[MOL] Encouraging therapies for metastatic renal cell carcinoma.... [01858] Medicine On Line

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[MOL] Encouraging therapies for metastatic renal cell carcinoma....

Encouraging therapies for metastatic renal cell carcinoma

A DGReview of :"Treatment Strategies in Metastatic Renal Cell Carcinoma"

By Mark Greener

Currently, the prognosis for patients suffering from metastatic renal cell carcinoma (RCC) is bleak. Despite encouraging results from studies of new treatments, a recent review suggests that these need further assessment in large randomised trials.

The report notes that chemotherapeutic agents, radiation and hormones are generally unsuccessful. RCC shows a variable natural history characterized by late relapse after nephrectomy, prolonged stabile metastatic disease and spontaneous regression. The authors remark that these characteristics suggest that immune mechanisms may regulate tumour growth. As a result, a number of therapeutic strategies now aim to modulate the host immune response - including cytokines, adoptive immunotherapy, gene therapy and monoclonal antibodies.

While interferons (IFN) are widely used, only 12 per cent of metastatic RCCs show objective responses and complete remissions are rare. High-dose intravenous interleukin-2 (IL-2) is more effective rates, but causes considerable toxicity. Combining the two drugs produces a better outcome than that associated with either agent alone.

The authors add that studies adding 5-fluoro-uracil and 13-cis-retinoic acid to IFN plus IL-2 show encouraging results. Similarly, trials of tumour-infiltrating lymphocytes, autolymphocyte therapy with activated memory-T cells, ex vivo primed cytotoxic T cells or dendritic cells are also showing promising results.

Gene therapy is also being investigated as a possible RCC treatment. For example, ex vivo gene transfer, as a tumour cell vaccine, and intralesional in vivo gene therapy are undergoing assessment as a way to boost tumour cell immunogenicity. A monoclonal antibody against RCC is also being assessed as a new diagnostic test and therapy.

However, despite these efforts, cure rates are low and a standard therapy is unavailable. So if systemic therapy does not produce palliation, clinicians need to treat tumour-related symptoms with "aggressive supportive therapy." Assessing therapy-related quality of life will become increasingly important, say the authors.

The researchers recommend that as many patients as possible be enrolled in controlled studies. Despite encouraging results with the new treatment strategies reviewed in this paper, further assessment in large randomised trials is still needed.
Warmly, lillian

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