Hormonal therapy and chemotherapy of renal-cell carcinoma.

At best, hormonal treatment gives a small proportion of objective responses in patients treated; most commonly the responses are incomplete and of short duration. In practice, treatment with a progestational agent, such as medroxyprogesterone acetate, is often used because of minimal production of unwanted side effects and lack of more effective therapy. Single-agent chemotherapy appears to add little in terms of tumor response, although a small fraction of patients will have favorable responses to single agents such as vinblastine. Combination chemotherapy may give a slightly higher response rate according to results reported in several small series, but there is a considerable increase in toxicity, and, as yet, no clearly definable improvement in patient survival. Further studies are needed to explore the roles of new agents, new drug combinations, and perhaps interactions of modalities such as chemotherapy, hormonal therapy, and immunotherapy. Methods of in vitro testing or testing in the nude mouse or a similar model could provide ways to obtain information in this regard more quickly and without undue exposure of the patient to ineffective and potentially toxic therapy.