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Outcomes based on age in patients with metastatic renal cell carcinoma treated with first line targeted therapy or checkpoint immunotherapy: Older patients more prone to toxicity.

Abstract：

OBJECTIVES:Older patients with metastatic renal cell carcinoma (mRCC) were underrepresented in pivotal trials. MATERIALS AND METHODS:Consecutive patients with mRCC treated at Aarhus University Hospital with first line tyrosine kinase inhibitors (TKI), mTOR inhibitors, or checkpoint immunotherapy (CPI) were retrospectively analyzed in age-subgroups; ≥ 75, 65-74, and < 65 years, with overall survival (OS), time-to-treatment discontinuation (TTD), and progression-free survival (PFS) as endpoints. Hazards ratios were adjusted (aHR) for International Metastatic RCC Database Consortium (IMDC) risk factors, histology, and age. RESULTS:Of 838 patients, 159 (19%) were ≥ 75 years, 324 (39%) 65-74 years, and 355 (42%) < 65 years. Treatments were TKI in 729 (87%) patients, mTOR in 43 (5%) and CPI in 67 (8%). Older patients ≥ 75 years compared with 65-74 years and < 65 years had lower toxicity-adjusted median doses of pazopanib, 300 mg vs. 400 mg vs. 600 mg, respectively, (p < 0.001), and sunitinib, 25 mg vs. 37.5 mg vs. 50 mg, respectively (p < 0.001); numerically fewer doses of CPI, median 2 vs. 5 vs. 5, respectively, (p = 0.2); a higher proportion had dose reduction/interruption, 76% vs. 55% vs. 41%, respectively, (p < 0.001); and shorter mean time to dose reduction/interruption, 0.5 months vs. 1.9 months vs. 3.4 months, respectively, (p < 0.001). After adjusting IMDC prognostic factors and histology in multivariate analyses, age did not impact OS (aHR 1.0; 95% CI 0.99-1.02, p = 0.2), TTD (aHR 1.0; 95% CI 0.99-1.01, p = 0.4) or PFS (aHR 1.0, 95% CI 0.99-1.01; p = 0.9). CONCLUSION:Older patients with mRCC were more prone to toxicity; but age did not impact outcomes. Proactive dose modification/interruption and awareness may help to reduce toxicity while maintaining efficacy.

journal_name

J Geriatr Oncol

journal_title

Journal of geriatric oncology

authors

Hermansen CK,Donskov F

doi

10.1016/j.jgo.2020.12.008

subject

Has Abstract

pub_date

2020-12-31 00:00:00

eissn

1879-4068

issn

1879-4076

pii

S1879-4068(20)30530-0

pub_type

杂志文章

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Outcomes based on age in patients with metastatic renal cell carcinoma treated with first line targeted therapy or checkpoint immunotherapy: Older patients more prone to toxicity.