Renal cell carcinoma - innovative medical treatments

This review highlights recent innovations of medical treatments in advanced renal cell carcinoma. Because of significant toxicity many patients do not benefit from standard systemic cytokine therapy using interleukin-2, interferon-alpha, or both. Their median progression-free survival is about 2 months and their overall survival is poor. Here we report improvements in patient outcome, focusing on overall survival, progression-free survival and quality of life to meet their needs.

Rating treatment results requires analysis of patient selection and risk stratification. In well-selected patients systemic interleukin-2 therapy as well as combinations of cytokines (interleukin-2 and interferon-alpha) improve outcome, induce long-term survival and, in a minority of patients, even produce long-lasting complete remissions. Within the group of patients who are not candidates for systemic cytokines, interleukin-2 for pulmonary metastases given locally by inhalation achieves long-term progression-free survival and long-term overall survival similar to high-dose systemic interleukin-2 but without the toxicity associated with it. In patients at high risk for metastatic disease progression-free survival is prolonged by autologous tumor vaccine as reported in a recent randomized study. However, in established metastatic disease no clear benefit has been demonstrated by any of the many recent vaccine protocols. Chemotherapeutic agents and thalidomide generally fail to improve patient outcome but produce significant and sometimes irreversible toxicity.

Cytokine-based immunotherapy can be considered standard in the treatment of metastatic renal cell carcinoma today. Long-term survival and sometimes even cure seems possible in patients using systemic and local (inhaled) applications of interleukin-2 alone or in combination with interferon-alpha. Noncytokine treatment approaches are scientifically interesting but still disappointing from a patient's perspective.