• Chemotherapy
• Clinical Trials
• Future Treatments
• Immunotherapy
• Nephrectomy
• Radiation Therapy
• Surgical Treatments
• Treatment Choices by Stage

Although curative treatments for RCC involve removing the local (primary) tumor, cancer that has spread beyond the kidney requires treatment of all areas of the body (systemic therapy). Consequently, a lot of attention is now focused on a relatively new approach to treatment of RCC called immunotherapy. The goal of immunotherapy is to boost the body's immune system to more effectively fight off or destroy cancer cells. There are several types of immunotherapy used to treat patients with metastatic RCC. Use of cytokines (proteins that activate the immune system) has become one of the standard treatments for metastatic RCC. The two cytokines most often used are interleukin-2 (IL-2) and interferon-alpha. Both cytokines can cause about 20% of RCCs to shrink to less than half their original size (partial or complete response). Unfortunately, only 4-6 % of RCCs respond completely. In addition, many patients cannot tolerate the side effects of immunotherapy.

Some studies indicate that patients treated with IL-2 tend to have longer lasting responses. Combining low doses of both cytokines seems at least as effective as high dose IL-2, and the low dose combination has fewer and less severe side effects. Recent research with a combination of IL-2, interferon and chemotherapy (using 5-fluorouracil) is also promising, and may offer some patients a better chance of complete remission (no remaining cancer detectable by imaging tests). The side effects of cytokine therapy include low blood pressure, fluid accumulation in the lungs, kidney damage, heart attacks, intestinal bleeding, high fever, and chills. These side effects are often severe and, rarely, can be fatal. For this reason, this treatment should be given only by doctors' experienced with this approach to RCC treatment.

Cytokines can also be used to stimulate an RCC patients's immune cells that have been removed from the patient's tumor or blood stream. After cytokine treatment outside of body (in vitro), the activated immune system cells are then returned to the patient's blood stream. The stimulated immune cells then seek out and attack the RCC cells. RCC tumors contain cancer cells as well as immune system cells that are fighting the cancer cells. These immune system cells are referred to tumor infiltrating lymphocytes or TILs. Some studies indicate that cytokine activated TILs are more effective than cytokine activated immune cells from the bloodstream.

Researchers are also working on a new approach to immunotherapy that uses tumor vaccines. This involves genetically adding genes (segments of DNA) that can be activated to produce cytokines within a patient's cancer cells. After a cancer is removed, scientists add these genes to RCC cells in the laboratory and then inject the altered cells back into the patient. Adding cytokines to cancer cells identifies them as a target for the patient's immune system. Without this treatment, the body's immune system is rarely effective at recognizing RCC well enough to completely destroy the tumor. But after this treatment, the immune system may begin to better recognize the altered cancer cells and even the unaltered cancer cells remaining in the patient's body. This approach is being tested in very early stages and it is not yet known if it will be more effective than standard immunotherapy with cytokines.

Recurrent RCC
As with stage IV RCC, cytokine immunotherapy or clinical trials of new treatments are treatment options for patients able and willing to tolerate the side effects. In rare cases, a patient willl have a solitary site of recurrence of RCC detected several years after nephrectomy. In these exceptional cases, surgical removal of the solitary site of recurrence may be possible after extensive imaging tests have shown no other evidence of cancer spread. Radiation therapy can be used to reduce symptoms of some metastases. Appropriate treatment of pain is an important way of maintaining quality of life. It is important to realize that medications to relieve pain do not interfere with other treatments, and that there are new approaches to pain medication that do not prevent a patient from being alert and active. In fact, proper treatment of pain often helps people with cancer to be more active and continue their usual activities.