Survival Benefit With Resection of Brain Metastases From Renal Cell Carcinoma in the Setting of Molecular Targeted Therapy and Immune Therapy

Abstract

Abstract INTRODUCTION Patient survival with renal cell carcinoma (RCC) has improved with the use of molecular targeted agents and immunotherapy. Given the potential activity of these agents in treating brain metastases (BM), the role of aggressive local management with surgery and/or radiation may diminish. This study evaluated the benefit of aggressive local therapy of RCC BM in the setting of molecular targeted agents and/or immunotherapy. METHODS A retrospective single-center review between 2011 and 2018 identified 1659 patients treated for RCC. The study group included patients that developed BM and received molecular targeted agents and/or immunotherapy during the course of their disease. Data analyzed included demographic information, systemic treatments, and local BM treatment modalities. Kaplan-Meier curves and log-rank values were used to assess progression free survival (PFS) and overall survival (OS) following RCC and BM diagnosis. RESULTS Of 1659 patients, 108 (6.5%) were diagnosed with BM during their clinical course. Mean OS from diagnosis of RCC for these 108 patients was 44.5 ± 40.1 mo, with 1-, 3-, and 5-yr survival of 76.9%, 43.3%, and 38.1%. All patients were treated with molecular targeted agents and/or immunotherapy. OS was analyzed based on three treatment groups: systemic therapy only (26.1 ± 31.2, n = 21), systemic and radiotherapy (41.4 ± 34.9, n = 54), and systemic and radiotherapy plus BM resection (61.4 ± 46.9, n = 33). Survival benefit was seen with surgery compared to systemic therapy alone (P = .002) and the systemic and radiotherapy cohort (P = .038). PFS did not differ significantly between cohorts. Variables such as pre-treatment performance status (ECOG P = .085; KPS P = .231), number of BM (median 2, P = .685) and status of systemic disease at the time of BM diagnosis did not differ significantly. CONCLUSION In the setting of molecular targeted agents and immunotherapy, BM resection maximizes OS in surgical candidates. Prospective clinical trials are needed to elucidate activity of newer molecular targeted agents and immunotherapy in RCC BM treatment.