Active Surveillance in Metastatic Renal Cell Carcinoma: Results From the Canadian Kidney Cancer Information System

We aimed to assess the outcomes and safety of active surveillance (AS) in patients with metastatic renal cell carcinoma (mRCC). We identified 853 patients who met the criteria for AS. We compared them to a cohort of patients who received immediate systemic therapy. Our data demonstrated that a large subset of patients with mRCC can be safely observed without immediate initiation of systemic therapy for a significant period of time. Background: Active surveillance (AS) is a commonly used strategy in patients with slow-growing disease. We aimed to assess the outcomes and safety of AS in patients with metastatic renal cell carcinoma (mRCC). Patients and Methods: We used the Canadian Kidney Cancer information system (CKCis) to identify patients with mRCC diagnosed between January 1, 2011, and December 31, 2016. The AS strategy was defined as (1) the start of systemic therapy >= 6 months after diagnosis of mRCC, or (2) never receiving systemic therapy for mRCC with an overall survival (OS) of >= 1 year. Patients starting systemic treatment <6 months after diagnosis of mRCC were defined as receiving immediate systemic treatment. OS and time until first-line treatment failure (TTF) were compared between the two cohorts. Results: A total of 853 patients met the cr iteria for AS (cohort A). Of these, 364 started treatment >6 months after their initial diagnosis (cohort A1) and 489 never started systemic therapy (cohort A2); 827 patients received immediate systemic treatment (cohort B). The 5-year OS probability was significantly greater for cohort A than for cohort B (70% vs. 33.6%; P <.0001). After adjusting for International Metastatic RCC Database Consortium risk criteria and age, both OS (hazard ratio [HR] = 0.58; 95% confidence interval [CI], 0.47-0.70; P <.0001) and TTF (HR = 0.72; 95% CI, 0.60-0.85; P =.0002) were greater in cohort A1 compared with B. For cohort A1, the median time on AS was 14.2 months (range, 6-71). Conclusions: Based on the largest analysis of AS in mRCC to date, our data suggest that a subset of patients may be safely observed without immediate initiation of systemic therapy. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

Based on the analysis of 853 mRCC patients under AS, it was concluded that a subset of patients can be safely observed without immediate initiation of systemic therapy.