Real-world patterns of treatment and response in metastatic renal cell carcinoma: a multicentre UK-wide review with UK Renal Oncology Collaborative (UK ROC).

Background: The introductions of immunotherapy and first-line combinations have led to major changes in systemic anti-cancer treatment (SACT) options and outcomes in metastatic renal cell carcinoma (mRCC). Objectives: To evaluate current real-world UK practice in the immunotherapy era looking at survival outcomes by International Metastatic RCC Database Consortium (IMDC) risk stratification and prescribing patterns/drop-off rates of SACT in mRCC. Materials and methods: This is a retrospective multi-institutional cohort of SACT patients for mRCC at 17 centres across the UK from 1 January 2018 and 30 June 2021. Patient characteristics, IMDC risk group and lines of therapy were recorded. Overall survival (OS) and progression-free survival (PFS) for IMDC groups were analysed. Results: Of the 1319 patients, 22.3%, 52.7% and 24.3% were IMDC group favourable, intermediate and poor, respectively. Across all risk groups and censoring for patients who have not progressed on their current therapy line, 59.2%, 23.5% and 6.3 % of first-line patients with SACT received second-, third- and fourth-line treatments; 40.1%, 33.2% and 44.2%, respectively, did not receive immunotherapy at any stage in their treatment. Median PFS was statistically different by IMDC risk group: 14.0, 8.2 and 4.8 months in the favourable, intermediate and poor groups ( Conclusions: The majority of patients receive only one or two treatment lines in mRCC. The IMDC prognostic risk groups remain valid in the immunotherapy era. A significant group of patients in this cohort did not receive immunotherapy at any stage.