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      Improving survival in metastatic renal cell carcinoma (mRCC) patients: do elderly patients benefit from expanded targeted therapeutic options?

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          Abstract

          Introduction

          Treatment advances in metastatic renal cell carcinoma (mRCC) have improved overall survival (OS) in mRCC patients over the last two decades. This single center retrospective analysis assesses if the purported survival benefits are also applicable in elderly mRCC patients.

          Methods

          401 patients with mRCC treated at Hannover Medical School from 01/2003–05/2016 were identified and evaluated by chart review. Treatment periods were defined as 01.01.2003–31.12.2009 (P1) and 01.01.2010–31.05.2016 (P2). Age groups were defined according to WHO classes (≤ 60 years: younger, > 60–75 years: elderly and > 75 years: old). Descriptive statistics, Kaplan–Meier analysis and logistic regression were performed.

          Results

          Median OS improved from 35.1 months in P1 to 59.1 months in P2. Sub-division into the respective age groups revealed median survival of 38.1 (95%-CI: 28.6–47.6) months in younger patients, 42.9 (95%-CI: 29.5–56.3) months among elderly patients and 27.3 (95%-CI: 12.8–41.8) months among old patients. Risk reduction for death between periods was most evident among old patients (young: HR 0.71 (95%-CI: 0.45–1.13, p = 0.2); elderly: HR 0.62 (95%-CI: 0.40–0.97, p = 0.04); old: HR 0.43 (95%-CI: 0.18–1.05, p = 0.06)). Age ≥ 75 years was an independent risk factor for death in P1 but not in P2.

          Conclusion

          Improved OS in the targeted treatment period was confirmed. Surprisingly elderly and old patients seem to profit the most form expansion of therapeutic armamentarium, within the TKI-dominated observation period.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00345-022-04110-3.

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          Most cited references19

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          Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

          This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high-quality cancer registry data, the basis for planning and implementing evidence-based cancer control programs, are not available in most low- and middle-income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1-31. © 2018 American Cancer Society.
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            Nivolumab versus Everolimus in Advanced Renal-Cell Carcinoma.

            Nivolumab, a programmed death 1 (PD-1) checkpoint inhibitor, was associated with encouraging overall survival in uncontrolled studies involving previously treated patients with advanced renal-cell carcinoma. This randomized, open-label, phase 3 study compared nivolumab with everolimus in patients with renal-cell carcinoma who had received previous treatment.
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              Pembrolizumab plus Axitinib versus Sunitinib for Advanced Renal-Cell Carcinoma

              The combination of pembrolizumab and axitinib showed antitumor activity in a phase 1b trial involving patients with previously untreated advanced renal-cell carcinoma. Whether pembrolizumab plus axitinib would result in better outcomes than sunitinib in such patients was unclear.
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                Author and article information

                Contributors
                Ivanyi.philipp@mh-hannover.de
                Journal
                World J Urol
                World J Urol
                World Journal of Urology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0724-4983
                1433-8726
                2 August 2022
                2 August 2022
                2022
                : 40
                : 10
                : 2489-2497
                Affiliations
                [1 ]GRID grid.10423.34, ISNI 0000 0000 9529 9877, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, , Hannover Medical School, ; Hannover, Germany
                [2 ]Comprehensive Cancer Center Lower Saxony, Hannover, Germany
                [3 ]GRID grid.489540.4, ISNI 0000 0001 0656 7508, Interdisciplinary Working Group Renal Cell Cancer of German Cancer Society (IAG-N), ; Berlin, Germany
                [4 ]GRID grid.410718.b, ISNI 0000 0001 0262 7331, Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, , Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Essen University Hospital, ; Essen, Germany
                [5 ]GRID grid.10423.34, ISNI 0000 0000 9529 9877, Department for Hematology, Hemostaseology, Oncology and Stem Cell Transplantation, , Hannover Medical School, ; OE 6860, Carl-Neuberg Str. 1, Hannover, Germany
                Article
                4110
                10.1007/s00345-022-04110-3
                9512722
                35916904
                95443dc5-a484-407e-b770-2698ce46bdae
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                Funding
                Funded by: Medizinische Hochschule Hannover (MHH) (3118)
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2022

                Urology
                renal cell cancer,cytokine,tyrosine kinase inhibition,metastases,age,geriatric patients
                Urology
                renal cell cancer, cytokine, tyrosine kinase inhibition, metastases, age, geriatric patients

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