Active Surveillance Occurs Frequently Versus Systemic Therapy for Metastatic Renal Cell Carcinoma

Active surveillance, which occurs in approximately 32% of patients in real-world practice, may be a safe alternative to immediate systemic therapy in some patients with metastatic renal cell carcinoma, according to a study published in Cancer.

“Although follow-up is currently too short to assess long-term outcomes, the median (overall survival) has still not been reached in the (active surveillance) cohort compared with a median (overall survival) of 30 months from metastatic diagnosis in the (systemic therapy) cohort,” the study authors wrote. “This suggests that in carefully selected patients, (active surveillance) is a justifiable management option for the treatment of (metastatic renal cell carcinoma).”

New approaches to treat patients with metastatic renal cell carcinoma focus on combining agents, which has been shown to benefit these patients.

“Although these systemic options have clear disease activity and possible survival benefits, they are associated with significant cost and (side effect) profiles,” the study authors wrote. “Rarely do these therapies lead to complete responses that allow for permanent treatment discontinuation, which suggests that most patients receiving (systemic therapy) will be treated indefinitely, sequencing from one therapy to the next. Recognizing that some of these patients may not require (systemic therapy) for months or years is an important and missing observation that our current study brings to the field.”

Researchers aimed to identify characteristics of patients who originally underwent active surveillance, the reasons for selecting that approach and patient outcomes. To do so, researchers analyzed data from 488 patients with metastatic renal cell carcinoma, of whom 143 were managed by active surveillance (median age 65 years; 72% men) and 305 were treated with systemic therapy (median age, 62 years; 71% men). Disease was identified in 69% of patients in the active surveillance group, and 31% of patients had no evidence of disease.

Half of the patients managed by active surveillance did not receive systemic therapy. Median overall survival in patients managed with active surveillance was not reached, meaning that more than half of these patients were alive at the end of the study. In contrast, median overall survival in patients treated with systemic therapy was 30 months.

Patients managed with active surveillance had a better quality of life at the start of the study compared with those treated with systemic therapy.

“Further study of these findings is warranted, including the identification of relevant clinical and laboratory factors and biomarkers, to more accurately clarify the characteristics of these patients,” the study authors wrote. “Given the totality of the evidence, including our large prospective study, (active surveillance) should become more of a standard approach for selected patients with (metastatic renal cell carcinoma).”

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