Asymptomatic CNS Involvement From Advanced Renal Cell Carcinoma
Posted: Thursday, April 22, 2021
According to research presented in JNCCN–Journal of the National Comprehensive Network, uniform screening for brain metastases may benefit patients with renal cell carcinoma who have a high metastatic burden or for whom disease progression occurred following first-line therapy. Martin H. Voss, MD, of Memorial Sloan Kettering Cancer Center, New York, and colleagues found that asymptomatic metastatic brain disease may occur in 4% to 5% of patients with metastatic renal cell carcinoma.
The retrospective multicenter chart review included 1,689 patients from 68 clinical trials performed at Gustave Roussy and Memorial Sloan Kettering Cancer Center between 2001 and November 2019. Trials requiring brain imaging to determine eligibility and patients whose brain metastases were discovered as a result of that imaging were included. Overall, 72 patients (4.3%), 54 (75%) of whom were men, were found to have neurologically asymptomatic incidental brain metastases. A total of 22 of 832 patients (2.6%) and 50 of 857 patients (5.8%) had brain metastases discovered during screening for first-line studies and treatment-refractory settings, respectively. The median patient age at metastatic renal cell carcinoma diagnosis was 56 years.
Patient International Metastatic Renal Cell Carcinoma Database Consortium risk status did not appear to affect incidence or outcomes. A total of 43 patients (60%) had metastatic disease at the time of diagnosis; among those found to have brain metastasis, 62 (86%) had multiple sites of extracranial disease. Among patients diagnosed with brain metastases, 45 (63%) had a single lesion, 10 (14%) had two lesions, and 17 (24%) had three or more lesions. Associated edema was present for 57 patients (79%). The median overall survival for this group was 10.3 months. The 1-year overall survival rate was 48%. At the time of data cutoff, 62 patients (86%) had died.
Disclosure: For full disclosures of the study authors, visit jnccn.org.