Perhaps because there was no evidence demonstrating the efficacy of any particular anticancer medication in the adjuvant setting for RCC except for the recent approval of adjuvant sunitinib by the FDA in the US,[78] all CEA focused on patients with advanced or metastatic RCC. Several observations in our review of CEA studies warrant further discussion. local treatment. For metastatic RCC (mRCC), pazopanib was reported to be cost-effective in the 1st-line setting. We also found that the economic burden of RCC has increased over time. Conclusion: RCC continues to impose a substantial economic burden to the healthcare system. Despite the large number of treatment alternatives now available for advanced RCC, the cost-effectiveness and budgetary impact of many new PIK-III agents remain unknown and warrant greater attention in future research. INTRODUCTION Kidney cancer is among the top 10 10 cancers for both men and women in the United States (US), accounting for approximately 4% of new cancer cases estimated in 2018.[1, 2] Globally, the PIK-III estimated incidence of kidney cancer from GLOBOCAN was 337,860 in 2012.[3] In Rabbit Polyclonal to C56D2 the US alone, it was estimated that 65,340 new cases of kidney cancer would be diagnosed and 14,970 Americans would die from kidney cancer in 2018.[1, 2] The average age of kidney cancer patients in the US is 64 years old.[4] Overall, men are twice as likely to be diagnosed with kidney cancer as women.[1] Risk factors known to be strongly associated with kidney cancer include obesity and tobacco use; other risk factors are high blood pressure, chronic renal failure, and environmental exposure to chemicals like trichloroethylene.[1] Of the various subtypes of kidney cancer, renal cell carcinoma (RCC) is the predominant form, accounting for 80% – 85% of all kidney cancers.[4] The majority (~65%) of kidney cancers are diagnosed at localized stage, with regional or distant stage each accounting for approximately 16% of the diagnosed cases.[2] The 5-year survival rate for patients with stage I RCC is over 90%; however, the recurrence rate is close to 40% for patients with stage II/III RCC.[4] For localized RCC, radical nephrectomy (RN) performed as open surgery was the standard of care in the past.[5] As medical technology advances, micro-invasive techniques such as laparoscopic procedures, with or without robotic-assistance, are becoming increasingly common in the surgical treatment of RCC.[5] At the same time, more small or indolent renal cell tumors have been detected as incidental findings while patients underwent imaging for PIK-III other diseases. For these tumors, concerns have been voiced regarding whether treatment with PIK-III RN or even partial nephrectomy (PN) may be too invasive and that active surveillance or ablation should be considered as viable alternatives.[5] The role of adjuvant treatment for RCC remains unclear and is currently under active clinical investigation.[6] For advanced or metastatic RCC (mRCC), PIK-III systemic treatment is the standard of care, with a subset of patients also benefiting from nephrectomy.[6] Prognostic models have been used to guide treatment selection for patients with RCC.[4, 6] Patients with mRCC have benefited considerably from scientific advances in cancer drug discoveries. As of May 19, 2016, 12 anticancer medications have been approved for the treatment of RCC by the Food and Drug Administration (FDA) in the United States.[7] These drugs include immunotherapy (e.g., high-dose interleukin-2 or checkpoint inhibitors such as nivolumab and ipilimumab), and targeted therapy. Compared to other cancers, a relatively large number of targeted therapy agents, both in oral and infused formulation, are indicated for RCC, including tyrosine kinase inhibitors (TKIs) (e.g., sunitinib, sorafenib, pazopanib, axitinib, cabozantinib, and lenvatinib), anti-vascular endothelial growth factor (anti-VEGF) agents (e.g., bevacizumab) and mammalian target of rapamycin (mTOR) inhibitors (e.g., temsirolimus and everolimus). A two-part article on the economic burden of RCC was published in PharmacoEconomics in 2011, including a comprehensive review (Part I)[8] and an analysis of databases in the US.[9] This 2011 review article covered studies published between 1 January 2000 and 15 June 2010 and reported substantial economic burden of RCC, with estimated annual costs ranging from $0.6 billion to $5.2 billion (2009 US dollars) in the US.[8] Given the technological advances in oncology in the past 10 years, the high price tag typically associated with new medical technologies, and the influx of new oncologic technologies to the treatment of RCC, the economic burden of RCC is likely to be considerably higher today. The objective of this study is to conduct a comprehensive review of economic studies related to the treatment of RCC for studies published after June 2010 as an update to the review article published in 2011.[8] The.