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Renal cell carcinoma: basic biology and current approaches to therapy
A Belldegrun1, A S Abi-Aad, R A Figlin
1Department of Surgery, University of California-Los Angeles School of Medicine 90024-1738.
Abstract:
Renal cell carcinoma (RCC) represents an unusual solid tumor for which no treatment other than surgical therapy has been effective. The remarkable heterogenous behavior of this tumor and the documented rare spontaneous regressions suggest an unusual sensitivity to host immunologic control. In recent years, exciting developments in molecular genetics, growth factors, modulators of invasion of metastases, and cytokine-lymphocyte interactions have produced new hypotheses and a wealth of information regarding the origin, behavior, and control of RCC. Interest in the immunotherapy of metastatic RCC has recently increased with the demonstrated reproducible tumor responses obtained with recombinant human interferon-alpha or interleukin-2. Durable clinical remissions in some patients with advanced RCC can now be achieved by using cytokine therapy alone or in combination with activated killer cells. This article reviews the current understanding of the basic biology of RCC, surgical approaches to localized RCC, and biologic therapy for advanced disease.
Insights
Renal cell carcinoma (RCC) is a rare solid tumor. Advances in immunotherapy, including cytokine therapy with interferon-alpha or interleukin-2, show promise for treating advanced RCC, offering durable remissions.
Area of Science:
- Oncology
- Immunology
- Molecular Biology
Background:
- Renal cell carcinoma (RCC) is an uncommon solid tumor where surgical intervention remains the primary treatment.
- The tumor's heterogeneous nature and rare spontaneous regressions suggest a link to immune system control.
- Recent molecular genetics and immunology research offers new insights into RCC's origin and behavior.
Purpose of the Study:
- To review the current understanding of renal cell carcinoma (RCC) biology.
- To discuss surgical management of localized RCC.
- To explore biologic therapies for advanced RCC.
Main Methods:
- Review of recent developments in molecular genetics, growth factors, and cytokine-lymphocyte interactions.
- Analysis of clinical data on recombinant human interferon-alpha and interleukin-2 efficacy.
- Examination of combination therapies involving cytokines and activated killer cells.
Main Results:
- Immunotherapy, particularly with cytokines like interferon-alpha and interleukin-2, has demonstrated reproducible tumor responses in metastatic RCC.
- Durable clinical remissions are achievable in advanced RCC patients using cytokine therapy alone or combined with activated killer cells.
- Current research provides a foundation for novel treatment strategies targeting RCC.
Conclusions:
- Immunotherapy represents a promising avenue for managing advanced renal cell carcinoma.
- Combining cytokine therapy with other immunomodulatory approaches may enhance treatment outcomes.
- Further research into RCC biology and immune interactions is crucial for developing more effective therapies.