title: The impact of kidney function on the outcome of metastatic renal cell carcinoma patients treated with vascular endothelial growth factor-targeted therapy.
abstract: BACKGROUND
  A study was undertaken to investigate the effect of baseline renal function on treatment outcome in patients treated with vascular endothelial growth factor (VEGF)-targeted therapy for metastatic renal cell carcinoma (mRCC).
  
  
  METHODS
  Retrospective data from 6 North American cancer centers (3 US and 3 Canadian) were pooled to identify patients with mRCC treated with VEGF-targeted therapy. Patient characteristics, response rate, time to treatment failure, and overall survival were collected. The Modification of Diet in Renal Disease formula was used at therapy initiation for calculation of glomerular filtration rate (GFR).
  
  
  RESULTS
  Five hundred twenty-nine patients with mRCC who received sunitinib (n = 323), sorafenib (n = 165), or bevacizumab (n = 41) were included in this analysis. Patient characteristics included: 74% male, median age 61 years, and median GFR 60.1 mL/min/1.73 m(2) (range, 6.5-174.2). On univariate analysis, patients with a GFR <60 (n = 262) were more likely to have had a previous nephrectomy (P < .0001) and to be older (P < .0001), but were less likely to have poor prognostic features such as anemia (P = .041), hypercalcemia (P = .008), neutrophilia (P = .039), thrombocytosis (P < .0001), short diagnosis to treatment interval (P = .007), and low Karnofsky performance status (P = .051). GFR <60, when adjusted for poor risk factors, did not have an impact on type of objective response (odds ratio, 1.31; 95% confidence interval [CI], 0.74-2.32; P = .359), time to treatment failure (hazard ratio [HR], 0.97; 95% CI, 0.79-1.19; P = .772), or overall survival (HR, 0.90; 95% CI, 0.69-1.17; P = .439).
  
  
  CONCLUSIONS
  Renal function at therapy initiation does not adversely affect the efficacy of VEGF-targeted therapy in mRCC. Clinicians should not avoid treating patients with impaired baseline renal function.
authors: Department of Medical Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors: Robyn
authors: R
authors: Macfarlane
authors: Daniel Y C
authors: DY
authors: Heng
authors: Wanling
authors: W
authors: Xie
authors: Jennifer J
authors: JJ
authors: Knox
authors: David F
authors: DF
authors: McDermott
authors: Brian I
authors: BI
authors: Rini
authors: Christian
authors: C
authors: Kollmannsberger
authors: Toni K
authors: TK
authors: Choueiri
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D000970:Antineoplastic Agents; D042461:Vascular Endothelial Growth Factor A