Real-World Treatment Patterns of Axitinib for Advanced Renal-Cell Carcinoma

Laura Morgan

May 2015, Vol 6, No 4 - Economics of Cancer Care


San Diego, CA—Approved in 2012 by the FDA, axitinib (Inlyta) is indicated for the treatment of patients with advanced renal-cell carcinoma (RCC) whose disease had failed 1 previous systemic therapy. The approval of axitinib was based on the safety and efficacy data from clinical trials, which are often limited in their patient population and short-term analysis.

Therefore, Elizabeth MacLean, PhD, Pfizer Global Health and Value, New York, NY, and colleagues sought to assess real-world patient experience with axitinib to help optimize therapy for patients with advanced RCC. The study was presented at the 2015 Academy of Managed Care Pharmacy annual meeting.

In this retrospective, observational study, researchers analyzed data from 1175 patients with advanced RCC who received axitinib as subsequent therapy.

The patient data from 22 specialty pharmacies were matched with patient data from longitudinal medical and pharmacy databases (between April 2009 and February 2014). The researchers focused their assessment on the duration of axitinib therapy, dose modifications of axitinib, and axitinib-­related patient out-of-pocket costs.

Overall, 56% of patients received ­axitinib as second-line therapy, 28% as third-line therapy, and 16% as fourth-line or later therapy. The 3 most common therapies that patients received before starting axitinib included sunitinib (Sutent; 38%), everolimus (Afinitor; 22%), and pazopanib (Votrient; 21%).

The mean duration of second- and third-line axitinib therapy was 172.3 days and 169.2 days, respectively. The researchers identified various patient characteristics that affected the duration of subsequent axitinib therapy, including sex, location, baseline hypothyroidism treatment, and previous therapy for RCC.

Longer treatment duration was reported in male patients versus female patients, patients in the Northeast versus the Midwest or the West, and patients with treatment for baseline hypothyroidism. Previous treatment with bevacizumab (Avastin) and temsirolimus (Torisel) was associated with shorter treatment duration compared with previous sunitinib therapy.

Of the patients who started subsequent therapy with axitinib, 87% received the standard 5-mg dose, and of these patients, 70% did not undergo dose adjustment. Conversely, 14% of patients decreased the axitinib dose, 10% increased the ­axitinib dose, and 6% increased then decreased the dose of axitinib.

The copayments for axitinib therapy ranged from $0 to $85 for 52% of the patients, and the mean copay was $294 for all patients: $153 for patients with commercial insuranc0e, $699 for patients with Medicare, and $16 for patients with Medicaid.

“Results from this analysis provide in­sight into routine clinical use of axitinib as subsequent RCC therapy in the United States in the period following FDA approval, and allows for comparison of axitinib dosing patterns in the real-world versus in a clinical trial setting,” the researchers said.