The treatment of metastatic Renal Cell Carcinoma (RCC) remains one of the most important problems in oncology today.  Since these tumors commonly display no early clinical signs or symptoms, the diagnoses are often made late in the course of the disease when the tumors have had ample time to grow large or become locally invasive.  A large number of patients have metastatic disease not only because metastases are already present by the time of diagnosis, but also because there is such a high relapse rate following radical nephrectomy.
    Traditional systemic treatment for RCC has been largely ineffective to date.  The current anti-tumor agents are ineffective both singularly and in combination.  Briefly will be described some of the traditional cancer treatments in the context of RCC.
 
 

    For patients with localized disease, surgical resection of the primary tumor is the primary therapy.  However, as RCC characteristically lacks early warning signs, a high proportion of patients have metastases by the time they are diagnosed or suffer relapse following nephrectomy.

    RCC is generally considered a radioresistent tumor, although sometimes radiation is used as an adjuvant therapy after surgery.

    Many studies have failed to identify a single drug or combination of drugs that has consistent activity against RCC.  One of the most recent and extensively studied drugs has been floxuridine, and although one trial yielded a 20% response rate for the drug, 7 subsequent trials for the drug yielded response rates from 0% to 14%.  Responses were also generally short and lasted only a few months ( "response" to treatment is defined as the disappearance of all evidence of tumor [complete], or more than 50% decrease in tumor burden [partial] ).  See the below table for a review of the current chemotherapeutic agents and their observed responses. (1)
    Lab models have demonstrated multi-drug resistance in RCC cells, and have associated this with the MDR1 gene and its protein product, P-glycoprotein.  Multi drug resistance reversal agents have been studied clinical trials, but none have shown to enhance anti-tumor activity.
    The search for effective chemotherapeutic agents is ongoing, as researchers and clinicians are working together in clinical phase trials to find better treatments
 
 

    To date, hormonal therapy and angiogenesis inhibitors have yet to show any promising results in showing responses in patients with RCC, and neither have combinations of chemotherapy plus hormonal agents.  See the below table for some hormonal therapies and their responses.

* Spontaneous regression must be considered when treatments results show low response activity.  A phase II trial was performed on patients with metastatic RCC who were only observed until evidence of progression.  Of  73 patients observed, 5 (7%) had complete spontaneous or partial response, and 12% remained progression free for about a year (1).
 
 

  * (This page was developed by undergraduate students at Brown University as a project for a course in Vaccine Development.
            The authors of this page are not certified medical professionals.  Biomedical Research and Clinical Medicine are constantly
            evolving fields, thus it is likely that significant advances in research and new treatments for Renal Cell Carcinoma have
            come into existence following the posting of this page.  To the best of our knowledge, all information presented in this
                                   page reflects the prevalent opinions of the field as of March 17, 2000)