Management and Treatment
Systemic Treatment
Immunotherapies
Transplantation
Allogeneic haemopoietic stem cell transplantation (HSCT), mainly used in the treatment of haematological malignancies, has also been investigated for the treatment of other cancers, including mRCC. In HSCT, donor cells can exhibit an immune response against the ‘foreign’ tumour cells, producing a graft-versus-tumour (GVT) effect. GVT effects, probably induced by donor T-lymphocytes, have been reported for a number of solid tumours, especially mRCC.1,2 A study has assessed the outcome of HSCT in 124 patients treated in 21 European centres; four complete and 24 partial responses were seen.2 Patients with a good prognosis appear to be the best candidates for HSCT. Factors associated with survival included high Karnofsky performance status (KPS;>70), less than three metastatic sites and chronic graft-versus-host disease.2 Another study, measuring survival in 70 patients with advanced RCC undergoing non-myeloablative allogeneic stem cell transplantation, identified three main prognostic factors (assessed pretransplant): KPS, C-reactive protein (CRP) level and lactate dehydrogenase (LDH) level.3 However, although early results have shown promise, this approach induces substantial toxicity. HSCT remains experimental and is not cur rently recommended in guidelines for the treatment of renal cancer.4,5
This information has been provided with the kind permission of Sylvie Négrier and Viktor Grünwald
References:
1. Takahashi Y, Childs RW. Nonmyeloablative transplantation: an allogeneic-based immunotherapy for renal cell carcinoma. Clin Cancer Res 2004;10:6353S–6359S.
2. Barkholt L, Bregni M, Remberger M et al. Allogeneic haematopoietic stem cell transplantation for metastatic renal carcinoma in Europe. Ann Oncol 2006;17:1134–1140.
3. Peccatori J, Barkholt L, Demirer T et al. Prognostic factors for survival in patients with advanced renal cell carcinoma undergoing nonmyeloablative allogeneic stem cell transplantation. Cancer 2005;104:2099–2103.
4. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer. 2009. Available at: http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/17070344
http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.nccn.org/professionals/physician_gls/f_guidelines.asp [accessed September 2010].
5. Ljungberg B, Hanbury DC, Kuczyk MA et al. Guidelines on renal cell carcinoma. 2009. Available at: http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.uroweb.org/fileadmin/tx_eauguidelines/2009/Full/RCC.pdf [accessed September 2010].