African Americans With RCC Maintain Inferior Survival in Targeted Therapy Era

Various genomic differences in African American patients with clear cell renal cell carcinoma (ccRCC) predict for reduced responsiveness to vascular endothelial growth factor (VEGF)-targeted therapy and inferior survival compared with Caucasian patients.¹

Although African American patients with RCC have historically had inferior survival relative to Caucasian patients, there are limited data on racial differences in tumor biology to explain this disparity in survival or if these racial differences impact response to targeted therapy.

Therefore, researchers sought to describe racial differences in tumor biology between African American and Caucasian patients with ccRCC and to assess if differences impact survival rates in the era of targeted therapy.

For the study, researchers analyzed data from African American and Caucasian patients with stage 4 ccRCC from the National Cancer Data Base and compared survival between races in the pre-targeted therapy era of 1998 to 2004 and in the post-targeted therapy era of 2006 to 2011. Differences in tumor biology were assessed using The Cancer Genome Atlas: Renal Clear Cell Carcinoma dataset.

Results showed that VHL mutations were present in 17% of African American patients and 50% of Caucasian patients (P = .04), while 79% and 45%, respectively were enriched in the ccB molecular subtype (P < .01). Furthermore, researchers found that several HIF-associated pathways were upregulated in Caucasian patients compared with African American patients.

The study also demonstrated overall survival was significantly longer in Caucasian patients than in African American patients (9.2 months vs 6.5 months; P < .01). African American patients were 8% more likely to die from ccRCC than Caucasian patients (HR, 1.08; 95% CI, 1.01 – 1.14) in the post-targeted therapy era, which was unchanged from the pre-targeted therapy era (HR, 1.07, 95% CI, 1.01 – 1.14).

“Data from a large national database confirm that African American patients maintain inferior survival compared to Caucasians in the era of targeted therapy, potentially related to underlying tumor biology,” the authors concluded.

Reference

1. Rose TL, Krishnan B, Kuykendal AR, et al. Genomic differences and survival in African Americans with metastatic clear cell renal cell carcinoma in the targeted therapy era. J Clin Oncol. 2016; 34 (suppl 2S; abstr 504).