Evidence for active surveillance in mRCC grows
medwireNews: Real-world data suggest that active surveillance may be a feasible treatment option for some patients with metastatic renal cell carcinoma (mRCC).
Of 448 individuals included in the prospective, observational, Metastatic Renal Cell Cancer Registry, 32% were initially managed by active surveillance, with the remainder receiving systemic therapy, report Michael Harrison (Duke University Medical Center, Durham, North Carolina, USA) and co-authors in Cancer.
The researchers found that people who received active surveillance were less likely to have an ECOG performance status of 2 or 3 than those who received systemic therapy (2.8 vs 15.4%) and were more likely to have a favorable IMDC risk profile (60 vs 14%).
They also had fewer metastatic sites (1 site, 69 vs 57%; 2 sites, 23 vs 26%; ≥3 sites, 8 vs 17%), a higher rate of adrenal metastasis (16 vs 8%), and a lower rate of bone metastasis (18 vs 27%).
The majority (69%) of people in the active surveillance group had measurable disease at baseline, but 31% had no evidence of disease when treatment was assigned. After a median 33 months of follow-up, 50% of patients in the active surveillance cohort, representing 16% of the patients studied, had not yet received systemic therapy.
Harrison and team observed that there were fewer deaths during follow-up in the active surveillance cohort than in the systemic therapy cohort, at 17% versus 52%, with median overall survival not reached versus 30 months, respectively, and 3-year estimated survival rates at 84% and 45%, respectively.
The investigators say that although long-term outcomes cannot yet be assessed, their findings suggest that, “in carefully selected patients, [active surveillance] is a justifiable management option for the treatment of mRCC.”
Nonetheless, they “acknowledge that further studies will be required to determine the optimal selection of patients with mRCC for [active surveillance].”
The authors also stress that their findings “should be interpreted in the context of other management options for mRCC,” noting that although treatment options for previously untreated mRCC are changing, currently available therapies rarely “lead to complete responses that allow for permanent treatment discontinuation.”
They therefore conclude: “Recognizing that some of these patients may not require [systemic therapy] for months or years is an important and missing observation that our current study brings to the field.”
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