To investigate whether black race is an independent predictor of overall survival (OS) in metastatic renal cell carcinoma (mRCC).
We performed a retrospective 2-cohort (International Metastatic Renal Cell Carcinoma Database Consortium [IMDC] and trial-database) study of patients with mRCC treated with first-line tyrosine kinase inhibitors (TKIs). Unmatched (UM) and matched (M) analyses accounting for imbalances in region, year of treatment, age, and sex between races were performed. Cox models adjusting for histology, number of metastatic sites, nephrectomy, and IMDC risk compared time to treatment failure (TTF; IMDC cohort), progression-free survival (PFS; trial-database cohort), and OS.
The IMDC cohort included 73 black versus 3,381 (UM) and 1,236 (M) white patients. The trial-database cohort included 21 black versus 1,040 (UM) and 431 (M) white patients. Median OS for black versus white patients was 18.5 versus 25.8 months in the IMDC group and 21.0 versus 25.6 months in the trial-database group. Differences in OS were not significant in multivariable analysis in the IMDC group (hazard ratio [HR]M, 1.0; 95% CI, 0.7 to 1.5; HRUM, 1.1; 95% CI, 0.8 to 1.4) and trial-database (HRM, 1.5; 95% CI, 0.8 to 2.7; HRUM, 1.4; 95% CI, 0.8 to 2.6) cohorts. TTF for black patients was shorter in the UM IMDC cohort (HRUM, 1.4; 95% CI, 1.1 to 1.8; P = .003), but not in the M analysis. PFS was shorter for black patients in both analyses in the trial-database cohort (HRM, 2.3; 95% CI, 1.4 to 3.9; P = .002; HRUM, 2.3; 95% CI, 1.4 to 3.9; P = .002).
Black patients had more IMDC risk factors and worse outcomes with TKIs versus white patients. Race was not an independent predictor of OS. Strategies to understand biologic determinants of outcomes for minority patients are needed to optimize care.
JCO global oncology. 2020 Feb [Epub]
Dominick Bossé, Wanling Xie, Xun Lin, Ronit Simantov, Aly-Khan A Lalani, Jeffrey Graham, J Connor Wells, Frede Donskov, Brian Rini, Benoit Beuselinck, Ajjai Alva, Aaron Hansen, Lori Wood, Denis Soulières, Christian Kollmannsberger, Francois Patenaude, Daniel Y C Heng, Toni K Choueiri, Rana R McKay
The Ottawa Hospital, Division of Medical Oncology, University of Ottawa, Ottawa, Ontario, Canada., Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA., Pfizer Oncology, La Jolla, CA., Juravinski Cancer Centre, Department of Oncology, McMaster University, Hamilton, Ontario, Canada., CancerCare Manitoba, Winnipeg, Manitoba, Canada., Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada., Aarhus University Hospital, Aarhus, Denmark., Department of Hematology and Medical Oncology, Cleveland Clinic-Taussig Cancer Institute, Cleveland, OH., University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium., University of Michigan, Ann Arbor, MI., Princess Margaret Cancer Centre, Toronto, Ontario, Canada., Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada., Centre Hospitalier de l'Université de Montréal, Division of Oncology, Montreal, Quebec, Canada., Department of Medicine, British Columbia Cancer Agency, Vancouver, British Columbia, Canada., Department of Oncology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada., University of California San Diego, Moores Cancer Center, San Diego, CA.