Abstract
Since the introduction of targeted therapies (TTs) for metastatic renal cell cancer (mRCC) in 2005, a limited amount of epidemiological data on efficacy of modern drug therapies for synchronous mRCC has been published. We present a comprehensive nationwide cohort including all cases of primarily metastasized renal cell cancer among adults diagnosed between 2005 and 2010, based on data from the Finnish Cancer Registry and patient records from treating hospitals. Applied treatment protocols and survival outcomes were analyzed. A total of 977 patients were included in the analysis; 499 patients were diagnosed between 2005 and 2007 and 478 patients were diagnosed between 2008 and 2010. The median overall survival (OS) was 8.80 months (95% confidence interval (CI): 7.60–10.02). The median OS of the patients diagnosed at the latter era was significantly better (11.1; 95% CI: 8.8–13.4 vs. 7.0; 95% CI: 5.7–8.3 months, p ≤ 0.001). A total number of 524 (53.8%) patients received drug therapy. Altogether, TTs including tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors (mTORi), and vascular endothelial growth factor inhibitor covered 331 (63.2%) of first-line treatments, whereas interferon and its combinations with chemotherapy were used for 186 (35.5%) patients. The median OS rates for TT and interferon as first-line therapy groups were 19.9 (16.9–22.8) and 14.9 (12.3–17.4) months, respectively. The OS for patients who did not receive drug therapy after cytoreductive nephrectomy was dismal. We found that the OS estimate of mRCC patients in Finland has improved since the introduction of tyrosine kinase inhibitors. However, the prognosis remains poor for frail, elderly patients with an impaired performance status.
Highlights
20–30% of renal cell cancer (RCC) patients have distant metastases at the time of initial diagnosis [1], being diagnosed with synchronous metastatic renal cell carcinoma
A total of 499 patients were diagnosed between 2005 and 2007 and 478 patients between 2008 and 2010. e median overall survival (OS) of the patients diagnosed at the latter era was significantly better (11.1; 95% CI: 8.8–13.4 months vs. 7.0; 95% CI: 5.7–8.3 months, p ≤ 0.001) (Figure 2). e proportions of patients treated with interferon and targeted therapies (TTs) and those without drug therapies for metastatic renal cell carcinoma (mRCC), with
We found a significant difference in the baseline factors Eastern Cooperative Oncology Group (ECOG) and increased CRP value between diagnostic time groups in favour of the latter era, but no statistically significant difference in the number or location of metastatic sites or other baseline factors (Table 1). us, the data suggests that the overall treatment of the more recently diagnosed patient population has been more effective. e transition of primary first-line drug therapy from interferon-based regimes to TT and simultaneous improvement of OS can be observed in Table 3 and Figure 2, respectively
Summary
20–30% of renal cell cancer (RCC) patients have distant metastases at the time of initial diagnosis [1], being diagnosed with synchronous metastatic renal cell carcinoma (mRCC). A limited amount of epidemiologic data on mRCC has been published, and the safety and efficacy of modern drug therapies have been shown in randomized controlled trials, there is a scarcity of evidence on the effect of advances in medical therapy on the mRCC population. Population-based registry studies from Norway, Denmark, Sweden, Estonia, and Czech Republic [2,3,4,5,6] have been published during the last decade, and according to these studies, the prognosis remains relatively poor, as overall survival (OS) of only 9–14 months for the entire mRCC population is reported in these studies. Until 2005, cytokine-based treatment with interferon alpha-2b (IFN-α), or less frequently interleukin-2, was considered the cornerstone of drug therapy but has been subsequentially replaced with targeted therapy (TT) such as vascular endothelial growth factor (VEGF) monoclonal antibodies and VEGF receptor tyrosine kinase inhibitors (TKIs). Since phase three trials showed the superiority of sunitinib compared to IFN-α with tolerable side effects, TKIs
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