SAN DIEGO—Greater percentages of patients with metastatic renal cell carcinoma (mRCC) are receiving treatment, according to new US trend data presented at the American Urological Association 2016 annual meeting.
The main driver is use of systemic therapy, according to lead researcher Nawar Hanna, MD, of Brigham and Women’s Hospital in Boston. Cytoreductive nephrectomy (CN) use remained stable in the targeted therapy (TT) era, but more patients are receiving a combination of CN and systemic therapy.
Dr Hanna and his team tapped the National Cancer Database to examine trends before and after the TT era, 1998–2012. Among 52,271 mRCC patients, 24,549 (47%) did not receive any treatment. Those treated included 14,137 (27.1%) with systemic therapy only (i.e., immunotherapy or chemotherapy with single or multiple agents, including TT); 6,787 (13%) with CN only; and 6,798 (13%) with combination treatment.
The proportion of patients undergoing CN increased from 8% in 1998 to 16% in 2005, then leveled off in the TT era, 2006-2012, according to estimated annual percent change analyses. Use of combination therapy continued to rise over the entire study period, from 5% in 1998 to 11% in 2005 to 18% in 2012. Systemic therapy usage initially declined from 30% in 1998 to 21% in 2005, then rebounded to 33% in 2012.
Using multivariable logistic regression, the researchers discovered independent predictors of CN utilization: papillary and chromophobe histology, higher Fuhrman grade, T2/T3 primary stage, and diagnosis within the TT era. African Americans, older patients, and those with more comorbidities were less likely to undergo CN, as were patients treated in non-academic centers or with no insurance.
“The significant advent of TT has blurred the role of CN in contemporary patients diagnosed with mRCC,” Dr Hanna stated.
Although there is an ongoing clinical trial assessing the role of CN with TTs (CARMENA), existing data for CN in this context were infrequently examined, he explained. Whether CN should remain an integral part of treatment for patients with mRCC following the immunotherapy era remains an open question.