Skip to main content

Kidney Cancer in Older Adults

  • Living reference work entry
  • First Online:
Geriatric Oncology

Abstract

RCC is a relatively common cancer that predominantly afflicts the elderly. About one third of all RCC patients are metastatic at diagnosis, while recurrence rates of those treated for localized disease are as high as 50%. There are a number of issues unique to the older adult with RCC which needs to be taken into account before assigning the appropriate treatment to them. Although new drugs approved for mRCC were assessed without age limitation and included patients over 65 years, no prospective trials dedicated to older RCC patients are available. All the phase III mRCC trials conducted thus far showed no differences in efficacy and toxicity in younger patients compared to older patients (>65 years old). A similar scenario is also observed in the setting of the treatment of localized RCC in the elderly. This textbook chapter aims to highlight the unique issues afflicting the elderly with both localized and metastatic RCC and comprehensively review the key treatment modalities that are currently used in their management.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  • Armstrong AJ, Halabi S, Eisen T, Broderick S, Stadler WM, Jones RJ, et al. Everolimus versus sunitinib for patients with metastatic non-clear cell renal cell carcinoma (ASPEN): a multicentre, open-label, randomised phase 2 trial. Lancet Oncol. 2016;17(3):378–88.

    Article  CAS  PubMed  Google Scholar 

  • Becker A, Ravi P, Roghmann F, Trinh QD, Tian Z, Larouche A, et al. Laparoscopic radical nephrectomy vs laparoscopic or open partial nephrectomy for T1 renal cell carcinoma: comparison of complication rates in elderly patients during the initial phase of adoption. Urology. 2014;83(6):1285–91.

    Article  PubMed  Google Scholar 

  • Bellmunt J, Negrier S, Escudier B, Awada A, Aapro M, Taskforce SIOG. The medical treatment of metastatic renal cell cancer in the elderly: position paper of a SIOG taskforce. Crit Rev Oncol Hematol. 2009;69(1):64–72.

    Article  PubMed  Google Scholar 

  • Biganzoli L, Lichtman S, Michel JP, Papamichael D, Quoix E, Walko C, et al. Oral single-agent chemotherapy in older patients with solid tumours: a position paper from the International Society of Geriatric Oncology (SIOG). Eur J Cancer. 2015;51(17):2491–500.

    Article  CAS  PubMed  Google Scholar 

  • Borghesi M, Brunocilla E, Volpe A, Dababneh H, Pultrone CV, Vagnoni V, et al. Active surveillance for clinically localized renal tumors: an updated review of current indications and clinical outcomes. Int J Urol. 2015;22(5):432–8.

    Article  PubMed  Google Scholar 

  • Choueiri TK, Escudier B, Powles T, Mainwaring PN, Rini BI, Donskov F, et al. Cabozantinib versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373(19):1814–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF, American College of Surgeons National Surgical Quality Improvement Program, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453–66.

    Article  PubMed  Google Scholar 

  • Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007;356(2):125.

    Article  CAS  PubMed  Google Scholar 

  • Escudier B, Porta C, Bono P, Powles T, Eisen T, Sternberg CN, et al. Randomized, controlled, double-blind, cross-over trial assessing treatment preference for pazopanib versus sunitinib in patients with metastatic renal cell carcinoma: PISCES study. J Clin Oncol. 2014;32(14):1412–8.

    Article  CAS  PubMed  Google Scholar 

  • Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001;345(23):1655–9.

    Article  CAS  PubMed  Google Scholar 

  • Fyfe GA, Fisher RI, Rosenberg SA, Sznol M, Parkinson DR, Louie AC. Long-term response data for 255 patients with metastatic renal cell carcinoma treated with high-dose recombinant interleukin-2 therapy. J Clin Oncol. 1996;14(8):2410–1.

    Article  CAS  PubMed  Google Scholar 

  • Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505–27.

    Article  PubMed Central  Google Scholar 

  • Gu W, Zhang G, Sun L, Ma Q, Cheng Y, Zhang H, et al. Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma. J Cachexia Sarcopenia Muscle. 2015;6(3):222–30.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gyawali B, Ando Y. Adjuvant sunitinib for high-risk resected renal cell carcinoma: a meta-analysis of ASSURE and S-TRAC trials. Ann Oncol. 2017;28(4):898–899.

    Google Scholar 

  • Haas NB, Manola J, Uzzo RG, Flaherty KT, Wood CG, Kane C, et al. Adjuvant sunitinib or sorafenib for high-risk, non-metastatic renal-cell carcinoma (ECOG-ACRIN E2805): a double-blind, placebo-controlled, randomised, phase 3 trial. Lancet. 2016;387(10032):2008–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol. 2009;27(34):5794–9.

    Article  CAS  PubMed  Google Scholar 

  • Heng DY, Wells JC, Rini BI, Beuselinck B, Lee JL, Knox JJ, et al. Cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol. 2014;66(4):704–10.

    Article  PubMed  Google Scholar 

  • Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356(22):2271–81.

    Article  CAS  PubMed  Google Scholar 

  • Hurez V, Padron AS, Svatek RS, Curiel TJ. Considerations for successful cancer immunotherapy in aged hosts. Clin Exp Immunol. 2017;187(1):53–63.

    Article  CAS  PubMed  Google Scholar 

  • Kader AK, Tamboli P, Luongo T, Matin SF, Bell K, Jonasch E, et al. Cytoreductive nephrectomy in the elderly patient: the M. D. Anderson Cancer Center experience. J Urol. 2007;177(3):855–60; discussion 60–1

    Article  PubMed  Google Scholar 

  • Kanesvaran R, Li H, Koo KN, Poon D. Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. J Clin Oncol. 2011;29(27):3620–7.

    Article  PubMed  Google Scholar 

  • Kim KH, Kim HY, Kim HR, Sun JM, Lim HY, Lee HJ, et al. Efficacy and toxicity of sunitinib in patients with metastatic renal cell carcinoma with renal insufficiency. Eur J Cancer. 2014;50(4):746–52.

    Article  CAS  PubMed  Google Scholar 

  • Klatte T, Grubmuller B, Waldert M, Weibl P, Remzi M. Laparoscopic cryoablation versus partial nephrectomy for the treatment of small renal masses: systematic review and cumulative analysis of observational studies. Eur Urol. 2011;60(3):435–43.

    Article  PubMed  Google Scholar 

  • Mickisch GH, Garin A, van Poppel H, de Prijck L, Sylvester R, European Organisation for Research, et al. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet. 2001;358(9286):966–70.

    Article  CAS  PubMed  Google Scholar 

  • Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM. The 2016 WHO classification of tumours of the urinary system and male genital organs-part a: renal, penile, and testicular tumours. Eur Urol. 2016;70(1):93–105.

    Article  PubMed  Google Scholar 

  • Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356(2):115–24.

    Article  CAS  PubMed  Google Scholar 

  • Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S, et al. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet. 2008;372(9637):449–56.

    Article  CAS  PubMed  Google Scholar 

  • Motzer RJ, Hutson TE, Cella D, Reeves J, Hawkins R, Guo J, et al. Pazopanib versus sunitinib in metastatic renal-cell carcinoma. N Engl J Med. 2013;369(8):722–31.

    Article  CAS  PubMed  Google Scholar 

  • Motzer RJ, Escudier B, McDermott DF, George S, Hammers HJ, Srinivas S, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373(19):1803–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Puts MT, Tapscott B, Fitch M, Howell D, Monette J, Wan-Chow-Wah D, et al. A systematic review of factors influencing older adults’ decision to accept or decline cancer treatment. Cancer Treat Rev. 2015;41(2):197–215.

    Article  PubMed  Google Scholar 

  • Ravaud A, Motzer RJ, Pandha HS, George DJ, Pantuck AJ, Patel A, et al. Adjuvant sunitinib in high-risk renal-cell carcinoma after nephrectomy. N Engl J Med. 2016;375(23):2246–54.

    Article  CAS  PubMed  Google Scholar 

  • Rini BI, Halabi S, Rosenberg JE, Stadler WM, Vaena DA, Archer L, et al. Phase III trial of bevacizumab plus interferon alfa versus interferon alfa monotherapy in patients with metastatic renal cell carcinoma: final results of CALGB 90206. J Clin Oncol. 2010;28(13):2137–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rini BI, Escudier B, Tomczak P, Kaprin A, Szczylik C, Hutson TE, et al. Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3 trial. Lancet. 2011;378(9807):1931–9.

    Article  CAS  PubMed  Google Scholar 

  • Rini BI, Dorff TB, Elson P, Rodriguez CS, Shepard D, Wood L, et al. Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Lancet Oncol. 2016;17(9):1317–24.

    Article  PubMed  Google Scholar 

  • Sternberg CN, Davis ID, Mardiak J, Szczylik C, Lee E, Wagstaff J, et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol. 2010;28(6):1061–8.

    Article  CAS  PubMed  Google Scholar 

  • Sun M, Thuret R, Abdollah F, Lughezzani G, Schmitges J, Tian Z, et al. Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur Urol. 2011;59(1):135–41.

    Article  PubMed  Google Scholar 

  • Wauthier V, Verbeeck RK, Calderon PB. The effect of ageing on cytochrome p450 enzymes: consequences for drug biotransformation in the elderly. Curr Med Chem. 2007;14(7):745–57.

    Article  CAS  PubMed  Google Scholar 

  • Wells JC, Stukalin I, Norton C, Srinivas S, Lee JL, Donskov F, et al. Third-line targeted therapy in metastatic renal cell carcinoma: results from the International Metastatic Renal Cell Carcinoma Database Consortium. Eur Urol. 2017;71(2):204–9.

    Article  PubMed  Google Scholar 

  • Williamson TJ, Pearson JR, Ischia J, Bolton DM, Lawrentschuk N. Guideline of guidelines: follow-up after nephrectomy for renal cell carcinoma. BJU Int. 2016;117(4):555–62.

    Article  PubMed  Google Scholar 

  • Yellen SB, Cella DF, Leslie WT. Age and clinical decision making in oncology patients. J Natl Cancer Inst. 1994;86(23):1766–70.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ravindran Kanesvaran .

Editor information

Editors and Affiliations

Section Editor information

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Kanesvaran, R., Tan, H.S. (2018). Kidney Cancer in Older Adults. In: Extermann, M. (eds) Geriatric Oncology . Springer, Cham. https://doi.org/10.1007/978-3-319-44870-1_24-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-44870-1_24-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-44870-1

  • Online ISBN: 978-3-319-44870-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics