Targeted Therapies May Benefit Older Patients With Metastatic Renal Cell Carcinoma

Targeted therapies helped older patients with metastatic renal cell carcinoma (RCC) live three months longer than those who received older treatments options, according to a new study conducted by researchers at the University of Pennsylvania School of Medicine.

The researchers wanted to determine how effective targeted therapies — 12 are approved by the Food and Drug Administration (FDA) — are for patients older than 65 who have advanced disease.

“Sometimes clinical trials don't include older patients, or older people may have additional medical conditions that make their individual situation more complicated,” co-author Amy R. Pettit, a clinical psychologist and adjunct fellow at the University of Pennsylvania Center for Public Health Initiatives, said in an interview CURE®. “Most people are wondering, ‘What can I expect?’ It’s easier to answer that question if there’s more information.”

Using data from patients on Medicare, the researchers examined the overall survival and estimated overall survival improvements in more than 1,100 patients with stage 4 clear cell RCC. Data was collected from 2000 to 2013. Most patients were 65 years or older. The study reviewed patients who had either received an FDA-approved targeted therapy (63%) or a nontargeted therapy (37%).

A modest survival benefit was seen in the targeted therapy group compared with the nontargeted therapy group despite patients in the targeted therapy group having characteristics that put them at risk for worse outcomes, said the researchers.

The in-depth analysis showed a three-month survival advantage with targeted therapies compared with older treatments. Also noted as significant were estimated overall survival improvements. For the targeted therapies they were 8% at one year, 7% at two years and 5% at three years.

“Sometimes we know how newer treatments compare to older treatments in clinical trials but not in the real world, where circumstances can be more complicated,” said senior author Jalpa A. Doshi, a professor of medicine in the Perelman School of Medicine at the University of Pennsylvania. “We were pleased to find that targeted therapies did perform better overall. We saw a range of benefit, which was probably related to the fact that people with a wide range of medical situations were included in our treatment group.”

Half of the targeted therapy group passed away within nine months, but 10% of people survived longer than four years, explained Doshi. Among that group with better outcomes, targeted therapies offered an 11-month survival advantage over older treatments.

“There are more treatment options now and RCC is a cancer where people can often try additional treatments if the first one isn’t effective,” she said. “So even small gains may mean that a person might live long enough to try the next innovation.”

However, Doshi stressed, research studies are focused on treatment outcomes for groups of patients, not individuals. “It’s important to get help from your treatment team to understand how new research findings might help inform your care,” she said.