{ "abstract": "Background\n\nRenal Cell Carcinoma (RCC) represents a growing global health burden, with rising incidence and mortality worldwide. Despite major therapeutic advances, access to novel systemic treatments remains uneven across countries and regions.Methods\n\nWe conducted a cross-sectional, web-based international survey to assess the availability and reimbursement status of 20 innovative systemic therapies for RCC. Responses were collected from 144 clinicians, including medical oncologists, radiation oncologists, urologists, and nuclear medicine specialists, across 58 countries. Analyses examined associations between national income level, gross domestic product (GDP), and treatment availability.Findings\n\nThirty-six percent of the countries analyzed had at least 15 of the 20 therapies available. Full reimbursement for at least 15 of the selected innovative therapies was reported in six countries (10%), while 21 countries (36%) fully reimbursed 10-14 therapies and 13 countries (23%) reimbursed 1-9 therapies. In contrast, no full reimbursement for any of the assessed therapies was reported in 18 countries (31%). Higher national income level was significantly associated with greater availability of innovative therapies (Kruskal-Wallis test, P < .0001). Armenia (0.709), Greece (0.685), and Israel (0.666) exhibited the highest GDP-adjusted Drug Availability Index (DAI), whereas India (5.195), Nigeria (4.612), and Morocco (3.794) demonstrated the greatest number of available therapies per US$1000 of GDP per capita.Interpretation\n\nAccess to innovative systemic therapies for RCC remains highly unequal at the global level, with reimbursement posing a major barrier even where drugs are available. Internationally coordinated efforts addressing health policy, infrastructure, and equitable pricing are urgently required to ensure that advances in RCC treatment translate into improved outcomes for patients across diverse economic settings.", "abstract_shown": true, "affiliations": [ "Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara 06620, Türkiye.", "Cancer Research Institute, Ankara University, Ankara, Turkiye.", "Department of Pharmacology & Therapeutics, College of Medicine & Health Sciences, Arabian Gulf University, Kingdom of Bahrain.", "Department of Obstetrics-Radiotherapy, Alexandru Trestioreanu Institute of Oncology, \"Carol Davila\" University of Medicine and Pharmacy, Bucharest, Romania.", "Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.", "Department of Clinical Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia.", "Department of Medical Oncology, Bahrain Oncology Center, Muharraq, Bahrain.", "Department of Urology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.", "Department of Urology, University Hospital Frankfurt, Goethe University, Frankfurt, Frankfurt am Main, Germany.", "Urologic Oncology, Champalimaud Clinical Center, Lisbon 1400-038, Portugal.", "Department of Medical Oncology, Koç University School of Medicine, Istanbul, Turkey.", "Oncocentro Ceará (Rede D'Or), Fortaleza, Brazil.", "Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.", "Section of Medical Oncology, Department of Internal Medicine, Corazon Locsin Montelibano Memorial Regional Hospital, Bacolod 6100, Philippines.", "Department of Clinical Sciences, College of Medicine, University of St. La Salle, Bacolod 6100, Philippines.", "Faculty of Medicine, University of Basel, Basel, Switzerland.", "Department of Oncology, St. Claraspital, Basel, Switzerland.", "St. Clara Research, Basel, Switzerland.", "International University of Health and Welfare Hospital, 852 Hatakeda, Narita-shi, Chiba 286-8520, Japan.", "Finnish Medicines Agency, Tampere, Finland.", "Oncologia D'OR, Salvador, Brazil.", "Jiangsu Key Laboratory of New Drug Screening & Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing 210009, China.", "Latin American Cooperative Oncology Group-LACOG, Porto Alegre, Brazil.", "Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.", "Department of Radiation Oncology and Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia.", "Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu 632004, India.", "Centro Oncológico do Triângulo, Uberlândia, Brazil.", "Department of Nephrology, King Hamad American Mission Hospital, Kingdom of Bahrain.", "Department of Medical Oncology, Cliniques Universitaires Saint Luc, Brussel, Belgium.", "Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.", "ANIMI-Unidad de Tratamento Oncológico, Lages, SC, Brazil.", "Division of Medical Oncology, Department of Internal Medicine, University of Kansas Cancer Center, Westwood, KS, United States.", "Department of Medical Oncology, AORN \"A. Cardarelli,\"Naples, Italy.", "Immune Oncology Research Institute, 7 Nersisyan, Yerevan 0014, Armenia.", "Yeolyan Hematology and Oncology Center, Yerevan, Armenia.", "Yerevan State Medical University, Yerevan, Armenia.", "Medical Oncology Service, Bradford Hill, Santiago de Chile, Chile.", "Department of Oncology, Gyumri Medical Center, Gyumri, Armenia.", "Department of Health Sciences, University of Florence, Florence, Italy.", "Hospital del Mar Research Institute, Barcelona, Spain." ], "article_type": "research article", "arxiv": null, "author_total": 142, "authors": [ { "affs": [ 0, 1 ], "name": "Yuksel Urun", "orcid": "0000-0002-9152-9887" }, { "affs": [ 2 ], "name": "Kannan Sridharan" }, { "affs": [ 3 ], "name": "Anca Zgura", "orcid": "0000-0002-2370-5762" }, { "affs": [ 4 ], "name": "Anas Zayed" }, { "affs": [ 5 ], "name": "Martin Ignacio Zapata Laguado" }, { "affs": [ 6 ], "name": "Tarkan Yetisyigit", "orcid": "0000-0002-4622-4742" }, { "affs": [ 7 ], "name": "Akihiro Yano" }, { "affs": [ 8 ], "name": "Mike Wenzel", "orcid": "0000-0002-4338-0889" }, { "affs": [ 9 ], "name": "Nuno Vau" }, { "affs": [ 10 ], "name": "Deniz Tural" }, { "affs": [ 11 ], "name": "Karine Trindade", "orcid": "0009-0006-4947-0304" }, { "affs": [ 12 ], "name": "Ben Tran" }, { "affs": [ 13, 14 ], "name": "Frederic Ivan Leong Ting", "orcid": "0000-0002-9161-4918" }, { "affs": [ 15, 16, 17 ], "name": "Arnoud J Templeton" }, { "affs": [ 18 ], "name": "Hideki Takeshita", "orcid": "0000-0002-1512-6904" }, { "affs": [ 19 ], "name": "Kaisa Sunela" }, { "affs": [ 20 ], "name": "Vinicius Carrera Souza", "orcid": "0000-0003-3216-7713" }, { "affs": [ 21 ], "name": "Mopa Alina Sooro" }, { "affs": [ 22, 23 ], "name": "Andrey Soares" }, { "affs": [ 24 ], "name": "Shankar Siva", "orcid": "0000-0003-2840-0658" }, { "affs": [ 25 ], "name": "Ashish Singh" }, { "affs": [ 26 ], "name": "Glauco Silveira" }, { "affs": [ 27 ], "name": "Shamik Shah" }, { "affs": [ 28 ], "name": "Emmanuel Seront" }, { "affs": [ 22, 29 ], "name": "Fabio A Schutz", "orcid": "0009-0000-6464-5391" }, { "affs": [ 30 ], "name": "Maitê de Liz Vassen Schurmann" }, { "affs": [ 31 ], "name": "Timothy Schieber", "orcid": "0000-0002-2016-7508" }, { "affs": [ 32 ], "name": "Sarah Scagliarini" }, { "affs": [ 33, 34, 35 ], "name": "Amalya Sargsyan" }, { "affs": [ 36 ], "name": "Carlos Salinas Simonetti", "orcid": "0000-0001-6607-3008" }, { "affs": [ 34, 37 ], "name": "Marine Rushanyan" }, { "affs": [ 38 ], "name": "Giandomenico Roviello", "orcid": "0000-0001-5504-8237" }, { "affs": [ 39 ], "name": "Alejo Rodriguez-Vida" }, { "name": "Orion Erenhu Rodriguez Gonzalez", "orcid": "0000-0002-6909-7010" }, { "name": "Robin Roberts" }, { "name": "Astrid A M Van der Veldt", "orcid": "0000-0003-0446-1907" }, { "name": "Mimma Rizzo" }, { "name": "Alessandro Rizzo", "orcid": "0000-0002-5257-8678" }, { "name": "Alexandr Poprach" }, { "name": "Alina Pirshtuk" }, { "name": "Alvaro Pinto" }, { "name": "Erin Pierce" }, { "name": "Jose Mauricio Peñaloza", "orcid": "0009-0006-0551-9452" }, { "name": "Martino Pedrani" }, { "name": "Se Hoon Park", "orcid": "0000-0001-5084-9326" }, { "name": "Ibukun Adewumi Okunade", "orcid": "0009-0003-0252-5564" }, { "name": "Karen Flora Odounga" }, { "name": "Julio Noriega" }, { "name": "Edriss Noorzai" }, { "name": "Maria Tereza Nieto Coronel", "orcid": "0000-0002-5606-6434" }, { "name": "Jiri Navratil" }, { "name": "Zin W Myint" }, { "name": "Vladan Mutavdzic" }, { "name": "Olivier Mukuku", "orcid": "0000-0001-6902-7023" }, { "name": "Robert Mugarura" }, { "affs": [ 22 ], "name": "Fernando Sabino Marques Monteiro" }, { "name": "Abdikarim Hussein Mohamed" }, { "name": "Daniel Mmereki" }, { "name": "Carlo Messina" }, { "name": "Bohuslav Melichar" } ], "bibtex": "https://research.draconitic.com/paper/bs6fgfnnns2ge.bib", "cited_by": 0, "doi": "10.1093/oncolo/oyag397", "fulltext_url": "https://europepmc.org/articles/PMC13674546", "id": "bs6fgfnnns2ge", "issns": [ "1083-7159", "1549-490X" ], "landing_url": "https://europepmc.org/article/MED/42836687", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2002|Pharmaceutical Economics and Policy" ] ], "openalex": "W7220660375", "pdf_url": "https://europepmc.org/articles/PMC13674546?pdf=render", "pmcid": "PMC13674546", "pmid": "42836687", "published": "2026-10-01", "publisher": null, "ris": "https://research.draconitic.com/paper/bs6fgfnnns2ge.ris", "sources": [ { "first_seen": "2026-10-30T12:18:10Z", "native_id": "MED:42836687", "source": "europepmc", "url": "https://europepmc.org/article/MED/42836687" } ], "subjects": [ { "field": "medicine", "origin": "journal-openalex:F27", "subfield": "general" } ], "title": "Global disparities in the availability and reimbursement of systemic therapies for renal cell carcinoma: results of the International ARON-AID Survey.", "title_text": "Global disparities in the availability and reimbursement of systemic therapies for renal cell carcinoma: results of the International ARON-AID Survey.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:18:10Z", "url": "https://research.draconitic.com/paper/bs6fgfnnns2ge", "venue": "The oncologist", "versions": [] }