Adjuvant Interferon not Effective for Patients with Renal Cell Carcinoma

Adjuvant Interferon not Effective for Patients with Locally Advanced Renal Cell Carcinoma

According to a recent article published in the Journal of Clinical Oncology, the use of adjuvant interferon alone may not improve long-term outcomes in patients with locally advanced renal cell (kidney) carcinoma.

The kidneys are a pair of bean shaped organs located on each side of the spine. The kidneys filter the blood and eliminate waste in the urine through a complex system of filtration tubules. All of the blood in the body passes through the kidneys approximately 20 times an hour. Renal cell cancer is an uncommon form of cancer that is most often characterized by the presence of cancer cells in the lining of the filtration tubules of the kidney.

Renal cell cancer (RCC) that has spread locally from the kidney but not to distant sites in the body, it is referred to as locally advanced. Although the surgical removal of the entire kidney (radical nephrectomy) or of the part of the kidney containing the cancer (partial nephrectomy) may cure some patients with locally advanced RCC, the majority of patients will experience a recurrence of cancer following treatment of surgery alone. Recurrences are due to undetectable cancer cells remaining in the body following surgery. Thus, researchers are evaluating different treatment options following surgery (ajuvant therapy), such as interferon, in order to kill the remaining cancer cells and improve long-term outcomes.

Interferon is a substance naturally produced in the body to help stimulate the immune system. Alfa-interferon is a compound produced in a laboratory that mimics the structure and action of interferon. The use of interferon has yielded promising results in some types of cancer, by stimulating the immune system to recognize and destroy cancer cells. However, alfa-interferon used alone as adjuvant treatment for renal cell cancer remains controversial, as side effects can be severe and no definitive conclusions regarding improved survival following treatment have been established.

A recent multi-institutional clinical trial was recently conducted to further evaluate the use of adjuvant alfa-interferon in patients with locally advanced RCC. This trial involved nearly 300 patients who underwent a radical nephrectomy and were randomly selected to received adjuvant alfa-interferon or placebo (inactive substitute) within 30 days following the surgery.

The average duration of survival was 7.4 years in the group of patients who received placebo, compared to 5.1 years for patients who received alfa-interferon. Recurrence-free survival was 3.3 years for patients who received placebo, compared to 2 years for patients treated with alfa-interferon. Patients treated with alfa-interferon experienced significantly more side effects than patients who received placebo. The most common severe side effects attribted to alpha-interferon included flu-like symptoms, fatigue and muscle pain.

The researchers concluded that treatment with adjuvant alfa-interferon alone for patients with locally advanced RCC does not appear to improve long-term outcomes compared to placebo. In addition, alfa-interferon causes significant side effects in patients, resulting in a decreased quality of life, increased time spent in the hospital and accrued medical costs. Future clinical trials will undoubtedly reveal the true clinical significance of adjuvant alfa-interferon in the treatment of locally advanced RCC. Patients with locally advanced RCC may wish to speak with their physician about the risks and benefits of adjuvant alfa-interferon or the participation in a clinical trial evaluating other novel therapeutic approaches.

Reference: Messing E, Manola J, Wilding G, et al. Phase III study of interferon alfa-NL as adjuvant treatment for resectable renal cell carcinoma: an Eastern Cooperative Oncology Group/Intergroup trial.

Journal of Clinical Oncology. 2003;21: 1214-1222.

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