Natural history and therapy of metastatic renal cell carcinoma

Abstract

The use of rIL-2 with or without IFN-alpha may represent the most useful therapeutic approach currently available for patients with good performance status. In patients with borderline performance status or severe comorbid disease, therapeutic approaches depend on patient factors and outcome expectation and may involve cytokine therapy. However, regardless of performance status, palliative measures and/or observation are important choices, because the majority of patients with metastatic RCC are incurable.

Intratumoural and peripheral blood lymphocyte subsets in patients with metastatic renal cell carcinoma undergoing interleukin-2 based immunotherapy: association to objective response and survival

“…This finding was in accordance with most other studies (Bukowski, 1997;Bukowski et al, 1997) except a single study by Gohring et al (1996) demonstrating that baseline number of peripheral blood B-cells correlated with clinical response.…”

“…Based on peripheral blood sample analyses during the last 15 years, it is still unclear whether lymphocyte subsets during immunomodulative therapy in mRCC have an impact on objective response and survival (Bukowski, 1997;Jeal and Goa, 1997;Hernberg, 1999). Several studies have demonstrated increased number of lymphocytes (Palmer et al, 1993;Lissoni et al, 1994;Bordin et al, 2000), lymphocyte subsets (Wersall and Mellstedt, 1995;Gohring et al, 1996) including natural killer (NK-) cells von Rohr et al, 1993) and increased cytotoxicity (von Rohr et al, 1993;Wersall and Mellstedt, 1995) in responding patients during immunotherapy, but no consistent findings have been demonstrated (Bukowski, 1997;Jeal and Goa, 1997).…”

Immunotherapy of metastatic kidney cancer

“…3 Furthermore, survival 3 years after the beginning of treatment is between 19% and 31%, 24 -29 5-18% being the survival of non-treated patients (Table VIII). 30,31 Sporadic long-term survivors are observed only among patients who underwent complete remission.…”

“…In 1,411 MRCC patients, the overall rate of response was 20%. 3,4 Nonetheless, despite the lowering of the IL-2 dosage and the decrease of the 4% fatal outcome of the initial studies, thanks to the improved selection of patients and the clinical experience acquired, 5,6 the persistence of more often than not severely adverse clinical side effects remains the most important hindrance for the wide use of IL-2.…”

“…In 1,411 MRCC patients, the overall rate of response was 20%. 3,4 Nonetheless, despite the lowering of the IL-2 dosage and the decrease of the 4% fatal outcome of the initial studies, thanks to the improved selection of patients and the clinical experience acquired, 5,6 the persistence of more often than not severely adverse clinical side effects remains the most important hindrance for the wide use of IL-2.Hence, being aware of the risk from a high IL-2 dose and of its ability to activate, at low doses, tumor mass rejection, 7-9 we attempted to develop alternative protocols. An observation made in 1 MRCC patient, in whom injection of a metastasis with IL-2 and LAK cells was followed by regression not only of the treated tumor but also of several other abdominal lymph node metastases, prompted us to further investigate the low-dose effect using the intralymphatic route.…”