A retrospective study comparing patterns of care and overall survival (OS) in older patients with metastatic renal cell carcinoma (mRCC) with that of their younger counterparts demonstrated that most concerns regarding clinical trial participation of older patients are unfounded. The findings from this study were published in the Journal of Geriatric Oncology.
Although median age at diagnosis of RCC is 64 years, potential physician concerns regarding organ dysfunction and polypharmacy in older patients with this disease have likely contributed to the underrepresentation of this group of patients in clinical trials.
The purpose of this study was to use real-world demographic and clinical data from the registries of 2 large academic cancer centers to compare treatment patterns and clinical outcomes in older (65 years and older) and younger (younger than 65 years) adult patients with mRCC who had disease progression on first-line therapy or treatment toxicity requiring early discontinuation of first-line therapy. Patients were classified according to their age at initiation of first-line therapy.
Of the 309 patients included in the study, 44.7% were classified as older. Median ages in the 2 groups were 71 years and 56 years. Approximately 70% of patients in both age groups had disease characterized by clear cell histology. Similarly, no significant difference in the distribution of patients according to International Metastatic RCC Database Consortium (IMDC) risk score category was observed when the 2 age groups were compared, with approximately 56% of patients in each group categorized by an intermediate score.
The most common first-line therapies administered to older patients were sunitinib (52.9%), pazopanib (10.1%), and temsirolimus (9.4%). Sunitinib (61.4%), temsirolimus (7.0%), and pazopanib (6.4%) were the most commonly administered first-line therapies in the younger cohort. Although the percentage of patients receiving second-line therapy was higher among younger patients than among older patients, this difference was not significant (63.7% vs 57.2%; P =.296).
At a median follow-up of 19 months, the median OS was 31.0 months for the older patients and 33.1 months for the younger patients (P =.956).
The possibility of selection bias was identified as a potential limitation in this study, given that only patients who had received first-line therapy were included.
“Our findings suggest that older patients warrant proportionate representation on clinical trials. Furthermore, these findings can help clinicians in selecting initial treatment and planning treatment sequencing,” the study authors concluded.
Reference Hahn AW, Esther J, Haaland B, et al. Patterns of treatment in metastatic renal cell carcinoma for older versus younger patients [published online August 8, 2019]. J Geriatr Oncol. doi: 10.1016/j.jgo.2019.07.002
This article originally appeared on Oncology Nurse Advisor