Original Contribution
Patients Perspectives on Adjuvant Therapy
in Renal Cell Carcinoma
Michael Staehler1, Dena Battle2, Ithaar Derweesh3, Dan George4,
Axel Bex5, Hans Hammers6, Börje Ljungberg7, Eric Jonasch8
1Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
2KCCure, Alexandria, VA;
3Department of Urology, Moores UCSD Cancer Center, University of California, San Diego, San Diego, CA;
4Duke Cancer Institute, Duke University Medical Center, Durham, NC;
5The Netherlands Cancer Center, Division of Surgical Oncology, Department of Urology, Amsterdam, Netherlands;
6Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX;
7Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden;
8Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX;
Abstract
Objectives:
Adjuvant therapy for renal cell carcinoma (RCC) is not
an established standard of care. Three randomized studies
show no median survival advantage for adjuvant treatment,
and one study demonstrated prolonged diseasefree
survival, with OS data still maturing. With the recent
approval of adjuvant sunitinib by the US Food and Drug
Administration (FDA), it is important to assess the attitudes
of patients at high-risk of recurrence from disease
towards adjuvant therapy in RCC.
Methods:
We conducted a survey-monkey survey distributed electronically
to patients with RCC. Twelve questions investigated
self-reported patient characteristics, disease state,
anxiety and attitude towards adjuvant therapy. Statistical
analysis was performed using SPSS statistics 2.
Results:
A total of 450 patients participated. Median age was 55.6
years (17-82 years) and 56.4% of the patients were female.
73.6% of the patients did not have metastatic disease at
initial diagnosis. Of patients with an initial M0 diagnosis,
39.1% reported recurrence, and 35.3% were receiving systemic
therapy for metastatic RCC. 63.1% of the patients
would use adjuvant therapy if it prolonged OS, 60.1% if
it prolonged disease free survival, 42.7% if it showed acceptable
toxicity, and 36.7% if they were guaranteed both
insurance coverage as well as treatment efficacy. Experience
with systemic therapy was correlated with a wish for
36 Kidney Cancer Journal
a prolonged OS (p<0.0001). 28.0% of the patients were
seeking more information prior to their decision. Patients
on systemic therapy had a significant higher acceptance
of toxicity (p<0.0001).
Conclusions:
Patients desire both DFS and OS when deciding on adjuvant
therapy, and over 30 percent are willing to accept
moderate to significant toxicity in return for clinical benefit.
This should be considered in future counseling of
patients contemplating adjuvant drug therapy.
Introduction
The incidence of renal cell carcinoma (RCC) has increased
worldwide by more than 30% from 1990–2013.1 The rise
in incidence is mainly due to increased imaging and earlier
detection of smaller masses. Despite these advances,
death rates in RCC continue to rise in some countries
while stabilizing or declining in other countries.2 The
only curative treatment available for stage 1, 2 or 3 disease
is surgery, followed by observation. Approximately
30 % patients undergoing curative surgery for nonmetastatic
RCC will have tumor recurrence within 5
years.3
Prior to the introduction of VEGF targeted agents for
the treatment of metastatic RCC adjuvant trials with pre-
VEGF era agents failed to meet their primary endpoints
and until recently, there were no approved therapies
available in the adjuvant setting.4
The S-TRAC trial comparing sunitinib versus placebo
in high-risk patients with clear cell RCC met its primary
endpoint of improving disease-free survival (DFS).5 Together
with the ASSURE trial (which did not meet its primary
endpoint), and the recently presented PROTECT
trial, these results have re-ignited the debate around the
utility of adjuvant treatment.5-7 Results on overall survival
(OS) so far are immature in all trials, but so far there
has been no clear trend towards an OS advantage for ad-
Keywords: renal cell carcinoma, kidney cancer, adjuvant therapy,
p atient’s perspective, patient survey, quality of live
Corresponding Author: Michael Staehler, MD PhD, Multidisciplinary
Center on Renal Tumors, Department of Urology, University of Munich,
Marchioninistr. 15 81377 Munich
michael.staehler@med.uni-muenchen.de
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