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A medical oncologist's approach to immunotherapy for advanced renal tumors: is nephrectomy indicated?

Matthew M Cooney1, Scot C Remick, Nicholas J Vogelzang

  • 1Division of Hematology/Oncology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA. matthewcooney@yahoo.com

Current Urology Reports
|January 22, 2004
PubMed

Insights

Metastatic renal cell carcinoma (kidney cancer) is difficult to treat. Surgery followed by interferon improved survival for patients with good performance status, but not for those with poor status.

Area of Science:

  • Oncology
  • Nephrology

Background:

  • Metastatic renal cell carcinoma (mRCC) exhibits significant resistance to systemic therapies.
  • Interleukin-2 and interferon are the most effective agents, yet long-term survival rates for mRCC remain suboptimal.

Purpose of the Study:

  • To evaluate the survival benefit of nephrectomy followed by interferon compared to interferon alone in patients with metastatic renal cell carcinoma.
  • To determine the impact of performance status on the efficacy of this combined treatment approach.

Main Methods:

  • Analysis of two Phase 3 clinical trials: European Organization for Research and Treatment of Cancer 30947 and Southwest Oncology Group 8949.
  • Comparison of outcomes in patients with excellent performance status (PS 0-1) versus moderate to poor performance status (PS 2-4).

Main Results:

  • Nephrectomy followed by interferon demonstrated a survival benefit over interferon alone in patients with excellent performance status (PS 0-1).
  • This combined approach was not recommended for patients with moderate or poor performance status (PS 2-4).

Conclusions:

  • For select patients with metastatic renal cell carcinoma and good performance status, nephrectomy followed by interferon offers a survival advantage.
  • Treatment decisions should consider patient performance status, and all patients with metastatic disease should be considered for clinical trials due to the overall poor prognosis.

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