848P - Prognostic significance of active surveillance (AS) in metastatic renal cell carcinoma (mRCC)

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Renal Cell Cancer
Presenter Guillermo De Velasco
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors G. De Velasco1, N. Ainsworth1, D. Holyoake2, K. Fife3, A. Matakidou1, T. Eisen1
  • 1Medical Oncology, Addenbrooke's Hospital University of Cambridge Hospitals, CB2 0QQ - Cambridge/GB
  • 2Oncology, Addenbrooke's Hospital University of Cambridge Hospitals, CB2 0QQ - Cambridge/GB
  • 3Oncology, Cambridge University Hospital, CB2 0QQ - Cambridge/GB

Abstract

Aim

mRCC is a heterogeneous group of tumours with different pathologic and clinical features. Systemic therapy based on tyrosine kinase inhibitors (TKI) is indicated for patients (pts) with metastatic disease; however TKI are not curative and therefore pts will need long-term, sequential therapies. In this context some selected pts may undergo a period of AS.

Methods

We performed a retrospective review of pts with mRCC who attended for the first time to our institution between January 2010 and December 2012. Survival data was collected from the entire cohort of pts. Pts managed with AS were selected for detailed analysis: Clinical characteristics, prognosis factors, time without any treatment and treatment before and after AS.

Results

Of the 260 new pts with mRCC, we identified 102 pts who were under a period of AS as part of their management. The main reasons for AS were low volume asymptomatic disease in 71 pts (68.3%) and comorbidities in 15 pts (14.4%). Treatments prior to AS included: none 69 pts, surgery for oligometastatic disease 19 pts, radiotherapy 13 pts, and biologic treatment 4 pts. At the beginning of AS, the patients MSKCC prognostic categories were: good in 35.6%, intermediate in 58.7% and poor in 5.8% of pts. The most common sites of metastases were: lung (60 pts), lymph nodes (32pts) and bone (17 pts). The number of metastatic sites was: 1/2/ ≥ 3: 59 pts/26 pts/8 pts. The median time on AS was 11 months (95% CI: 8.8-13.1). With a median follow-up of 27.5 months 56 pts had PD. Of these, 39 pts had new metastases but the MSKCC prognostic group deteriorated in only 5 pts. After PD, 42 pts started TKI, with a median PFS of 10 months (95% CI: 6.78-13.2). Sunitinib was the most common drug started (27 pts). The OS for the entire cohort (260 pts) was 32 months: 39 months for pts in AS compared with 17 months for those pts who weren't on AS (HR, 2.39; 95% CI: 1.57-3.53; P < .0001).

Conclusions

To date none of the cancer guidelines recommend surveillance for mRCC. This study suggests the consideration of AS based on expert decision may delay active treatment, probably without detriment to the OS. Moreover, it is a reasonable approach for pts where due to comorbidities the risk of treatment could be greater than the benefit. Molecular studies to achieve a better understanding are warranted.

Disclosure

All authors have declared no conflicts of interest.