Abstract
Renal cell carcinoma is the most lethal malignancy of all the urologic malignancies. Outcome of those with metastatic disease is dismal with less than 50 surviving beyond 1 year. Several therapeutic strategies have been tried to improve the survival of these patients. Conventional chemotherapy regimens single or in combination failed to improve the response rates. Demonstration of immunogenicity in metastatic renal cell carcinoma gave birth to the concept of immunomodulation as potential treatment strategy in this setting. Though the response rates were better than chemotherapy but occurrence of higher adverse effects limits their use. Exploiting the immune response against tumour with the help of non myeloablative transplant, monoclonal antibody therapy and tumour vaccines have shown promising results in phase I / II trials. Newer chemotherapeutic agents like gemcitabine, capecitabine and novel agents like retinoids are being used in phase II trials. Radiotherapy does not have much role to play in metastatic setting except for palliation of painful bone lesions. This review focuses on the various treatment options available for metastatic renal cell carcinoma.
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