Referral and adjuvant treatment patterns after nephrectomy in high-risk locoregional renal cell carcinoma.
adjuvant therapy
kidney cancer
sunitinib
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
14
10
2021
received:
12
08
2021
accepted:
19
10
2021
pubmed:
10
11
2021
medline:
18
3
2022
entrez:
9
11
2021
Statut:
ppublish
Résumé
It is unclear whether patients with renal cell carcinoma (RCC) are routinely assessed for recurrence risk post-nephrectomy and whether patients at high recurrence risk are seen by providers who can evaluate candidacy for adjuvant systemic therapy (AST) and clinical trials. We identified all patients with locoregional RCC who underwent nephrectomy via an institutional database within Duke University Health System between 1 April 2015 and 31 December 2019. Medical records were reviewed to identify patient characteristics, post-nephrectomy referrals, treatment, and follow-up. Patients with tumor stage ≥3 and grade ≥2, regional lymph node metastasis, or both, were classified as high recurrence risk. Of 618 patients with locoregional RCC who underwent nephrectomy, 136 (22%) had high recurrence risk. Of those, 25 patients with high-risk disease (18%) were referred to medical oncology for discussion of AST; 23 (92%) of these referrals took place in 2018-2019. One patient received adjuvant sunitinib and two patients participated in adjuvant immunotherapy trials. The decision not to receive AST was primarily made by the oncologist in 10 (46%), the patient in 8 (36%), and unrecorded in 4 (18%) of 22 cases, for multiple reasons. Individual surgeons referred high-risk patients for discussion of AST with varying frequency, ranging from 0% to 100% in 2019. Despite increasing number of patients with locoregional RCC at high recurrence risk referred to medical oncologists after nephrectomy, few patients received AST, including participation in clinical trials. With increasing AST options and ongoing clinical trials in this space, these findings highlight the need for continued efforts at identifying effective AST and referring patients most likely to benefit to medical oncologists. ClinicalTrials.gov, NCT04309617.
Sections du résumé
BACKGROUND
It is unclear whether patients with renal cell carcinoma (RCC) are routinely assessed for recurrence risk post-nephrectomy and whether patients at high recurrence risk are seen by providers who can evaluate candidacy for adjuvant systemic therapy (AST) and clinical trials.
MATERIALS AND METHODS
We identified all patients with locoregional RCC who underwent nephrectomy via an institutional database within Duke University Health System between 1 April 2015 and 31 December 2019. Medical records were reviewed to identify patient characteristics, post-nephrectomy referrals, treatment, and follow-up. Patients with tumor stage ≥3 and grade ≥2, regional lymph node metastasis, or both, were classified as high recurrence risk.
RESULTS
Of 618 patients with locoregional RCC who underwent nephrectomy, 136 (22%) had high recurrence risk. Of those, 25 patients with high-risk disease (18%) were referred to medical oncology for discussion of AST; 23 (92%) of these referrals took place in 2018-2019. One patient received adjuvant sunitinib and two patients participated in adjuvant immunotherapy trials. The decision not to receive AST was primarily made by the oncologist in 10 (46%), the patient in 8 (36%), and unrecorded in 4 (18%) of 22 cases, for multiple reasons. Individual surgeons referred high-risk patients for discussion of AST with varying frequency, ranging from 0% to 100% in 2019.
CONCLUSIONS
Despite increasing number of patients with locoregional RCC at high recurrence risk referred to medical oncologists after nephrectomy, few patients received AST, including participation in clinical trials. With increasing AST options and ongoing clinical trials in this space, these findings highlight the need for continued efforts at identifying effective AST and referring patients most likely to benefit to medical oncologists. ClinicalTrials.gov, NCT04309617.
Identifiants
pubmed: 34751002
doi: 10.1002/cam4.4407
pmc: PMC8683553
doi:
Substances chimiques
Freund's Adjuvant
9007-81-2
Banques de données
ClinicalTrials.gov
['NCT04309617']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
8891-8898Informations de copyright
© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
J Clin Oncol. 2020 Dec 1;38(34):4064-4075
pubmed: 33052759
Cancer. 2019 Sep 1;125(17):2935-2944
pubmed: 31225907
N Engl J Med. 2016 Dec 8;375(23):2246-2254
pubmed: 27718781
Urol Clin North Am. 2003 Nov;30(4):843-52
pubmed: 14680319
Curr Treat Options Oncol. 2019 May 3;20(5):44
pubmed: 31054006
Cancer Med. 2021 Dec;10(24):8891-8898
pubmed: 34751002
N Engl J Med. 2021 Aug 19;385(8):683-694
pubmed: 34407342
Lancet. 2016 May 14;387(10032):2008-16
pubmed: 26969090
Ann Oncol. 2018 Dec 1;29(12):2371-2378
pubmed: 30346481
J Natl Compr Canc Netw. 2020 Sep;18(9):1160-1170
pubmed: 32886895
Eur Urol. 2018 Jan;73(1):62-68
pubmed: 28967554
Cancer J. 2020 Sep/Oct;26(5):376-381
pubmed: 32947305
Expert Rev Anticancer Ther. 2007 Jun;7(6):847-62
pubmed: 17555395
JAMA Oncol. 2017 Sep 1;3(9):1249-1252
pubmed: 28278333
J Clin Oncol. 2002 Dec 1;20(23):4559-66
pubmed: 12454113
J Clin Oncol. 2004 Aug 15;22(16):3316-22
pubmed: 15310775