Active Surveillance May Be Beneficial for Certain Patients with Renal Cell Carcinoma

A recent study found that close monitoring for disease progression may be more effective than immediate treatment for patients with advanced renal cell carcinoma (RCC).

Survival for advanced RCC can vary from 5 months to 43 months. Immediate treatment with antiangiogenic drugs can have serious side effects, not curative, and is expensive. This “watch-and-wait” approach was the most beneficial among patients with limited metastasis, and those with prognosis factors like anemia, thrombocytosis, and others, according to a study published by The Lancet Oncology.

In the study, researchers included 52 treatment-naïve patients with advanced RCC. Patients underwent an initial CT scan to assess their tumor burden, and so physicians could create a prognosis.

Patients underwent active surveillance at the start of the study, but they could start systemic treatment at any time. Typically, patients underwent 14.9 months of monitoring before starting treatment.

Disease progression was experienced by 90% of participants, and 37 patients started treatment. The additional 20 patients continued their monitoring for an average of 15.8 additional months, according to the study.

There were 3 active surveillance patients who survived without the disease progressing further. Researchers found that 29 patients who had 1 or 2 organs affected by the disease, with 1 or zero risk factors, were on active surveillance 3 times as long as other patients.

“There is a perception that all cancers should be treated immediately because they are equally lethal. But what we've seen in this small phase 2 study is that a subset of adults with advanced kidney cancer have slow-growing disease that can be safely managed using active surveillance, which could spare them the inconvenience and debilitating side effects of aggressive treatments for about a year, and in some cases several years, without worsening anxiety and depression," said lead author Brian Rini. “With just 50 people involved in our trial, the risk and benefits of the approach will need to be studied in a larger group of patients.”

Approximately half of the patients died during the study period. However, only 1 patient died without receiving systemic therapy. Researchers also did not find any significant change in quality of life, anxiety, or depression scores, which suggests that the monitoring did not cause psychological harm to patients, according to the study.

However, researchers caution that patients included in the study were a highly selective group, and this treatment may not be for a larger population.

“With the development of novel immunotherapy in renal-cell carcinoma more work is needed to understand the risk and benefits of this initial observational approach,” Rini concluded. “However, our data provides guidance about how to select patients who could delay treatment and instead be monitored safely with active surveillance.”