scholarly journals AB0225 TUMOR NECROSIS FACTOR ALPHA (TNF-Α) INHIBITORS IN PATIENTS WITH REFRACTORY RHEUMATOID ARTHRITIS: REASONS FOR WITHDRAWAL

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1138.2-1139
Author(s):  
V. Sygyrta ◽  
E. Aronova ◽  
A. Lila ◽  
S. Glukhova
Keyword(s):  
Rheumatoid Arthritis ◽  
Common Reason ◽  
First Line ◽  
Line Therapy ◽  
Refractory Rheumatoid Arthritis ◽  
Tnf Α ◽  
Sequential Administration ◽  
On Line ◽  
Line Of Therapy ◽  
Line Drug

Background:Refractory rheumatoid arthritis (RRA) is a subtype of rheumatoid arthritis (RA), in which the sequential administration of optimal methotrexate doses in combination with glucocorticoids, and at least - two biologic disease-modifying antirheumatic drugs (bDMARDs) with different mechanisms of action during 18-24 months does not lead to a significant decrease in the inflammatory activity of RA.Objectives:to determine the reasons for the withdrawal of TNF-α inhibitors in patients with RRA.Methods:The retrospective study included data of 95 RRA patients (80 females, 80.8%), aged 23 to 80 years (mean age 57 years), treated with TNF-α inhibitors. Mean RA duration was 11.9±7.6 years. All patients were divided into 6 groups depending on the number of the lines of therapy received. A total of 154 cases of TNF-α were studied.Results:Infliximab (INF) was most often prescribed as the first line of therapy - 40 prescriptions. The reasons for the withdrawal of INF as the first bDMARDs were: insufficient effectiveness (IE) - 20 cases (50% of appointments), administrative reasons (AdmR) - 13 cases (32.5% of appointments), adverse reactions (AR) - 6 cases (15% of appointments), remission - 1 case (2.5% of appointments). In the 2nd line of therapy, INF was prescribed in only 3 cases, the drug was canceled in all cases due to IE. In 3 lines of therapy, INF was prescribed in 4 cases, the reasons for withdrawal in these cases were IE (50%, 2 cases) and AR (50%, 2 cases).Etanercept (ETC) was prescribed as the first line of therapy in 10 cases. The most common reason for withdrawal was IE in 5 cases (50% of appointments), AR - 4 cases (40%), AdmR - 1 case (10%). ETC was prescribed as a 2 line in 15 cases, the reasons for withdrawal then were: IE - 11 cases (73.3%), AR - 1 case (6.7%), AdmR - 3 cases (20%). ETC was prescribed as a 3-line therapy in 20 cases. The reasons for withdrawal were as follows: IE - 8 cases (40%), AR - 4 cases (20%), AdmR - 8 cases (40%). As a drug of 4 lines of therapy, ETC was prescribed 1 time and was canceled due to the development of AR. As the 5th line, ETC was appointed in 1 case and was canceled due to IE. ETC was assigned as line 6 in 1 case. The reason for the withdrawal was AR.Adalimumab (ADA) was prescribed as the first line of therapy in 19 cases, the reasons for withdrawal were: IE - 14 cases (73.7%), AR - 2 cases (10.5%), AdmR - 3 (15.8%). On line 2, ADA made 20 appointments, the reasons for withdrawal were: IE - 13 (65%), AR - 3 (15%), AdmR - 4 (20%). ADA was prescribed as line 3 in 8 cases, the reasons for withdrawal were: IE - 6 (75%), AR - 1 (12.5%), AdmR - 1 (12.5%). As a 4-line drug, ADA was prescribed in 4 cases and was canceled in all cases due to IE. On line 5, ADA was assigned 1 time and was discontinuation due to IE.Golimumab (GLM). He was appointed as the first line in 5 cases. The reasons for withdrawal were: IE - 1 case (20%), AdmR - 4 appointments (80%). As a 2-line drug, GLM was prescribed once and was canceled due to AdmR. The drug was not prescribed for the 3rd and 4th lines. As a 5-line therapy, it was prescribed once and was canceled due to IE.When assessing the frequency of drug withdrawal due to IE or AR, no significant differences were found between the lines of therapy. Discontinuation rates were also not statistically different in the study groups.Conclusion:The most common reason for the withdrawal of TNF-α in patients with RRA is IE. With an increase in the lines of TNF-α therapy, remission as a reason for withdrawal was not identified. As a result of the increase in the number of sequentially prescribed bDMARDs, the frequency of discontinuation of TNF-α in connection with IE did not decrease. A significant reason for cancellation is AdmR, to which we attributed the absence of the drug in the pharmacy network, financial reasons limiting the continuation oDisclosure of Interests:None declared

scholarly journals AB0324 REASONS FOR DISCONTINUATION OF BIOLOGICS IN PATIENTS WITH REFRACTORY RHEUMATOID ARTHRITIS: RESULTS OF A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1461.1-1461
Author(s):  
V. Sygyrta ◽  
S. Glukhova ◽  
E. Aronova ◽  
A. Satybaldyev ◽  
A. Lila
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Adverse Events ◽  
Certolizumab Pegol ◽  
Refractory Rheumatoid Arthritis ◽  
Tnf Α ◽  
Sequential Administration ◽  
The Mean ◽  
Third Line ◽  
Line Of Therapy

Background:Refractory rheumatoid arthritis (RRA) is a subtype of rheumatoid arthritis (RA), in which the sequential administration of optimal methotrexate (MT) doses in combination with glucocorticoids (GCs), and at least - two biologic disease-modifying antirheumatic drugs (bDMARDs) with different mechanisms of action during 18-24 months does not lead to a significant decrease in the inflammatory activity of RA.Objectives:Analysis of the selection strategy and the “survival” of bDMARDs in patients with RRA.Methods:The retrospective study included data of 95 RRA patients (80 females, 80.8%), aged 23 to 80 years (mean age 57 years), treated with bDMARDs. Mean RA duration was 11.9±7.6 years. All patients were divided into 6 groups depending on the number of the lines of therapy (LOTs) received (from 2 to 7 consecutive bDMARDs). Totally 348 cases of bDMARDs administration were analyzed.Results:TNF-α inhibitors were most commonly used as the first and second lines of therapy: infliximab (INF) – 43 prescriptions, adalimumab (ADA) – 39, etanercept (ETC) – 25, certolizumab pegol (CZP) – 11, golimumab (GLM) - 6. Abatacept (ABA) was prescribed in 32 cases, rituximab (RTM) in 22 cases, and tocilizumab (TCZ) - in 12 cases. The following reasons for bDMARDs discontinuation were identified: lack of efficacy (LE) (55.2% of cases), adverse events (AE), including serious adverse events (14.8% of cases), administrative reasons (10.0% of cases), persistent remission (2.1% of cases), pregnancy (0.6%), and other (17.3% of cases)TNF-α inhibitors were also used in third-line bDMARDs therapies, but preference was given to drugs with a different mechanism of action: ABA-20 patients (23.2%), RTM – 20 (21.1%), TCZ – 15 (15.8%), ETC – 22 (23.2%), ADA – 9 (9.5%), INF – 4 (4.1%), CZP – 3 (3.1%). Treatment was discontinued in 74 patients (77.9%). In this cohort the following reasons for bDMARDs withdrawal were identified: LE (54.1%), AE (17.6%), administrative reasons (9.5%), remission (1.3%), and other (17.5%).The fourth line of therapy was administered in 45 patients: ABA-16 (35.6%), RTM-9 (20%), ADA – 6 (13.3%), TCZ – 5 (11.1%), ETC – 4 (8.9%), CZP – 4 (8.9%), GLM – 1 (2.2%). The reasons for discontinuation (29 patients, 64.4%) were as follows: LE (44.8%), AE (13.8%), other (41.4%).The fifth bDMARDs was used in 3 patients: TСZ-6 (46.1%), RTM – 3 (23.1%), ABA – 1 (7.7%), ETC – 1 (7.7%), ADA – 1 (7.7%), GLM – 1 (7.7%). Therapy was discontinued in 11 patients (84.6%) for the following reasons: LE (45.5%), AE (18.2%), other (36.3%).The sixth line of therapy was necessary in 4 patients: ETC (25%), GLM (25%), CZP (25%), ABA (25%) and was discontinued in 3 (75%) of them due to AE (33.3%) and other reasons (66.7%). One patient received TCZ as the seventh line of therapy.Mean duration of the first line of therapy was 7.6 ± 6.5 months, of the second line - 9.6 ± 7.5 months, of the third line - 11.5 ± 7.1 months, fourth line - 12.5 ± 8 months, fifth line - 13.4 ± 4.8 months, and sixth line - 14.6 ± 4.4 months. Statistical analysis revealed significant differences (p<0.05) in the mean duration of therapy (retention on therapy) between the 1st and 3rd, as well as the between the 1st and 4th lines of therapy. There were no significant differences in rates of bDMARDs discontinuation due to LE or AE. The rates of bDMARDs discontinuation did not differ significantly in the study groups.Conclusion:The mean retention on a drug in the 3rd and 4th lines of therapy in patients with refractory rheumatoid arthritis was significantly longer than on the 1st line of therapy. The most common reason for bDMARDs discontinuation was lack of efficacy. Additional lines of bDMARDs therapy were not associated with increasing rates of adverse events.Disclosure of Interests:None declared

scholarly journals Patient Profile and Treatment Patterns in a Commercially Insured Population with Follicular Lymphoma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5880-5880
Author(s):  
Nathan H Fowler ◽  
Yanni Hao ◽  
Stephen Lim ◽  
Guifang Chen ◽  
Frank Li ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Research Funding ◽  
Second Line ◽  
First Line ◽  
Advisory Committees ◽  
First Line Therapy ◽  
Line Therapy ◽  
Third Line ◽  
Line Of Therapy

Introduction: Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma in the Western hemisphere. Patient characteristics and burden of FL are incomplete and vary from previous studies. This study evaluated patient profile, including patient characteristics, treatment patterns, and duration using real-world data. Methods: Using the Truven MarketScan® databases, patients with FL who were newly initiated with FL indicated regimens were identified from 1/1/2010-12/31/2013 (initial treatment identification period). Patients were selected if they were ≥18 years old, had 1 FL ICD-9 code (202.0) as primary or secondary diagnosis, at least 1 FL commonly prescribed systemic anti-cancer therapy after the diagnosis, and did not use any FL indicated regimen in the past 6 months prior to first agent included in the initial treatment identification period. These patents were followed ≥3 months or to June 30, 2018. Primary outcomes were the distribution of regimens by line, the number of patients who switched from first- to second-line therapies, and from second- to third-line therapies. The treatment duration by line of therapy and regimen were also analyzed. Discontinuation was defined as 3 months without receiving a regimen after treatment. Results: This study identified 4,970 patients who initiated treatment for FL. Of these patients, 48.1% were female (n=2,390), with a mean age of 62.0 (SD: 14.0) years. The average follow-up time was approximately 2 years (median: 733 days). In this analysis, 4,970 patients with FL received first-line therapy for 153 days (median: 94 days), 1,985 received second-line therapy (39.9% of patients who received first-line therapy) for 208 days (median: 80 days), and 664 received third-line therapy (13.4% of patients who received first-line therapy) for 117 days (median: 43 days). Of the 4,970 patients on first-line therapy, 453 (9.1%) remained on first-line therapy, 2,532 (51.0%) discontinued treatment, and 1,985 (39.9%) patients switched to the next line of therapy during the follow-up period. Of the 1,985 patients who switched to second-line therapy, 328 (16.5%) remained by the end of follow-up period, 993 (50.0%) discontinued, and 664 (33.4%) switched to the next line of therapy during the follow-up period. Of the 664 patients who switched to third-line therapy, 125 (18.8%) remained, 269 (40.5%) discontinued, and 270 (40.7%) switched to the next line of therapy. The most common first-line regimens in descending order received by patients were rituximab (n=1,478, 29.7%), R-CHOP (n=1,368, 27.5%), BR (n=1,050, 21.1%), R-CVP (n=371, 7.5%), and FCR (n=63, 1.3%). Second-line treatment regimens were (N=1,985) rituximab (n=992, 50.0%), BR (n=202, 10.2%), R-CHOP (n=138, 7.0%), and R-CVP (n=120, 6.1%). Third-line treatment regimens were (N=664) rituximab (n=228, 34.3%), BR (n=91, 13.7%), R-CHOP (n=75, 11.3%), cyclophosphamide (n=35, 5.3%) and R-CVP (n=31, 4.7%). Conclusion: This data set describes the percentage of patients that transition from first- to second-line and second- to third-line treatment for FL. The primary regimens used across the treatment lines conform to those recommended by the NCCN guidelines. In addition, smaller numbers of non-recommended regimens were reported. Disclosures Fowler: Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; ABBVIE: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis Pharmaceuticals Corporation: Consultancy; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding. Hao:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Lim:Novartis Pharmaceuticals Corporation: Employment. Chen:Novartis Pharmaceuticals Corporation: Consultancy, Employment. Li:Novartis Pharmaceuticals Corporation: Employment. Arcona:Novartis Pharmaceuticals Corporation: Employment.

scholarly journals Changing Demographics and Treatment Patterns in Patients the United States with Chronic Lymphocytic Leukemia in the First-Line Setting As Assessed Using a Novel Electronic Health Record Database

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4787-4787 ◽  
Author(s):  
Brandon Arnieri ◽  
Coen Bernaards ◽  
Kenneth Wilhelm ◽  
James Black ◽  
Ceri Hirst ◽  
...  
Keyword(s):  
United States ◽  
Treatment Initiation ◽  
The United States ◽  
Treatment Patterns ◽  
Health Record ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
The Us ◽  
Line Of Therapy

Abstract Introduction: Approximately 18,960 new cases of CLL and 4,660 deaths from CLL are estimated in the US in 2016, with an overall estimated 5-year survival rate of 82%. Despite this, CLL patients with unfavorable genetic features such as 17p deletion have relatively poor outcomes when treated with conventional chemoimmunotherapy (e.g. fludarabine and cyclophosphamide, or bendamustine plus rituximab); however, several new treatments have been approved by the FDA for the treatment of previously untreated CLL in the past 3 years, including obinutuzumab with chlorambucil and ibrutinib. The aim of this analysis was to assess demographics and treatment patterns in patients with previously untreated CLL since the introduction of new treatment options using a novel oncology electronic health record (EHR) database. Methods: A cohort of CLL patients was selected by identifying patients within Flatiron's real-world oncology database. The Flatiron provider network comprises 230 clinics, 2,000 clinicians, and more than 1 million cancer patients throughout the United States (US). Patients included in the cohort were required to meet the following criteria: ≥2 clinic encounters on different days occurring on or after January 1, 2011; ≥1 medication order for an antineoplastic occurring on or after January 1, 2013; physician documentation of CLL; and, evidence in unstructured documents (ie, information not organized in a pre-existing data model, such as free text from a physician note/lab report) of having been treated specifically for CLL. The latter two criteria were assessed based on technology-enabled abstraction of unstructured data (e.g., pathology reports, clinician notes). Patients who lacked unstructured documents, absence of evidence of first-line treatment, or received CLL treatment at a practice outside of the Flatiron network were excluded. The cohort included patients of all ages treated between 2011 and 2015 from all 50 states of the US. The index date was defined as the date of the patient's CLL treatment initiation. Start of first-line therapy after January 1, 2011, was defined as the first episode of an eligible therapy given after or up to 14 days before the date of the patient's CLL treatment initiation. Line of therapy was the first eligible drug episode plus other eligible drugs given within 28 days. Therapies eligible for inclusion in lines of therapy were systemic treatment, as evidenced by an order or administration of an antineoplastic agent recorded in the EHR; radiotherapy and surgery were not included. For patients with documented transformation of CLL, the abstracted date of transformation ended any active line of therapy, and the patient was not considered eligible for any subsequent CLL lines of therapy. Any treatment that occurred after the date of transformation was not included as a CLL line of therapy (steroids were not included in the definition of CLL lines of therapy). Results: As of June 2016, the cohort consisted of 766 eligible CLL patients with a median age of 71 years, and 64% were male (Table 1). While distribution of first-line therapies initiated in 2011 to 2013 remained relatively constant by year, changes were observed during 2014 and 2015 following the introduction of obinutuzumab and ibrutinib (Figure 1); obinutuzumab monotherapy as first-line therapy increased from 8.2% in 2014 to 14.5% in 2015, and ibrutinib monotherapy or ibrutinib + rituximab increased from 10.5% in 2014 to 13.6% in 2015. Of note, fludarabine containing regimens declined from 19.8% in 2012 to 8.8% in 2015. Decreases were also observed with rituximab monotherapy from 21.0% to 16.2%, bendamustine + rituximab (BR) from 36.1% to 31.6%, and rituximab + fludarabine + cyclophosphamide (RFC) from 11.0% to 8.8%. Factors associated with chlorambucil treatment (as monotherapy or in combination) vs. chemoimmunotherapy included older age (75.9 years vs. 68.7 years and 62.6 years for BR and RFC, respectively) and Rai stage (78.1% of patients treated with chlorambucil had Rai stage 0-I disease vs. 70.1% and 71.7% treated with BR and RFC, respectively). A fifth of patients with 17p deletion were treated with ibrutinib. Updated data inclusive of 2016 treatments will be presented. Conclusion: Using a novel EHR database, the marked change in CLL treatments from 2011 to 2015 shows increased utilization of newer agents. Further follow-up and analysis will contrast treatment patterns beyond RCT data in a real-world setting. Disclosures Arnieri: F. Hoffmann La-Roche Ltd: Employment. Bernaards:F. Hoffmann La-Roche Ltd: Employment. Wilhelm:Roche: Equity Ownership; Genentech: Employment. Black:F. Hoffmann La-Roche Ltd: Employment. Hirst:F. Hoffmann La-Roche Ltd: Employment; AstraZeneca: Other: Previous employment . Taylor:F. Hoffmann La-Roche Ltd: Employment. Lambert:F. Hoffmann La-Roche Ltd: Employment. Green:F. Hoffmann La-Roche Ltd: Employment. Lu:F. Hoffmann La-Roche Ltd: Employment. Humphrey:Genentech, Inc.: Employment.

Reasons for Biologic and Targeted Synthetic Disease-modifying Antirheumatic Drug Cessation and Persistence of Second-line Treatment in a Rheumatoid Arthritis Dataset

2019 ◽  
Vol 47 (8) ◽  
pp. 1174-1181
Author(s):  
Peter Youssef ◽  
Bruno Marcal ◽  
Peter Button ◽  
Matt Truman ◽  
Paul Bird ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Common Reason ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Start Date ◽  
Real World Evidence ◽  
Disease Modifying ◽  
Noninterventional Study ◽  
First Line Treatment

Objective.To provide real-world evidence about the reasons why Australian rheumatologists cease biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARD) when treating patients with rheumatoid arthritis (RA), and to assess (1) the primary failure rate for first-line treatment, and (2) the persistence on second-line treatments in patients who stopped first-line tumor necrosis factor inhibitors (TNFi).Methods.This is a multicenter retrospective, noninterventional study of patients with RA enrolled in the Australian Optimising Patient outcome in Australian RheumatoLogy (OPAL) dataset with a start date of b/tsDMARD between August 1, 2010, and June 30, 2017. Primary failure was defined as stopping treatment within 6 months of treatment initiation.Results.Data from 7740 patients were analyzed; 6914 patients received first-line b/tsDMARD. First-line treatment was stopped in 3383 (49%) patients; 1263 (37%) were classified as primary failures. The most common reason was “lack of efficacy” (947/2656, 36%). Of the patients who stopped first-line TNFi, 43% (1111/2560) received second-line TNFi, which resulted in the shortest median time to stopping second-line treatment (11 months, 95% CI 9–12) compared with non-TNFi. The longest second-line median treatment duration after first-line TNFi was for patients receiving rituximab (39 months, 95% CI 27–74).Conclusion.A large proportion of patients who stopped first-line TNFi therapy received another TNFi despite evidence for longer treatment persistence on second-line b/tsDMARD with a different mode of action. Lack of efficacy was recorded as the most common reason for making a switch in first-line treatment of patients with RA.

An overview of some drugs: Lopinavir, Ritonavir, Chloroquine, Hydroxy chloroquine and Interferon as a effective treatment against COVID-19

2020 ◽  
Vol 10 (1) ◽  
pp. 20-24
Author(s):  
Sujaritha J ◽  
Deepa sankar N ◽  
Mathivathani K ◽  
Aravindh G ◽  
Gnanasekaran G
Keyword(s):  
Rheumatoid Arthritis ◽  
Plasmodium Falciparum ◽  
Drug Therapy ◽  
Hiv Infection ◽  
Effective Treatment ◽  
Protease Inhibitors ◽  
First Line ◽  
Duration Of Illness ◽  
Line Drug

Lopinavir, Ritonovir and Interferon (IFN) are anti-viral drugs mainly used in the treatment of HIV infection by protease inhibitors. Chloroquine and Hydroxychloroquine are used in the treatment of malarial causing infection such as Plasmodium falciparum and also auto immune condition such as rheumatoid arthritis. Chloroquine makes toxic for the parasite to digest its host hemoglobin and disrupting the virus ability to enter the cell. The anti-viral and anti-malarial drugs are used in the first line drug therapy for the treatment of COVID-19. The aim of this therapy is to minimize the symptoms and shortens the duration of illness.

Efficacy of targeted therapy (TT) after checkpoint inhibitors (CPI) in metastatic renal cell carcinoma (mRCC): Results from the Canadian Kidney Cancer Information System (CKCis).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 568-568 ◽  
Author(s):  
Austin Kalirai ◽  
Lori Wood ◽  
Aly-Khan A. Lalani ◽  
Daniel Yick Chin Heng ◽  
Sunita Ghosh ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Mammalian Target Of Rapamycin ◽  
Cancer Information ◽  
Second Line ◽  
First Line ◽  
The Third ◽  
Factor Inhibitor ◽  
On Line ◽  
Third Line ◽  
Line Of Therapy

568 Background: While the use of CPI has demonstrated clinical benefit in patients with mRCC, data showing the efficacy of subsequent TT is limited. This real-world analysis evaluated the efficacy of TT post CPI in mRCC patients. Methods: Data was collected and analyzed from CKCis. Patients with mRCC who received TT after CPI were identified and analyzed based on line of therapy. Time to treatment failure (TTF – time from starting first subsequent TT to stopping TT) and overall survival (OS) were calculated. Hazard Ratio (HR) calculations were adjusted for IMDC group and age. Results: 102 patients were treated with TT post CPI (table). Those who received first-line ipilimumab + nivolumab (I/N) versus a vascular endothelial growth factor inhibitor (VEGFi) + CPI combination prior to second-line TT had a median TTF of 8.0 vs 5.2 months (m) (HR=0.43, 95% CI: 0.13-1.44) and median OS of 16.5 m vs not reached (HR=0.76, 95% CI: 0.11-5.24). Patients who received a VEGFi versus a mammalian target of rapamycin inhibitor (mTORi) as third-line TT had a median TTF of 7.6 vs 4.4 m (HR=0.52, 95% CI: 0.24-1.10) and median OS of 21.7 vs 16.2 m (HR=0.41, 95% CI: 0.16-1.08). All third-line TT patients received first-line VEGFi and second-line nivolumab. Of the third-line VEGFi TT patients, 24 received axitinib (TTF 7.1 m, OS 21.7 m) and 22 received cabozantinib (data immature). Conclusions: Activity of TT in mRCC patients after CPI is demonstrated in multiple lines. In second-line, VEGFi TT had numerically better outcomes after I/N than after VEGFi+CPI combination. Efficacy of third-line TT was seen with a trend favoring VEGFi over mTORi. Axitinib in the third-line has notable activity after CPI, while data on cabozantinib and fourth-line TT are maturing. These results support the use of VEGFi after CPI in mRCC patients. [Table: see text]

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