Tumor burden plays an independent prognostic and predictive role in metastatic renal cell carcinoma (mRCC), a clinical trial shows.
Reported in the British Journal of Urology International, the study findings may help clinicians to better stratify mRCC patients' risk for cancer progression or death and enable them to assess which patients will benefit from a given treatment.
The trial comprised 124 patients, 66% of whom received either sorafenib or sunitinib, while 34% received placebo. At baseline, the median tumor burden was 12.8 cm.
The researchers, led by Roberto Iacovelli (Institut Gustave Roussy, Villejuif, France), found that tumor burden (measured by RECIST 1.0) was directly and significantly related to progression-free survival (PFS) and overall survival (OS) even after adjusting for modified Memorial Sloan Kettering Cancer Centre (MSKCC) risk class and treatment.
Each 1-cm increase in tumor burden raised the risk for progression by 4.5% and the risk for death by 5.0%.
This association was confirmed in exploratory analyses. Patients with a tumor burden above the median of 12.8 cm had an average PFS of 4.2 months compared with 5.6 months for patients with a tumor burden below the median.
Over the past decade several classifications have been suggested to determine mRCC prognosis, with most clinical trials adopting the MSKCC approach, the researchers note.
Until now, tumor burden has not been considered as a prognostic factor in mRCC despite evidence from other tumor types. However, this prospective study found a direct relationship between the absolute baseline value of tumor burden and OS and importantly its prognostic role in multivariate analysis independently of the site of metastases and the MSKCC risk score.
In a related editorial, Laure Fornier (Université Paris Descartes Sorbonne Paris Cité, France), comments that, "overall, measuring tumors remains the simplest way to estimate the severity of disease and predict response or progression."
She adds: "The focus must be on finding clinically relevant criteria, which will help guide the oncologist in terms of therapeutic choices. Thus, collaboration must continue between oncologists and radiologists, to better understand when and how patients should be treated, or when they would not benefit from further therapy."
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