MIAMI – Clinical benefit and patient characteristics were common reasons for initial systemic therapy for patients with metastatic renal cell carcinoma (mRCC), while side-effect profile rarely impacted initial systemic therapy selection, a study presented at the 14th International Kidney Cancer Symposium 2015 (IKCS 2015) has shown.1

Because clinical trial patients with mRCC differ from real-world patients and physicians are not asked why they make certain treatment decisions in trials, researchers sought to identify reasons for treatment selection in real-world patients with mRCC.

“The primary goal of this prospective, observational, phase 4 study is to understand the treatment of patients with mRCC in routine real-world clinical practice in the United States, including both academic and community settings,” said Brian A. Costello, MD, of the Mayo Clinic in Rochester, MN, during a poster presentation.

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For the study, researchers analyzed data from 105 patients who had been enrolled in the MaRCC Registry. Patients had a median age of 64 years, 66% were male, 87% had clear cell histology, and 31% had stage 4 cancer at the time of diagnosis.

Of the 105 patients, 40% had deferred systemic therapy, 22% had initiated pazopanib therapy, 18% participated in a clinical trial, 10% received sunitinib, and 6% were classified as other.

Results showed that among the 61 patients who had received systemic therapy, the most common reasons for therapy choice as selected by health care providers were likelihood of clinical benefit and patient characteristics.

Among the 41% of patients whose therapy was chosen based on likelihood of clinical benefit, the most common reason was overall/progression-free survival benefit. Among those whose systemic treatment was selected based on patient characteristics, the most common reasons were performance status/frailty or prognostic factors.

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Researchers also found that active surveillance with disease present, active surveillance without disease present after a procedure, and local therapy were the most common reasons for deferment of systemic therapy.

“This is the first report describing factors driving physician decision-making in the management of mRCC,” Dr. Costello concluded. “Management choices are not captures in other prospective or retrospective studies.”


  1. Costello BA, Harrison MR, Bhavsar NA, et al. Physician treatment selection in the Prospective Metastatic Renal Cell Cancer (MaRCC) Registry [abstract]. BJU Int. 2015. doi: 10.1111/bju.13365.