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A Review of Current and Future Treatment Options in Renal Cancer

  • Review Article
  • Published:
American Journal of Cancer

Abstract

Renal cancer is a malignancy that has been rising in incidence over the past 5 decades. The treatment of choice for localized cancer is radical nephrectomy, although nephron-sparing surgery can be considered in selected cases with small tumors. The risk of recurrence or metastatic disease ranges from 15 to 80%. Some of the factors predictive of prognosis are histology, stage, and grade of the cancer. Metastatic or stage IV disease is the major cause of mortality. The treatment of choice for metastatic disease is surgical resection of metastases, if feasible, as it can result in prolonged remissions in a small proportion of patients (10–20%). The results of randomized trials demonstrated a survival benefit with nephrectomy in metastatic disease. Consequently, this should be a consideration in patients with good functional status prior to immunotherapy. Adjuvant therapy has no proven role in renal cancer.

The approved systemic immunotherapy is interleukin-2 (IL-2) with a reported overall response rate of 15% and durable remission rate of 7%. The wide application of IL-2 is limited by the severe toxicity profile. Thus, the use of IL-2 is restricted to patients with excellent performance status. Less toxic doses, schedules, and routes of administration of IL-2 have demonstrated responses in metastatic disease, but prolonged remission has not been clearly established. Cytotoxic chemotherapy has not shown promising results to date; however, novel cytotoxic agents and combinations are in the clinical evaluation phase. Biochemotherapy regimens, such as combinations of gemcitabine and capecitabine with IL-2 and interferon, have shown responses ranging from 15 to 40% with 10 to 15% complete remissions which, although favorable, have not resulted in major improvements in overall survival. In a preliminary study, allogeneic mini transplant produced responses in 10 of 19 patients with metastatic disease: three complete and seven partial remissions. However, the 10 to 20% treatment-related mortality associated with mini transplant, excellent performance status requirement, and low availability of matched donor, in this highly selected group of patients, indicates that this would be feasible in <10% of patients screened. Further follow-up and validation of the safety and efficacy of transplant are required.

Targeted therapies such as tyrosine kinase inhibitors, epithelial growth factor inhibitors and monoclonal antibodies will be evaluated in the next few years. There is a strong rationale for the antiangiogenic strategy due to the hypervascular nature of this tumor type.

The future promises improvement in tumor characterization techniques and advances in targeted therapies to enable effective, individually tailored treatment for metastatic renal cell carcinoma.

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  1. Wayne State University School of Medicine/Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA

    Ulka Vaishampayan

  2. Hudson Harper Hospital, 3990 John R Road, Detroit, MI, 48201, USA

    Ulka Vaishampayan

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Vaishampayan, U. A Review of Current and Future Treatment Options in Renal Cancer. Am J Cancer 2, 201–210 (2003). https://doi.org/10.2165/00024669-200302030-00004

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