Inflammatory markers may guide treatment decisions in metastatic renal cell cancer

The common inflammatory marker C-reactive protein (CRP) is independently associated with time from diagnosis to initiation of treatment in metastatic renal cell cancer (mRCC). Therefore, this easily accessible test can be used to help guide clinical decision-making on when to initiate systemic therapy.

Some mRCC patients experience a prolonged time between initial diagnosis and disease progression. Systemic treatment of mRCC can be both toxic and non-curative; therefore, patients who experience an indolent disease course are usually placed on active surveillance, delaying treatment until there are signs of disease progression. However, it can be challenging to identify which patients will be appropriately managed by active surveillance and to determine when patients on active surveillance should begin systemic anti-cancer therapy (SACT). To predict survival in mRCC, inflammatory biomarkers and a patient’s International Metastatic Database Consortium (IMDC) risk score are used.

Ms Vishwani Chauhan (University of Edinburgh, UK) presented the current retrospective study that included patients diagnosed with mRCC who were on active surveillance [1]. The relationship was assessed between 6 key inflammatory biomarkers (i.e. haemoglobin, white cell count, neutrophil count, platelets, CRP, and albumin) and time to initiation of SACT.

The primary endpoint was time from diagnosis to initiation of SACT. Of the 126 patient records examined, 66 patients (52.4%) initiated SACT, with a median time between diagnosis and SACT initiation of 17.2 months. Of the remaining 60 patients, 17 (13.5%) had died while on active surveillance; this group had a median survival time of 40.4 months. The final 43 patients (34.1%) remained on active surveillance and were followed for a median period of 39.6 months.

Both CRP and albumin were predictive of duration of active surveillance (P=0.01 and P=0.049, respectively). Multivariate analysis revealed that only CRP was independently associated with time between diagnosis and initiation of SACT (P=0.035).

These results suggest that some patients diagnosed with mRCC may be appropriately managed by active surveillance for a considerable period and suggest that monitoring of CRP levels can contribute to the timing of the decision to initiate SACT.

1. Chauhan V. Prognostic biomarkers of systemic inflammation in patients on active surveillance for metastatic renal cell carcinoma (mRCC): A biobank analysis. Abstract 348, ASCO Genitourinary Cancers Symposium, 11–13 February 2021.

 

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Posted on 24 March 202118 June 2021