Research published in Clinical Genitourinary Cancer this month looked at the use of systemic therapy for the treatment of patients with spread of metastatic renal cell carcinoma (RCC) to the brain (brain metastases).
In recent years, the use of modern radiotherapy has resulted in significant improvements in the control and overall survival of RCC that has spread to the brain. However, the usefulness of systemic therapy in patients who are developing RCC brain metastases remains unknown.
This was a retrospective study of metastatic RCC patients diagnosed with brain metastases. Patients were grouped as having either metachronous brain metastases (i.e., they developed 3 months or more after diagnosis with metastatic RCC) or synchronous brain metastases (i.e., they developed less than 3 months from metastatic RCC diagnosis).
Seventy-four patients were assessed, 40 of which had metachronous brain metastases and 34 had synchronous brain metastases. Seventy-two patients (97%) received systemic therapy for their brain metastases. Patients who developed brain metastases 3 months or more after metastatic RCC diagnosis (metachronous) had a longer median overall survival of 64.2 months compared to those patients who developed brain metastases less than 3 months from the metastatic RCC diagnosis (synchronous), who had a median overall survival of 22.4 months. However, this survival was not significantly different between the two groups from when bone metastases were diagnosed (20.6 versus 15.7 months, respectively).
In conclusion, systemic therapy prolonged overall survival for metastatic RCC patients with either metachronous or synchronous brain metastases. For patients diagnosed with metachronous brain metastases, the development of brain metastases may be an early sign of failure of the systemic therapy.