Biological Therapy May Afford Better Survival Time than Chemotherapy

Biological Therapy May Afford Better Survival Time than Chemotherapy for Metastatic Renal Cell Cancer

Persons with renal cell cancer that has spread beyond the area of the kidney are commonly treated with chemotherapy or biologic therapy to relieve the symptoms of disease and prolong survival time. Researchers from New York recently reported that the use of biologic therapy with interferon-alfa and/or interleukin-2 appears to produce a greater survival benefit than the use of chemotherapy.

Renal cell cancer is an uncommon cancer that affects the kidney. Specifically, this type of disease is characterized by the presence of cancer cells in the lining of the tubules, the small tubes in the kidney responsible for filtering and removing waste products from the blood. When renal cell cancer spreads beyond the area of the kidney to the main blood vessels, lymph nodes, or other parts of the body, it is referred to as metastatic disease. Persons who have metastatic renal cell cancer often receive chemotherapy, hormone therapy, or biologic therapy (therapy to help the immune system fight the cancer) to relieve the symptoms of disease and prolong survival time. Some researchers also propose that surgery to remove the diseased kidney, called a nephrectomy, may afford some survival advantage for persons with this type of disease.

Interferon-alfa and interleukin-2 are 2 biologic agents commonly used to treat persons with this type of disease. These agents have been reported to produce response rates of 10 to 20%, but the resulting survival benefit compared with that of chemotherapy is not yet fully known. Researchers from New York recently evaluated the treatment outcomes of persons with metastatic renal cell cancer to determine which treatment approach, chemotherapy (or hormone therapy) or biologic therapy, would result in longer survival times.

Researchers evaluated the survival rates and times of 670 persons with metastatic renal cell cancer; 274 persons underwent chemotherapy or hormonal therapy and 396 persons underwent biologic therapy with interferon-alfa, interleukin-2, or both. Patients were also assessed for certain risk factors before therapy, and were categorized as having a favorable risk, intermediate risk, or poor risk, with those with poor risk having the poorest prognosis (predicted survival time). For this study, persons who survived 5 years or more were considered long-term survivors.

The average survival time for all patients was 11 months. When the results were analyzed by risk category and by whether the patients received biologic therapy or chemotherapy, those having a favorable or intermediate risk and receiving cytokine therapy had the best outcomes. Specifically, the average survival times for patients at favorable risk, intermediate risk, and poor risk who received biologic therapy were 27 months, 12 months, and 6 months, respectively. The average survival times for patients at favorable risk, intermediate risk, and poor risk who received chemotherapy were 15 months, 7 months, and 3 months, respectively. The researchers determined that those who had a nephrectomy as part of treatment and/or had an interval from diagnosis to treatment of more than 1 year were also more likely to have longer survival times. Unfortunately, only 4.5% of the 670 patients survived 5 years or longer. Those who were long-term survivors were more likely to have had a nephrectomy, to have a favorable or intermediate risk classification, and to have received biologic therapy.

These findings show that biologic therapy with interferon-alfa and/or interleukin-2 appears to afford a prolonged survival time over chemotherapy for persons with metastatic renal cell cancer. Persons who have this type of disease may wish to talk with their doctor about the risks and benefits of receiving a biologic therapy combination or of participating in a clinical trial in which treatment strategies, consisting of surgery and biologic therapy combinations (with interferon-alfa, interleukin-2, and or other promising new agents) are being studied. (Journal of Clinical Oncology, Vol 18, No 9, pp 1928-1935, 2000)

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