/ICI and ICI/ICI combinations can be considered and the choice of the best regimen is complex. MATERIALS AND

methodsWe performed an updated decision-making analysis among 11 international kidney cancer experts. Each expert provided their treatment strategy and relevant decision criteria in the first line treatment of mccRCC. After the collection of all input a list of unified decision criteria was determined and compatible decision trees were created. We used a methodology based on diagnostic nodes, which allows for an automated cross-comparison of decision trees, to determine the most common treatment recommendations as well as deviations.

resultsDiverse parameters were considered relevant for treatment selection, various drugs and drug combinations were recommended by the experts. The parameters, chosen by the experts, were performance status, International Metastatic renal cell carcinoma Database Consortium (IMDC) risk group, PD-L1 status, zugzwang and contraindication to immunotherapy. The systemic therapies selected for first line treatment were sunitinib, pazopanib, tivozanib, cabozantinib, ipilimumab/nivolumab or pembrolizumab/axitinib.

conclusionA wide spectrum of treatment recommendations based on multiple decision criteria was demonstrated. Significant inter-expert variations were observed. This demonstrates how data from randomized trials are implemented differently when transferred into daily practice.

Indexed as

Carcinoma, Renal CellKidney NeoplasmsHumansImmunotherapySunitinibSunitinibclear cell renal cell carcinomadecision-makingimmune checkpoint inhibitorsystemic treatmenttyrosine kinase inhibitor

Identifiers

PMID33460963
PMCPMC7815472

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.