Long survival of patients with metastatic clear cell renal cell carcinoma. Results of real life study of 344 patients

Abstract

The treatment landscape in metastatic renal cell carcinoma has changed fundamentally over the last decade by the development of antiangiogenic agents, mammalian target of rapamycin inhibitors and immunotherapy. Outside of the context of a clinical trial, the treatments are used sequentially. We describe results under real‐life conditions of a sequential treatment strategy, before the era of immunotherapy. All patients were treated according to their prognostic score (either Memorial Sloan Kettering Cancer Center or International Metastatic Renal Cell Carcinoma Database Consortium) for advanced renal cell carcinoma. A treatment strategy involving 1 to 4 lines was determined including a rechallenge criterion for the repeat use of a treatment class. Three hundred forty‐four patients were included over 3 years. Overall survival was 57 months in patients with good or intermediate prognosis and 19 months in patients with poor prognosis. In the former group, the proportions of patients treated with 2 to 4 treatment lines were 70%, 38% and 16%, respectively. The best objective response rates for lines 1 to 4 were 46%, 36%, 16% and 17%, respectively. Grade III/IV toxicity did not appear to be cumulative. The recommended strategy was followed in 68% of patients. A large proportion of patients with good or intermediate prognosis who progress after two lines of treatment still have a performance status good enough to receive a systemic treatment, which justifies such a strategy. Overall survival of patients with good and intermediate prognosis was long, suggesting a benefit from the applied approach. These results might be used as selection criterion for the treatment of patients in the era of immune checkpoint inhibitors.

Sequential treatment of metastatic renal cancer in a complex evolving landscape

“…The large armamentarium of therapies available today for metastatic clear cell renal cell carcinoma (mCCRCC) has prolonged the survival of these patients in real-life as many of them are treated outside clinical trials with a sequential treatment strategy. The paper recently published by Voog et al (1) confirms the observation most clinicians share that a large proportion of patients with good or intermediate prognosis who progress after two lines of treatment still have a performance status acceptable enough to furtherly receive additional systemic therapy, thus conferring this dreadful disease a longer survival expectancy. The overall survival they report was 57 months in patients with good or intermediate prognosis and 19 months in patients with bad prognosis, classified according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC).…”

“…Voog et al (1) prospectively confirm that treatment with a second or third TKI provides additional clinical benefit without cumulative toxicity in unselected patients, and also that rechallenge, defined as using a treatment class that previously produced duration of tumor control over 6 months in patients with good or intermediate prognosis according to the IMDC, is feasible. However, it should be born in mind that the clinical scenario they present has changed greatly over the last couple of years with the advent of the multi-kinase inhibitor cabozantinib, and the introduction of immunotherapy with monoclonal anti-bodies nivolumab, ipilimumab, pembrolizumab, atezolizumab and avelumab, that target the immune checkpoint proteins PD-1, PD-L1 and CTLA-4.…”

Cutaneous Metastases and Long-Term Survival of a Patient With Clear Cell Renal Carcinoma

“…RCC is responsible for approximately 3% of adult tumors, and the five-year overall survival in the metastatic setting is only 12% [1,11]. In patients with a good-to-intermediate prognosis, the overall survival in a multicentric real-world study was 57 months (range: 51 to 70 months), and only 5% of the patients received five or more treatments lines [6]. Our patient is alive 156 months after mRCC diagnosis and completed five lines of treatment, which is very uncommon in the literature.…”

“…The prognosis of metastatic RCC (mRCC) depends greatly on risk factors and is changing based on new treatments and new combinations [5]. According to a real-life study, the overall survival of patients with good-to-intermediate prognosis is 57 months, and 19 months in patients with a poor prognosis due to new treatment modalities [6,7]. Sequential treatments with vascular endothelial growth factor tyrosine kinase inhibitors, inhibitors of the mammalian target of rapamycin pathway (imTOR), and, more recently, immunotherapy are recommended depending on patient prognosis, although the ideal sequence has not been determined [8].…”