Real-world treatment patterns and clinical outcomes among patients with metastatic renal cell carcinoma post immune-oncology and vascular endothelial growth factor receptor targeted therapies: A multicenter community oncology-based study

• The study provides one of the most comprehensive real-world evaluations of treatment patterns and outcomes in patients with metastatic renal cell carcinoma after receiving IO and TKI therapies. • TKI-based therapies were the most common, with a subset of patients also receiving a combination of IO+TKI treatments. • Overall, the efficacy findings from our real-world studies were similar to clinical trials, and no clinically meaningful differences in outcomes among various treatment options were observed. • The findings underscore the ongoing need for innovative therapies with novel mechanisms of action for mRCC patients in the post-IO and TKI treatment landscape. First-line immune-oncology (IO) agents and VEGF-targeted tyrosine kinase inhibitors (TKIs) for metastatic renal cell carcinoma (mRCC) have complicated subsequent treatment decisions. This study describes real-world treatment patterns and clinical outcomes of mRCC patients in post-IO and TKI space in community oncology settings. This retrospective cohort study utilized the iKnowMed electronic health record database to identify adult mRCC patients who received a subsequent line of therapy (LOT; index date) post-IO and TKI in combination or sequence between January 2018 and March 2023. Patients were followed from the index date until June 2023. Outcomes included time on treatment (ToT), Time to next treatment (TTNT), and overall survival (OS). A multivariate Cox proportional hazards regression model was used to evaluate the associations between index regimens and outcomes. The Study included 820 mRCC patients who received anticancer treatment post-IO and TKI therapies (median IQR age, 66 58, 72 years; 72.6% male; 74.5% had an intermediate/poor IMDC risk score). Overall, 253 (30.9%) received index treatment in LOT2, 509 (62.1%) in LOT3, and 58 (7.1%) in LOT4+. Common treatments post-IO and TKI settings were cabozantinib (35.6%) and everolimus plus lenvatinib (9.5%). Median ToT for LOT2 was 2.5 months, LOT3 was 3.5 months, and LOT4 was 6.2 months. Median TTNT for LOT2, LOT3, and LOT4 were 6.4, 7.7, and 11.5 months, respectively. Median OS for LOT2, LOT3, and LOT4 were 18.0, 17.8, and 28.6 months, respectively. This large cohort study presents one of the most comprehensive analyses of treatment patterns and clinical outcomes among patients with mRCC in the post-IO and TKI settings. TKI, with or without IO-based treatments, was the most preferred treatment and associated with improved survival. Novel therapies are needed in this patient population to improve long-term outcomes.