Victoria Socha

DocwireNews

In patients with renal cell carcinoma (RCC) with low tumor burden or slow growing disease, active surveillance is a common strategy. However, there are few available data on the use of active surveillance versus immediate treatment for the management of patients with metastatic RCC (mRCC). <a href="https://www.ottawacancer.ca/">Igal Kushnir, MD</a>, and colleagues in Canada conducted an analysis designed to examine the outcomes and safety of active surveillance compared with immediate systemic treatment for patients with mRCC.Results were reported during a poster session at the ASCO 2019 Annual Meeting. The poster was titled Active Surveillance in Metastatic Renal Cell Carcinoma (mRCC): Results from the Canadian Kidney Center Information System (CKCis).Utilizing data from the CKCis, the researchers identified patients with mRCC between January 2, 2011, and December 31, 2016. A strategy of <a href="https://www.docwirenews.com/conference-coverage/2019-hopa/updates-renal-cell-carcinoma/">active surveillance</a> was defined as: (1) start of systemic therapy &ge;6 months after diagnosis of mRCC; or (2) never receiving systemic therapy for mRCC with an overall survival of &ge;1 year (overall survival &ge;1 year was a surrogate to exclude patients not started on treatment due to poor prognosis).Immediate systemic treatment was defined as starting systemic treatment &le;6 months following diagnosis of mRCC. The analysis compared overall survival and time until first-line treatment failure between the two cohorts.Of the patients identified during the study period, 863 met the criteria for active surveillance (cohort A). Of those, 370 started systemic treatment &ge;6 months following their initial diagnosis (cohort A1); 493 never received systemic treatment and were alive for &ge;1 year (cohort A2). Cohort B included 848 patients who received immediate systemic treatment.Median age for cohort A was 65.1 years compared with 62.2 years for cohort B (P&lt;.0001). There were no statistically significant differences in sex distribution between the two cohorts. Patients in cohort A had fewer sites of metastatic disease compared with cohort B (P&lt;.0001) and 23% of patients in cohort A had metastasectomy compared with 5% in cohort B (P=.0001).Five-year overall survival probability was significantly greater for cohort A than for cohort B (70.2% vs 32.1%; P&lt;.0001). Following adjustment for International Metastatic RCC Database Consortium risk criteria and age, both overall survival (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.38-0.56; P&lt;.0001) and time to treatment failure (HR, 0.79; 95% CI, 0.69-0.92; P=.0021) were greater in cohort A1 compared with cohort B. Median time on active surveillance in cohort A1 was 14.2 months.&ldquo;Based on the largest analysis of active surveillance in mRCC to date, our data suggest that a subset of patients may be safely observed without immediate initiation of systemic therapy. Prospective validation is required in the contemporary immunotherapy era,&rdquo; the researchers said.Source: Kushnir I, Basappa N, Ghosh S, et al. Active surveillance in metastatic renal cell carcinoma (mRCC): Results from the Canadian Kidney Cancer information system (CKCis). Abstract of a poster presented at the American Society of Clinical Oncology 2019 Annual Meeting, June 3, 2019, Chicago, Illinois.

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Active Surveillance vs Immediate Treatment in mRCC

ASCO 2019

In patients with renal cell carcinoma (RCC) with low tumor burden or slow growing disease, active surveillance is a common strategy. However, there are few available data on ...

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