Impact of Brain Metastases on Systemic Renal Cell Carcinoma Treatment Outcomes: A Systematic Literature Review - Beyond the Abstract

In our recent review, we summarised the evidence on brain metastases and systemic treatment in patients with metastatic renal cancer. Historically presence of brain metastases has been a predictor of poor prognosis. Brain metastases are thought to affect 10-13% of patients. However, many are asymptomatic, and the incidence of detected metastases may rise as brain screening becomes more common practice.
Our research included 62 publications and 4,637 patients with brain metastases from renal cancer, treated with systemic therapy. Phase 2 and 3 trials and non-interventional studies were included. Publications were included from Embase and MEDLINE databases. Systemic therapies were all FDA and EMA-approved. The most evaluated systemic therapies were sunitinib, nivolumab, ipilimumab + nivolumab, cabozantinib, and sorafenib.

It is clear that comparative systemic treatment outcome data are limited. In clinical trials, the benefits of differing systemic treatments for patients with brain metastases were equivocal, and hence, there were no robust comparative data to guide systemic treatment selection.

In non-interventional studies, survival was generally poorer in patients with brain metastases from renal cancer than in patients without.

Survival and intracranial control benefits in patients with brain metastases were reported for some multimodal treatment strategies that incorporated systemic therapy and local therapies

This study has highlighted a need for robust data from clinical trials evaluating intracranial and extracranial responses to systemic therapy in patients with brain metastases from renal cancer, taking into account prior local therapy exposure.

Written by: Natalie Charnley, Lancashire Teaching Hospitals, Cancer Services, Preston, UK

Disclosures:
Ipsen, MSD, Merk, BMS
This research was funded by Ipsen
All opinions are my own and not reflective of the opinions of the other authors or the study sponsor

Read the Abstract