Skip to main content

Advertisement

SpringerLink
Log in

Active surveillance for metastatic or recurrent renal cell carcinoma

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Metastatic renal cell carcinoma (mRCC) sometimes presents with an indolent course without any significant symptoms. Here, the potential impact of active surveillance (AS) on clinical outcomes in asymptomatic or minimally symptomatic mRCC patients was retrospectively evaluated.

Methods

mRCC patients who were followed up with deferred treatment for the purpose of AS between 2000 and 2012 were enrolled. Patient and disease characteristics, outcomes of AS and subsequent therapies, and predictive factors for rapid disease progression were analyzed. The primary endpoint was time-to-progression (TTP).

Results

First-line systemic therapy was deliberately deferred in 58 patients. During AS, the best overall responses were stable disease for 48 patients (83 %) and progressive disease (PD) for 10 patients (17 %), and 47 patients ultimately experienced disease progression at the time of data cutoff. With a median follow-up of 31.4 months, the median TTP was 12.4 months (95 % confidence interval 8.4–16.5) and median overall survival was not reached. After univariate and multivariate analyses for TTP, Karnofsky performance status <100 %, liver metastasis, and a time from diagnosis to AS of less than 1 year were found to be predictive factors for a shorter TTP. After PD, 30 patients received systemic treatment (14 sunitinib, 11 pazopanib, 4 immunotherapy, and 1 temsirolimus). The objective response rates were 71 % for sunitinib and 46 % for pazopanib, which were deemed comparable with historical controls.

Conclusions

Asymptomatic or minimally symptomatic mRCC patients can be observed for a prolonged period of time without active treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Ardeshna KM, Smith P, Norton A, Hancock BW, Hoskin PJ, MacLennan KA, Marcus RE, Jelliffe A, Vaughan Hudson G, Linch DC, British National Lymphoma I (2003) Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: a randomised controlled trial. Lancet 362:516–522

    Article  CAS  PubMed  Google Scholar 

  • Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M, Negrier S, Chevreau C, Solska E, Desai AA, Rolland F, Demkow T, Hutson TE, Gore M, Freeman S, Schwartz B, Shan M, Simantov R, Bukowski RM, Group TS (2007) Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 356:125–134

    Article  CAS  PubMed  Google Scholar 

  • Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Staehler M, Negrier S, Chevreau C, Desai AA, Rolland F, Demkow T, Hutson TE, Gore M, Anderson S, Hofilena G, Shan M, Pena C, Lathia C, Bukowski RM (2009) Sorafenib for treatment of renal cell carcinoma: final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial. J Clin Oncol 27:3312–3318

    Article  CAS  PubMed  Google Scholar 

  • Fisher R, Pender A, Thillai K, Chowdhury S, Pickering L, Khabra K, Gore M, Larkin J (2012) Observation as a treatment strategy for advanced renal cell carcinoma-a call for prospective validation. Front Oncol 2:155

    PubMed Central  PubMed  Google Scholar 

  • Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, Eigl BJ, Ruether JD, Cheng T, North S, Venner P, Knox JJ, Chi KN, Kollmannsberger C, McDermott DF, Oh WK, Atkins MB, Bukowski RM, Rini BI, Choueiri TK (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 27:5794–5799

    Article  CAS  PubMed  Google Scholar 

  • Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, Staroslawska E, Sosman J, McDermott D, Bodrogi I, Kovacevic Z, Lesovoy V, Schmidt-Wolf IG, Barbarash O, Gokmen E, O’Toole T, Lustgarten S, Moore L, Motzer RJ, Global AT (2007) Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 356:2271–2281

    Article  CAS  PubMed  Google Scholar 

  • Linehan WM, Walther MM, Zbar B (2003) The genetic basis of cancer of the kidney. J Urol 170:2163–2172

    Article  CAS  PubMed  Google Scholar 

  • Lokich J (1997) Spontaneous regression of metastatic renal cancer. Case report and literature review. Am J Clin Oncol 20:416–418

    Article  CAS  PubMed  Google Scholar 

  • Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J (1999) Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 17:2530–2540

    CAS  PubMed  Google Scholar 

  • Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, Oudard S, Negrier S, Szczylik C, Kim ST, Chen I, Bycott PW, Baum CM, Figlin RA (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356:115–124

    Article  CAS  PubMed  Google Scholar 

  • Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S, Grunwald V, Thompson JA, Figlin RA, Hollaender N, Urbanowitz G, Berg WJ, Kay A, Lebwohl D, Ravaud A, Group R-S (2008) Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet 372:449–456

    Article  CAS  PubMed  Google Scholar 

  • Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Oudard S, Negrier S, Szczylik C, Pili R, Bjarnason GA, Garcia-del-Muro X, Sosman JA, Solska E, Wilding G, Thompson JA, Kim ST, Chen I, Huang X, Figlin RA (2009) Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 27:3584–3590

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S, Grunwald V, Thompson JA, Figlin RA, Hollaender N, Kay A, Ravaud A, Group R-S (2010) Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer 116:4256–4265

    Article  CAS  PubMed  Google Scholar 

  • Oda T, Miyao N, Takahashi A, Yanase M, Masumori N, Itoh N, Tamakawa M, Tsukamoto T (2001) Growth rates of primary and metastatic lesions of renal cell carcinoma. Int J Urol 8:473–477

    Article  CAS  PubMed  Google Scholar 

  • Oliver RT, Miller RM, Mehta A, Barnett MJ (1988) A phase 2 study of surveillance in patients with metastatic renal cell carcinoma and assessment of response of such patients to therapy on progression. Mol Biother 1:14–20

    CAS  PubMed  Google Scholar 

  • Ratain MJ, Eckhardt SG (2004) Phase II studies of modern drugs directed against new targets: if you are fazed, too, then resist RECIST. J Clin Oncol 22:4442–4445

    Article  PubMed  Google Scholar 

  • Rini BI, Campbell SC, Escudier B (2009) Renal cell carcinoma. Lancet 373:1119–1132

    Article  CAS  PubMed  Google Scholar 

  • Rini BI, Escudier B, Tomczak P, Kaprin A, Szczylik C, Hutson TE, Michaelson MD, Gorbunova VA, Gore ME, Rusakov IG, Negrier S, Ou YC, Castellano D, Lim HY, Uemura H, Tarazi J, Cella D, Chen C, Rosbrook B, Kim S, Motzer RJ (2011) Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3 trial. Lancet 378:1931–1939

    Article  CAS  PubMed  Google Scholar 

  • Smith AD, Lieber ML, Shah SN (2010) Assessing tumor response and detecting recurrence in metastatic renal cell carcinoma on targeted therapy: importance of size and attenuation on contrast-enhanced CT. AJR Am J Roentgenol 194:157–165

    Article  PubMed  Google Scholar 

  • Sternberg CN, Davis ID, Mardiak J, Szczylik C, Lee E, Wagstaff J, Barrios CH, Salman P, Gladkov OA, Kavina A, Zarba JJ, Chen M, McCann L, Pandite L, Roychowdhury DF, Hawkins RE (2010) Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol 28:1061–1068

    Article  CAS  PubMed  Google Scholar 

  • Sternberg CN, Hawkins RE, Wagstaff J, Salman P, Mardiak J, Barrios CH, Zarba JJ, Gladkov OA, Lee E, Szczylik C, McCann L, Rubin SD, Chen M, Davis ID (2013) A randomised, double-blind phase III study of pazopanib in patients with advanced and/or metastatic renal cell carcinoma: final overall survival results and safety update. Eur J Cancer 49:1287–1296

    Article  CAS  PubMed  Google Scholar 

  • Wong AS, Chong KT, Heng CT, Consigliere DT, Esuvaranathan K, Toh KL, Chuah B, Lim R, Tan J (2009) Debulking nephrectomy followed by a “watch and wait” approach in metastatic renal cell carcinoma. Urol Oncol 27:149–154

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was presented in part at the 38th European Society for Medical Oncology (ESMO) annual meeting, September 27, 2013–October 1, 2013 in Amsterdam, the Netherlands.

Funding

This study was supported by a Grant (HI12C17880300) from the Korean Health Technology R&D Project, Ministry of Health and Welfare, and a Grant (2011K00871) from Converging Research Center Program for the Ministry of Education, Science and Technology, Republic of Korea.

Conflict of interest

The authors have declared no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Oncology, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-gu, Seoul, 138-736, Korea

    Inkeun Park, Jae-Lyun Lee, Jin-Hee Ahn & Dae-Ho Lee

  2. Department of Medicine, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Seoul, 138-736, Korea

    Jae-Lyun Lee, Jin-Hee Ahn, Dae-Ho Lee & Kyoo-Hyung Lee

  3. Department of Urology, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Seoul, 138-736, Korea

    In Gab Jeong, Cheryn Song, Bumsik Hong, Jun Hyuk Hong & Hanjong Ahn

  4. Department of Internal Medicine, Gachon University Gil Medical Centre, 1198, Guwol-Dong, Namdong-Gu, Incheon, 405-760, Korea

    Inkeun Park

Authors
  1. Inkeun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jae-Lyun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin-Hee Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dae-Ho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyoo-Hyung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. In Gab Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cheryn Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bumsik Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jun Hyuk Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hanjong Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jae-Lyun Lee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, I., Lee, JL., Ahn, JH. et al. Active surveillance for metastatic or recurrent renal cell carcinoma. J Cancer Res Clin Oncol 140, 1421–1428 (2014). https://doi.org/10.1007/s00432-014-1680-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-014-1680-9

Keywords

Search

Navigation