First-Line Considerations in Metastatic Renal Cell Carcinoma

It is important to consider carefully whether a patient with renal cell carcinoma (RCC) has progressive disease before starting therapy, states Bernard Escudier, MD. Performance status of the patient, age, and comorbidities are the most important prognostic factors to consider. First-line treatment may be delayed in a patient with good performance status who has small lung nodules that are not progressing, for example, notes Susanne Osanto, MD. It is also important to consider the characteristics and the histology of the tumor.

The patient’s disease is generally categorized as either poor-, intermediate-, or favorable-risk, and this influences the treatment choice. A tyrosine kinase inhibitor (TKI) is the upfront therapy option for patients who are considered favorable- or intermediate-risk, says Osanto, while interferon, temsirolimus, or a TKI may be chosen for a patient who is poor-risk.

The primary goal of first-line treatment in patients with metastatic RCC is to improve overall survival. If patients are symptomatic, then it is also important to palliate these symptoms, notes Osanto. The majority of patients will not be cured, adds Escudier. Thus, improving quality of life is also very important.