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. 2011 May;22(5):1048-1053.
doi: 10.1093/annonc/mdq563. Epub 2010 Nov 29.

Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy

S L Richey  1 , S H Culp  2 , E Jonasch  1 , P G Corn  1 , L C Pagliaro  1 , P Tamboli  3 , K K Patel  4 , S F Matin  2 , C G Wood  2 , N M Tannir  5
Affiliations

Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy

S L Richey et al. Ann Oncol. 2011 May.

Abstract

Background: Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown.

Patients and methods: We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors.

Results: One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8%) or poor-risk (44.1%) disease. Median OS for all patients was 10.4 months [95% confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95% CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0%) survived for 2+ years.

Conclusions: These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curve of patients with metastatic renal cell carcinoma and primary tumor in place treated with targeted therapy at M.D. Anderson Cancer Center (2003–2009).
Figure 2.
Figure 2.
Kaplan–Meier survival curves of patients with metastatic renal cell carcinoma and primary tumor in place treated with targeted therapy based on the presence zero to one, two to three, or four or more poor prognostic factors.
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References

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