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14-07-2013 | Urology | Article

Some mRCC patients miss out on molecular era benefits

Abstract

Free abstract

medwireNews: Researchers report that certain subgroups of Japanese patients with metastatic renal cell carcinoma (mRCC) fare no better since the introduction of molecular-targeted therapies than patients treated with cytokine-based immunotherapy alone.

Results from their retrospective study found that although overall survival in mRCC patients was a median 13 months longer in the molecular era, the prognosis for some, such as those with non-clear cell tumors or metastases at three or more sites, remains poor, reflecting a need for new treatment strategies.

The study, reported in the International Journal of Clinical Oncology, included 50 patients treated with molecular-targeted therapy (MT group), 29 of whom had also received prior immunotherapy, and 94 patients treated with immunotherapy alone (IT group). The patients were followed up for a median of 26 and 18 months, respectively.

Patients in the MT group had a 32% lower risk for death during follow up than patients in the IT group (overall survival 45 vs 32 months), report Osamu Ogawa (Kyoto University, Japan) and colleagues. And, in patients who were treated with molecular-targeted therapy alone, survival was even greater at 57 months, corresponding with a 53% reduced risk for death.

However, the results highlighted that there were some patients who experienced worse overall survival, irrespective of the type of systemic therapy they received. This included those with non-clear cell type tumors, decreased blood hemoglobin, elevated lactate dehydrogenase levels, elevated C-reactive protein, and those with metastases at three or more sites. These patients had a 1.89-, 2.01-, 3.24-, 2.76-, and 4.85-fold increased risk for death, respectively, compared with patients without these characteristics.

The authors found that patients with an intermediate Memorial Sloan-Kettering Cancer Center score for recurrence risk were most likely to benefit from molecular-targeted therapy over immunotherapy, a finding that is consistent with previous reports. Additionally, women seemed to benefit more than men from the advent of molecular-targeted therapy, although the authors caution that their sample was too small to confirm this.

Ogawa and colleagues explain that while molecular-targeted therapies have almost entirely replaced immunotherapy in US and European treatment guidelines, there is evidence suggesting that Japanese patients had better prognosis than Western patients during the cytokine era. They note that this could be one factor explaining the relatively modest improvement in survival with molecular-targeted treatments in their study.

And, they conclude that for the Japanese patients who fail to reap any benefit from this “paradigm shift” in treatment strategy, alternatives must be sought.

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

By Kirsty Oswald, medwireNews Reporter