Treatment for renal cancer: are we beyond the cytokine era?

Abstract

Small molecule inhibitors target growth-receptor signaling, cell-cycle regulation and angiogenesis, and have been the subject of much interest for their potential in treating patients with renal cancer. Although data reported at the 2006 ASCO Annual Meeting have provided further evidence of their potential, it is important that cytokine-based therapies are not forgotten. This review examines the different treatment options for patients with renal cancer. 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.