Kidney Cancer

Drs. Wolchok and Motzer provide a succinct, timely review of the diagnosis and management of renal carcinoma. The article leads us to ask a number of questions: What factors account for the major increase in the incidence of renal carcinoma? How has surgical management evolved with the advent of newer operative techniques? What role, if any, does chemotherapy play in the treatment of this disease? What is the current status of and future outlook for immunotherapeutic approaches?

BETHESDA, Md-Some kidney cancer patients in an ongoing phase II trial of an experimental antiangiogenesis monoclonal antibody have shown improvement. The randomized, three-arm study by National Cancer Institute researchers compares two different doses of the drug against a placebo.

Often overshadowed by more common genitourinary cancers, such as prostate, testicular, and kidney cancers, penile and urethral cancers nonetheless represent difficult treatment challenges for the clinician. The management of these cancers is slowly evolving. In the past, surgery, often extensive, was the treatment of choice. Recently, however, radiation and chemotherapy have begun to play larger roles as initial therapies, with surgery being reserved for salvage. With these modalities in their treatment armamentarium, oncologists may now be able to spare patients some of the physical and psychological sequelae that often follow surgical intervention without compromising local control and survival. Part 1 of this two-part article, published in last month’s issue, dealt with cancer of the penis. This second part focuses on cancer of the urethra in both females and males. [ONCOLOGY 13(11):1511-1520, 1999]

Many patients with kidney cancer who had been exposed to high levels of trichloroethylene have a unique pattern of genetic mutations within their cancerous cells. These findings were reported by Hiltrud Brauch, PhD, of the University of Hamburg,

WASHINGTON-“The possibility of spontaneous regression suggests that immunotherapy is a valid route to pursue in kidney cancer research,” said Ronald M. Bukowski, MD, director of the experimental therapeutics program at the Cleveland Clinic Cancer Center.

WASHINGTON-“Enough evidence has accumulated to suggest that interleukin-12 [IL-12] deserves continued study in kidney cancer and other malignancies, even though it has had a difficult track record so far,” Janice P. Dutcher, MD, said at the 1999 Kidney Cancer Association Annual Convention. Dr. Dutcher is associate director for clinical affairs, Our Lady of Mercy Cancer Center/New York Medical College.

WASHINGTON-Monoclonal antibodies are the basis of many diagnostic tests, but now are catching on as therapy as well, said Neil Bander, MD, surgical director, Urologic Oncology Program, Cornell University and New York Presbyterian Hospital, New York. “This particular type of approach has now been validated clinically and is being used to treat patients with various types of cancer,” Dr. Bander said at the Kidney Cancer Association Annual Convention.

Very little has changed in the management of advanced renal cell carcinoma since the approval of interleukin-2 (IL-2, aldesleukin [Proleukin]) in 1992 by the FDA for the systemic treatment of this disease. Dr. Bukowski succinctly reviews the

Patients with metastatic renal cell carcinoma continue to present a therapeutic challenge. Current therapeutic approaches involve surgery and various types of immunotherapy. The rationale for this latter form of therapy

CLEVELAND, Ohio-The importance of the spiritual domain in comprehensive patient care was emphasized during the care of Mrs. S, a 64-year-old woman with renal cell carcinoma with bone metastasis, Cathy Palcisco, LISW, said at a symposium on palliative medicine held at the Cleveland Clinic Foundation.

Renal cancer occurs in nearly 10 of every 100,000 people in the United States and in approximately 45 of every 100,000 of those over 65 years of age. Standard treatment is open surgery, often involving total removal of the tumor along with the kidney. However, a study in the September issue of the Journal of Ultrasound in Medicine reports that ultrasound-guided renal cryoablation is a feasible technique for treating renal malignancies while still preserving the renal parenchyma.

Renal cancer occurs in nearly 10 of every 100,000 people in the United States and in approximately 45 of every 100,000 of those over 65 years of age. Standard treatment is open surgery, often involving total removal of the tumor along with the

BETHESDA, Md-Proleukin (al-desleukin, Chiron) has won the backing of the Oncologic Drugs Advisory Committee (ODAC) for a new indication. The panel recommended that the FDA approve the recombinant human inter-leukin-2 as “indicated for the treatment of adult patients with metastatic melanoma.” The FDA approved Proleukin for use in renal cell carcinoma in 1992.

SAN FRANCISCO-The use of interleukin-2 (IL-2, Proleukin) in hematologic malignancies is much less advanced than similar work in metastatic melanoma or renal cell carcinoma.

SAN FRANCISCO-Interleukin-2 is proving to be one of the most effective treatments yet discovered for renal cell carcinoma. Speaking at the Proleukin First International Congress, sponsored by Chiron Corporation, Richard I. Fisher, MD, director of Loyola University’s Cardinal Bernadin Cancer Center, Maywood, Ill, dubbed IL-2 “the new gold standard against which other treatments need to be compared.”

ST. PETERSBURG, Russia--High doses of the investigational antiestrogen toremifene (Fareston) proved safe and effective as palliative therapy in patients with advanced renal cell carcinoma, say Dr. Michael Gershanovich and colleagues, of the Professor N. N. Petrov Research Institute of Oncology, St. Petersburg, and Orion Corporation, Turku, Finland.

Dr. Paulino has written an excellent review of our present knowledge of Wilms' tumor. Not everyone would agree, however, that ultrasound has replaced the intravenous pyelogram (IVP). The National Wilms' Tumor Study Group (NWTSG) recommends IVP together with real-time ultrasonography as the preoperative imaging studies for the abdomen.[1] The former is used to establish the presence of a functioning opposite kidney and of any congenital abnormality. The latter identifies the presence and status of inferior vena cava thrombi.

Dr. Paulino provides an excellent summary of current knowledge about Wilms' tumor and its treatment. He stresses the need to improve treatment for those with aggressive tumors and possibly avoid adjuvant treatment in a subset of patients.

Paulino has thoughtfully reviewed the etiology, diagnosis, and management of Wilms' tumor. Investigators from the National Wilms' Tumor Study Group (NWTSG) first divided Wilms' tumors into two groups: those with a favorable histology and those with an unfavorable histology.[1]

Significant advances have been made in the treatment of children with Wilms' tumor. Whereas 50 years ago overall survival was less than 10%, current survival estimates approach 90%. This progress has been made