Real-world management and clinical outcomes of first line treatment of advanced renal cell carcinoma in older patients in Canada

IF 2.7 3区医学 Q3 GERIATRICS & GERONTOLOGY

Journal of geriatric oncology Pub Date : 2026-04-01 Epub Date: 2026-02-14 DOI:10.1016/j.jgo.2026.102905

Lauren Curry , Sunita Ghosh , Erica Arenovich , Simon Tanguay , Aly-Khan A. Lalani , Daniel Yick Chin Heng , Bimal Bhindi , Naveen S. Basappa , Jeffrey Graham , Georg A. Bjarnason , Rodney H. Breau , Vincent Castonguay , Denis Soulieres , Frederic Pouliot , Dominick Bosse , Christian K. Kollmannsberger , Antonio Finelli , Nazanin Fallah-Rad , Maryam Soleimani

{"title":"Real-world management and clinical outcomes of first line treatment of advanced renal cell carcinoma in older patients in Canada","authors":"Lauren Curry , Sunita Ghosh , Erica Arenovich , Simon Tanguay , Aly-Khan A. Lalani , Daniel Yick Chin Heng , Bimal Bhindi , Naveen S. Basappa , Jeffrey Graham , Georg A. Bjarnason , Rodney H. Breau , Vincent Castonguay , Denis Soulieres , Frederic Pouliot , Dominick Bosse , Christian K. Kollmannsberger , Antonio Finelli , Nazanin Fallah-Rad , Maryam Soleimani","doi":"10.1016/j.jgo.2026.102905","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>There is a paucity of data with respect to optimal management of metastatic renal cell carcinoma (mRCC) in older patients. Real-world data may help close this knowledge gap and improve care in this understudied and growing patient population.</div></div><div><h3>Materials and methods</h3><div>The Canadian Kidney Cancer information system (CKCis) was utilized to identify patients with mRCC, categorizing them as either older (defined as age ≥ 75 years) or younger (age < 75 years). Our primary objective was to identify if first line (1 L) mRCC management strategies differed by age. Secondary outcomes of interest were potential differences in treatment-related toxicities, overall survival (OS), progression free survival (PFS), and time to treatment discontinuation (TTD) by age.</div></div><div><h3>Results</h3><div>In total, 2585 patients were included (<75 years of age <em>n</em> = 2205; ≥ 75 years of age <em>n</em> = 380). Baseline demographics were comparable between cohorts, though older patients more often had five or more comorbidities (95% vs. 67%, <em>p</em> < 0.001) and more frequently had Karnofsky Performance Status ≤70% (19% vs. 13%, <em>p</em> = 0.002). Older patients underwent metastasectomy (15% vs. 24%, <em>p</em> < 0.001) and cytoreductive nephrectomy less frequently (2% vs. 7%, <em>p</em> = 0.047), and were less likely to be enrolled in clinical trials (10% vs. 23%, <em>p</em> < 0.001). Older patients received 1 L targeted monotherapy more frequently than immune checkpoint inhibitor (ICI)-based therapy in the post-ICI era (65% vs. 44%, <em>p</em> < 0.001). Older patients did not experience more treatment-related toxicities from ICI-based therapy. Older patients experienced shorter OS when controlling for International mRCC Database Consortium (IMDC) classification, comorbidities, and histology (HR 1.25, 95% CI 1.1–1.4, <em>p</em> = 0.003) in the overall cohort.</div></div><div><h3>Discussion</h3><div>Patients ≥75 years of age received 1 L targeted monotherapy more frequently than those <75 years of age, though when they received combination ICI-based therapy, they did not experience more treatment-related toxicities. Clinicians should individualize treatments for older patients not strictly based on age, but after discussion of available options in a patient-centered manner, considering comorbidities, disease burden, and patient preferences.</div></div>","PeriodicalId":15943,"journal":{"name":"Journal of geriatric oncology","volume":"17 3","pages":"Article 102905"},"PeriodicalIF":2.7000,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of geriatric oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1879406826000597","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/2/14 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

There is a paucity of data with respect to optimal management of metastatic renal cell carcinoma (mRCC) in older patients. Real-world data may help close this knowledge gap and improve care in this understudied and growing patient population.

Materials and methods

The Canadian Kidney Cancer information system (CKCis) was utilized to identify patients with mRCC, categorizing them as either older (defined as age ≥ 75 years) or younger (age < 75 years). Our primary objective was to identify if first line (1 L) mRCC management strategies differed by age. Secondary outcomes of interest were potential differences in treatment-related toxicities, overall survival (OS), progression free survival (PFS), and time to treatment discontinuation (TTD) by age.

Results

In total, 2585 patients were included (<75 years of age n = 2205; ≥ 75 years of age n = 380). Baseline demographics were comparable between cohorts, though older patients more often had five or more comorbidities (95% vs. 67%, p < 0.001) and more frequently had Karnofsky Performance Status ≤70% (19% vs. 13%, p = 0.002). Older patients underwent metastasectomy (15% vs. 24%, p < 0.001) and cytoreductive nephrectomy less frequently (2% vs. 7%, p = 0.047), and were less likely to be enrolled in clinical trials (10% vs. 23%, p < 0.001). Older patients received 1 L targeted monotherapy more frequently than immune checkpoint inhibitor (ICI)-based therapy in the post-ICI era (65% vs. 44%, p < 0.001). Older patients did not experience more treatment-related toxicities from ICI-based therapy. Older patients experienced shorter OS when controlling for International mRCC Database Consortium (IMDC) classification, comorbidities, and histology (HR 1.25, 95% CI 1.1–1.4, p = 0.003) in the overall cohort.

Discussion

Patients ≥75 years of age received 1 L targeted monotherapy more frequently than those <75 years of age, though when they received combination ICI-based therapy, they did not experience more treatment-related toxicities. Clinicians should individualize treatments for older patients not strictly based on age, but after discussion of available options in a patient-centered manner, considering comorbidities, disease burden, and patient preferences.

查看原文本刊更多论文

加拿大老年晚期肾细胞癌一线治疗的现实世界管理和临床结果

关于老年患者转移性肾细胞癌（mRCC）的最佳治疗，目前缺乏相关数据。真实世界的数据可能有助于缩小这一知识差距，并改善对这一研究不足和不断增长的患者群体的护理。材料和方法利用加拿大肾癌信息系统（CKCis）识别mRCC患者，将其分为老年（定义为年龄≥75岁）或年轻（年龄≤75岁）。我们的主要目的是确定一线（1l） mRCC管理策略是否因年龄而异。次要结局是治疗相关毒性、总生存期（OS）、无进展生存期（PFS）和按年龄划分的治疗停止时间（TTD）的潜在差异。结果共纳入2585例患者（≤75岁n = 2205；≥75岁n = 380）。基线人口统计数据在队列之间具有可比性，尽管老年患者通常有五种或更多合并症（95%对67%，p < 0.001），并且更常见的Karnofsky Performance Status≤70%（19%对13%，p = 0.002）。老年患者接受转移瘤切除术（15%对24%，p < 0.001）和细胞减少性肾切除术的频率较低（2%对7%，p = 0.047），参加临床试验的可能性较低（10%对23%，p < 0.001）。老年患者在免疫检查点抑制剂（ICI）后接受1 L靶向单药治疗的频率高于基于ICI的治疗（65% vs. 44%, p < 0.001）。老年患者在以ici为基础的治疗中没有经历更多的治疗相关毒性。在整个队列中，当控制国际mRCC数据库联盟（IMDC）的分类、合共病和组织学时，老年患者的OS较短（HR 1.25, 95% CI 1.1-1.4, p = 0.003）。≥75岁的患者比≥75岁的患者更频繁地接受1 L靶向单药治疗，尽管当他们接受基于ci的联合治疗时，他们并没有经历更多的治疗相关毒性。临床医生对老年患者的个体化治疗不应严格基于年龄，而应以患者为中心，在考虑合并症、疾病负担和患者偏好的情况下，讨论可用的治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of geriatric oncology ONCOLOGY-GERIATRICS & GERONTOLOGY

CiteScore

5.30

自引率

10.00%

发文量

379

审稿时长

80 days

期刊介绍： The Journal of Geriatric Oncology is an international, multidisciplinary journal which is focused on advancing research in the treatment and survivorship issues of older adults with cancer, as well as literature relevant to education and policy development in geriatric oncology. The journal welcomes the submission of manuscripts in the following categories: • Original research articles • Review articles • Clinical trials • Education and training articles • Short communications • Perspectives • Meeting reports • Letters to the Editor.