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
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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.