Differences in patient characteristics, treatment patterns, and clinical outcomes of renal cell carcinoma patients in public vs private health care systems in Brazil: Insights from the LACOG 1120 registry.

Abstract

4552 Background: Brazil's dual healthcare system presents unique challenges in addressing disparities in cancer care. Understanding the differences in clinical characteristics, treatment patterns, and clinical outcomes of renal cell carcinoma (RCC) patients (pts) between public and private health systems is crucial for optimizing care. Methods: LACOG 1120 Registry collected data from 230 eligible RCC pts across Brazil from Sep. 2022 to Nov. 2023. Patient demographics, tumor characteristics, treatment information, and clinical outcomes were analyzed and stratified by healthcare system (public vs. private). Descriptive statistics and survival analyses were performed using Kaplan-Meier methods. Results: 230 pts were included. Median age at diagnosis was 61.0 (52.0–67.0), 65.2% were male, 58.7% white, 26.1% of mixed skin color and 4.3% black. 61.3% were treated in the public system, and 36.5% in the private system. Pts in the public system were more likely to present with advanced disease (stage IV: 25.5% vs. 17.9%) and had a lower proportion of early-stage disease (stage I: 20.6% vs. 33.3%) compared to the private system. Out of 230, 11 (4.8%) received adjuvant treatment, 3 (2.1%) from the public 8 (9.5%) from the private system. Pts from the public system predominantly received adjuvant sunitinib (66.7%) whereas all the 8 pts from the private systems received adjuvant immune checkpoint inhibitor (ICI) (87.5% pembrolizumab, 12.5% nivolumab). First-line treatment for metastatic RCC was given to 34.0% of public and 53.6% of private system pts. Public pts mainly received sunitinib (47.9%) or pazopanib (31.3%), while private pts predominantly received ICIs (42.2%) or ICI-Tyrosine kinase inhibitors (TKI) combos (26.6%). Treatment discontinuation due to toxicity was higher in the public system (40.9% vs. 36.4%). 20.0% and 31.7% of pts were classified as favorable risk in the public and private systems respectively according to IMDC risk criteria. At median follow-up of 41.7 months (95%CI 27.6 - 48.8), median overall survival (OS) from diagnosis was 79.4 months (95% 66.0 - NR). The 5-year (yr) median OS rate differed between systems, 89.6% (95%CI 70.1-90.6) in private and 42.0% (95%IC 31.1-56.7) in public. When stratified by clinical stage (CS), the 2-yr OS for pts with CS I-III was 87% in the public and 96.8% in the private system. For pts with CS IV, the 2-yr OS was 23.8% in the public compared to 60.0% in the private system. Conclusions: Significant disparities exist between RCC pts treated in Brazil's public and private health systems, with public system pts presenting with more advanced disease, with restricted access to novel therapies, and experiencing worse clinical outcomes. These findings underscore the urgent need for health policy reforms to address inequities in cancer care access and treatment in Brazil.