Therapeutic options in renal cell carcinoma.

The management of renal cell carcinoma remains a therapeutic challenge. For patients with localized disease, surgery represents the only curative treatment modality. Neither postoperative radiotherapy nor systemic hormonal therapy is of additional benefit in this setting. There are ongoing studies evaluating the role of biologic response modifiers, such as interferon and interleukin-2, as adjuncts to surgery. Patients with recurrent or metastatic disease have a poor prognosis and are a natural target for clinical trials designed to evaluate potential therapeutic modalities. Cytotoxic drugs and hormonal therapies are usually ineffective. The advent of interferon, and more recently of interleukin-2, has resulted in a modest advance in therapy of metastatic renal cell carcinoma. Studies designed to evaluate mechanisms associated with intrinsic or acquired resistance to cytotoxic drugs, as well as to biologic response modifiers, will lead to a better understanding of the biology of the disease and, ultimately, to a more rational and effective use of various therapeutic agents.