Defining risk status in the first-line treatment of metastatic renal cell carcinoma.
Targeted agents, such as sunitinib, have significantly improved the prognosis of patients with metastatic renal cell carcinoma (mRCC) and are now well-established treatment options for these patients. Several pre-treatment clinical features have been associated with shorter survival, and identification of these prognostic factors has led to the development of risk models, such as the Memorial Sloan-Kettering Cancer Center (MSKCC) model. These risk models can be used to stratify patients according to their risk status. The risk status of patients can have important implications for their response to different treatment strategies; therefore, risk models enable treatment to be tailored for individual patients. In the MSKCC model, patients are stratified into one of three groups according to defined risk factors: favourable, intermediate or poor risk. The MSKCC model is well established and has been used to stratify patients in many clinical studies with targeted agents. However, some studies have used modified criteria which can make it difficult to make direct comparisons between studies. This can have important implications when selecting the most appropriate treatment for individual patients. In this review the rationale for establishing risk status is discussed and the practical application of risk models to aid the selection of appropriate first-line treatments is examined. Additionally, the evidence supporting the use of targeted agents in patients with mRCC according to their risk status is reviewed.
Schmidinger
Manuela
M
Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. manuela.schmidinger@meduniwien.ac.at
Zielinski
Christoph C
CC
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D009362:Neoplasm Metastasis / Q000188:drug therapy*; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors
D016898:Interferon-alpha
Cancer. 2008 Oct 1;113(7):1552-8
18720362
J Clin Oncol. 2010 Feb 20;28(6):1061-8
20100962
Lancet Oncol. 2009 Aug;10(8):757-63
19615940
Urol Clin North Am. 2003 Nov;30(4):843-52
14680319
N Engl J Med. 1996 Sep 19;335(12):865-75
8778606
J Clin Oncol. 2009 Dec 1;27(34):5794-9
19826129
J Clin Oncol. 2008 Nov 10;26(32):5204-12
18838713
Cancer Treat Rev. 2009 May;35(3):297-307
19249157
World J Urol. 2005 Jul;23(3):175-9
15726382
J Natl Cancer Inst. 2007 Jan 3;99(1):81-3
17202116
N Engl J Med. 2007 May 31;356(22):2271-81
17538086
J Clin Oncol. 2002 Jan 1;20(1):289-96
11773181
J Clin Oncol. 2009 Aug 1;27(22):3584-90
19487381
Lancet. 2007 Dec 22;370(9605):2103-11
18156031
Eur Urol. 2008 May;53(5):917-30
18054825
N Engl J Med. 2007 Jan 11;356(2):115-24
17215529
J Clin Oncol. 1994 Jan;12(1):206-12
8270978
CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
15761078
Ann Oncol. 2009 May;20 Suppl 1:i7-12
19430007
Ann Oncol. 2007 Mar;18(3):581-92
17287242
J Clin Oncol. 2008 Nov 20;26(33):5422-8
18936475
Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001425
15674877
Cancer. 2010 Mar 1;116(5):1272-80
20082451
J Natl Compr Canc Netw. 2009 Jun;7(6):618-30
19555584
Lancet. 2008 Aug 9;372(9637):449-56
18653228
N Engl J Med. 2007 Jan 11;356(2):125-34
17215530
Cancer Treat Rev. 2010 Feb;36(1):16-23
19819078