ABSTRACT
Introduction and Objectives
Many patients in the favorable International Metastatic renal cell carcinoma (RCC)
Data Base Consortium group (F-MRC) may have a relatively indolent disease course.
Surveillance and delay of systemic therapy could be an option in this specific population.
However, the question whether this delay could alter patients’ outcome remains unanswered.
Our objective was to determine if delaying first-line treatment influences the survival
of F-MRC patients.
Materials and Methods
We performed a retrospective multicenter national study involving the French Network
for Research on Kidney Cancer UroCCR (NCT03293563). We included treatment naive F-MRC
patients. We compared the overall survival of patients with immediate medical treatment
(IMT) (started less than 3 months after metastatic diagnosis) to those with delayed
medical treatment (DMT).
Results
We included 90 patients treated between 2009 and 2018. The median time before occurrence
of metastases from diagnosis was 28 (12-137) months. The two groups (IMT vs. DMT)
were comparable for follow-up, age, sarcomatoid feature, number, and localization
of metastatic sites and ECOG performance status. IMT was given in 25 (27.8 %) patients.
Local treatment of metastasis (LTM) was performed in 47 (52%) patients. Patients with
DMT had more LTM (63% vs. 24%, P = .001). Among patients with DMT (n = 65); 27 (41%) received a systemic treatment
and median systemic treatment-free survival was 39 months (95% CI, 26.3-51.6). Median
overall survival from metastasis disease diagnosis was 55 months (95% CI, 42.4-67.5)
in the IMT group and 88 months (95%CI, 64-111.9) in the DMT group (P = .028). In multivariable analysis LTM was the only prognostic factor associated
to survival improvement (HR: 0.33; P = .024).
Conclusions
Selected Patients with F-MRC may safely undergo DMT. LTM positively impacted survival
in this population and should be considered whenever possible. Prospective trial with
a larger population is needed to confirm these results.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68 (nov): 394‑424
- 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 (1 déc): 5794‑9
- Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma.N Engl J Med. 2018; 378 (5 avr): 1277‑90
- Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma.N Engl J Med. 2021; 384 (4 mars): 829‑41
- Lenvatinib plus everolimus or pembrolizumab versus sunitinib in advanced renal cell carcinoma: study design and rationale.Future Oncol. 2019; 15 (mars): 929‑41
- Updated European association of urology guidelines on renal cell carcinoma: nivolumab plus cabozantinib joins immune checkpoint inhibition combination therapies for treatment-naïve metastatic clear-cell renal cell carcinoma.Eur Urol. 2021; 79 (mars): 339‑42
- Incidence and outcomes of delayed targeted therapy after cytoreductive nephrectomy for metastatic renal-cell carcinoma: a nationwide cancer registry study.Clin Genitourin Cancer. 2018; 16 (déc): e1221‑35
- Active surveillance of metastatic renal cell carcinoma: Results from a prospective observational study (MaRCC).Cancer. 2021; 127 (1 juill): 2204‑12
- Active surveillance in metastatic renal-cell carcinoma: a prospective, phase II trial.Lancet Oncol. 2016; 17 (sept): 1317‑24
- Survival outcomes and independent response assessment with nivolumab plus ipilimumab versus sunitinib in patients with advanced renal cell carcinoma: 42-month follow-up of a randomized phase III clinical trial.J Immunother Cancer. 2020; 8 (e000891)
- EAU guidelines on renal cell carcinoma: 2014 update.Eur Urol. 2015; 67 (mai): 913‑24
- First experience of active surveillance before systemic target therapy in patients with metastatic renal cell carcinoma.Urology. 2013; 82 (juill): 118‑23
- Active surveillance in metastatic renal cell carcinoma: results from the canadian kidney cancer information system.Clin Genitourin Cancer. 2021; 19 (déc): 521‑30
- Outcomes following complete surgical metastasectomy for patients with metastatic renal cell carcinoma: a systematic review and meta-analysis.J Urol. 2017; 197 (janv): 44‑9
- Metastasectomy in patients with renal cell carcinoma: when and how?.Curr Opin Urol. 2020; 30 (juill): 602‑9
- [French ccAFU guidelines - update 2020-2022: management of kidney cancer].Prog Urol. 2020; 30 (nov): S2‑51
- miR-9-5p in nephrectomy specimens is a potential predictor of primary resistance to first-line treatment with tyrosine kinase inhibitors in patients with metastatic renal cell carcinoma.Cancers (Basel). 2018; 10: 321
- Resistance to targeted therapy in renal-cell carcinoma.Lancet Oncol. 2009; 10 (oct): 992‑1000
- Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma.N Engl J Med. 2019; 380 (21 mars): 1116‑27
- Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma.N Engl J Med. 2019; 380 (21 mars): 1103‑15
- Quality-adjusted time without symptoms or toxicity analysis of pazopanib versus sunitinib in patients with renal cell carcinoma.Cancer. 2016; 122 (1 avr): 1108‑15
- Evaluation of clear cell, papillary, and chromophobe renal cell carcinoma metastasis sites and association with survival.JAMA Netw Open. 2021; 4 (4 janv)e2021869
Article info
Publication history
Published online: July 09, 2022
Accepted:
July 6,
2022
Received in revised form:
April 22,
2022
Received:
February 13,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
