BERKELEY, CA (UroToday.com) - Despite our ability to perform single site laparascopic nephrectomy and increasingly challenging nephron-sparing surgery with robotic assistance, the outlook for our patients post-nephrectomy for renal cell carcinoma remains bleak, as those with intermediate- or high-risk disease face a 40-70% risk of developing metastatic disease.
The current study was conceived in the immunotherapy era and chose as the treatment arm a 3-drug combination-5-FU,IL-2, and interferon-alpha which at the time was reported to show the highest response rate in metastatic patients. The entry criteria reflect the understanding of high-risk factors for the development of metastatic spread at that time.
Despite being given triple therapy, no difference in disease-free and overall survival was demonstrated. A subset analysis, however, did demonstrate a difference in disease-free survival in lower stage T1/T2 tumours compared with higher stage T3/4 tumours.
This raises the question of whether we may be targeting the wrong groups in adjuvant treatment. It may be that the behaviour of larger more aggressive tumours cannot be modified by adjuvant treatment, and that lower-risk patients may be the group we should be targeting. It will be interesting to see if the 2 large adjuvant trials (SORCE and ASSURE) using biological agents and targeting high-risk patients will show any benefit.
Michael Aitchison, MD, FRCS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Consultant Urologist, Gartnavel Hospital, 1053 Great Western Road, Glasgow G12 0YN, Scotland, United Kingdom
Adjuvant 5-flurouracil, alpha-interferon and interleukin-2 versus observation in patients at high risk of recurrence after nephrectomy for renal cell carcinoma: Results of a Phase III randomised European Organisation for Research and Treatment of Cancer (Genito-Urinary Cancers Group)/National Cancer Research Institute trial - Abstract