[Metastatic cancer of the kidney. What can be done today?]

Metastatic cancer of the kidney kills one half of the patients concerned within one year and there are no survivors two years later. All of the treatments used up until the present time have been disappointing. Nephrectomy does not prolong survival, does not induce regression of metastases and does not modify the mode of metastatic dissemination. It only has a palliative role. Lymphadenectomy associated with nephrectomy only has a prognostic value. Hormone therapy and chemotherapy are ineffective. Resection of a single metastasis is justified by 5-year survival rates of 30 to 50% in certain series. At the present time, the hopes for effective treatment are raised by the use of recombinant alpha interferon. Therapeutic trials obtain an overall complete response rate of 2.5% (disappearance of all signs of tumour for 4 weeks) and a partial response rate of 14% (decrease in the neoplastic lesions by at least 50%). The combination of interferon with vinblastine ensures much better results with complete and partial response rates of up to 43%. The characteristics of responder patients are discussed in terms of the natural history of renal cancer and the respective results of other treatments. There is a sub-population of patients with metastatic renal cancer suitable for this combination of interferon-vinblastine: they are young patients, in good general condition, previously nephrectomised and preferably suffering from lung metastases. The essential limiting factor of this treatment is the high cost of interferon.