Impact of age on treatment trends and clinical outcome in patients with metastatic renal cell carcinoma

Abstract

OBJECTIVES Clinical outcomes in older adults with metastatic renal cell carcinoma (mRCC) are poorly understood, particularly in the era of targeted therapies. We characterize survival and relevant treatment-related variables in a modern series. MATERIALS AND METHODS From an institutional database including 562 patients with RCC, a total of 219 patients with metastatic disease were identified for the current analysis. Survival was assessed in four age-based cohorts: (1) age < 55, (2) age 55–64, (3) age 65–74, and (4) age ≥ 75. The number of lines of therapy rendered was collected for each patient, and the reason for treatment discontinuation was characterized. RESULTS Of the 219 patients assessed, median age was 58 (range, 26–87), and most patients had clear cell histology (82%) and prior nephrectomy (70.9%). The majority of patients were characterized as intermediate-risk (53%) by MSKCC criteria. Median survival in patients age ≥ 75 was 12.5 months, as compared to 26.4 months for patients age < 75 (P=0.003). Patients age ≥ 75 received fewer lines of systemic therapy as compared to other age-based subsets, and more frequently discontinued therapies due to toxicity. CONCLUSIONS Older adults represent a unique subpopulation of patients with mRCC, with distinct clinical outcomes. Further research is warranted to better understand the safety and tolerability of current therapies for mRCC in this group.

A Gap in Disease-Specific Survival Between Younger and Older Adults With De Novo Metastatic Renal Cell Carcinoma: Results of a SEER Database Analysis

“…In our aforementioned institutional experience, we observed that 70% of patients aged ≥ 75 years did not receive systemic therapy. 5 In contrast, only 33.5% of patients aged < 75 years received no systemic therapy. The reasons for this are unclear; our analyses were limited by a lack of comorbidity data, and it is entirely possible that the older adults in our series were less able to withstand systemic treatment.…”

“…To explore a more heterogeneous pool, we performed an assessment of our institutional database, capturing outcomes associated with 219 patients with mRCC (irrespective of therapeutic assignment). 5 Survival was significantly shorter in those patients aged ≥ 75 years (12.5 vs. 26.4 months; P = .003).…”

Patterns of care for metastatic renal cell carcinoma in Australia

“…Age is also likely to influence treatment decisions, in addition to concerns over toxicity and underlying tumour biology. While the selection of first‐line treatment, the use of an initial watchful‐waiting approach, and the impact of age on treatment decisions have been explored by some studies, these are yet to be examined in an Australian population, where the limited number of Pharmaceutical Benefits Scheme‐reimbursed treatment options are likely to have a significant impact .…”

Ageing-related responses to antiangiogenic effects of sunitinib in atherosclerosis-prone mice

“…Prior clinical and experimental studies provided multiple indications as to the role of ageing in cancer biology and progression (Ershler, Socinski, and Greene 1983;Ershler et al 1984;Pili, Guo, Chang, Nakanishi, Martin, and Passaniti 1994;Rivard, Fabre Ageing is presently seen merely as a source of additional side effects and limitations in the context of antiangiogenic therapeutics, and the clinical activity of VEGF inhibitors is thought to be retained in both younger and older patients (Pal, Hsu, Hsu, Hu, Bergerot, Carmichael, Saikia, Liu, Lau, Twardowski, Figlin, and Yuh 2013;Escudier, Albiges, and Sonpavde 2013;Killock2014). This is enforced by comparable clinical efficacy of these drugs at the late age cutoff, typical for major indications such as in mccRCC patients (Killock2014).…”

“…While functionality of the VEGF pathway changes markedly with age (Rivard, Fabre, Silver, Chen, Murohara, Kearney, Magner, Asahara, and Isner 1999), systematic studies in this regard involving sunitinib effects are largely lacking. Moreover, the efficacy of this agent is predominantly compared between older groups of cancer patients (Chowdhury et al 2013;Pal et al 2013;Killock2014), while the biological effects in more distant age groups (elderly and children) are scarcely characterized.…”