Metastatic kidney cancer: To treat or not to treat

• Renal cell carcinoma (RCC) is a form of kidney cancer.
• When RCC spreads and becomes metastatic, guidelines recommend treatments but don’t mention active surveillance — careful monitoring without any treatment.
• In a Phase II study, patients with metastatic RCC achieved notable overall survival while being on active surveillance without treatment.

RCC accounts for 90% of kidney cancers. Once RCC spreads and becomes metastatic, guidelines suggest that first line of defense should be treatments consisting primarily of targeted therapies.

But, is treatment the only answer?

Maybe not, suggests Dr. Rini and colleagues in a Phase II study published in Lancet Oncology. In this study, patients with metastatic RCC who chose active surveillance over treatments survived on average for 3½ years or more.

A quick scan of some of the pivotal studies of other guideline-recommended treatments reveals the significance of their findings.

Of course, caution should be exercised when comparing data between separate studies.

The study recruited about 50 patients with newly diagnosed metastatic RCC who showed no symptoms. All of the patients and their doctors agreed to withhold treatment until both the patient and physician have decided otherwise.

Patients in the study consented to be on active surveillance for an average of 14.9 months. Average period where patients were alive and progression-free was 9.4 months.

Active surveillance is not a new concept for treating cancer. For instance, it is often recommended for patients with prostate cancer. The idea is that if rushing into therapy offers no benefit over waiting, side effects might end up doing more harm than good.

Bottom line

• This study doesn’t suggest for all patients with metastatic RCC to abandon treatment. Rather, carefully selected patients may benefit considerably with active surveillance before starting treatment.
• It’s important for doctors to know how to identify patients who might benefit the most from active surveillance, as well as from treatment.
• If you or a loved one have been diagnosed with metastatic RCC, consider the benefits of active surveillance and talk to your doctor about it.

*Inlyta is not indicated for first-line treatment.

Source study: Rini BI, et al. Lancet Oncol 2016. Published online: August 3, 2016. A paid subscription may be required.

References: 1. National Comprehensive Cancer Network. NCCN guidelines: Kidney cancer version 3.2016. Available at: https://www.nccn.org. Accessed on August 11, 2016. 2. Rini BI, et al. Lancet Oncol 2016. Published online: August 3, 2016. 3. National Comprehensive Cancer Network. NCCN guidelines: Prostate cancer version 3.2016. Available at: https://www.nccn.org. Accessed on August 11, 2016. 4. Motzer RJ, et al. J Clin Oncol 2009;27:3584–90. 5. Hudes G, et al. N Engl J Med 2007;356(22):2271–81. 6. Escudier B, et al. J Clin Oncol 2010;28(13):2144–50. 7. Sternberg CN, et al. Eur J Cancer 2013;49(6):1287–96. 8. Hutson TE, et al. Lancet Oncol 2013;14:1287–94. 9. Szczylik C, et al. J Clin Oncol 2007;25(18s): 5025.

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