Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy

S. L. Richey, S. H. Culp, E. Jonasch, P. G. Corn, L. C. Pagliaro, P. Tamboli, K. K. Patel, S. F. Matin, C. G. Wood, N. M. Tannir

Research output: Contribution to journalArticle

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Abstract

Background: Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown. Patients and methods: We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors. Results: One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8%) or poorrisk (44.1%) disease. Median OS for all patients was 10.4 months [95% confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95% CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0%) survived for 2+ years. Conclusions: These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.

Original languageEnglish (US)
Pages (from-to)1048-1053
Number of pages6
JournalAnnals of Oncology
Volume22
Issue number5
DOIs
StatePublished - 2011
Externally publishedYes

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Nephrectomy
Renal Cell Carcinoma
Survival
Therapeutics
Interferon-alpha
Confidence Intervals
Thrombocytosis
Lymphopenia
L-Lactate Dehydrogenase
Immunotherapy
Smoking
Regression Analysis
Neoplasm Metastasis
Calcium

Keywords

  • Cytoreductive nephrectomy
  • Prognosis
  • Renal cell carcinoma
  • Targeted therapy

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Richey, S. L., Culp, S. H., Jonasch, E., Corn, P. G., Pagliaro, L. C., Tamboli, P., ... Tannir, N. M. (2011). Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy. Annals of Oncology, 22(5), 1048-1053. https://doi.org/10.1093/annonc/mdq563

Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy. / Richey, S. L.; Culp, S. H.; Jonasch, E.; Corn, P. G.; Pagliaro, L. C.; Tamboli, P.; Patel, K. K.; Matin, S. F.; Wood, C. G.; Tannir, N. M.

In: Annals of Oncology, Vol. 22, No. 5, 2011, p. 1048-1053.

Research output: Contribution to journalArticle

Richey, SL, Culp, SH, Jonasch, E, Corn, PG, Pagliaro, LC, Tamboli, P, Patel, KK, Matin, SF, Wood, CG & Tannir, NM 2011, 'Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy', Annals of Oncology, vol. 22, no. 5, pp. 1048-1053. https://doi.org/10.1093/annonc/mdq563
Richey, S. L. ; Culp, S. H. ; Jonasch, E. ; Corn, P. G. ; Pagliaro, L. C. ; Tamboli, P. ; Patel, K. K. ; Matin, S. F. ; Wood, C. G. ; Tannir, N. M. / Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy. In: Annals of Oncology. 2011 ; Vol. 22, No. 5. pp. 1048-1053.
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abstract = "Background: Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown. Patients and methods: We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors. Results: One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8{\%}) or poorrisk (44.1{\%}) disease. Median OS for all patients was 10.4 months [95{\%} confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95{\%} CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0{\%}) survived for 2+ years. Conclusions: These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.",
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AU - Richey, S. L.

AU - Culp, S. H.

AU - Jonasch, E.

AU - Corn, P. G.

AU - Pagliaro, L. C.

AU - Tamboli, P.

AU - Patel, K. K.

AU - Matin, S. F.

AU - Wood, C. G.

AU - Tannir, N. M.

PY - 2011

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N2 - Background: Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown. Patients and methods: We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors. Results: One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8%) or poorrisk (44.1%) disease. Median OS for all patients was 10.4 months [95% confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95% CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0%) survived for 2+ years. Conclusions: These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.

AB - Background: Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown. Patients and methods: We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors. Results: One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8%) or poorrisk (44.1%) disease. Median OS for all patients was 10.4 months [95% confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95% CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0%) survived for 2+ years. Conclusions: These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.

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