For real-world patients with metastatic renal cell carcinoma (mRCC), active surveillance may be a worthwhile alternative to immediate systemic therapy, according to the results of the Metastatic Renal Cell Cancer (MaRCC) Registry study published in Cancer.
The MaRCC Registry was a prospective observational study, conducted from March 2014 to December 2016, of patients with mRCC and included 448 patients from community and academic centers. Of these patients, 143 underwent active surveillance and 305 received immediate received systemic therapy.
The active surveillance group was followed for a median of 33 months from enrollment, 42 months from metastatic diagnosis, and 79 months from initial diagnosis. The systemic therapy group was followed for a median of 29 months from enrollment, 32 months from metastatic diagnosis, and 46 months from initial diagnosis.
Patient-reported outcomes were gathered at baseline using the National Comprehensive Cancer Network–Functional Assessment of Cancer Therapy Kidney Symptom Index 19 (NCCN-FACT FKSI-19) and Functional Assessment of
Cancer Therapy–General (FACT-G) questionnaires. The active surveillance group had significantly higher scores for both questionnaires (both P <.0001) compared with the systemic therapy group.
Median overall survival (OS) was assessed from the time of metastatic disease diagnosis and was not reached (95% CI, 122 months to not estimable) for the active surveillance group and was 30 months (95% CI, 25-44 months) for the systemic therapy group. At 3 years, the estimated proportion of patients alive was 84% for the active surveillance group and 45% for the systemic therapy group.
Analysis of survival outcomes also revealed that when patients were stratified by International Metastatic Renal Cell Database Consortium (IMDC) risk group — a known prognostic variable — survival rates varied in the systemic therapy group but not the active surveillance group, suggesting that “…those selected for [active surveillance] may have a different tumor biology than those undergoing immediate [systemic therapy].”
“Although follow-up is currently too short to assess long-term outcomes,” the study authors concluded, “in carefully selected patients, AS is a justifiable management option for the treatment of mRCC.”
Disclosures: Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ affiliations.
Harrison MR, Costello BA, Bhavsar NA, et al. Active surveillance of metastatic renal cell carcinoma: results from a prospective observational study (MaRCC). Cancer. Published online March 25, 2021. doi:10.1002/cncr.33494