Many older patients with metastatic renal cell carcinoma (mRCC) can benefit from treatment with targeted therapies, according to a study published in JAMA Network Open.
 
Patients over the age of 65 years are typically excluded from clinical trials investigating the benefits of targeted medicine, leaving a knowledge gap for the efficacy of these newer therapies in this population.
 
For the study, the researchers used Medicare data from 2000 to 2013 to examine patients with stage 4 RCC at the time of diagnosis who received any targeted or nontargeted therapy. The cohort included 1015 patients, of whom 37% received nontargeted therapy and 63% received targeted therapy. Most patients in the study were aged 65 years or older, however, approximately 13% were younger but eligible for Medicare due to disability prior to RCC diagnosis.
 
Compared with older treatments, targeted therapies had showed a modest benefit in patients older than 65 years. Initially, the researchers did not identify a statistically significant difference between targeted and nontargeted therapies.
 
However, a deeper analysis using instrumental variable analysis determined a 3-month survival advantage with targeted therapies. Overall survival improvements with targeted therapy versus nontargeted therapies were also statistically significant: 8% at 1 year, 7% at 2 years, and 5% at 3 years.
 
During the follow-up period of 8 months, 99% of patients who received nontargeted therapy and 88% of those who received targeted therapy died from any cause, according to the study. The data showed that the RCC-specific mortality rate was 76% for the nontargeted therapy group and 62% for the targeted therapy group.
 
“In keeping with clinical trial results, we found that the use of targeted therapy was associated with longer overall survival and RCC-specific survival compared with the use of nontargeted therapy among Medicare beneficiaries who received a diagnosis of mRCC,” the researchers wrote in the study.
 
However, the median survival benefits observed in this real-world patient population were still smaller compared with the benefits seen in clinical trial participants, suggesting that research studies may not accurately reflect how treatments will perform in the real world. Treatment decisions also need to weigh the potential risks, benefit, and cost for each individual patient.
 
Still, the findings indicate that targeted therapies can offer new options for patients who may have foregone treatment due to toxicity concerns.
 
“The finding highlights the need for patient-centered conversations that focus on potential benefits and risks in the context of the diverse personal circumstances, values, and goals of individuals treated in real-world settings,” the study authors concluded.
 
References
 
Li P, Jahnke J, Pettit AR, et al. Comparative survival associated with use of targeted versus nontargeted therapy in Medicare patients with metastatic renal cell carcinoma. JAMA Network Open. 2019. doi:10.1001/jamanetworkopen.2019.5806
 
Many Elderly Patients with Metastatic Renal Cell Carcinoma Benefit from Targeted Therapies [news release]. Penn Medicine. https://www.pennmedicine.org/news/news-releases/2019/june/many-elderly-patients-with-metastatic-renal-cell-carcinoma-benefit-from-targeted-therapies. Accessed June 21, 2019.