Cytokine therapy: a standard of care for metastatic renal cell carcinoma?

Metastatic renal cell carcinoma (RCC) is refractory to standard cytotoxic chemotherapy regimens. The rationale for the use of cytokines in RCC is based on compelling evidence that RCC is sensitive to immunologic manipulation. Cytokine-based therapy with interleukin-2 (IL-2) or interferon (IFN)-alpha can result in objective tumor responses in as many as 15% of patients, and in selected patients, these responses can be durable. The development of targeted therapies for clear-cell RCC with the potential for greater antitumor activity and less toxicity has brought into question the role of cytokines in this patient population. However, no noncytokine therapy to date has proven curative in patients with metastatic RCC. Until results from ongoing trials clearly demonstrate superiority of newer agents over IFN-alpha or IL-2, these agents should remain a standard of care for the treatment of RCC.