The impact of kidney function on the outcome of metastatic renal cell carcinoma patients treated with vascular endothelial growth factor-targeted therapy

BACKGROUND: A study was undertaken to investigate the effect of baseline renal function on treatment outcome in patients treated with vascular endothelial growth factor (VEGF)-targeted therapy for metastatic renal cell carcinoma (mRCC). METHODS: Retrospective data from 6 North American cancer centers (3 US and 3 Canadian) were pooled to identify patients with mRCC treated with VEGF-targeted therapy. Patient characteristics, response rate, time to treatment failure, and overall survival were collected. The Modification of Diet in Renal Disease formula was used at therapy initiation for calculation of glomerular filtration rate (GFR). RESULTS: Five hundred twenty-nine patients with mRCC who received sunitinib (n=323), sorafenib (n=165), or bevacizumab (n=41) were included in this analysis. Patient characteristics included: 74% male, median age 61 years, and median GFR 60.1 mL/min/1.73 m(2) (range, 6.5-174.2). On univariate analysis, patients with a GFR < 60 (n=262) were more likely to have had a previous nephrectomy (P <.0001) and to be older (P <.0001), but were less likely to have poor prognostic features such as anemia (P.041), hypercalcemia (P.008), neutrophilia (P=.039), thrombocytosis (P <. 0001), short diagnosis to treatment interval (P.007), and low Karnofsky performance status (P=.051). GFR < 60, when adjusted for poor risk factors, did not have an impact on type of objective response (odds ratio, 1.31; 95% confidence interval [ CI], 0.74-2.32; P.359), time to treatment failure (hazard ratio [HR], 0.97; 95% CI, 0.79-1.19; P=.772), or overall survival (HR, 0.90; 95% CI, 0.69-1.17; P.439). CONCLUSIONS: Renal function at therapy initiation does not adversely affect the efficacy of VEGF-targeted therapy in mRCC. Clinicians should not avoid treating patients with impaired baseline renal function. Cancer 2012; 118: 365-70. (C) 2011 American Cancer Society.