The effect of a treatment delay on outcome in metastatic renal cell carcinoma.

To investigate if a first-line treatment delay (TD) can negatively affect the outcomes of patients affected by metastatic renal cancer.

Patients with a diagnosis of metastatic renal cancer who were ineligible for active surveillance were included in the sample. A TD was defined as the time from the diagnosis of metastatic disease to the start of first-line therapy with tyrosine kinase inhibitors.

A total of 835 patients were assessed and 635 were included in the final analysis. The median TD was 6.3 weeks. No significant differences were found in baseline characteristics between patients experiencing a TD below/equal to or above the median value, with the exceptions being the rate of bone metastases (25.3% vs. 35.9%) and advanced disease at diagnosis (34.7% vs. 54.9%). In patients who had received a previous nephrectomy for localized disease, the TD was 5.3 compared to 8.0 weeks for those with metastatic disease at diagnosis (P = 0.001). Among this latter group, 68.7% had received a cytoreductive nephrectomy. In patients with a TD below/equal to and above the median value, the median progression-free survival was 10.3 and 11.2 months, respectively (hazard ratio = 1.03; 95% confidence intervals, 0.86-1.22; P = 0.78); the median overall survival was 27.3 and 28.2 months, respectively (hazard ratio = 1.04; 95% confidence intervals, 0.86-1.27; P = 0.68). The lack of differences was confirmed when adjusted for prognostic factors and baseline characteristics.

This study reports that patients with bone metastases and advanced disease at diagnosis have a significant probability of experiencing delayed first-line therapy of more than 6 weeks from the time of diagnosis. However, a TD does not significantly affect outcomes and survival.

Urologic oncology. 2019 Mar 29 [Epub ahead of print]

Roberto Iacovelli, Luca Galli, Ugo De Giorgi, Camillo Porta, Franco Nolè, Paolo Zucali, Roberto Sabbatini, Alessandra Mosca, Francesco Atzori, Daniele Santini, Gaetano Facchini, Giuseppe Fornarini, Sebastiano Buti, Francesco Massari, Cristina Masini, Riccardo Ricotta, Elisa Biasco, Cristian Lolli, Nicole Gri, Elena Verri, Chiara Miggiano, Maria Giuseppa Vitale, Giampaolo Tortora

Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy. Electronic address: ., Medical Oncology 2, AOUP, Istituto Toscano Tumori, Pisa, Italy., Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy., Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy., Medical Oncology Division of Urogenital and Head & Neck Tumours, European Institute of Oncology, Milan, Italy., Humanitas Clinical and Research Center, Humanitas Cancer Center, Rozzano, Milano, Italy., Department of Oncology and Haematology and Respiratory Disease, University Hospital, Modena, Italy., Medical Oncology Unit, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy., Medical Oncology Unit, Azienda Ospedaliero Universitaria of Cagliari, Cagliari, Italy., Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy., Departmental Unit of Clinical and Experimental Uro-Andrologic Oncology, Istituto Nazionale Tumori - Irccs - Fondazione G. Pascale, Napoli, Italy., Medical Oncology Department, IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy., Medical Oncology Unit, University Hospital of Parma, Italy., Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy., Medical Oncology Unit, Arcispedale Santa Maria Nuova, IRCCS Reggio Emilia, Reggio Emilia, Italy., Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy., Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.