Interleukin-2 based immunotherapy for metastatic renal cell carcinoma withthe kidney in place

Purpose: We assessed morbidity, response and survival in patients with meta static renal carcinoma treated with high dose intravenous interleukin-2 (IL -2) based immunotherapy with the primary renal tumor in place. Materials and Methods: We retrospectively analyzed the records of patients with metastatic renal carcinoma and the primary kidney tumor in situ who we re treated at the surgery branch of the National Cancer Insititute. Of the patients 607 were treated with IL-2 based therapy. Patient age, sex, sites of extrarenal disease, morbidity, and response and survival rates were exam ined. Results: From 1986 to 1996, 51 patients with the majority of disease at ext rarenal sites were treated with the primary tumor in place. Treatment invol ved IL-2 based regimens, reflecting the evolution of immunotherapy at the N ational Institutes of Health. When evaluating only extrarenal sites, respon se was complete in 1 and partial in 2 of the 51 cases (6%). No responses we re noted in the primary renal tumor. Three patients with responses at extra renal sites underwent nephrectomy. The duration of response in these 3 case s was greater than 88, 11 and 4 months, respectively. Median survival in al l 51 patients was 13 months (range 1 to 86). Conclusions: Select patients may be treated with IL-2 based immunotherapy w ith the primary renal tumors in place with morbidity. A randomized study is needed to assess the role of cytoreductive nephrectomy for treating metast atic renal cell carcinoma.