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Summary and Introduction
Summary
Cytokines have been the mainstay of treatment for metastatic renal cancer for the past 20 years. Response rates of patients treated with these agents are low, and toxicity is high, but there is evidence from large multicenter randomized trials that indicate that there are survival benefits with interferon-based immunotherapy. A large number of new small molecule inhibitors are emerging that have caused considerable interest in the oncology community. The evidence for benefit from these compounds is based on small studies, using progression-free survival as an end-point. New compounds may provide an improvement in survival for patients with metastatic renal cancer; however, any trial of these agents should be tested against established, standard cytokine therapy.
Introduction
For the 30% of patients with renal cancer who present with widespread metastatic disease, and the further 30% who will develop metastases despite apparently curative resection of their primary tumor, cytokine therapy has been the mainstay of treatment for the last 20 years. Treatment is toxic, with a low response rate of approximately 12%.[1] Although a survival benefit has been demonstrated for cytokine therapy, it is short-term and only measured in months.[1] It is no surprise that the arrival of a new concept of treatment in the form of small molecule inhibitors (SMIs) has stimulated interest both in the oncology community and in pharmaceutical companies. At present, over 80 new compounds are currently under development for treatment of advanced renal cancer. What started as a whisper that "the era of cytokines may be over" is now gathering volume. Before we abandon cytokines for the new treatment paradigm of SMIs, however, we need to look critically at the evidence for these new compounds and compare it with the considerable body of data available for cytokine therapy.
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