Improved overall survival after implementation of targeted therapy for patients with metastatic renal cell carcinoma: results from the Danish Renal Cancer Group (DARENCA) study-2.
OBJECTIVE
To evaluate the implementation of targeted therapy on overall survival (OS) in a complete national cohort of patients with metastatic renal cell carcinoma (mRCC).


METHODS
All Danish patients with mRCC referred for first line treatment with immunotherapy, TKIs or mTOR-inhibitors between 2006 and 2010 were included. Baseline and outcome data were collected retrospectively. Prognostics factors were identified using log-rank tests and Cox proportional hazard model. Differences in distributions were tested with the Chi-square test.


RESULTS
1049 patients were referred; 744 patients received first line treatment. From 2006 to 2010 we observed a significant increase in the number of referred patients; a significant increase in treated patients (64% versus 75%, P=0.0188); a significant increase in first line targeted therapy (22% versus 75%, P<0.0001); a significant increase in second line treatment (20% versus 40%, P=0.0104), a significant increased median OS (11.5 versus 17.2 months, P=0.0435) whereas survival for untreated patients remained unchanged. Multivariate analysis validated known prognostic factors. Moreover, treatment start years 2008 (HR 0.74, 95% CI, 0.55-0.99; P=0.0415), 2009 (HR 0.72, 95% CI, 0.54-0.96; P=0.0277) and 2010 (HR 0.63, 95% CI, 0.47-0.86; P=0.0035) compared to 2006, and more than two treatment lines received for patients with performance status 0-1 (HR 0.76, 95% CI, 0.58-0.99; P=0.0397) and performance status 2-3 (HR 0.19, 95% CI, 0.06-0.60; P=0.0051) were significantly associated with longer OS.


CONCLUSIONS
This retrospective study documents that the implementation of targeted therapy has resulted in significantly improved treatment rates and overall survival in a complete national cohort of treated mRCC patients.
Department of Oncology, University Hospital of Copenhagen Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark. Electronic address: Anne.Vest.Soerensen@regionh.dk.
Anne V
AV
Soerensen
Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark.
Frede
F
Donskov
Department of Urology, University Hospital of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Gregers G
GG
Hermann
Department of Oncology, Odense University Hospital, Sdr. Boulvard 29, 5000 Odense, Denmark.
Niels V
NV
Jensen
Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, Postbox 561, 9100 Aalborg, Denmark.
Astrid
A
Petersen
Technical University of Denmark, Bygning 303B, 2800 Kongens Lyngby, Denmark.
Henrik
H
Spliid
Pfizer Oncology, Vetenskapsvägen 10, 19190 Sollentuna, Sweden.
Rickard
R
Sandin
Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark.
Kirsten
K
Fode
Department of Oncology, University Hospital of Copenhagen Herlev, Herlev Ringvej 75, 2730 Herlev, Denmark.
Poul F
PF
Geertsen
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods*; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D015996:Survival Rate; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
D047428:Protein Kinase Inhibitors; C546842:MTOR protein, human; D011505:Protein-Tyrosine Kinases; D058570:TOR Serine-Threonine Kinases
Metastatic renal cell carcinoma; National cohort; Overall survival; Population-based study; Targeted therapy