Inflammatory marker may highlight aggressive RCC treatment need

By Eleanor McDermid, Senior medwireNews Reporter

Patients with metastatic renal cell carcinoma (mRCC) who have high preoperative levels of the inflammatory marker C-reactive protein (CRP) may need intensive multimodal treatment to optimize their survival, say researchers.

Hideaki Miyake and colleagues, from Kobe University Graduate School of Medicine in Japan, found that preoperative CRP level and treatment with targeted agents, rather than cytokines, were the only two independent predictors of survival in a large series of Japanese patients.

“These findings suggest that because immunotherapy has been replaced by targeted agents in recent years, the preoperative serum value of CRP could be a useful marker for the prognostic stratification of patients with metastatic RCC scheduled to undergo cytoreductive nephrectomy,” they write in the International Journal of Clinical Oncology.

The 164 patients in the study were treated between 2001 and 2011. Molecular-targeted agents were approved in Japan in 2008, so 51.2% of the patients received such treatments following cytoreductive nephrectomy, whereas the others were given immunotherapy.

Receipt of targeted agents doubled patients’ chances for overall survival, after accounting for confounders, as did having a preoperative CRP level below 4 mg/dL. Other predictors that were significant in univariate analysis, such as Memorial Sloan-Kettering Cancer Center risk group, metastasis site, and histologic subtype, did not remain so in the multivariate analysis.

Miyake et al note that the median overall survival time of their patients was 25 months, “which is markedly longer than found in those treated in the era of immunotherapy.”

They put the difference down to use of the newer targeted therapies in about half of their patients, with the others commonly receiving combined immunotherapy with interferon (IFN)-α and interleukin-2, rather than with IFN-α alone.

“The introduction of molecular-targeted agents following cytoreductive nephrectomy may result in the improved survival of patients with mRCC compared with cytokine therapy alone,” the researchers conclude.

But they stress that it may be “necessary to perform aggressive multimodal treatment for patients with an increased preoperative serum value of CRP.”

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