{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T22:09:38Z","timestamp":1767650978864,"version":"3.40.5"},"reference-count":28,"publisher":"Wiley","issue":"15","license":[{"start":{"date-parts":[[2019,9,19]],"date-time":"2019-09-19T00:00:00Z","timestamp":1568851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The objective of this study is to describe the use of targeted therapies for the treatment of advanced renal cell carcinoma (RCC) and overall survival (OS) among patients in clinical practice in the Veterans Health Administration (VHA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort of 286 patients from 24 VHA Medical Centers diagnosed with advanced clear cell RCC between Fiscal Year (FY) 2010 and FY2014 was followed through September 30, 2016. Among patients who received targeted therapy, we described the medications taken, duration of therapy, and overall survival. We also assessed the effect of the first therapy received on overall survival using Cox Proportional Hazards models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 66 patients who did not receive therapy for their advanced RCC. Of the 220 treated patients, the mean (sd) number of medications received was 1.9 (1.1). The medications most commonly used first were sunitinib (61.8%), pazopanib (17.3%), and temsirolimus (10.9%). The median duration of first\u2010line therapy was 86\u00a0days (interquartile range [IQR] 42, 210). Median total duration of therapy was 159\u00a0days (IQR 58, 397). 62.3% of patients had\u00a0\u2265\u00a01 dose of therapy held or reduced, mainly due to an adverse drug event (ADE). Median survival from the start of treatment to death was 1.08\u00a0years (IQR 0.80, 1.31). Finally, receipt of temsirolimus vs sunitinib (HR 1.95 [95%CI 1.09,3.47]) as the first targeted therapy was independently associated with an increased hazard of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our analysis of targeted therapies for advanced RCC in VHA suggests duration of treatment is shorter in a real\u2010world setting than in clinical trials, and dose reductions and ADEs are more common.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.2531","type":"journal-article","created":{"date-parts":[[2019,9,19]],"date-time":"2019-09-19T20:09:30Z","timestamp":1568923770000},"page":"6651-6661","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Use of targeted therapies for advanced renal cell carcinoma in the Veterans Health Administration"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1342-6938","authenticated-orcid":false,"given":"Sherrie L.","family":"Aspinall","sequence":"first","affiliation":[{"name":"VA Pharmacy Benefits Management Services Hines IL"},{"name":"VA Center for Health Equity Research and Promotion VA Pittsburgh Healthcare System Pittsburgh PA"},{"name":"School of Pharmacy University of Pittsburgh Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinhua","family":"Zhao","sequence":"additional","affiliation":[{"name":"VA Center for Health Equity Research and Promotion VA Pittsburgh Healthcare System Pittsburgh PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark C.","family":"Geraci","sequence":"additional","affiliation":[{"name":"VA Pharmacy Benefits Management Services Hines IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chester B.","family":"Good","sequence":"additional","affiliation":[{"name":"VA Pharmacy Benefits Management Services Hines IL"},{"name":"VA Center for Health Equity Research and Promotion VA Pittsburgh Healthcare 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