Targeted Approaches for Treating Advanced Clear Cell Renal Carcinoma

Pretreatment with interferon-alpha2a modulates perioperative immunodysfunction in patients with renal cell carcinoma

INTRODUCTION

Complex perioperative immunodysfunction occurs in patients with renal cell carcinoma undergoing surgery. Here, we report on the effect of preoperative treatment with interferon-alpha2a (IFN-alpha2a).

MATERIALS AND METHODS

30 patients with a renal tumour received preoperative IFN-alpha2a for 6 days beginning 1 week before nephrectomy, 30 did not. Parameters of cellular and humoral immunity were measured in venous blood at various intervals using flow cytometry and ELISA. Endpoints included effects on immune parameters, toxicity, and survival.

RESULTS

Toxicity was grade 1 in 52%, 2 in 30%, and 3 in 4%. During IFN-alpha2a administration, leukocytes, monocytes, granulocytes, B-cell marker CD19, activation markers, CD4+CD25+ regulatory T-cells, and vascular endothelial growth factor (VEGF) dropped significantly, but no difference was observed in T-cell and natural killer (NK)-cell markers, and IL-10. Postoperatively, T-cell and activation markers decreased in both groups, but CD4, CD28, IL-6, IL-10, and HLA-DR alterations were significantly less accentuated in patients who had been treated with IFN-alpha2a. After a median follow-up of 23 months, survival did not differ between the groups (p = 0.54).

CONCLUSIONS

Perioperative immunodysfunction can be modulated by preoperative administration of IFN- alpha2a. IFN-alpha2a decreased the level of VEGF and CD4+CD25+ regulatory T-cells implicating a potential combination with tyrosine kinase inhibitors and vaccines.

Managing Side Effects of Angiogenesis Inhibitors in Renal Cell Carcinoma

Anti-angiogenetic agents are currently considered standard therapy for metastatic renal cell carcinoma (RCC) for the majority of the patients. In contrast to immuno- or chemotherapy, the inhibition of specific signaling pathways has been considered essentially non-toxic. The advance of these tyrosine kinase inhibitors into clinical practice has led to a more detailed understanding of their targets in both, the tumor and the patient. At the advent of targeted therapies, oncologists are in the process of developing surveillance strategies tailored for specific side effects of individual classes of agents to the individual needs of patients. In the current article, the significance of adverse events and their management in RCC patients is reviewed in order to guide the clinical oncologist through patient surveillance and treatment of adverse events.