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Immunotherapy for advanced renal cell cancer
1Division of Medical Oncology, Fraser Valley Cancer Centre, 13750-96th Avenue, Surrey, BC, Canada, V3V 1Z2. ccoppin@bccancer.bc.ca
The Cochrane Database of Systematic Reviews
|January 28, 2005
Summary
Interferon-alfa offers a modest survival benefit for advanced renal cell carcinoma patients. Combining nephrectomy with interferon-alfa improves survival strategies for select patients.
Area of Science:
- Oncology
- Immunotherapy
- Renal Cell Carcinoma
Background:
- Advanced renal cell carcinoma (RCC) presents variable clinical courses.
- Immunotherapy shows promise but requires robust evaluation.
Purpose of the Study:
- To systematically evaluate immunotherapy for advanced RCC.
- Compare high-dose interleukin-2 and interferon-alfa against other treatments.
- Primary outcome: one-year overall survival; secondary outcome: remission rates.
Main Methods:
- Systematic search of CENTRAL, MEDLINE, EMBASE (1966-2003).
- Inclusion of randomized controlled trials (RCTs) in advanced RCC patients.
- Data extraction on remission and survival outcomes from 53 eligible studies (6117 patients).
Main Results:
- Overall remission rates for various immunotherapies were 12.9% vs. 2.5% (non-immunotherapy controls).
- Interferon-alfa demonstrated superiority over controls (OR for death: 0.56) with a median survival improvement of 3.8 months.
- Up-front nephrectomy followed by interferon-alfa improved median survival by 4.8 months in select patients.
Conclusions:
- Interferon-alfa provides a modest survival benefit and is a suitable control arm for future systemic agent studies.
- Nephrectomy followed by interferon-alfa is the optimal validated survival strategy for fit patients with metastatic RCC at diagnosis.
- There is a clear need for more effective therapies for advanced renal cell carcinoma.