André P Fay1, Wanling L Xie1, Jae-Lyn Lee2, Lauren C Harshman3, Georg A Bjarnason4, Jennifer J Knox5, Scott Ernst6, Lori Wood7, Ulka N Vaishamayan8, Takeshi Yuasa9, Min-Han Tan10, Sun-Young Rha11, Frede Donskov12, Neeraj Agarwal13, Christian K Kollmannsberger14, Scott A North15, Brian I Rini16, Toni K Choueiri1, Daniel Y C Heng17. 1. Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 2. University of Ulsan College of Medicine, Asan, South Korea. 3. Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Stanford Cancer Institute, Stanford, CA. 4. Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada. 5. Princess Margaret Hospital, Toronto, Canada. 6. London Health Sciences Center, London, ON, Canada. 7. Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada. 8. Karmanos Cancer Center, Detroit, MI. 9. Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 10. National Cancer Center, Singapore. 11. Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea. 12. Aarhus University Hospital, Aarhus, Denmark. 13. University of Utah Huntsman Cancer Institute, Salt Lake City, UT. 14. British Columbia Cancer Agency, Vancouver, Canada. 15. Cross Cancer Institute, Edmonton, AB, Canada. 16. Cleveland Clinic Taussig Cancer Institute, Cleveland, OH. 17. Tom Baker Cancer Center and University of Calgary, Calgary, Canada. Electronic address: daniel.heng@albertahealthservices.ca.
Abstract
BACKGROUND: Targeted therapies improve survival in metastatic renal cell carcinoma (mRCC). However, survival patterns can be divergent, and patients at the 2 extremes of the survival spectrum need to be characterized. PATIENTS AND METHODS: Data from 2161 patients included in the International mRCC Database Consortium (IMDC) were analyzed. We identified patients on the basis of their duration of survival. Long-term survival (LTS) was defined as overall survival (OS) of ≥ 4 years, and short-term survival (STS) was defined as OS of ≤ 6 months from the start of targeted therapy. Baseline characteristics, including demographic, clinicopathologic, and laboratory data, were compared between LTS and STS. Treatment response by the RECIST criteria was summarized for the 2 survival groups. RESULTS: A total of 152 patients experienced LTS and 218 experienced STS. Adverse clinical and laboratory prognostic factors previously described in the IMDC prognostic model were significantly more frequent in the STS group (P < .0001). In the LTS group, 138 patients (91%) had nonprogressive disease (non-PD) as best response to first-line targeted therapy, and 56 (60%) of 94 patients who received second-line therapy had non-PD. In the STS group, only 51 patients (23%) had non-PD on first-line therapy. None of 21 the patients who received second-line therapy had non-PD as best response. In LTS, the median duration of therapy was 23.6 months (range 0.4 to 81.8+ months) for first-line therapy and 11.5 months (range 0.6 to 45.7 months) for second-line therapy, compared to 2.0 and 0.8 months for the STS group, respectively. CONCLUSION: Baseline prognostic criteria and absence of PD after first and second-line targeted therapy may characterize long-term survival.
BACKGROUND: Targeted therapies improve survival in metastatic renal cell carcinoma (mRCC). However, survival patterns can be divergent, and patients at the 2 extremes of the survival spectrum need to be characterized. PATIENTS AND METHODS: Data from 2161 patients included in the International mRCC Database Consortium (IMDC) were analyzed. We identified patients on the basis of their duration of survival. Long-term survival (LTS) was defined as overall survival (OS) of ≥ 4 years, and short-term survival (STS) was defined as OS of ≤ 6 months from the start of targeted therapy. Baseline characteristics, including demographic, clinicopathologic, and laboratory data, were compared between LTS and STS. Treatment response by the RECIST criteria was summarized for the 2 survival groups. RESULTS: A total of 152 patients experienced LTS and 218 experienced STS. Adverse clinical and laboratory prognostic factors previously described in the IMDC prognostic model were significantly more frequent in the STS group (P < .0001). In the LTS group, 138 patients (91%) had nonprogressive disease (non-PD) as best response to first-line targeted therapy, and 56 (60%) of 94 patients who received second-line therapy had non-PD. In the STS group, only 51 patients (23%) had non-PD on first-line therapy. None of 21 the patients who received second-line therapy had non-PD as best response. In LTS, the median duration of therapy was 23.6 months (range 0.4 to 81.8+ months) for first-line therapy and 11.5 months (range 0.6 to 45.7 months) for second-line therapy, compared to 2.0 and 0.8 months for the STS group, respectively. CONCLUSION: Baseline prognostic criteria and absence of PD after first and second-line targeted therapy may characterize long-term survival.