Advances in the Management of Metastatic Renal Cell Cancer

摘要

Renal cell carcinoma (RCC) represents a therapeutic challenge. In 2008, an estimated 54 390 new cases of RCC were diagnosed, and the disease accounted for approximately 13 010 deaths in the United States [1]. RCC comprises multiple subtypes, each with a distinct pheno-type, clinical course, and response to treatment [2]. Most research is focused on clear-cell RCC, which represents >75% of all histologic subtypes. Papillary RCC is the second most common subtype, followed by chromophobe RCC, accounting for 15% and 5% of all subtypes, respectively. Patients with von Hippel-Lindau (VHL) disease commonly develop RCC, specifically the clear-cell type [2,3].With regard to the management of RCC, surgery is the primary treatment approach for localised RCC. Metastatic RCC (mRCC) is generally resistant to chemotherapy, radiation therapy and hormone therapy, and is associated with a poor prognosis. Immunotherapy using the cytokines interleukin-2 (IL-2) and/or interferon-alpha (IFN-alpha) has been the standard treatment for patients with mRCC over the past 20 yr. Cytokine therapy appears to be associated withlow response rates of approximately 15% and a median overall survival (OS) of 10-12 mo, but only in patients with good prognostic features [4,5].