Renal cell carcinoma: management of advanced disease.

We provide a current review of the management of advanced renal cell carcinoma. A comprehensive literature review of peer reviewed articles which address the current management of metastatic renal cell carcinoma was performed. Renal cell carcinoma is the seventh leading cause of cancer, accounting for 3% of malignancies in men. The incidence of renal cell carcinoma has increased significantly by 38% from 1974 through 1990 at least in part related to earlier diagnosis with the common use of new radiological techniques. Cytotoxic chemotherapy remains poor as a treatment alternative. Interferon-alpha produces responses in 15 to 20% of patients but clinical usefulness as monotherapy has been surpassed by interleukin-2 (IL-2). IL-2 is the first immunotherapy to produce durable remissions resulting in approval by the Food and Drug Administration. Although high dose bolus IL-2 schedules have the longest followup, IL-2 administered on other schedules may have enhanced efficacy. Randomized trials are attempting to delineate the appropriate role for various doses and schedules. Advanced renal cell carcinoma, once a disease relegated to the incurable, during the last decade has evolved into a malignancy that may be associated with cure. The first evidence of this potential is the clear and unequivocal demonstration that IL-2 produces durable complete remissions. Building upon this immunotherapeutic approach the future treatment of renal cell carcinoma will incorporate new immunological technology, including gene, dendritic cell, vaccine and antibody therapy.