Nils Kroeger1, Haoran Li2, Guillermo De Velasco3, Frede Donskov4, Hao-Wen Sim5, Viktoria Stühler6, J Connor Wells2, Igor Stukalin2, Johannes Heide7, Jens Bedke6, Neeraj Agarwal8, Hiral Parekh9, Brian I Rini9, Jennifer J Knox5, Allan Pantuck10, Toni K Choueiri3, Daniel Yick Chin Heng11. 1. Department of Urology, Ernst-Moritz-Arndt University Greifswald, Germany; Tom Baker Cancer Center, University of Calgary, Alberta, Canada. 2. Tom Baker Cancer Center, University of Calgary, Alberta, Canada. 3. Dana-Farber Cancer Institute, Boston, MA. 4. Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. 5. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 6. Department of Urology, Eberhard-Karls-University, Tübingen, Germany. 7. Department of Urology, Ernst-Moritz-Arndt University Greifswald, Germany. 8. Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT. 9. Cleveland Clinic Taussig Cancer Institute, Cleveland, OH. 10. UCLA Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA. 11. Tom Baker Cancer Center, University of Calgary, Alberta, Canada. Electronic address: daniel.heng@albertahealthservices.ca.
Abstract
BACKGROUND: Smoking increases the risk of developing renal cell carcinoma (RCC) but the effect of tobacco consumption on survival outcome of patients with metastatic RCC (mRCC) treated with targeted therapies has not been well characterized. PATIENTS AND METHODS: The primary outcome was overall survival (OS) and secondary outcome was progression-free survival (PFS). Patients with mRCC were categorized as current, former, and nonsmokers at the time of starting targeted therapy. Smoking data from 1980 patients with mRCC treated with targeted therapy were collected through the International mRCC Database Consortium (IMDC) from 12 international cancer centers. RESULTS: Although former and nonsmokers had comparable OS times (23.8 vs. 23.4 months; P = .898), current smokers had significantly shorter OS (16.1 months; P < .001) than nonsmokers. Current but not former smoking status was an independent poor prognosis factor (hazard ratio [HR], 1.3; P = .002) when adjusted for the IMDC risk criteria. Each pack-year increased the risk of death by 1% (HR, 1.01; P = .036). The duration of first-line therapy response was not different and was 7.7 months versus 7.5 months versus 6.4 months in never, former (P = .609), and current smokers (P = .839), respectively. CONCLUSION: Active smoking is associated with diminished OS in mRCC patients treated with targeted therapy agents. However, patients who quit smoking returned to a similar risk of death from RCC compared with patients who never smoked. Smoking cessation should be a counseling priority among mRCC patients receiving targeted agents and smoking should be considered as a confounding factor in major clinical trials.
BACKGROUND: Smoking increases the risk of developing renal cell carcinoma (RCC) but the effect of tobacco consumption on survival outcome of patients with metastatic RCC (mRCC) treated with targeted therapies has not been well characterized. PATIENTS AND METHODS: The primary outcome was overall survival (OS) and secondary outcome was progression-free survival (PFS). Patients with mRCC were categorized as current, former, and nonsmokers at the time of starting targeted therapy. Smoking data from 1980 patients with mRCC treated with targeted therapy were collected through the International mRCC Database Consortium (IMDC) from 12 international cancer centers. RESULTS: Although former and nonsmokers had comparable OS times (23.8 vs. 23.4 months; P = .898), current smokers had significantly shorter OS (16.1 months; P < .001) than nonsmokers. Current but not former smoking status was an independent poor prognosis factor (hazard ratio [HR], 1.3; P = .002) when adjusted for the IMDC risk criteria. Each pack-year increased the risk of death by 1% (HR, 1.01; P = .036). The duration of first-line therapy response was not different and was 7.7 months versus 7.5 months versus 6.4 months in never, former (P = .609), and current smokers (P = .839), respectively. CONCLUSION: Active smoking is associated with diminished OS in mRCC patients treated with targeted therapy agents. However, patients who quit smoking returned to a similar risk of death from RCC compared with patients who never smoked. Smoking cessation should be a counseling priority among mRCC patients receiving targeted agents and smoking should be considered as a confounding factor in major clinical trials.
Authors: Shreya Chawla; Ishaan A Tewarie; Qingwei O Zhang; Alexander F C Hulsbergen; Rania A Mekary; Marike L D Broekman Journal: Neurosurg Rev Date: 2022-07-14 Impact factor: 2.800