Metastatic renal cell carcinoma: Immunotherapy may still play a role

Stockholm, Sweden-Today, targeted therapy is the first choice for most patients with metastatic renal cell carcinoma, but some patients can still be reasonably treated with immunotherapy, according to study results presented at the European Society for Medical Oncology 33rd Congress.

"We believe that immunotherapy can still play a role for metastatic RCC patients, but exclusively for those with a very favorable profile," study co-author Teodoro Sava, MD, chief of the genitourinary group for medical oncology at the University of Verona, Italy, told Urology Times. "Obviously, this is a very limited number, probably around 15% of metastatic RCC patients. After first-line immunotherapy, targeted therapy is a reasonable choice for these patients."

The study was based on a retrospective review of 157 patients with metastatic RCC at the University of Verona followed from 1999 to 2006. Most had clear cell carcinoma, underwent nephrectomy, and were treated with single-agent interferon (Roferon-A), interleukin-2 (Proleukin), or the combination of interferon plus thalidomide (Thalomid).

The most statistically significant factors were performance status (p=.0002), metastasis in at least two sites (p<.0001), nodal metastasis (p<.0001), elevated LDH (p<.0001), elevated calcium (p<.0001), elevated ALP (p=.0001), presence of bone metastasis (p=.005), low levels of hemoglobin (p=.001), and presence of synchronous metastasis (p=.001), reported senior author Gianluigi Cetto, MD, professor of medical oncology at the University of Verona.

Also statistically significant, though at a lower p-value, were advanced age at diagnosis (p=.021), absence of prior nephrectomy in patients with synchronous metastasis (p=.024), hepatic metastasis (p=.029), and elevated Fuhrman grade (p=.035).

Positive outcomes, however, were significantly associated with the presence of pulmonary metastasis as a unique site (p=.049). Approximately 75% of such patients were alive at 100 days. Performance status was also highly correlated with survival.

"We suggest that first-line immunotherapy should be proposed only for patients with lung metastasis, a good performance status, a long interval from the nephrectomy and diagnosis of metastasis, a low Fuhrman grading score, and normal values of LDH, ALP, hemoglobin and calcium," Dr. Cetto concluded.