Survival still poor in non-clear cell RCC despite targeted therapies
By Lucy Piper, Senior medwireNews Reporter
13 August 2013
Cancer 2013; Advance online publication

medwireNews: Even in the era of targeted therapy, most patients with non-clear cell renal cell carcinoma (nccRCC) still have inferior survival compared with their clear-cell counterparts, despite outcomes being significantly improved, study findings indicate.

The results suggest that “new drugs that better consider the unique biological properties of each nccRCC subtype are needed,” say the study researchers.

They also found that the International mRCC Database Consortium (IMDC), which classifies patients into risk groups based on six independent predictors for poor survival, helped predict overall survival and time to treatment failure.

It could therefore be employed to reliably determine patients’ need for counseling and in clinical trial designs, researchers Daniel Heng (University of Calgary, Alberta, Canada) and colleagues suggest.

Although the 252 patients with nccRCC tended to be younger than the 1963 with ccRCC and more often presented with low hemoglobin and elevated neutrophils, the two groups had similar clinicopathologic features.

Despite this, however, overall survival (OS) following the initiation of targeted therapy was significantly shorter for patients with nccRCC than for patients with ccRCC, at a median 12.8 months versus 22.3 months. When the subtypes of nccRCC were assessed separately, only patients with the chromophobe RCC subtype had survival outcomes comparable to those of ccRCC patients.

The time to treatment failure (TTF) for first-line therapy was also shorter for patients with nccRCC, at an average of 4.2 months versus 7.8 months for patients with ccRCC.

After accounting for prognostic factors (Karnofsky performance status <80%, <1 year from diagnosis to treatment, anemia, hypercalcemia, neutrophilia, and thrombocytosis), patients with nccRCC had a significant 1.41-fold increased risk for death and a 1.54-fold increased risk for treatment failure, compared with patients with ccRCC.

These six prognostic factors together were significantly associated with TTF and OS, the researchers point out in Cancer.

The median OS of those with nccRCC classified as having a favorable prognosis (13%) was 31.4 months, compared with 16.1 months for those with an intermediate prognosis (57%), and 5.1 months for those with a poor prognosis (30%).

The TTF for the favorable, intermediate, and poor prognosis groups was 9.6 months, 4.9 months, and 2.1 months, respectively.

“To the best of our knowledge, there is actually no other modern prognostic model that has been assessed exclusively in advanced nccRCC,” the researchers remark.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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