The Impact of Age and Gender on Outcomes of Patients With Advanced Renal Cell Carcinoma Treated With Targeted Therapy

Panian, Justine; Lin, Xun; Simantov, Ronit; Derweesh, Ithaar; Choueiri, Toni K.; McKay, Rana R.

doi:10.1016/j.clgc.2020.03.010

Cited by 12 publications

(8 citation statements)

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“…Pooled analysis of phase 2 and 3 trials in mRCC encompassing 4736 patients examined the question if age represented an independent prognostic determinant of OS. Stratified according to three age groups—young (< 50 years), intermediate (50–70 years) and elderly (> 70 years)—no significant differences in OS were observed, returning at 20, 17.3 and 21 months, respectively [ 20 ]. However, in that analysis, patients above 70 years did experience more adverse events, irrespective of improvements in OS [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Stratified according to three age groups—young (< 50 years), intermediate (50–70 years) and elderly (> 70 years)—no significant differences in OS were observed, returning at 20, 17.3 and 21 months, respectively [ 20 ]. However, in that analysis, patients above 70 years did experience more adverse events, irrespective of improvements in OS [ 20 ]. It has also been demonstrated that mRCC patients ineligible for clinical trials tend to experience inferior outcomes with a median OS of 12.5 months for ineligible vs. 28.4 months for eligible patients [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…Concerning patient fitness, it has been shown that elderly patients experience more adverse events than their younger counterparts when receiving targeted therapy of mRCC and this may be more pronounced when using combination treatment. 20 The discordance among experts concerning use of PD-L1 expression for treatment selection may be explained by the fact that a post-hoc analysis of CheckMate 214 showed longer OS and a higher overall response rate (ORR)with ipilimumab/nivolumab than with sunitinib among intermediate-risk and poor-risk patients across tumour PD-L1 expression levels. 13 Though, partial responders and complete responders to ipilimumab/nivolumab both had higher baseline tumour PD-L1 expression than non-responders.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 pandemic on treatment patterns in metastatic clear cell renal cell carcinoma

et al. 2020

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BackgroundThe coronavirus pandemic has provoked discussions among healthcare providers how to manage cancer patients when faced with the threat of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) infection. Immune checkpoint inhibitor (ICI) containing regimens are standard of care in the majority of metastatic clear cell renal cell carcinoma (mccRCC) patients. It remains unclear whether therapies should be modified in response to the COVID-19 pandemic.MethodsWe performed an online survey among physicians involved in the treatment of mccRCC, and 41 experts responded. Questions focused on criteria relevant for treatment decision outside the pandemic and the modifications of systemic therapy during COVID-19.FindingsFor the majority of experts (73%), the combination of International metastatic renal cell carcinoma Database Consortium (IMDC) risk category and patient fitness are two important factors for decision-making. The main treatment choice in fit, favourable risk patients outside the pandemic is pembrolizumab/axitinib for 53%, avelumab/axitinib, sunitinib or pazopanib for 13% of experts each. During the pandemic, ICI-containing regimens are chosen less often in favour of a tyrosine kinase inhibitors (TKI) monotherapy, mainly sunitinib or pazopanib (35%).In fit, intermediate/poor-risk patients outside the pandemic, over 80% of experts choose ipilimumab/nivolumab, in contrast to only 41% of physicians during COVID-19, instead more TKI monotherapies are given. In patients responding to established therapies with ICI/ICI or ICI/TKI combinations, most participants modify treatment regimen by extending cycle length, holding one ICI or even both.ConclusionmccRCC treatment modifications in light of the coronavirus pandemic are variable, with a shift from ICI/ICI to ICI/TKI or TKI monotherapy.

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“…In the study by Panian J et al, overall survival (OS) in 4736 metastatic RCC patients did not differ among three age groups (<50 years, 50-70 years, and >70 years), but progression-free survival (PFS) in the youngest group (<50 years) was found to be shorter (15).…”

Section: Discussionmentioning

confidence: 95%

Böbrek Tümörlü Hastalarda Histopatolojik Prognostik Veriler Açısından İleri Yaşın Öneminin Değerlendirilmesi

Çokbankir

Ekmekçi

Küçük

2022

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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Amaç: Böbrek tümörleri erkeklerde daha fazla görülen ve sıklıkla ileri yaş tümörleri kategorisinde yer alan tümörlerdendir. Bu çalışmada histolojik alt tür yanı sıra birçok tanımlanmış histopatolojik prognostik parametrenin bulunduğu böbrek tümörleri için histopatolojik prognostik veriler açısından yaşın öneminin değerlendirilmesi amaçlanmıştır. Yöntem: 2010-2020 yılları arasında nefrektomi uygulanarak böbrek kanseri tanısı almış 75 yaş üzerinde olan 24 hasta çalışmaya dahil edilmiştir. Tümör histolojik alt tipi, tümör derecesi, lenfovasküler invazyon (LVI), perinöral invazyon (PNI), nekroz varlığı, hiler yağ doku ve perirenal yağ doku invazyonu ile cerrahi sınırların durumunu içeren histopatolojik bulguların yaş ile ilişkisi belirlenmiştir. Bulgular: Tümörlerin 23’ü renal hücreli karsinom (RCC), birisi düşük malignite potansiyelli multiloküler kistikrenal hücreli neoplazm olarak sınıflandı. RCC’nin histopatolojik alt tipleri sırasıyla; şeffaf hücreli RCC (n:19, %79.1), kromofob RCC (n:2, %8.3), Tip 1 papiller RCC (n:1, %4.2) ve Tip 2 papiller RCC (n:1, %4.2) idi. İncelenen histopatolojik veriler arasında renal ven invazyonunun sağkalım açısından istatistiksel anlamlılık gösterdiği saptanmıştır (p=0.002). Ayrıca artan tümör derecesi ile LVI arasında anlamlı ilişki gözlenmiştir (p=0.009). Sonuçlar: Tümör boyutu, tümör derecesi, nekroz varlığı, lenf nodu metastazı varlığı, perirenal yağ doku invazyonu ve renal ven invazyon varlığı RCC için prognostik belirteçler arasında yer almaktadır. Ancak ileri yaş olgulardan oluşan serimizde; yalnızca renal ven invazyonununun sağkalım açısından prognostik önemli olduğu, diğer tanımlanan belirteçlerin bu yaş gurubunda belirgin etkisinin olmadığı görülmüştür. Bu durum; ileri yaş tümörlerinin diğer yaş gruplarındaki tümörlerden farklılık gösterebileceğine ve rutin kullandığımız verilerin hastaların gidişatını ön görmekte yetersiz kalabileceğine işaret etmektedir.

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The Impact of Age and Gender on Outcomes of Patients With Advanced Renal Cell Carcinoma Treated With Targeted Therapy

Cited by 12 publications

References 50 publications

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

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

Impact of COVID-19 pandemic on treatment patterns in metastatic clear cell renal cell carcinoma

Böbrek Tümörlü Hastalarda Histopatolojik Prognostik Veriler Açısından İleri Yaşın Öneminin Değerlendirilmesi

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