Correspondence

Nephrectomy and Interleukin-2 for Metastatic Renal-Cell Carcinoma

N Engl J Med 2001; 345:1711-1712December 6, 2001

Article

To the Editor:

In this issue of the Journal, Flanigan et al.1 report the results of a randomized trial conducted by the Southwest Oncology Group (SWOG), which compared interferon alone with nephrectomy followed by interferon for the treatment of metastatic renal-cell cancer. There was a survival advantage in the surgery-plus-interferon group, as well as in all the risk strata. Similar results have been demonstrated in Europe by the Genito-Urinary Group of the European Organisation for Research and Treatment of Cancer, in a study with a similar protocol.2 However, the issue of the most effective immunotherapeutic agent to use after nephrectomy is still unsettled because no prospective trials have addressed this question. We used our program's Kidney Cancer Database, containing the records of more than 450 patients with metastatic renal-cell cancer who have received immunotherapy, to obtain survival data on patients treated with interleukin-2 after undergoing nephrectomy.

We identified 89 patients who met the eligibility criteria for the SWOG study and who had been treated with interleukin-2–based regimens after undergoing nephrectomy. The survival of these patients, analyzed with the use of the Kaplan–Meier method, was compared with the survival of 120 patients in the SWOG surgery-plus-interferon group (Figure 1Figure 1Kaplan–Meier Analysis of Survival among Patients with Metastatic Renal-Cell Carcinoma Who Were Treated with Nephrectomy plus Interleukin-2, Nephrectomy plus Interferon, or Interferon Alone.). The median survival of the patients treated with nephrectomy plus interleukin-2 was 16.7 months — twice the survival in the SWOG interferon-only group and 5 months longer than that in the SWOG surgery-plus-interferon group (P<0.05 with the use of the reported 95 percent confidence interval of 9.2 to 16.5 months for the SWOG surgery-plus-interferon group). The rate of survival at five years was 19.6 percent in the group of patients who received interleukin-2, as compared with 10 percent in the group of patients who received interferon. The median survival in a group of contemporaneous, eligible patients undergoing nephrectomy alone at the University of California, Los Angeles (UCLA), was 7.2 months, which was not significantly different from the median survival in the SWOG interferon-only group (8.1 months; 95 percent confidence interval, 5.4 to 9.5) or from the median survival at 6 months in a group of historical UCLA controls who received no treatment at all.3

Our analysis suggests that the survival of patients with metastatic renal-cell cancer can be improved by treatment with nephrectomy followed by adjuvant immunotherapy. Either nephrectomy or immunotherapy alone appears to be of less benefit. Although our data are retrospective, we believe that they support the use of interleukin-2 after nephrectomy in patients with metastatic renal-cell cancer. The data warrant validation in a randomized trial comparing the two cytokines.

Allan J. Pantuck, M.D.
Arie S. Belldegrun, M.D.
Robert A. Figlin, M.D.
University of California School of Medicine, Los Angeles, CA 90095
rfiglin@mednet.ucla.edu

3 References

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   Full Text | Web of Science | Medline

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   Mickisch GH, Garin A, Madej M, de Prijck L, Sylvester R, EORTC-GU Group. Tumor nephrectomy plus Interferon α is superior to Interferon α alone in metastatic renal cell carcinoma. J Urol 2000;163:Suppl:176-176 abstract.
   

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   deKernion JB, Ramming KP, Smith RB. The natural history of metastatic renal cell carcinoma: a computer analysis. J Urol 1978;120:148-152
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