Active surveillance: A potential role in metastatic RCC?
A new prospective phase II trial suggests that immediate treatment is not necessary for all adults with advanced kidney cancer and that active surveillance may be suitable for some without the disease worsening.
Since its publication online in The Lancet Oncology (Aug. 3, 2016), the study has given credence to those who believe active surveillance and close monitoring for evidence of disease progression is suitable sometimes rather than starting immediate treatment with highly toxic anticancer drugs.
“This is something that was done, but not formally prospectively studied before,” lead author Brian Rini, MD, of Cleveland Clinic Taussig Cancer Institute, Cleveland, told Urology Times. “Patients and doctors can find some comfort in the fact that they don’t necessarily need to be treated right away. It’s obviously a clinical decision between the doctor and patient and based on the comfort level and disease, and some intangibles that are hard to objectify.”
During the time between Aug. 21, 2008, and June 7, 2013, Dr. Rini and colleagues analyzed 52 patients with treatment-naive, asymptomatic, metastatic renal cell carcinoma from five hospitals in the U.S., Spain, and the United Kingdom.
The patients were put under surveillance and radiographically assessed at baseline every 3 months during the first year, every 4 months for the second year, and every 6 months thereafter. The patients continued on observation until initiation of systemic therapy for metastatic renal cell carcinoma.
On average, the authors observed patients for a little over a year. There was a cohort of patients only observed for one or two scans, said Dr. Rini, as well as a cohort who were observed for many months to over 3-4 years.