Watch-and-wait approach may prove fruitful in subset of adults with advanced kidney cancer

Watch-and-wait approach may prove fruitful in subset of adults with advanced kidney cancer -

watch-and-wait approach means that some patients may delay taking highly toxic non-curative cancer drugs that come with significant side effects

some adults with advanced kidney cancer (renal cell carcinoma) who a slow-growing disease can live for months and even years without the disease getting worse with active surveillance, or close monitoring for signs of disease progression, instead of having to undergo immediate treatment with anticancer drugs very toxic, suggests a new study published in the Lancet Oncology .

The approach shows-and-wait was the most successful among adults with limited site of metastatic disease and those with one or less unfavorable prognostic factors such as anemia, thrombocytosis (high platelet ), and greater disability. For example, 29 patients who had two or fewer organs affected and one or no risk factors at baseline remained on average almost three times longer on active surveillance than other patients (22.2 months vs. 8.4 months).

"There is a perception that all cancers must be treated immediately because they are just as deadly. But what we have seen in this small phase 2 study is a subset of adults advanced kidney cancer is a disease that can be managed safely by using active surveillance, which could save them the inconvenience and side effects debilitating effects of aggressive treatment to slow growth about a year, and in some cases several years without worsening anxiety and depression, "says lead author Professor Brian Rini Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA." with only 50 people involved in our trial, the risks and benefits the approach should be studied in a larger group of patients "

Each year about 62,700 new cases of kidney cancer are diagnosed in the United States and about 14,240 people die from the disease. UK there are approximately 11,873 new cases and 4,421 deaths from the disease. Survival varies greatly from as short as 5 months in patients with poor prognosis without systemic therapy, to 43 months in patients with a good prognosis with a systemic treatment.

When kidney cancer has spread to other body parts, the objective of systemic treatment is to slow the cancer down with anti-angiogenic drugs such as sunitinib and sorafenib are designed to prevent the formation of new blood vessels, thereby stopping or slowing the growth or spread of tumors. But these treatments are expensive, not curative, and have serious side effects, including increased risk of stroke and heart attack.

disease

Some people with advanced kidney cancer have very slow growth, and small case studies suggest that active monitoring and delayed treatment could be a safe and effective alternative to an immediate systemic treatment without compromising the response to subsequent processing.

In this Phase 2 study, Rini and colleagues enrolled 52 adults (aged 18 years or over) with advanced cancer who have not received prior systemic treatment in five hospitals in the United States kidney , Spain and the UK. Participants had a CT scan of the chest, abdomen and pelvis at the beginning of the study and at regular intervals to assess the burden and time to tumor progression. Patients were closely monitored and could decide with their doctor to start systemic treatment at any time. Changes in quality of life, anxiety and depression were also measured at baseline and on the monitoring period. Participants were followed for an average (median) of 38.1 months.

In the 48 participants included in the analyzes, the (median) average time on active surveillance prior systemic treatments from was 14.9 months and overall survival of the start of the monitoring was 44.5 months.

43 (0%) participants experienced disease progression at some point during the study, most of them (37) began a systemic treatment. However, nearly half (20) of participants chose to continue monitoring for an average of 15.8 more months after disease progression. Six patients remain on active monitoring to date. Three participants have survived without their disease getting worse and two withdrew or were lost to view.

Nearly half (22) of the patients died during the study, but only one patient died (brain metastases) without ever receiving systemic therapy.

Importantly, the quality of life, and anxiety and depression scores did not change significantly during the monitoring period, suggesting that living with untreated cancer has not cause psychological harm to patients with advanced kidney cancer in this study.

authors sound a note of caution about the limits of this process could reduce the wide applicability of the approach. For example, patients included in the trial were a very small group selected by the physician, rather than based on the characteristics of the disease, such as tumor burden or the pace of growth of the disease. Furthermore, the decision to end the surveillance was left to the discretion of the patient and physician

According to Professor Rini :.

With the development of new immunotherapy in renal carcinoma cells more work is needed to understand the risks and benefits of this initial observation approach. However, our data provides guidance on how to select patients who may delay treatment and instead be monitored safely with active surveillance.

Writing in a linked comment, Dr Paul Russo Memorial Sloan Cancer Center, Weill Cornell College of Medicine, New York, USA said:

This document provides guidance to both medical and surgical oncologists who, when faced with a newly diagnosed patient with metastatic renal cell carcinoma cells that has a good performance and limited metastatic disease, may offer a period of close supervision with the prolonged survival potential before progression of the disease and the initiation of systemic therapies. There is no evidence from this study that this close supervision for the security or survival of the patient. It remains to be seen whether the current genomics research can identify genes that can be used together with the selection factors described above to better select appropriate patients for initial active surveillance.