New treatment modalities - The urologist's view

Therapy of metastatic RCC is still unsatisfactory. To date, biochemotherapy with IL-2 s.c., IF a2 s.c. and 5-FU i.v. is probably the best treatment av ailable. Response rates range between 30 and 40 %. Toxicity is tolerable. P atients belonging to the law risk group.(presenting none of the following r isk parameters: BSR > 70 mm, LDH > 280 U/l, neutrophilic granulocytes > 600 0 /mu l, hemoglobin < 10 g/l, extrapulmonary or bone metastases) show the b est I results. Response rates of 60 % and 2-year survival rates of 65 % can be achieved. When selecting candidates for biotherapy, risk parameters men tioned above should be considered. Patients presenting these criteria do no t profit from biochemotherapy. Nephrectomy in metastatic RCC is indicated i n symptomatic patients. As part of an integrated treatment regimen with bio therapy in asymptomatic patients, nephrectomy should be performed only afte r response to biotherapy. These patients show a long-lasting progression-fr ee survival. A randomized study proving, the beneJit of cytoreductive surge ry, however; does ndt exist. Experimental research recently developed numer ous strategies for, potential therapy. The most interesting and hopeful sta rting points are gene manipulation and angiogenesis. Clinical trials, howev er, have to be awaited.