A subset of patients with metastatic renal cell carcinoma (mRCC) can safely receive active surveillance prior to initiating systemic therapy,  a study published in The Lancet Oncology has shown.1

A proportion of patients with mRCC present with indolent metastasis- growth. Some of these patients may benefit more from initial active surveillance than immediate systemic therapy. In the present study researchers described the time to initiation of systemic therapy for patients with mRCC undergoing active surveillance.

For this prospective, phase 2 trial, investigators enrolled 52 treatment-naive patients with asymptomatic mRCC. Participants were radiographically evaluated at baseline, every 3 months for 1 year, every 4 months during the next year, and every 6 months thereafter.

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Patients received active surveillance until the treating physician and the patient decided to initiate systemic therapy for mRCC.

After a median follow-up of 38.1 months, the median time on surveillance from enrollment until systemic therapy initiation was 14.9 months (95% CI, 10.6-25.0) among the 48 evaluable patients.

After adjusting for confounding factors, researchers found that higher numbers of International Metastatic Database Consortium (IMDC) adverse risk factors (P = .0403) and higher numbers of metastatic disease sites (P = .0414) were associated with a shorter period of surveillance.

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Forty-six percent of the 48 patients died during the study, all due to their disease.

Further evaluation is needed to fully determine the benefits and risks of active surveillance in this patient population.                       


  1. Rini BI, Dorff TB, Elson P, et al. Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Lancet Oncol. 2016 Aug 3. doi: 10.1016/S1470-2045(16)30196-6 [Epub ahead of print]