Elderly mRCC patients should not be excluded from targeted therapy option

By Sarah Pritchard, medwireNews Reporter

Advanced age is not a reason to preclude patients from receiving vascular endothelial growth factor (VEGF)-targeted therapy for metastatic renal cell carcinoma (mRCC), show study findings from a mixed-age patient population.

Not only were median treatment duration, overall response rates, and overall survival comparable between those aged 75 years and above versus their younger counterparts, but after adjusting data for poor prognostic factors, older age had no association with poor survival.

The study cohort included 1381 mRCC patients, of whom 144 were aged 75 years or older. The most common initial therapy given to these elderly individuals was sunitinib, followed by sorafenib, bevacizumab and AZD2171 (cediranib). There was no significant difference in the distribution of risk groups – defined using the Heng Journal of Clinical Oncology 2009 prognostic factors – according to age.

Indeed, the main baseline differences between those aged 75 years and above and younger patients were fewer nephrectomies and brain metastases in the older population, note Daniel Heng, from the University of Calgary in Alberta, Canada, and team.

The median treatment duration was similar regardless of age, at 5.5 and 7.5 months for the older and younger groups, respectively. Likewise, overall response and median survival rates were also comparable, at a respective 18% versus 25%, and 16.8 versus19.7 months.

Heng and colleagues adjusted data for known poor prognostic factors: haemoglobin levels less than the lower limit of normal, a Karnofsky performance status of less than 80%, a corrected serum calcium level greater than the upper limit of normal, increased serum neutrophil and platelet counts, and less than a year between time of RCC diagnosis and treatment.

The results of this multivariate analysis showed no association between age over 75 years and either treatment duration or overall survival,, reports the research team.

These findings are in contrast to the idea that older patients with RCC also present with concurrent conditions such as hypertension, diabetes, cardiovascular and cerebrovascular diseases and other respiratory illnesses, write the researchers in Clinical Genitourinary Cancer.

“Because of these age-related comorbidities, it is thought that treatment might not be well-tolerated”, they add, suggesting that the use of targeted therapy in elderly RCC patients warrants further study.

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