Certain patients with metastatic renal cell carcinoma can (RCC) safely undergo active surveillance before initiating systemic treatment, findings from a study published in The Lancet Oncology show.
RCC has a wide range of clinical presentations and pathology, from small tumors that can be managed with kidney sparing surgical approaches, to highly symptomatic metastatic tumors that can progress rapidly to cause death despite prompt treatment with surgical and systemic therapies.
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Due to toxicity and non-curative nature of systemic therapy for RCC, some of these patients could benefit from initial active surveillance prior to treatment initiation. In a study led by Brian I Rini, MD, Cleveland Clinic Taussig Cancer Institute (Cleveland, OH), investigators aimed to characterize the time to initiation of systemic therapy in patients with metastatic RCC under active surveillance.
A total of 52 patients with treatment-naïve, asymptomatic, metastatic RCC from 5 hospitals in the United States, Spain, and the United Kingdom were enrolled in the trial between August 2008 and June 2013. Median follow-up was 38.1 months.
Among the 48 patients included in the final analysis, median time on surveillance from registration in study until initiation of systemic therapy was 14.9 months. Additionally, investigators found that a higher number of International Metastatic Database Consortium adverse risk factors and a higher number of metastatic disease sites were both associated with shorter surveillance period. Almost half of the patients (n=22 [46%]) included in the analysis died during the study period, all from metastatic RCC.
Thus, researchers concluded that active surveillance prior to starting systemic therapy may be feasible for some patients with metastatic RCC. However, more research is needed to better define the risks and benefits of this approach.
