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JNCCN Study: Important potential role for routine brain imaging in advanced kidney cancer

International study finds 4% of patients with metastatic renal cell carcinoma developed asymptomatic brain metastases, which correlated to poorer outcomes

National Comprehensive Cancer Network

Research News

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Credit: JNCCN

PLYMOUTH MEETING, PA [April 13, 2021] -- The April 2021 issue of JNCCN--Journal of the National Comprehensive Cancer Network publishes new research from Memorial Sloan Kettering Cancer Center (MSK) and Gustave Roussy Institute, which suggests that baseline brain imaging should be considered in most patients with metastatic kidney cancer. The researchers studied 1,689 patients with metastatic renal cell carcinoma (mRCC) who had been considered for clinical trial participation at either of the two institutions between 2001 and 2019 and had undergone brain imaging in this context, without clinical suspicion for brain involvement. The researchers discovered 4% had asymptomatic brain metastases in this setting. This group was found to have a low median 1-year overall survival rate (48%), and median overall survival (10.3 months).

"With 4% overall incidence in this cohort, one might conclude that baseline brain imaging should be considered in all patients with metastatic kidney cancer, particularly those with multiorgan involvement and/or pulmonary metastases" said lead MSK researcher Ritesh R. Kotecha, MD, who also worked with investigators from Gustave Roussy, a leading academic cancer center located just outside Paris, France.

"Brain imaging is routinely obtained for kidney cancer patients with symptoms that suggest central nervous system (CNS) metastases, but none of the patients with brain metastases included here were symptomatic," added senior researcher Martin H. Voss, MD, also with MSK. "In current practice chest, abdomen, and pelvis are routinely imaged from the time that metastatic disease is first detected yet many oncologists do not image the brain."

The researchers found 86% of the patients with asymptomatic brain metastases harbored metastatic disease in 2 or more additional organ systems, most-commonly the lung, followed by liver and bone.

"The retrospective study by Kotecha, et. al. demonstrates that incidental brain metastases occur in a clinically significant percentage of patients with newly diagnosed metastatic renal cell carcinoma," commented Eric Jonasch, MD, Professor, Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, who was not involved in this research.

Dr. Jonasch, who is Vice-Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Kidney Cancer, continued: "The findings in this study are important for two reasons. First, they show that the overall prognosis of patients with brain metastases is consistently worse than the broader population of patients with metastatic renal cell carcinoma. We need to develop a deeper scientific understanding of why this patient population has a worse outcome, and we need to include them in future clinical trials. Second, they underscore the utility for MRI imaging of all patients with metastatic renal cell carcinoma both at initial diagnosis, and at regular intervals, to detect occult brain metastases, since specific treatment strategies are required for this patient population."

The researchers acknowledged that their data cannot provide input as to how frequently brain surveillance should be repeated, and called for additional study.

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To read the entire article, visit JNCCN.org. Complimentary access to "Prognosis of Incidental Brain Metastases in Patients With Advanced Renal Cell Carcinoma" is available until July 10, 2021.

About JNCCN--Journal of the National Comprehensive Cancer Network

More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN--Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.aspx. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information and follow NCCN on Facebook @NCCNorg, Instagram @NCCNorg, and Twitter @NCCN.

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