A Multidisciplinary Team Algorithm for Treating Metastatic Renal Cell Carcinoma
Posted: Monday, April 13, 2020
A multidisciplinary team algorithm seems to be effective in selecting treatment for patients with metastatic renal cell carcinoma, according to a recent retrospective study. Thomas Powles, MD, of Barts Cancer Institute in London, published the report with colleagues in the World Journal of Urology.
“Multidisciplinary team, pathway-based treatment strategy may improve patient selection for cytoreductive nephrectomy,” the authors wrote. “Potential benefits for identifying candidates for cytoreductive nephrectomy include deferring the onset of systemic therapy and its potential toxicities.”
A total of 87 treatment-naive synchronous patients with metastatic renal cell carcinoma received care through the London Cancer initiative between January 2015 and December 2018. The researchers developed a multidisciplinary team algorithm—based on performance status, metastatic disease burden, and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) score—for selecting what type of care patients would receive.
Patients with a high tumor burden, a poor performance status, and high IMDC scores received best supportive care. Patients with a low metastatic burden, a performance status of 0 or 1, and intermediate IMDC scores were considered for cytoreductive nephrectomy; the exceptions were two patients with high IMDC scores but an exceptionally good performance status.
Of the 87 patients, 18 underwent cytoreductive nephrectomy, 43 received systemic therapy alone, and 26 received best supportive care. The median progression-free survival was 28.6 months with cytoreductive nephrectomy and 4.5 months with systemic therapy. The hazard ratio for death was 3.63. The 1-year overall survival rates were 78% for the cytoreductive nephrectomy group, 56% for the systemic therapy group, and 23% for the best supportive care group. According to the authors, 23% was “notably high” for 1-year overall survival of the best supportive care group. Although it is too early to determine a median overall survival for the cytoreductive nephrectomy group, more than 50% survived at the time of analysis.
Disclosure: The authors’ conflicts of interest can be found at springer.com.