From the Guidelines
The prognosis of metastatic renal cell carcinoma (RCC) remains serious, with a 5-year survival rate of approximately 12%, as reported in the most recent guidelines from 2020 1. The prognosis varies based on several factors, including performance status, time from diagnosis to metastasis, number and location of metastatic sites, laboratory values, and histologic subtype.
- The International Metastatic RCC Database Consortium (IMDC) risk model stratifies patients into favorable, intermediate, and poor risk groups, with median overall survival ranging from under 1 year for poor-risk patients to over 3 years for favorable-risk patients.
- First-line treatment typically involves immunotherapy combinations or targeted therapies, with the choice of treatment depending on the patient's risk status and tumor histology.
- Some patients with limited metastatic disease may benefit from surgical resection of metastases (metastasectomy), as suggested by the European Association of Urology guidelines from 2022 1.
- Regular imaging follow-up every 3-6 months is essential to monitor treatment response, as recommended by the NCCN guidelines from 2020 1. The biology of RCC, particularly its immunogenicity and dependence on angiogenesis pathways, explains why immunotherapies and anti-angiogenic drugs have become the cornerstone of treatment for this disease, with the most recent guidelines emphasizing the importance of targeted therapies and immunotherapies in improving patient outcomes 1. Based on the most recent and highest-quality evidence, the recommended approach for managing metastatic RCC involves a multidisciplinary team, including urologists, medical oncologists, and radiologists, to provide comprehensive care and improve patient outcomes 1.
From the FDA Drug Label
The median OS was 22.9 months for patients randomized to pazopanib and 20.5 months for the placebo arm [HR = 0.91 (95% CI: 0.71,1. 16)]. The prognosis of metastatic RCC is poor, with a median overall survival (OS) of approximately 22.9 months with pazopanib treatment, as seen in the VEG105192 trial 2.
- Key points:
- Median OS: 22.9 months
- Hazard ratio (HR): 0.91 (95% CI: 0.71,1.16)
- The majority of patients had clear cell histology (90%) or predominantly clear cell histology (10%).
- Approximately 50% of all patients had 3 or more organs involved with metastatic disease.
From the Research
Prognosis of Metastatic Renal Cell Carcinoma (mRCC)
- The prognosis of mRCC has been studied in various clinical trials and real-world databases, providing insights into the overall survival (OS) rates and prognostic factors for patients with this disease 3, 4, 5, 6.
- According to a study published in 2017, the 1-, 3-, and 5-year OS rates for patients with mRCC in the Russian Federation were 49.4%, 18.9%, and 8.2%, respectively 5.
- Another study published in 2012 identified the Motzer risk classification, Fuhrman grade, and previous cytokine therapy as independent prognostic factors for OS in patients with mRCC receiving targeted therapies 6.
- The use of tyrosine kinase inhibitors (TKIs) has been shown to improve OS rates in patients with mRCC, with a median OS of 24 months and a 5-year OS rate of 24.6% reported in one study 6.
- Thyroid dysfunction, particularly hypothyroidism, has been observed as a potential biomarker of response and efficacy of treatment with TKIs in patients with mRCC 7.
Treatment Options and Outcomes
- Sunitinib, a multi-targeted TKI, has been shown to be effective in the treatment of mRCC, with a recommended dose of 50 mg orally daily for 4 weeks, followed by 2 weeks off treatment 3, 4.
- Other treatment options, including pazopanib and axitinib, have also demonstrated efficacy in mRCC patients 4, 7.
- The management of adverse events, such as hypertension, hypothyroidism, and hand-foot syndrome, is crucial to maximize the efficacy of therapy in mRCC patients 7.
Prognostic Factors
- The Motzer risk classification has been confirmed as an independent prognostic factor for OS in patients with mRCC receiving targeted therapies 6.
- Fuhrman grade and previous cytokine therapy have also been identified as independent prognostic factors for clinical outcome in patients with mRCC 6.
- Thyroid dysfunction, particularly hypothyroidism, may be associated with a better outcome in mRCC patients treated with TKIs, although the biological mechanisms underlying this correlation are not well understood 7.