We hypothesized that the evolving treatment paradigms recommended based on phase III trials may have translated into improved overall survival (OS) in contemporary community-based patients with clear-cell metastatic renal cell carcinoma (ccmRCC) undergoing active treatment.
Within the SEER database, contemporary (2017-2020) and historical (2010-2016) patients with ccmRCC treated with either systemic therapy (ST), cytoreductive nephrectomy (CN), or both (ST+CN) were identified. Univariable and multivariable Cox-regression models were used.
Overall, 993 (32%) contemporary versus 2,106 (68%) historical patients with ccmRCC were identified. Median OS was 41 months in contemporary versus 25 months in historical patients (Δ=16 months; P<.001). In multivariable Cox-regression analyses, contemporary membership was independently associated with lower overall mortality (hazard ratio [HR], 0.7; 95% CI, 0.6-0.8; P<.001). In patients treated with ST alone, median OS was 17 months in contemporary versus 10 months in historical patients (Δ=7 months; P<.001; multivariable HR, 0.7; P=.005). In patients treated with CN alone, median OS was not reached in contemporary versus 33 months in historical patients (Δ=not available; P<.001; multivariable HR, 0.7; P<.001). In patients treated with ST+CN, median OS was 38 months in contemporary versus 26 months in historical patients (Δ=12 months; P<.001; multivariable HR, 0.7; P=.003).
Contemporary community-based patients with ccmRCC receiving active treatment clearly exhibited better survival than their historical counterparts, when examined as one group, as well as when examined as separate subgroups according to treatment type. Treatment advancements of phase III trials seem to be applied appropriately outside of centers of excellence.
Journal of the National Comprehensive Cancer Network : JNCCN. 2024 Jun 05 [Epub ahead of print]
Reha-Baris Incesu, Simone Morra, Lukas Scheipner, Andrea Baudo, Letizia Maria Ippolita Jannello, Mario de Angelis, Carolin Siech, Anis Assad, Zhe Tian, Fred Saad, Shahrokh F Shariat, Felix K H Chun, Alberto Briganti, Ottavio de Cobelli, Luca Carmignani, Sascha Ahyai, Nicola Longo, Derya Tilki, Markus Graefen, Pierre I Karakiewicz
1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada., 11Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., 10Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany., 8Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy., 7Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy., 5Department of Urology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy., 4Department of Urology, Medical University of Graz, Graz, Austria., 3Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy., 2Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.