The effect of targeted therapy on overall survival in advanced renal cancer: a study of the national surveillance epidemiology and end results registry database.
BACKGROUND
With the advent and availability of targeted therapy, the treatment of advanced/metastatic renal cell carcinoma (RCC) underwent a drastic change in 2005. The effect of this change on clinical outcome within the population has not been studied. The aim of this study was to evaluate the overall survival (OS), before, and after availability of targeted therapy, for advanced RCC cases in the population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry.


METHODS
All advanced (regional and distant stage) RCC cases diagnosed within the 2000 to 2008 time periods were included. Because SEER does not report the exact therapy, and because targeted therapy was initially approved in 2005, we evaluated and compared the OS outcomes of advanced RCC cases diagnosed between the years 2000 and 2003 (before targeted therapy era) with that of those diagnosed between 2005 and 2008 (targeted therapy era).


RESULTS
There was a significant improvement in OS for advanced RCC patients treated in the targeted therapy era (n = 12,330) compared with those treated in the era before targeted therapy (n =11,565) (median OS 20 months vs. 15 months, P = .0006). Multivariate analysis revealed that in the time period before targeted therapy, age older than 65 years, black race, and lack of nephrectomy were predictors of a shorter OS.


CONCLUSIONS
In univariate and multivariate analysis, targeted therapy demonstrated improvement in OS. Increasing access to targeted therapies is likely to improve outcomes in advanced RCC.
Wayne State University/Karmanos Cancer Institute, Detroit, MI. Electronic address: vaishamu@karmanos.org.
Ulka
U
Vaishampayan
Wayne State University/Karmanos Cancer Institute, Detroit, MI.
Hema
H
Vankayala
Wayne State University/Karmanos Cancer Institute, Detroit, MI.
Fawn D
FD
Vigneau
Wayne State University/Karmanos Cancer Institute, Detroit, MI.
William
W
Quarshie
Wayne State University/Karmanos Cancer Institute, Detroit, MI.
Brenda
B
Dickow
Wayne State University/Karmanos Cancer Institute, Detroit, MI.
Supraja
S
Chalasani
Wayne State University/Karmanos Cancer Institute, Detroit, MI.
Kendra
K
Schwartz
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D015999:Multivariate Analysis; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program
D000970:Antineoplastic Agents
Kidney cancer; Nephrectomy; Outcomes; Racial disparity; SEER database