Improving survival in metastatic renal cell carcinoma (mRCC) patients: do elderly patients benefit from expanded targeted therapeutic options?

Abstract

Introduction Treatment advances in metastatic renal cell carcinoma (mRCC) have improved overall survival (OS) in mRCC patients over the last two decades. This single center retrospective analysis assesses if the purported survival benefits are also applicable in elderly mRCC patients. Methods 401 patients with mRCC treated at Hannover Medical School from 01/2003–05/2016 were identified and evaluated by chart review. Treatment periods were defined as 01.01.2003–31.12.2009 (P1) and 01.01.2010–31.05.2016 (P2). Age groups were defined according to WHO classes (≤ 60 years: younger, > 60–75 years: elderly and > 75 years: old). Descriptive statistics, Kaplan–Meier analysis and logistic regression were performed. Results Median OS improved from 35.1 months in P1 to 59.1 months in P2. Sub-division into the respective age groups revealed median survival of 38.1 (95%-CI: 28.6–47.6) months in younger patients, 42.9 (95%-CI: 29.5–56.3) months among elderly patients and 27.3 (95%-CI: 12.8–41.8) months among old patients. Risk reduction for death between periods was most evident among old patients (young: HR 0.71 (95%-CI: 0.45–1.13, p = 0.2); elderly: HR 0.62 (95%-CI: 0.40–0.97, p = 0.04); old: HR 0.43 (95%-CI: 0.18–1.05, p = 0.06)). Age ≥ 75 years was an independent risk factor for death in P1 but not in P2. Conclusion Improved OS in the targeted treatment period was confirmed. Surprisingly elderly and old patients seem to profit the most form expansion of therapeutic armamentarium, within the TKI-dominated observation period.

Improved socioeconomic status, as indicated by education and income, enhances the prognosis of central nervous system tumours

“…Age was recoded as follow: young (25 ~ 44 years old), middle (45 ~ 59 years old), presenium (60 ~ 74 years old), and senectitude (≥ 75 years old), which also known as young, middle, young-old, and old-old. This age groups are consistent with US census bureau age divisions as well as previous research about various diseases [17][18][19][20][21][22][23][24] . Primary site in cerebrum means the site in cerebral hemisphere but excluding hypothalamus, pallium or thalamus.…”

Association of lncRNA and transcriptome intersections with response to targeted therapy in metastatic renal cell carcinoma

“…TEREzA TESAROVA 1,2 , KAmILA KOuCKA 1 , RADkA VACLAVIkOVA 1,2 , kAROLINA SEbOROVA 1 , mILAN HORA 3 , ONdREj HES 4 , kRISTyNA PIVOVARCIkOVA 4 , PAVEL SOUCEk 1,2 and ONdREj FIALA 5,6 1 Laboratory of Pharmacogenomics, Biomedical Center, Faculty of medicine in Pilsen, Charles university, 323 00 Pilsen; 2 Toxicogenomics Unit, National Institute of Public Health, 100 00 Prague 10; Departments of 3 urology and 4 Pathology, Faculty of Medicine in Pilsen and University Hospital, Charles University, 301 00 Pilsen; 5 department of Oncology and Radiotherapeutics, Faculty of medicine in Pilsen and university Hospital, Charles university; 6 Laboratory of Cancer Treatment and Tissue Regeneration, biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic SARCC increases its efficacy (23). In mRCC specifically, mostly protein-coding genes have been studied (24,25).…”

“…A total of ~20% of patients are initially diagnosed with metastatic ccRCC (mRCC) and ~20% of primary localized cases become metastatic during follow-up ( 4 , 5 ). The management of mRCC has markedly changed in recent years with the introduction of novel therapies leading to substantial improvements in the survival and quality of life of patients ( 6 ). Antiangiogenic tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs) and their combination represent novel systemic therapies in mRCC ( 7 , 8 ).…”