Outcomes in Renal Cell Carcinoma with Brain Metastases

In patients with metastatic renal cell carcinoma (mRCC), there is an association between brain metastases and poor prognosis. I. Alex Brown, MD, and colleagues at the University of Texas Southwestern Medical Center, have previously reported improved outcomes for RCC patients with brain metastases prior to or during first line therapy among patients treated with modern systemic and local therapies. Outcomes in all mRCC patients regardless of the timing of the diagnosis of brain metastases were reported in conjunction with the ASCO 2019 Annual Meeting.

The researchers complied a retrospective database of mRCC patients treated at the center between 2006 and 2015. Patients with brain metastases were identified. The Kaplan-Meier method was used to analyze overall survival from the diagnosis of metastatic RCC, according to brain metastases status and by International Metastatic RCC Database Consortium (IMDC) risk group.

A total of 271 patients were identified; of those, 29.2 (n=79) were diagnosed with brain metastases. With the exception of clear-cell histology, which was more common among patients with brain metastases (94.2% vs 81.0%; P=.01), patient characteristics were similar between those with and those without brain metastases.

Brain metastases were diagnosed prior to systemic therapy (44.3%), or following one or more lines of therapy (one 26.6%, two 13.9%, three 5.1%, four 6.3%, five 3.8%). Among the patients with brain metastases, 68.4%v (n-54) received local therapy with stereotactic radiosurgery (SRS) and/or surgical resection, 17.7% (n=14) received whole brain radiation therapy along, and 13.9% (n=11) had no central nervous system (CNS)-directed treatment. Local therapy consisted of SRS in 54.4% (n=43) and surgical resection in 22.8% (n=18); some patients received both.

There was no significant difference in medial overall survival from metastatic diagnosis for those with brain metastases compared with those without brain metastases (26.4 months vs 27.8 months; P=.305). When analyzed according to IMDC risk factors, the results were similar.

“Overall survival from the diagnosis of metastatic RCC did not significantly differ with or without brain metastases in a cohort treated with modern systemic and CNS-directed therapies regardless of the timing of brain metastases diagnosis or presence of IMDC risk factors,” the researchers said.

Source: Bowman IA, Christie A, Le TC, Bent A, Brugarolas J. Overall survival with or without brain metastases from diagnosis of metastatic renal cell carcinoma. Abstract presented in conjunction with the American Society of Clinical Oncology 2019 Annual Meeting, May 31-June 4, 2019, Chicago, Illinois.