Researchers who studied a population-based cohort of patients with metastatic renal cell carcinoma (mRCC) found a trend toward improved survival with the shift from the cytokine to the targeted therapy era. The degree of improvement, however, was slightly less than that observed in clinical trials of targeted therapies.
For non-clear-cell mRCC, the limited therapeutic options translated into modest survival gains in the targeted therapy era, according to the investigators.1
“These data permit accurate counseling of a heterogeneous, ‘real world’ population of mRCC patients seeking care, especially in the setting of late presentation and unclear histology,” a research team led by Liam C. Macleod, MD, of the University of Washington in Seattle, concluded.
“We are hopeful this work may serve as an impetus to systematically improve implementation of histologically guided care for mRCC.”
Using the Surveillance, Epidemiology, and End Results (SEER) database, Dr. Macleod’s group identified 14,521 patients diagnosed with mRCC from 1990 to 2009. They analyzed survival by treatment era (cytokine era, 1990–2005; targeted therapy era, 2006–2009).
Prior to the mid-2000s, the authors noted, mRCC treatments included the cytokines interferon alfa and interleukin-2. As a result of studies elucidating the molecular biology of kidney cancer, researchers developed agents targeting the vascular endothelial growth factor pathway (such as sunitinib, sorafenib, and bevacizumab) and the mammalian target of rapamycin pathway (such as temsirolimus and everolimus).
Results showed that median survival among the 4,149 patients with clear-cell mRCC improved significantly from 11 to 14 months before and after the debut of targeted therapy.
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Median survival improved significantly from 7 to 9 months among the 904 patients with non-clear-cell mRCC. Median survival did not change significantly among the 608 patients who had mRCC with sarcomatoid features and the 8,860 patients with RCC not otherwise specified.