Renal Cell Carcinoma Metastases

If a single metastatic renal cell carcinoma metastases, it can take a kidney transplant or excision, and adjuvant chemotherapy or biological therapy. The main clinical manifestations of pulmonary metastasis of cough, hemoptysis, or shortness of breath, but many patients and asymptomatic, often in conventional chest radiography or chest was discovered. Solitary pulmonary metastasis should be lobe lobectomy or wedge, 5-year survival rate of 25% to 35%.
    Multiple metastatic renal tumors, when conditions permit, should be given after resection of the primary lesion comprehensive treatment, stable disease or relieve symptoms, with occasional reports of metastatic lesions disappear on their own, and thus the treatment of metastatic renal cell carcinoma can not be ignored.
    Targeted therapy has become a second-line treatment of metastatic renal cell carcinoma primary
    In the past, the treatment of metastatic renal cell carcinoma limited to cytokine therapy or clinical trials. In the past 15 years, a number of targeted metastasis, recurrence or unresectable clear cell carcinoma in patients with IL-2 and interferon combined with different doses of different forms of clinical trials. These studies show that high-dose IL-2 are more efficient than low-dose. Therefore, the guidelines recommend a good physical condition, especially the tumor load is small or mainly in patients with lung metastases, can be used high-dose IL-2 treatment.
    Cytokine immunotherapy treatment of renal cell carcinoma is still the first choice for the current stage of non-surgical therapy, in the traditional chemical treatment on the basis of renal cancer cells with the biological characteristics and its inherent better understanding of physiological and biochemical processes, new and more targeted drugs and monoclonal antibodies for renal cell carcinoma are being gradually used clinically for the treatment of metastatic kidney cancer hope.
    At the same time vaccine therapy and bone marrow / stem cell transplantation for treatment although the implementation is very complex and in rare cases for treatment, but this method of treatment for patients with good effect, there is still possibility of further development. The final treatment of renal cell carcinoma will still be a comprehensive treatment of a variety of methods. With the biological characteristics of renal cell carcinoma and treatment methods, step by step to reveal the diversity, the survival rate of patients with kidney cancer will be further improved.
    Immunotherapy treatment of renal cell carcinoma is the conventional means. High-dose interleukin-2 (HD IL-2) for the treatment of metastatic renal cell carcinoma of the effective drugs, in 1992, was formally approved by the U.S. FDA, and its efficiency up to 14%. In order to improve the therapeutic index of IL-2, Boston, USA cytokine Working Group (CWG) conducted a prospective multi-center clinical trial (SELECT).
    The study included 120 cases of renal cell cancer (Abstract No. 4514). The results showed, HD IL-2 are significantly higher than reported in previous studies (95% CI 21% ~ 38%, P = 0.0009). The median progression-free survival (PFS) was 4.4 months, response rate was 30% (95% CI 22% ~ 40%, P = 0.0004; 35/115 patients), IL-2's effectiveness and clinical pre- processing factors or high-UCLA SANI score has nothing to do.
    The research suggests, HD IL-2 are significantly higher than previous studies, IL-2 may be transparent to the treatment of tissue with a certain selectivity. Tumor analysis and predictive blood-based markers analysis may improve the HD IL-2 in patients with renal cell carcinoma sensitive screening standards.
    In addition, CWG study group also bevacizumab (Bev) combined HD IL-2 therapy for metastatic renal cell carcinoma has a phase Ⅱ clinical trial (Abstract No. 4530). The results showed that 51 patients were included, with a median PFS of 9.0 months (90% CI 5.7 ~ 13.0), 2-year PFS rate was 15% (90% CI 5% ~ 24%). 8 cases of complete remission (CR), 10 partial response (PR) and 21 stable disease (SD). Markedly and the treatment fails in patients with a median baseline serum VEGF concentrations were 459 μg / L and 383 μg / L. Compared with the monotherapy group, two-drug combination group, no significant differences in toxicity. It follows that bevacizumab combined HD IL-2 in the treatment of metastatic renal cell carcinoma has a good safety and efficiency, while prompts to extend bevacizumab has received IL-2 therapy in patients with PFS .
    Danish researchers report Donskov a professor of IL-2-based treatment of unresectable metastatic renal cell cancer study (Abstract No. 4591). The study included 422 cases of patients with a total effective rate was 15%, of which 17 cases of CR, 47 例 PR. 36 patients with no signs of disease (9%), with a median follow-up was 76 months and median overall survival time was 15.7 months, the expected 5-year and 10 year survival rates were 15% and 10%. The findings suggest that the use of the IL-2-based immunotherapy, either single-agent or joint surgery, no signs of disease, the expected 10-year survival rate of patients up to 10%. IL-2-based immunotherapy is still first-line treatment of metastatic renal cell carcinoma and effective program.