DALLAS — Among veterans, renal cell carcinoma (RCC) accounts for 3% of all diagnosed malignancies or approximately 2,250 new diagnoses each year.

While patients diagnosed with localized RCC have a 93% five-year survival rate, patients with distant metastases have only a 12% five-year survival rate. About 15% of veterans are first diagnosed with RCC after their cancer has already metastasized.1

What can be done to improve the survival of veterans with metastatic RCC?

It appears the most important step is delaying progression on their first line of therapy, according to an abstract published in conjunction with the 2020 American Society of Clinical Oncology Annual Meeting held May 29-31.2

Texas Oncology Sammons Cancer Center-led researchers identified veterans newly diagnosed with metastatic RCC between October 2013 and March 2018 from the VHA database. They analyzed results for those treated with tyrosine kinase inhibitor (TKI) monotherapy in the first line, followed by any second-line therapy, a total of 289 veterans.

All patients had continuous enrollment for six months or longer after their second-line therapy unless they died.

The average age of veterans in the study was 67.4 years and the median time to initiation of the second line of therapy was 6.1 months.

While patient characteristics were similar between the veterans who progressed early (145) and those whose progression was delayed (144), the outcomes were very different.

Early progressors discontinued their second-line therapy in less than eight months, on average, while those with delayed progression had a mean of 18 months from the time they started their first therapy until they stopped the second. The group that took longer to progress had a 60% reduced risk of discontinuation of their second-line therapy.

Not surprisingly, delayed progressors also had more than twice the length of time between when they started their first line and started the third line (21.8 months) compared to early progressors (9.4 months). They also had 58% reduced risk of initiating a third line of therapy.

Overall, those who progressed more slowly on their first therapy lived nearly twice as long, a median of 36.4 months compared to 19.7 months for those who progressed more quickly. Delayed progression was associated with a 54% reduction in the risk of death.

  1. Lynch KE, Lynch JA, Efimova O, Chang J, Berse B, et al. Cardiotoxicity of tyrosine kinase inhibitors among veterans diagnosed with renal cell carcinoma. J Clin Oncol 35, 2017 (suppl; abstr 318248).
  2. Hutson TE, Liu FX, Pandya S, Dieyi C, Kim R, Krulewicz S, Kasturi V, Bhanegaonkar A. “Clinical impact of early progression among patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors in first-line setting: IMPACT RCC real-world study. Abstract e17079. 2020 ASCO Annual Meeting. May 29-31, 2020.