Kidney Cancer

Drs. Uzair Chaudhary and GeraldHull provide a comprehensivereview of the role ofcytoreductive surgery in metastaticrenal cell carcinoma. This controversialtopic has been debated for manyyears. Metastatic renal cell carcinomacontinues to be a chemotherapyresistanttumor with a poor prognosis.About 30% of newly diagnosedpatients present with metastatic disease.In the metastatic setting, themost recognized treatment modalitiesinvolve the biologic agents interferon-alpha and interleukin-2 (IL-2,Proleukin). They produce an objectiveresponse rate of about 10% to15%, with approximately 5% of patientsachieving a durable completeresponse.

In this issue of ONCOLOGY,Chaudhary and Hull succinctlysummarize historical trends andcurrent thinking regarding the role ofcytoreductive nephrectomy in patientswith metastatic kidney cancer.Before the era of immunotherapy,there was little evidence that the naturalhistory of metastatic renal cellcarcinoma was improved by cytoreductivenephrectomy.[1] Patientswith metastatic cancer generally diefrom complications related to theirsites of tumor spread and not fromthe primary tumor; thus, on face value,it seems illogical to surgicallyremove the primary tumor in thesepatients.

Metastatic renal cell carcinoma is a devastating disease associatedwith poor survival. Immunotherapy is the mainstay of treatment, butresponse rates are low. The role of cytoreductive surgery in thepresence of metastatic disease is evolving. From both retrospective andrecently published randomized clinical trials, it is now apparent thatamong patients with metastatic renal cell carcinoma and good performancestatus, cytoreductive surgery followed by immunotherapy improvessurvival. However, this approach is likely to be detrimental inpatients with poor performance status. Clinical trials of novel agentsremain a priority in this disease.

FRAMINGHAM, Massachusetts-Genzyme Molecular Oncology has launched a phase I/II vaccine trial in advanced kidney cancer. The vaccine is made by combining the patient’s own cancer cells with dendritic cells using an electrical fusion approach. Up to 20 patients will be enrolled at Beth Israel Deaconess Medical Center and the Dana-Farber Cancer Institute, Boston.

Women who received radiation therapy for Wilms’ Tumor are at increased risk of complications during pregnancy and, therefore, should be carefully assessed and monitored by their obstetricians. These conclusions were part of a National Wilms’

Despite significant advances in the treatment of a variety of malignancies, highly effective therapies for most patients with metastatic renal cell carcinoma or metastatic melanoma are rare. Traditional oncologic treatment methods, such as

Interleukin-2 (IL-2, Proleukin) is one of the most effective agents in the treatment of metastatic renal cell carcinoma and metastatic melanoma. High-dose IL-2 therapy produces overall response rates of 15% to 20%;

Although high-dose interleukin-2 (IL-2, Proleukin), a highly toxic agent used in the treatment of renal cell carcinoma and melanoma, was initially associated with treatment-related mortality, it can, in the appropriate

Flavopiridol [2-(2-chlorophenyl 5 ,7-dihydroxy-8-[cis-(3-hydroxy-1-methyl-4-piperidinyl)-4H-1-benzopyran-4-one, hydrochloride] is a semisynthetic flavone with a novel structure compared with that of polyhydroxylated flavones, such as quercetin and genistein.[1] It is derived from rohitukine, an alkaloid isolated from the stem bark of Dysoxylum binectariferum, a plant indigenous to India.[2] Originally synthesized and supplied by Hoechst India Limited, flavopiridol is provided to the Division of Cancer Treatment and Diagnosis of the National Cancer Institute (NCI) by Aventis Pharmaceuticals, Inc.

Phase II studies of single-agent docetaxel (Taxotere) yielded promising results in advanced or metastatic transitional cell carcinoma (TCC) of the urothelium. Antitumor responses have been demonstrated in previously treated and chemotherapy-naive TCC patients, as well as in a subgroup of patients with renal impairment unable to receive traditional cisplatin-based regimens.

A 68-year-old man is referred for further evaluation and treatment of jaundice. He describes pruritus, intermittent mild midabdominal discomfort, and progressive weight loss. There is no history of fever. His history is significant for renal cell carcinoma with pulmonary metastasis.

ANAHEIM, California-Percutaneous radiofrequency ablation, which is FDA-approved for treating liver and soft tissue neoplasms, may also be useful in renal cell carcinoma, according to several reports from the American Urological Association annual meeting.

SAN FRANCISCO-Trials employing outpatient use of subcutaneous (SC) interleukin-2 (IL-2, Proleukin) in lower doses suggest that the overall response rate in metastatic renal cell carcinoma is adversely affected by the decrease in dose or the subcutaneous route of administration.

Preliminary results of a phase III trial of high-dose recombinant human interleukin-2 (IL-2, Proleu kin) demonstrated increased response rates with a longer median duration, compared to outpatient subcutaneous IL-2 in conjunction with

BMS-247550 is a methyl, semi-synthetic analog of the natural product epothilone B. Provided to the National Cancer Institute (NCI) by Bristol-Myers Squibb, BMS-247550 was chosen for clinical development because it demonstrated

With the understanding of the mechanism of malignant transformation has come the knowledge that oncogene products are frequently growth factors, growth factor receptors, or elements of growth factor signal-transduction pathways. Overexpression

A pilot study was performed at The University of Texas M. D. Anderson Cancer Center to determine the feasibility of using thalidomide in a population of renal-cell carcinoma patients who had progressive disease despite chemotherapy and immunotherapy. Metastatic renal-cell carcinoma patients with adequate oral function were entered onto a study after signing an internal review board-approved informed consent. There were no exclusion criteria for prior therapy. Nineteen previously treated patients and one untreated patient with progressive renal-cell carcinoma received oral thalidomide as a single agent. The starting dose was 200 mg and the dose was increased by 100 to 200 mg every week until it reached 1,200 mg/d. Response was assessed on the basis of a radiographic reduction of the metastatic sites involved. A case report describing one of the patients involved in the pilot trial is included. [ONCOLOGY 14(Suppl 13):33-36, 2000]

BETHESDA, Md-In a pilot study, 10 of 19 patients with advanced renal cell cancer had a response to nonmye-loablative allogeneic peripheral blood stem cell transplantation, reported Richard Childs, MD, of the National Heart, Lung, and Blood Institute.

Thalidomide (Thalomid) has antiangiogenic and immunomodulatory properties with activity in myeloma and other tumors. We treated 15 patients with advanced progressive metastatic renal-cell cancer with escalating divided daily doses of thalidomide

MAYWOOD, Ill-Removing the cancerous kidney before administering interferon alfa-2b (Intron A) improves survival in advanced renal cancer, according to results of Southwest Oncology Group (SWOG) Trial 8949. The role of interferon treatment, however, remains controversial.

ASCO-Cytoreductive nephrectomy prior to interferon-alfa-2b (Intron A) therapy increased survival by 50% in patients with previously untreated metastatic renal cell cancer, compared with interferon alone, Robert Flanigan, MD, reported at the plenary session of the 36th Annual Meeting of the American Society of Clinical Oncology in New Orleans.

ATLANTA-A fluorescent marker given 4 hours before surgery lights up renal cell carcinoma cells and eliminates the need for frozen sections to guarantee clean margins during kidney-preserving tumor resection, German researchers reported in a poster presented at the 95th Annual Meeting of the American Urological Association (AUA).

An ongoing phase I clinical trial shows that a new anticancer agent, CCI-779, is well-tolerated and may have antitumor activity. CCI-779 is a derivative of rapamycin, an immunosuppressive agent. Results of the study were presented at the

Renal cell carcinomas include a group of epithelial neoplasms, such as clear-cell and papillary carcinomas, that continue to pose significant management challenges in patients

Surgical resection remains the cornerstone of management for localized renal cell carcinoma. No effective postsurgical adjuvant therapy has been established for