Patient reported outcomes on treatment related side effects with combination therapy in metastatic renal cell carcinoma (RCC).
Authors: Battle Dena , Vaishampayan Ulka N. , Griffith Meghan , Pal Sumanta Kumar , Zhang Tian , Msaouel Pavlos , Staehler Michael D. 
Published: June 2024

e16540

Background: Combination treatments have transformed the landscape for metastatic renal cell carcinoma (mRCC). In the context of life-long therapy, effective management of treatment related toxicities is crucial to maximizing outcomes. Outside of trials, little is known about patient experiences with side-effects. We sought to assess patient experiences with combination therapy in the real-world setting. Methods: The survey was developed by the Kidney Cancer Research Alliance (KCCure) and was broadcast between 07/2022 and 09/2022 to pts via website, mailing lists and social media platforms. Those who agreed to participate were surveyed for demographics (age, gender, race, income, country) and clinical characteristics (date of the diagnosis, disease stage, treatment history). Results: 399 out of 1,062 pts responding had metastatic disease with a median age of 57 years. 245 patients had received treatment with combination therapy, 51% (126) were treated with combination IO/IO and 49% (119) were treated with combination IO/TKI. The IO/TKI breakdown were as follows: 44% (52) pembro/axi, 35% (42) cabo/nivo, 16% (19) len/pembro, and 5% (6) cabo/ipi/nivo. Among patients being treated with combination IO/IO, the most poorly managed side-effect was loss of appetite (16%), fatigue (15%) and taste alteration (11%). Patients treated with combination IO/TKI reported higher rates of daily, poorly managed side-effects, with the most bothersome being fatigue (26%), loss of appetite (15%), taste alteration (16%) and pain (11%). 63% of patients being treated with IO/TKI combinations reported dose reductions for their oral treatment. 42% of pts expressed worry that their dose reduction would reduce efficacy. Only 16% of patients proactively asked for a dose reduction. When asked if they had been prescribed additional drugs to manage their side effects, among patients being treated on IO/IO, only 10% said no. 56% of pts received steroids, 45% were prescribed anti-nausea drugs, 32% needed hormone substitute treatment, and 28% got anti-diarrheal drugs. Among pts being treated with IO/TKI, only 7% of pts reported they did not need additional drugs to manage side-effects. Most prescribed drugs were anti-nausea (56%), anti-diarrheal (45%), steroids (44%), and hormone substitute (34%). Conclusions: 90% of pts require additional medications to manage AEs. Patients being treated with combination IO/TKI regimens report higher rates of bothersome, daily side effects compared to patients being treated on IO/IO. Loss of appetite and taste alteration are side-effects that are rarely reported or discussed in the context of clinical trials. This survey indicates these toxicities may warrant closer attention. With prolonged duration of therapies in RCC and the majority of patients being affected by toxicities, judicious management is likely to make a meaningful impact on patients daily lives.