Prognostic Model MSKCC in Patients with Metastatic Renal Carcinoma Treated in 1st Line with Sunitinib

Aim of the Study

The MSKCC prognostic model is widely used to predict outcomes of systemic treatment in patients with mRCC. The aim of this Czech study was to evaluate the correlation between the MSKCC score and the outcomes achieved in mRCC patients treated with sunitinib in the 1st line. The authors particularly focused on the intermediate-risk group.

Design

This is a retrospective analysis of data from the RENIS registry, including mRCC patients treated with sunitinib in the 1st line between May 2016 and January 2018. Sunitinib was administered orally according to the recommended dosage until disease progression or unacceptable toxicity. The evaluated parameters were progression-free survival (PFS), overall survival (OS), and the proportion of patients with an objective response to treatment (ORR) in the low, intermediate, and high-risk subgroups. In the intermediate-risk subgroup, these parameters were also evaluated based on the number of risk factors.

Evaluated Population

A total of 2390 patients were analyzed, of whom 806 had low, 1450 intermediate, and 134 high risk according to MSKCC. In the intermediate-risk subgroup, there were 969 patients with 1 risk factor and 481 patients with 2 risk factors. The average age of all included patients at the time of mRCC diagnosis was 60 years, 72% were men, 94% had an ECOG performance status of 0-1, and 42% had Stage IV tumors.

Results

In the entire population, median PFS was 10.6 months, median OS was 28.5 months, and ORR was 26.5%. In the low-risk subgroup according to MSKCC, PFS reached 17 months, OS was 44.7 months, and ORR was 33%. In the intermediate-risk subgroup, PFS was 9.0 months, OS was 24.1 months, and ORR was 24.1%. In the high-risk subgroup, PFS was 4.5 months, OS was 9.5 months, and ORR was 13.4%. Differences were statistically significant for all three evaluated parameters. In the intermediate-risk subgroup, the median PFS was 10.1 months for patients with 1 risk factor compared to a median of 6.2 months for patients with 2 risk factors (p < 0.001), median OS was 28.2 months vs. 16.2 months (p < 0.001), and ORR was 26.7% vs. 18.7% (p = 0.001).

Each of the risk factors included in the MSKCC score showed a significant relationship with PFS and OS: high serum lactate dehydrogenase (LDH) levels, subnormal hemoglobin concentrations, elevated calcium concentrations, ECOG performance status (PS) of ≥2, and time from diagnosis to initiation of systemic therapy of <1 year.

Conclusion

This study demonstrated that the number of unfavorable prognostic factors included in the MSKCC score significantly affects the outcomes of 1st line treatment with sunitinib in mRCC patients.

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Source:

Fiala O., Fínek J., Poprach A. et al. Outcomes according to MSKCC risk score with focus on the intermediate-risk group in metastatic renal cell carcinoma patients treated with first-line sunitinib: a retrospective analysis of 2390 patients. Cancers (Basel) 2020 Mar 27; 12 (4): 808, doi: 10.3390/cancers12040808.