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Immunotherapy for Renal Cell Carcinoma

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Renal Cell Carcinoma

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Renal cell carcinoma (RCC) is a highly immunogenic tumor as evidenced by the occasional dramatic spontaneous remission seen even in advanced disease. Since the earliest days, immunotherapeutic approaches have been utilized in an attempt to replicate this.

Based on early single agent trials that demonstrated a modest survival benefit, IFN-α became the reference standard in phase III trials including the initial trials involving molecular targeted agents. Although HD IL-2 results in durable complete remissions in a small subset of treated patients, the treatment-related morbidity, administration costs, and low response rate limit wider use. Early phase studies of alternative immunotherapeutic strategies including vaccines, carbonic-anhydrase IX (CAIX) antibody therapy, and attempts at non-myeloablative allo-transplantation have demonstrated interesting responses but these have not been pursued in the phase III setting.

Following the advent of the therapies targeting vascular endothelial growth factor (VEGF), tyrosine kinase (TK) and mammalian target of rapamycin (mTOR) pathways, immunotherapeutic approaches have become increasingly limited except for the upfront combination of IFN-α with bevacizumab and high-dose IL-2 in selected patients. However, improved understanding of immunoregulatory pathways in RCC suggests that targeted immunotherapy using immune checkpoint inhibitors may be promising, and clinical trials are underway. This chapter discusses various immunotherapeutic options that have been evaluated in the management of advanced RCC.

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Authors and Affiliations

  1. Division of General Internal Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Diwakar Davar

  2. Division of Hematology-Oncology, University of Pittsburgh Medical Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA

    Moon Fenton & Leonard J. Appleman

Authors
  1. Diwakar Davar
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  2. Moon Fenton
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  3. Leonard J. Appleman
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Correspondence to Leonard J. Appleman .

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Editors and Affiliations

  1. Glickman Urological and Kidney Institute, Center for Urologic Oncology, Cleveland Clinic, Cleveland, 44195, Ohio, USA

    Steven C. Campbell

  2. College of Medicine, Case Western Reserve University, Cleveland Clinic Lerner, Department of Solid Tumor Oncology, Cleveland, 44195, Ohio, USA

    Brian I. Rini

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Davar, D., Fenton, M., Appleman, L.J. (2013). Immunotherapy for Renal Cell Carcinoma. In: Campbell, S., Rini, B. (eds) Renal Cell Carcinoma. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-062-5_16

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  • DOI: https://doi.org/10.1007/978-1-62703-062-5_16

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