Active surveillance (AS) is a commonly used strategy in patients with slow-growing disease. We aimed to assess the outcomes and safety of AS in patients with metastatic renal cell carcinoma (mRCC).
We used the Canadian Kidney Cancer information system (CKCis) to identify patients with mRCC diagnosed between January 1, 2011, and December 31, 2016. The AS strategy was defined as (1) the start of systemic therapy ≥ 6 months after diagnosis of mRCC, or (2) never receiving systemic therapy for mRCC with an overall survival (OS) of ≥1 year. Patients starting systemic treatment <6 months after diagnosis of mRCC were defined as receiving immediate systemic treatment. OS and time until first-line treatment failure (TTF) were compared between the two cohorts.
A total of 853 patients met the criteria for AS (cohort A). Of these, 364 started treatment >6 months after their initial diagnosis (cohort A1) and 489 never started systemic therapy (cohort A2); 827 patients received immediate systemic treatment (cohort B). The 5-year OS probability was significantly greater for cohort A than for cohort B (70% vs. 33.6%; P < .0001). After adjusting for International Metastatic RCC Database Consortium risk criteria and age, both OS (hazard ratio [HR] = 0.58; 95% confidence interval [CI], 0.47-0.70; P < .0001) and TTF (HR = 0.72; 95% CI, 0.60-0.85; P = .0002) were greater in cohort A1 compared with B. For cohort A1, the median time on AS was 14.2 months (range, 6-71).
Based on the largest analysis of AS in mRCC to date, our data suggest that a subset of patients may be safely observed without immediate initiation of systemic therapy.
Clinical genitourinary cancer. 2021 May 15 [Epub ahead of print]
Igal Kushnir, Naveen S Basappa, Sunita Ghosh, Aly-Khan A Lalani, Aaron R Hansen, Lori Wood, Christian K Kollmannsberger, Daniel Y C Heng, Georg A Bjarnason, Denis Soulières, David E Dawe, Simon Tanguay, Rodney H Breau, Frédéric Pouliot, Anil Kapoor, Jeffrey Graham, M Neil Reaume
Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada; Institute of Oncology, Sackler Faculty of Medicine, Meir Medical Center, Tel Aviv University, Kfar Saba, Israel. Electronic address: ., Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada., Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada., Princess Margaret Cancer Centre, Toronto, ON, Canada., Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada., BC Cancer Research Institute, University of British Columbia, Vancouver, BC, Canada., Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada., Sunnybrook Odette Cancer Centre, Toronto, ON, Canada., Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada., Section of Hematology and Medical Oncology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada., Division of Urology, McGill University Health Center, Montreal, QC, Canada., Division of Urology, University of Ottawa, Ottawa, ON, Canada., Laval University, Quebec, QC, Canada., Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.