Prognostic Factors for mRCC: Relevance in Clinical Practice Daniel Heng MD MPH FRCPC Chair, GU Tumor Group Tom Baker Cancer Center University of Calgary
Prognostic Factors Patient Factors
Patient X
Performance Status Symptoms Patient Y Tumor Burden Prior nephrectomy Sites of metastases Bone / Liver Metastases LDH Anemia Calcium Sodium
Proinflammatory Markers IL-6 ESR Neutrophilia Thrombocytosis C-reactive protein
Treatment-related Factors Patient Z Prior therapy Prior radiotherapy Disease-free interval Diagnosis to treatment interval
MSKCC Prognostic Profiles
Motzer et al JCO 2002
IKCWG Prognostic Criteria
Manola et al Clin Cancer Res 2011
International mRCC Database Consortium Currently includes 3700 patients from 25 institutions
Int’l mRCC Database Consortium Prognostic Factors
KPS < 80% Dx to Tx Interval 1 year?
Important for clinical trial risk stratification and retrospective study adjustment methods
Italian Database
281/2065 had 3 lines of targeted therapy VEGF VEGF mTOR vs VEGF mTOR VEGF HR 2.59 (1.59-4.22) after adjusting for prognostic criteria Assumes patients make it to three lines of therapy No axitinib in study Iacovelli et al EJC 2013
Prognostic Factors
Important for planning therapy We use temsirolimus for poor risk patients Is active surveillance appropriate for small
bulk, not growing, favorable risk, highly selected patients Is cytoreductive nephrectomy appropriate?
Cytoreductive Nephrectomy 3245 mRCC patients
2569 (79%) patients with nephrectomy
676/1658 (41%) No nephrectomy
982/1658 (59%) Cytoreductive Nephrectomy
FINAL NUMBERS
EXCLUDED 1587 (49%) w/ nephrectomy prior to metastases
