Abstract. interleukin (il)-2 and interferon (iFn)-α combination therapy for metastatic renal cell carcinoma (rcc) improves the prognosis for a subset of patients, while some patients suffer from severe adverse drug reactions with little benefit. To establish a method to predict responses to this combination therapy (approximately 30% response rate), the gene expression profiles of primary RCCs were analyzed using an oligodna microarray consisting of 38,500 genes or ESts, after enrichment of the cancer cell population by laser microbeam microdissection. The analysis of 10 responders and 18 non-responders identified 24 genes that exhibited significant differential expression between the two groups. In addition, the patients whose tumors did not express hla-dQa1 or HLA-DQB1 molecules demonstrated poor clinical response. Exclusion of patients with tumors lacking either of these two genes is likely to improve the response rate to il-2 and iFn-α combination therapy from 30 to 67%, indicating that a simple pretreatment test provides useful information with which to subselect patients with renal cancer in order to improve the efficacy of this treatment and reduce unnecessary medical costs.
Introductionrenal cell carcinomas (rccs) account for 2-3% of all malignancies (1,2). Surgical resection is the first choice of treatment for RCC at an early stage. However, when patients present at an advanced stage or have local recurrence or distant metastasis to other organs, immunotherapy, chemotherapy and radiation therapy are applied, although the response rates are poor. recently, new molecular targeted agents, such as sunitinib and sorafenib, have been developed and are widely used (3-7). although these drugs have demonstrated a better clinical response than previously used treatments, serious adverse reactions, such as fatigue, mucositis, hand-foot syndrome, diarrhea and hypertension, are often observed and become the cause of discontinuation of the drug administration. monotherapy or combination therapy of interleukin (il)-2 and interferon (iFn)-α has been relatively widely applied for the treatment of advanced kidney cancers. In Japan, to reduce the risk of adverse reactions, the dose of il-2 is lower than that used in other countries (8)(9)(10)(11). While the response rate of monotherapy is as low as 10-20%, that of combination therapy is slightly better, 20-25% (12-17). However, the rate of adverse reactions associated with this combination therapy appears to Identification of a set of genes associated with response to interleukin-2 and interferon-α combination therapy for renal cell carcinoma through genome-wide gene expression profiling