Survival among patients with advanced renal cell carcinoma in the pretargeted versus targeted therapy eras

Abstract

Between December 2005 and October 2009, FDA approved six targeted therapies shown to significantly extend survival for advanced renal cell carcinoma (RCC) patients in clinical trials. This study aimed to examine changes in survival between the pretargeted and targeted therapy periods in advanced RCC patients in a real-world setting. Utilizing the 2000-2010 SEER Research files, a pre-post study design with a contemporaneous comparison group was employed to examine differences in survival outcomes for patients diagnosed with advanced RCC (study group) or advanced prostate cancer (comparison group, for whom no significant treatment innovations happened during this period) across the pretargeted therapy era (2000-2005) and the targeted therapy era (2006-2010). RCC patients diagnosed in the targeted therapy era (N = 6439) showed improved survival compared to those diagnosed in the pretargeted therapy era (N = 7231, hazard ratio (HR) for all-cause death: 0.86, P < 0.01), while the change between the pre-post periods was not significant for advanced prostate cancer patients (HR: 0.97, P = 0.08). Advanced RCC patients had significantly larger improvements in overall survival compared to advanced prostate cancer patients (z = 4.31; P < 0.01). More detailed year-to-year analysis revealed greater survival improvements for RCC in the later years of the posttargeted period. Similar results were seen for cause-specific survival. Subgroup analyses by nephrectomy status, age, and gender showed consistent findings. Patients diagnosed with advanced RCC during the targeted therapy era had better survival outcomes than those diagnosed during the pretargeted therapy era. Future studies should examine the real-world survival improvements directly associated with targeted therapies.

Keywords: Advanced renal cell carcinoma; metastatic kidney cancer; population-based study; survival; targeted therapies.

Figure 1

(A) Kaplan–Meier curves of overall survival (in years) for study group of advanced RCC patients diagnosed in 2000–2005 versus those diagnosed in 2006–2010. The difference in survival times between pretargeted therapy era and targeted therapy era was statistically significant (P < 0.01) based on Cox regression. (B) Kaplan–Meier curves of overall survival (in years) for control group of advanced prostate cancer patients diagnosed in 2000–2005 versus those diagnosed in 2006–2010. The difference in survival times between pretargeted therapy era and targeted therapy era was not statistically significant (P = 0.25) based on Cox regression. (C) Kaplan–Meier curves of cause‐specific survival (in years) for study group of advanced RCC patients diagnosed in 2000–2005 versus those diagnosed in 2006–2010. The difference in survival times between pretargeted therapy era and targeted therapy era was statistically significant (P < 0.01) based on Cox regression. (D) Kaplan–Meier curves of cause‐specific survival (in years) for control group of advanced prostate cancer patients diagnosed in 2000–2005 versus those diagnosed in 2006–2010. The difference in survival times between pretargeted therapy era and targeted therapy era was not statistically significant (P = 0.08) based on Cox regression.

Figure A1

Sample selection diagram.

Figure A2

Kaplan–Meier curves of overall survival (in months) for advanced RCC patients (A) receiving and (B) not receiving nephrectomy, diagnosed in 2000–2005 versus those diagnosed in 2006–2010. The difference in survival times between pretargeted therapy era and targeted therapy era was statistically significant (P < 0.01) based on Cox regression, for both subsamples. Kaplan–Meier curves of cause‐specific survival (in years) for advanced RCC patients (C) receiving and (D) not receiving nephrectomy diagnosed in 2000–2005 versus those diagnosed in 2006–2010. *The difference in survival times between pretargeted therapy era and targeted therapy era was statistically significant (P < 0.01) based on Cox regression, in both subsamples.