Journal of geriatric oncology · 2026
Real-world management and clinical outcomes of first line treatment of advanced renal cell carcinoma in older patients in Canada.
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Curry Lauren, Ghosh Sunita, Arenovich Erica, Tanguay Simon, Lalani Aly-Khan A, Heng Daniel Yick Chin, Bhindi Bimal, Basappa Naveen S, Graham Jeffrey, Bjarnason Georg A, Breau Rodney H, Castonguay Vincent, Soulieres Denis, Pouliot Frederic, Bosse Dominick, Kollmannsberger Christian K, Finelli Antonio, Fallah-Rad Nazanin, Soleimani Maryam
Аннотация
INTRODUCTION: There is a paucity of data with respect to optimal management of metastatic renal cell carcinoma (mRCC) in older patients. Real-world data may help close this knowledge gap and improve care in this understudied and growing patient population.
MATERIALS AND METHODS: The Canadian Kidney Cancer information system (CKCis) was utilized to identify patients with mRCC, categorizing them as either older (defined as age ≥ 75 years) or younger (age < 75 years). Our primary objective was to identify if first line (1 L) mRCC management strategies differed by age. Secondary outcomes of interest were potential differences in treatment-related toxicities, overall survival (OS), progression free survival (PFS), and time to treatment discontinuation (TTD) by age.
RESULTS: In total, 2585 patients were included (<75 years of age n = 2205; ≥ 75 years of age n = 380). Baseline demographics were comparable between cohorts, though older patients more often had five or more comorbidities (95% vs. 67%, p < 0.001) and more frequently had Karnofsky Performance Status ≤70% (19% vs. 13%, p = 0.002). Older patients underwent metastasectomy (15% vs. 24%, p < 0.001) and cytoreductive nephrectomy less frequently (2% vs. 7%, p = 0.047), and were less likely to be enrolled in clinical trials (10% vs. 23%, p < 0.001). Older patients received 1 L targeted monotherapy more frequently than immune checkpoint inhibitor (ICI)-based therapy in the post-ICI era (65% vs. 44%, p < 0.001). Older patients did not experience more treatment-related toxicities from ICI-based therapy. Older patients experienced shorter OS when controlling for International mRCC Database Consortium (IMDC) classification, comorbidities, and histology (HR 1.25, 95% CI 1.1-1.4, p = 0.003) in the overall cohort.
DISCUSSION: Patients ≥75 years of age received 1 L targeted monotherapy more frequently than those <75 years of age, though when they received combination ICI-based therapy, they did not experience more treatment-related toxicities. Clinicians should individualize treatments for older patients not strictly based on age, but after discussion of available options in a patient-centered manner, considering comorbidities, disease burden, and patient preferences.
MATERIALS AND METHODS: The Canadian Kidney Cancer information system (CKCis) was utilized to identify patients with mRCC, categorizing them as either older (defined as age ≥ 75 years) or younger (age < 75 years). Our primary objective was to identify if first line (1 L) mRCC management strategies differed by age. Secondary outcomes of interest were potential differences in treatment-related toxicities, overall survival (OS), progression free survival (PFS), and time to treatment discontinuation (TTD) by age.
RESULTS: In total, 2585 patients were included (<75 years of age n = 2205; ≥ 75 years of age n = 380). Baseline demographics were comparable between cohorts, though older patients more often had five or more comorbidities (95% vs. 67%, p < 0.001) and more frequently had Karnofsky Performance Status ≤70% (19% vs. 13%, p = 0.002). Older patients underwent metastasectomy (15% vs. 24%, p < 0.001) and cytoreductive nephrectomy less frequently (2% vs. 7%, p = 0.047), and were less likely to be enrolled in clinical trials (10% vs. 23%, p < 0.001). Older patients received 1 L targeted monotherapy more frequently than immune checkpoint inhibitor (ICI)-based therapy in the post-ICI era (65% vs. 44%, p < 0.001). Older patients did not experience more treatment-related toxicities from ICI-based therapy. Older patients experienced shorter OS when controlling for International mRCC Database Consortium (IMDC) classification, comorbidities, and histology (HR 1.25, 95% CI 1.1-1.4, p = 0.003) in the overall cohort.
DISCUSSION: Patients ≥75 years of age received 1 L targeted monotherapy more frequently than those <75 years of age, though when they received combination ICI-based therapy, they did not experience more treatment-related toxicities. Clinicians should individualize treatments for older patients not strictly based on age, but after discussion of available options in a patient-centered manner, considering comorbidities, disease burden, and patient preferences.