Renal cell carcinoma: Management of advanced disease

Purpose: We provide a current review of the management of advanced renal ce ll carcinoma. Materials and Methods: A comprehensive literature review of peer reviewed a rticles which address the current management of metastatic renal cell carci noma was performed. Results: Renal cell carcinoma is the seventh leading cause of cancer, accou nting for 3% of malignancies in men. The incidence of renal cell carcinoma has increased significantly by 38% from 1974 through 1990 at least in part related to earlier diagnosis with the common use of new radiological techni ques. Cytotoxic chemotherapy remains poor as a treatment alternative. Inter feron-alpha produces responses in 15 to 20% of patients but clinical useful ness as monotherapy has been surpassed by interleukin-2 (IL-2). IL-2 is the first immunotherapy to produce durable remissions resulting in approval by the Food and Drug Administration. Although high dose bolus IL-2 schedules have the longest followup, IL-2 administered on other schedules may have en hanced efficacy. Randomized trials are attempting to delineate the appropri ate role for various doses and schedules. Conclusions: Advanced renal cell carcinoma, once a disease relegated to the incurable, during the last decade has evolved into a malignancy that may b e associated with cure. The first evidence of this potential is the clear a nd unequivocal demonstration that IL-2 produces durable complete remissions . Building upon this immunotherapeutic approach the future treatment of ren al cell carcinoma will incorporate new immunological technology, including gene, dendritic cell, vaccine and antibody therapy.