Systemic therapy (ST) can be deferred in patients who have metastatic renal cell carcinoma (mRCC) and slow-growing metastases. Currently, this subset of patients managed with active surveillance (AS) is not well described in the literature.
This was a prospective observational study of patients with mRCC across 46 US community and academic centers. The objective was to describe baseline characteristics and demographics of patients with mRCC initially managed by AS, reasons for AS, and patient outcomes. Descriptive statistics were used to characterize demographics, baseline characteristics, and patient-related outcomes. Wilcoxon 2-sample rank-sum tests and χ2 tests were used to assess differences between ST and AS cohorts in continuous and categorical variables, respectively. Kaplan-Meier survival curves were used to assess survival.
Of 504 patients, mRCC was initially managed by AS (n = 143) or ST (n = 305); 56 patients were excluded from the analysis. Disease was present in 69% of patients who received AS, whereas the remaining 31% had no evidence of disease. At data cutoff, 72 of 143 patients (50%) in the AS cohort had not received ST. The median overall survival was not reached (95% CI, 122 months to not estimable) in patients who received AS versus 30 months (95% CI, 25-44 months) in those who received ST. Quality of life at baseline was significantly better in patients who were managed with AS versus ST.
AS occurs frequently (32%) in real-world clinical practice and appears to be a safe and appropriate alternative to immediate ST in selected patients.
Cancer. 2021 Mar 25 [Epub ahead of print]
Michael R Harrison, Brian A Costello, Nrupen A Bhavsar, Ulka Vaishampayan, Sumanta K Pal, Yousef Zakharia, Heather S L Jim, Mayer N Fishman, Ana M Molina, Christos E Kyriakopoulos, Che-Kai Tsao, Leonard J Appleman, Benjamin A Gartrell, Arif Hussain, Walter M Stadler, Neeraj Agarwal, Russell K Pachynski, Thomas E Hutson, Hans J Hammers, Christopher W Ryan, Brant A Inman, Jack Mardekian, Azah Borham, Daniel J George
Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina., Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota., Karmanos Cancer Institute, Detroit, Michigan., Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California., Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa., Moffitt Cancer Center, Tampa, Florida., Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York., University of Wisconsin Carbone Cancer Center, Madison, Wisconsin., Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York., The University of Pittsburgh Medical Center (UPMC) Cancer Pavilion, Pittsburgh, Pennsylvania., Department of Medical Oncology, Montefiore Medical Center, Bronx, New York., Department of Medicine, University of Maryland, Baltimore, Maryland., Section of Hematology/Oncology, Department of Medicine, Comprehensive Cancer Center, University of Chicago, Chicago, Illinois., Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah., Siteman Cancer Center, Department of Medicine, Washington University School of Medicine, St Louis, Missouri., Baylor Sammons Cancer Center-Texas Oncology, Dallas, Texas., Division of Hematology-Oncology, University of Texas Southwestern, Dallas, Texas., Department of Medicine, Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon., Pfizer, New York, New York.