Impact of age on treatment trends and clinical outcome in patients with metastatic renal cell carcinoma

ObjectivesClinical outcomes in older adults with metastatic renal cell carcinoma (mRCC) are poorly understood, particularly in the era of targeted therapies. We characterize survival and relevant treatment-related variables in a modern series.Materials and MethodsFrom an institutional database including 562 patients with RCC, a total of 219 patients with metastatic disease were identified for the current analysis. Survival was assessed in four age-based cohorts: (1) age < 55, (2) age 55–64, (3) age 65–74, and (4) age ≥ 75. The number of lines of therapy rendered was collected for each patient, and the reason for treatment discontinuation was characterized.ResultsOf the 219 patients assessed, median age was 58 (range, 26–87), and most patients had clear cell histology (82%) and prior nephrectomy (70.9%). The majority of patients were characterized as intermediate-risk (53%) by MSKCC criteria. Median survival in patients age ≥ 75 was 12.5 months, as compared to 26.4 months for patients age < 75 (P = 0.003). Patients age ≥ 75 received fewer lines of systemic therapy as compared to other age-based subsets, and more frequently discontinued therapies due to toxicity.ConclusionsOlder adults represent a unique subpopulation of patients with mRCC, with distinct clinical outcomes. Further research is warranted to better understand the safety and tolerability of current therapies for mRCC in this group.