Active surveillance (AS) is a commonly used strategy in patients with slow-growing disease. We aimed to assess the outcomes and safety of AS in patients with metastatic renal cell carcinoma (mRCC).
Patients and Methods
We used the Canadian Kidney Cancer information system (CKCis) to identify patients with mRCC diagnosed between January 1, 2011, and December 31, 2016. The AS strategy was defined as (1) the start of systemic therapy ≥ 6 months after diagnosis of mRCC, or (2) never receiving systemic therapy for mRCC with an overall survival (OS) of ≥1 year. Patients starting systemic treatment <6 months after diagnosis of mRCC were defined as receiving immediate systemic treatment. OS and time until first-line treatment failure (TTF) were compared between the two cohorts.
A total of 853 patients met the criteria for AS (cohort A). Of these, 364 started treatment >6 months after their initial diagnosis (cohort A1) and 489 never started systemic therapy (cohort A2); 827 patients received immediate systemic treatment (cohort B). The 5-year OS probability was significantly greater for cohort A than for cohort B (70% vs. 33.6%; P < .0001). After adjusting for International Metastatic RCC Database Consortium risk criteria and age, both OS (hazard ratio [HR] = 0.58; 95% confidence interval [CI], 0.47-0.70; P < .0001) and TTF (HR = 0.72; 95% CI, 0.60-0.85; P = .0002) were greater in cohort A1 compared with B. For cohort A1, the median time on AS was 14.2 months (range, 6-71).
Based on the largest analysis of AS in mRCC to date, our data suggest that a subset of patients may be safely observed without immediate initiation of systemic therapy.
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- Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma.J Clin Oncol. 2009; 27: 3584-3590
- Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma.N Engl J Med. 2018; 378: 1277-1290
- Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma.N Engl J Med. 2019; 380: 1116-1127
- A cost-effectiveness analysis of nivolumab and ipilimumab versus sunitinib in first-line intermediate- to poor-risk advanced renal cell carcinoma.Oncologist. 2019; 24: 366-371
- Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study.J Clin Oncol. 2009; 27: 5794-5799
- First experience of active surveillance before systemic target therapy in patients with metastatic renal cell carcinoma.Urology. 2013; 82: 118-123
- Active surveillance for metastatic or recurrent renal cell carcinoma.J Cancer Res Clin Oncol. 2014; 140: 1421-1428
- Deferred systemic therapy in patients with metastatic renal cell carcinoma.Clin Genitourin Cancer. 2015; 13: e159-e166
- Predictive role of changes in the tumor burden and International Metastatic Renal Cell Carcinoma Database Consortium class during active surveillance for metastatic renal cell carcinoma.Urol Oncol. 2018; 36: 526.e13
- Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial.Lancet Oncol. 2016; 17: 1317-1324
- Determining generalizability of the Canadian Kidney Cancer information system (CKCis) to the entire Canadian kidney cancer population: generalizability of CKCis to the entire Canadian RCC population.Can Urol Assoc J. 2020; 14: E499-E506
- Real-world treatment patterns and costs for patients with renal cell carcinoma initiating treatment with sunitinib and pazopanib.J Manag Care Spec Pharm. 2016; 22: 979-990
- Cost-effectiveness analysis of pembrolizumab plus axitinib versus sunitinib in first-line advanced renal cell carcinoma in China.Clin Drug Investig. 2019; 39: 931-938
- Surgical metastasectomy in renal cell carcinoma: a systematic review.Eur Urol Oncol. 2019; 2: 141-149
- Outcomes of complete metastasectomy in metastatic renal cell carcinoma patients: the Canadian Kidney Cancer information system experience.Urol Oncol. 2020; 38: 799.e1-799.e10
- Safety and efficacy of stereotactic ablative radiation therapy for renal cell carcinoma extracranial metastases.Int J Radiat Oncol. 2017; 98: 91-100
- Comparison of stereotactic body radiotherapy versus metastasectomy outcomes in patients with pulmonary metastases: SBRT vs. metastasectomy for PM.Thorac Cancer. 2018; 9: 1671-1679
- Role of stereotactic body radiation therapy for the management of oligometastatic renal cell carcinoma.J Urol. 2019; 201: 70-76
- Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer.N Engl J Med. 2001; 345: 1655-1659
- Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial.Lancet. 2001; 358: 966-970
- Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma.N Engl J Med. 2018; 379: 417-427
- Comparison of immediate vs deferred cytoreductive nephrectomy in patients with synchronous metastatic renal cell carcinoma receiving sunitinib: the SURTIME randomized clinical trial.JAMA Oncol. 2019; 5: 164-170
- Cytoreductive nephrectomy in the current treatment algorithm.Ther Adv Med Oncol. 2019; 11175883591987902
- Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2019; 30: 706-720
- Management of advanced kidney cancer: Kidney Cancer Research Network of Canada (KCRNC) consensus update 2019.Can Urol Assoc J. 2019; 13: 343-354
Published online: May 15, 2021
Accepted: May 3, 2021
Received in revised form: April 23, 2021
Received: January 22, 2021
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