Patterns of Care and Clinical Outcomes in Patients With Metastatic Renal Cell Carcinoma-Results From a Tertiary Cancer Center in India

Clin Genitourin Cancer. 2017 Jun;15(3):e345-e355. doi: 10.1016/j.clgc.2016.09.006. Epub 2016 Oct 19.

Abstract

Introduction: The current treatment of metastatic renal cell carcinoma (mRCC) revolves around targeted agents, which have resulted in a median overall survival of 22 to 26 months in registration trials. However, the outcomes in a non-trial, real-world Indian population have not yet been evaluated.

Materials and methods: The present study was a part of a prospective Clinical Trials Registry-India-registered study, the Kidney Cancer Registry, a prospectively maintained kidney cancer registry. The data of patients with a diagnosis of mRCC from February 2007 to August 2015 who were potential candidates for systemic therapy were extracted from the database and analyzed for treatment patterns and outcomes.

Results: The data from 212 patients were eligible for analysis. Of these 212 patients, 204 (96.2%) received first-line systemic treatment with sunitinib (40.6%), sorafenib (37.7%), pazopanib (2.8%), temsirolimus (2.8%), or everolimus (1.9%). The risk status of 91% of the patients could be stratified using the Heng criteria into favorable (18.9%), intermediate (43.9%), and poor risk (28.3%) categories. The response rate, clinical benefit rate, median progression-free survival, and median overall survival with first-line targeted therapy were 22.5%, 60.7%, 7.09 months, and 12.87 months, respectively. The common adverse events seen included skin rash (31.7%), hypertension (29.4%), grade 3 hand-foot syndrome (27.4%), mucositis (26.4%), dyslipidemia (20%), and hyperglycemia (17.6%). Patients receiving second-line therapy (22.6%) had superior overall survival to patients who had not (16.46 vs. 10.67 months; P = .032).

Conclusion: The present registry-based study is the first, to the best of our knowledge, of its type from India and showed that the overall outcomes in this real-world cohort appear comparable to non-trial data worldwide. An increased incidence of metabolic adverse events that require monitoring during treatment was also found.

Keywords: Clinical practice; Metastatic RCC; Registry; TKI; Treatment patterns.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma, Renal Cell / drug therapy*
  • Everolimus / therapeutic use
  • Female
  • Humans
  • Indazoles
  • India
  • Indoles / therapeutic use
  • Kidney Neoplasms / drug therapy*
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Niacinamide / analogs & derivatives
  • Niacinamide / therapeutic use
  • Phenylurea Compounds / therapeutic use
  • Practice Patterns, Physicians'
  • Prospective Studies
  • Pyrimidines / therapeutic use
  • Pyrroles / therapeutic use
  • Retrospective Studies
  • Sirolimus / analogs & derivatives
  • Sirolimus / therapeutic use
  • Sorafenib
  • Sulfonamides / therapeutic use
  • Sunitinib
  • Survival Analysis
  • Tertiary Care Centers
  • Treatment Outcome
  • Young Adult

Substances

  • Antineoplastic Agents
  • Indazoles
  • Indoles
  • Phenylurea Compounds
  • Pyrimidines
  • Pyrroles
  • Sulfonamides
  • Niacinamide
  • temsirolimus
  • pazopanib
  • Everolimus
  • Sorafenib
  • Sunitinib
  • Sirolimus