Overall survival after immunotherapy, tyrosine kinase inhibitors and surgery in treatment of metastatic renal cell cancer: outcome of 143 consecutive patients from a single centre

Trine Honnens De Lichtenberg, Gregers G Hermann, Mikael Rørth, Mari-Janne Højer Larsen, Zahra Mansourvar, Mette L Holm, Thomas Scheike
Scandinavian Journal of Urology 2014, 48 (4): 379-86

OBJECTIVE: The aim of this study was to evaluate overall survival (OS) after treatment of metastatic renal cell carcinoma (mRCC) following the introduction of tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin (mTOR) inhibitors.

MATERIAL AND METHODS: One-hundred and forty-three consecutive mRCC patients were given immunotherapy (n = 59), TKIs (n = 49) or sequential therapy (IMM → TKI group; n = 35). The TKI group included patients with higher age (p < 0.001), worse performance status (p = 0.005) and higher risk profile (p < 0.001) than the other two treatment groups. Number of metastases and sites and tumour histology did not differ between groups.

RESULTS: First line immunotherapy gave a median OS of 16.3 months and first line TKIs 10.9 months (p = 0.003). Survival longer than 5 years was limited to immunotherapy. Sarcomatoid component, metastatic sites, papillary histology, stage, performance status and white cell blood count were related to poor OS. Using multivariate analyses to adjust for risk predictors the difference in OS disappeared. Median OS before and after introduction of TKIs was 16 months and 14 months, respectively (p = 0.189). Memorial Sloan Kettering Cancer Center (MSKCC) risk groups were related to OS (p < 0.001). Heng's prognostic criteria appeared slightly more predictive than MSKCC (p = 0.12). Metastasectomy (n = 42) may improve OS [surgery: median OS 18.8 months, 95% confidence interval (CI) 12.3-48.5; no surgery: median OS 15 months, 95% CI 10.4-16.5; p = 0.07].

CONCLUSIONS: MSKCC and Heng's prognostic algorithms were valid for prognostication and can be used for individual planning of treatment and follow-up. Surgical removal of metastases may improve OS.

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