The effect of a treatment delay on outcome in metastatic renal cell carcinoma

Iacovelli, Roberto; Galli, Luca; Giorgi, Ugo De; Porta, Camillo; Nolè, Franco; Zucali, Paolo Andrea; Sabbatini, Roberto; Mosca, Alessandra; Atzori, Francesco; Santini, Daniele; Facchini, Gaetano; Fornarini, Giuseppe; Buti, Sebastiano; Massari, Francesco; Masini, Cristina; Ricotta, Riccardo; Biasco, Elisa; Lolli, Cristian; Gri, Nicole; Verri, Elena; Miggiano, Chiara; Vitale, Maria Giuseppa

doi:10.1016/j.urolonc.2019.03.005

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…In our research, we showed that patients who started first-line treatment early than a year from diagnosis had better survival than those who delayed the treatment (13 months vs. 9.5 months, p=0,001). The results were similar to what was found in previous studies, showing that the risk of death significantly increases with a more significant time interval from diagnosis to treatment [8,9] .…”

Section: Discussionsupporting

confidence: 91%

Prognostic Factors in First-line Metastatic Renal Cell Carcinoma: How to Improve the Prognostic Ability of the IMDC and MSKCC Score?

Paroşanu

Stanciu²,

Parlog³

et al. 2022

ijirms

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Background: The incidence of metastatic renal cell carcinoma has steadily increased. Therefore, it is essential to identify precise biomarkers to predict survival and improve clinical care. Objectives: This study aimed to evaluate potential prognostic factors among patients with mRCC. Methods: We retrospectively analyzed 74 patients with metastatic RCC treated between January 2020 and October 2022. We analyzed which risk factors from the MSKCC and IMDC models more accurate correlated with survival in advanced kidney cancer. Results: We identified that poor performance status, late treatment initiation, anemia, and high LDH are statistically significant prognostic factors for predicting overall survival (OS). Conclusion: Our study raised the possibility of actualization of the classical prognostic factors in metastatic RCC patients.

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Section: Discussionsupporting

confidence: 91%

Prognostic Factors in First-line Metastatic Renal Cell Carcinoma: How to Improve the Prognostic Ability of the IMDC and MSKCC Score?

Paroşanu

Stanciu²,

Parlog³

et al. 2022

ijirms

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“…Local therapy to control the most rapidly progressing lesion or observation beyond progression was an additional means to defer systemic therapy. In a large, retrospective European cohort of patients ineligible for AS, Iacovelli and colleagues [96] found that a delay of >6 wk in the initiation of systemic therapy did not significantly affect the cancer-specific outcomes. Finally, the survival implications of delayed initiation of targeted therapy have also been investigated at the population level using the National Cancer Database (NCDB) data [95].…”

Section: Metastatic Rccmentioning

confidence: 98%

“…Apart from imperative indications due to the COVID-19 pandemic, the notion of deliberate treatment delays in selected patients with metastatic RCC, particularly those with International Metastatic RCC Database Consortium (IMDC) good-risk disease, has previously been assessed in a number of studies, including two narrative reviews [87,88], two prospective studies [89,90], six retrospective studies [91][92][93][94][95][96], and a further three abstracts of retrospective studies. In each, the majority of patients initiated treatment at disease progression.…”

Section: Metastatic Rccmentioning

confidence: 99%

Risks from Deferring Treatment for Genitourinary Cancers: A Collaborative Review to Aid Triage and Management During the COVID-19 Pandemic

et al. 2020

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Context: The coronavirus disease 2019 (COVID-19) pandemic is leading to delays in the treatment of many urologic cancers. Objective: To provide a contemporary picture of the risks from delayed treatment for urologic cancers to assist with triage. Evidence acquisition: A collaborative review using literature published as of April 2, 2020. Evidence synthesis: Patients with low-grade non-muscle-invasive bladder cancer are unlikely to suffer from a 3-6-month delay. Patients with muscle-invasive bladder cancer are at risk of disease progression, with radical cystectomy delays beyond 12 wk from diagnosis or completion of neoadjuvant chemotherapy. Prioritization of these patients for surgery or management with radiochemotherapy is encouraged. Active surveillance should be used for low-risk prostate cancer (PCa). Treatment of most patients with intermediate-and high-risk PCa can be deferred 3-6 mo without change in outcomes. The same may be true for cancers with the highest risk of progression. With radiotherapy, neoadjuvant androgen deprivation therapy (ADT) is the standard of care. For surgery, although the added value of neoadjuvant ADT is questionable, it may be considered if a patient is interested in such an approach. Intervention may be safely deferred for T1/T2 renal masses, while locally advanced renal tumors (!T3) should be treated expeditiously. Patients with metastatic renal cancer may consider vascular endothelial growth factor targeted therapy over immunotherapy. Risks for delay in the treatment of upper tract urothelial cancer depend on grade and stage. For patients with high-grade disease, delays of 12 wk in nephroureterectomy are not associated with adverse survival outcomes. Expert guidance recommends expedient local treatment of testis cancer. In penile

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“…TD was 8 weeks for the CN patients compared to 5.3 weeks for those who underwent nephrectomy for initially localized disease (P=0.001). However, TD after CN did not affect OS ( 45 ). Taken together, these studies provide evidence that AS may be a safe initial treatment strategy in some carefully selected mRCC patients and does not necessitate and tradeoff between survival and QoL ( 1 , 44 , 45 ).…”

Section: Cn and Active Surveillancementioning

confidence: 94%

Cytoreductive nephrectomy for metastatic renal cell carcinoma, the ultimate urologic ‘Choosing Wisely’ campaign: a narrative review

Tabakin¹,

Stein²,

Anderson³

et al. 2020

Transl Cancer Res TCR

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In the early 2000s, cytoreductive nephrectomy in addition to systemic cytokines became standard of care for treating metastatic renal cell carcinoma. Since that time, the development of novel systemic targeted therapies and immuno-oncologic agents have challenged the utility of cytoreductive nephrectomy in clinical practice. In 2019, the controversial CARMENA study was published, providing the first level one evidence suggesting that cytoreductive nephrectomy combined with targeted therapy yielded no survival advantage over targeted therapy alone in intermediate and poor risk metastatic renal cell carcinoma patients. Later that year, the SURTIME trial demonstrated that patients undergoing targeted therapy with delayed nephrectomy maintained a survival advantage over those that underwent upfront cytoreductive nephrectomy followed by targeted therapy. Both of these studies underscored the importance of patient selection and timing of cytoreductive nephrectomy and systemic therapy. As new immuno-oncologic agents are trialed, particularly in combination, the role of cytoreductive nephrectomy will continue to be questioned. In this narrative review, we discuss the evolution of the role of cytoreductive nephrectomy in treating metastatic renal cell carcinoma through the context of the ever-changing landscape of targeted therapies and immuno-oncologic agents. We assess the evidence for cytoreductive nephrectomy with respect to patient factors, timing of surgery, and combination with other therapies.

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The effect of a treatment delay on outcome in metastatic renal cell carcinoma

Cited by 7 publications

References 22 publications

Prognostic Factors in First-line Metastatic Renal Cell Carcinoma: How to Improve the Prognostic Ability of the IMDC and MSKCC Score?

Prognostic Factors in First-line Metastatic Renal Cell Carcinoma: How to Improve the Prognostic Ability of the IMDC and MSKCC Score?

Risks from Deferring Treatment for Genitourinary Cancers: A Collaborative Review to Aid Triage and Management During the COVID-19 Pandemic

Cytoreductive nephrectomy for metastatic renal cell carcinoma, the ultimate urologic ‘Choosing Wisely’ campaign: a narrative review

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