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Kidney Cancer in Older Adults

  • Ravindran Kanesvaran
  • Hui Shan Tan
Living reference work entry

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.

Keywords

Geriatric Older generation Kidney cancer Renal cell carcinoma Guidelines 

References

  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedCentralGoogle Scholar
  13. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 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
  15. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. Hurez V, Padron AS, Svatek RS, Curiel TJ. Considerations for successful cancer immunotherapy in aged hosts. Clin Exp Immunol. 2017;187(1):53–63.CrossRefPubMedGoogle Scholar
  20. 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 60–1CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 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.CrossRefPubMedGoogle Scholar
  37. 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.CrossRefPubMedGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 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.CrossRefPubMedGoogle Scholar
  40. Yellen SB, Cella DF, Leslie WT. Age and clinical decision making in oncology patients. J Natl Cancer Inst. 1994;86(23):1766–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Medical OncologyNational Cancer Centre SingaporeSingaporeSingapore

Section editors and affiliations

  • Etienne Brain
    • 1
  1. 1.Department of Medical OncologyInstitut Curie/Hôpital René HugueninSaint-CloudFrance

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