Application of the American society of clinical oncology frameworks to compare tyrosine kinase inhibitors used in first line treatment of metastatic renal cell carcinoma: had we solved the mystery?

INTRODUCTION: The approval of multiple biological therapies as a first line treatment for metastatic renal cell carcinoma (mRCC) in the last decade have made the selection of the best treatment between these drugs, especially tyrosine kinase inhibitors (TKIs), a great challenge to oncologists and patients. The four TKIs recommended by the National Comprehensive Cancer Network guidelines in this setting have a relatively similar mechanism of action and analogical adverse events. Areas covered: In this article, the two published American Society of Clinical Oncology frameworks are applied to calculate the net health benefits of the four TKIs used as the first line in mRCC and this was balanced against their monthly cost. The available clinical data that is present for each drug has been displayed and compared to the use of the ASCO frameworks. Expert commentary: There is an urgent need to develop a comprehensive model incorporating all relevant aspects of each drug together. Oncologists should consider all data available for the drugs in order to give the patients an informed opportunity to select the best drug fitting for them.