Immunotherapy for renal carcinoma: theoretical basis and current standard of care.

Abstract

Carcinoma of the kidney (a.k.a. ‘hypernephroma’ or renal cell cancer) accounts for 2–3% of all adult cancers, and over 4000 new cases are reported in the UK every year [1]. It occurs more commonly in men, and has a peak incidence around 60–70 years, although can occur at any age. The incidence is increasing [2]. If confined to the kidney, surgical resection is the treatment of choice, and cure can result. However, most patients with metastatic disease survive less than 1 year [3], and chemotherapeutic or hormonal approaches are generally ineffective. The natural history of renal cancer characteristically manifests an indolent course, with long periods of stable disease. In addition, the ‘spontaneous regression’ of metastases has often been reported in the literature, and Evenson & Cole [4] made the observation that renal cancer appeared to have the highest incidence of this controversial and intriguing phenomenon. The actual frequency of spontaneous regression in renal tumours is not known, but estimates put it at around 0.3% [5]. A higher frequency has been reported following nephrect-omy in patients with established metastatic disease [6]. The existence of spontaneous regression has been put forward as evidence that a form of innate ‘host factor’ or immunological response may be involved in its pathogen-esis. Such a hypothesis is supported by the increase in renal cancer cases observed in patients receiving long-term immunosuppressive therapy for organ transplantation [7].