High-risk RCC: survival worsened with adjuvant targeted therapy

  • Chakiryan NH & et al.
  • Urol Oncol
  • 31 Mar 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Adjuvant targeted therapy was tied to significantly decreased OS in patients with high-risk locoregional renal cancer carcinoma (RCC) who underwent partial or radical nephrectomy.
  • pN+ patients had worse survival with adjuvant therapy.

Why this matters

  • Clinical trials did not capture OS decline with adjuvant targeted therapy reported in current real-world analysis.

Study design

  • Study of 41,127 patients with high-risk nonmetastatic clear cell RCC who underwent nephrectomy during 2006-2015.
  • Adjuvant therapy was defined as chemotherapy received within 3 months of surgery.
  • Primary outcome: OS.
  • Funding: None disclosed.

Key results

  • 5.04% of patients received adjuvant targeted therapy.
  • Significant risk factors for off-label adjuvant targeted therapy use:
    • pT4 (OR, 2.85; P<.001>
    • pN+ (OR, 3.49; P<.001>
  • Propensity score-matched analysis (n=802 in each group).
  • Patients who received adjuvant targeted therapy had worse OS (52 vs 79 months; P<.001>
  • Subgroup analysis showed worse OS with adjuvant targeted therapy in pT3/4N0/x patients (median OS, 75 vs 86 months; P=.0009).

Limitations

  • Retrospective design.