Immunotherapy for renal cell cancer in the era of targeted therapy

Until recently, cytokine therapy has been the only validated option for patients with advanced renal cancer. IFN-alpha is one of very few treatments that have demonstrated improved median survival compared with the appropriate control. In patients with synchronous metastases at diagnosis, debulking nephrectomy prior to interferon, further improves overall survival. High-dose IL-2 appears to be able to cure a small percentage of highly selected patients. There is potential to further improve patient selection for these options. The demonstrated value of cytokines should not be overlooked in the rush to use new drugs. In the adjuvant setting, vaccine therapy has provided the only systemic approach that has any promise. New insights into the complexities of the immune system at the molecular level, as well as the ingenuity and enthusiasm of immunotherapists, will undoubtedly lead to continuing attempts to identify and overcome obstacles to achieve the grail of human tumor rejection in clinical practice. Targets within the immune regulatory system and the use of vaccines as targeting agents may bring together the fields of immunotherapy and targeted therapy in the near future.