CGA strong indicator of TKI treatment outcomes in elderly mRCC patients

The comprehensive geriatric assessment (CGA) can accurately identify metastatic renal cell carcinoma (mRCC) patients at higher risk of grade 3–4 toxicities and shorter progression-free survival (PFS) after treatment with tyrosine kinase inhibitors (TKIs), a recent study has found.

Researchers conducted a retrospective, single-centre analysis of 86 eligible patients (median age, 74.5 years; 64 percent men) who had been treated with first-line sunitinib or pazopanib for at least 6 months. CGA was administered to all participants at baseline and was used to categorize them as fit, vulnerable, or frail according to Balducci’s Criteria. Survival, disease control, and tolerability were study outcomes.

The median PFS and overall survival (OS) in the whole cohort were 15.2 and 25.1 months, respectively, and did not differ according to the type of TKI used.

CGA category showed strong impact on survival outcomes. Median OS was 35.5 months among fit participants and dropped to 14.6 and 10.9 months in vulnerable and frail patients, respectively (p<0.001 for both hazard ratios [HRs]). PFS was likewise significantly longer for fit vs vulnerable and frail patients (18.9 vs 11.2 and 5.1 months; p=0.001 for both HRs).

When combining both vulnerable and frail patients into a broader category of unfit, the prognostic impact of CGA improved for both OS (35.5 vs 12.8 months; HR, 2.84, 95 percent confidence interval [CI], 1.62–4.97; p<0.001) and PFS (18.9 vs 7 months; HR, 2.21, 95 percent CI, 1.38–3.55; p=0.002) vs those categorized as fit.

Multivariate Cox regression further confirmed that CGA category was a significant and independent prognostic factor for OS (HR, 2.71, 95 percent CI, 1.52–4.83; p<0.001).

In addition, fit patients developed grade 3–4 adverse events significantly less frequently (19 percent vs 45 percent; p=0.026) and needed fewer temporary dose interruptions due to toxicities (10.3 percent vs 29.8 percent; p=0.034) than unfit comparators.