End-of-life treatment patterns in patients (pts) with metastatic renal cell carcinoma (mRCC).

Abstract

466 Background: The treatment landscape of mRCC has rapidly evolved in recent years, particularly with the introduction of tyrosine kinase inhibitors (TKIs) and programmed cell death protein 1 inhibitors (PD-1i). However, therapeutic options after progression on these agents remain limited, and data on how treatment decisions are made near the end of life are lacking. Herein, we sought to assess treatment patterns in relation to the time of death in real-world pts with mRCC. Methods: This study used the US-based, electronic health record-derived deidentified Flatiron Health Research Database. Eligibility: pts with mRCC who initiated first-line (1L) therapy and had a recorded date of death. The data cutoff was 10/31/2024. Pts were categorized into two groups: treatment-free, if no systemic therapy was administered during the last 3 months of life, or on-treatment, if systemic therapy was received within 3 months preceding death. Demographic and clinical variables at their last line of therapy (LOT) initiation, including age, race, region, socioeconomic status, practice type, and insurance, were summarized using medians (IQR) or proportions. Comparisons were performed using Wilcoxon rank-sum or chi-squared tests. Results: Among 13,909 pts with mRCC diagnosed between 1/1/2011 and 7/18/2024, 7,179 initiated 1L therapy, had a recorded date of death, and were eligible and included in our analysis. Of these, 4,731 (65.9%) received systemic therapy within 3 months of death (on-treatment), while 2,448 (34.1%) did not (treatment-free). At the time of their last LOT initiation, patients in the treatment-free group were older with a median age 70 years (IQR 62 – 77), as compared to 68 years (IQR 60 – 75) in on-treatment group (p < 0.001). Patients in the on-treatment group were more likely to be treated in community practice (p < 0.001), and to have commercial health plan (p < 0.001). The most common last treatments within 3 month of death were TKIs (42%), followed by single agent PD-1i (15%), and PD-1i + TKI (12%). Additional baseline characteristics and treatment patterns will be presented at the meeting. Conclusions: In this large real-world cohort, most pts with mRCC remained on systemic therapy within 3 months of death, most commonly TKIs or PD-1i. These results highlight the need to better define appropriate end-of-life care and optimize treatment decision-making for pts with mRCC to balance therapeutic benefit with quality of life. Limitations include retrospective nature of study and possible data missingness.