Role of Immunotherapy in Renal Cell Carcinoma

Ronald M. Bukowski, MD

Disclosures
In This Article

Abstract and Introduction

Renal cell carcinoma develops in over 30,000 individuals annually in the United States, with 12,000 deaths attributed to this tumor on a yearly basis. The etiology of this neoplasm is unknown, but cigarette use appears to be a significant risk factor. Recent molecular studies have identified mutations in the von Hippel-Lindau gene in clear-cell cancers and the c-met proto-oncogene in papillary tumors.

Treatment for patients with advanced disease remains unsatisfactory. The use of immunotherapy is based on the following 3 observations: (1) recognition of spontaneous regression, (2) presence of a T-cell immune response, and (3) tumor regressions associated with cytokine treatment. In patients with metastatic disease, administration of interleukin-2 (IL-2), interferon-alpha, or the combination produces responses in 15% to 20% of patients. From 2% to 5% will have complete remissions, which, in patients receiving high-dose IL-2, appear durable. Increases in median survival have been observed in the patients receiving interferon in several randomized trials. The subset of patients most likely to benefit from cytokine treatment include those with few symptoms (ECOG performance status 0 to 1) and/or limited pulmonary disease.

Patients with metastatic renal cancer continue to present a therapeutic challenge. Acceptable therapy includes IL-2, interferon-alpha, or the combination. Patient characteristics such as performance status and comorbid disease influence this choice. Investigation of new approaches and agents in this group of patients is required.

Adenocarcinoma of the kidney is the most common renal tumor and is diagnosed in over 30,000 people annually in the United States. It is estimated that 12,000 individuals die per year from this neoplasm in the United States.[1] The incidence of renal cancer appears to be slowly increasing at a rate of about 2%. This disease most typically occurs in adults between the ages of 15 and 70 years, although it has been reported in children as young as 6 months. It affects males approximately 2 to 3 times more frequently than females.[2]

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