UroToday- Systemic immunotherapy has been a mainstay in the treatment of metastatic renal cell carcinoma (RCC) for decades, until the recent introduction of new targeted therapies that were developed based on the elucidation of molecular pathways important in RCC biology. One of the greatest impediments to the delivery of systemic immunotherapy to patients with RCC, particularly interleukin 2 (IL-2), has been the significant toxicity associated with therapy. Much effort has been expended to develop novel methods of drug delivery to minimize patient toxicity and maintain or improve disease response. Here, Esteban-Gonzalez and colleagues report on the Spanish-Portuguese experience with inhaled IL-2 administered through a nebulizer.

In this retrospective review, the authors report on 51 patients treated over a 4 year period. Forty-three patients were treated with inhalational IL-2 alone, whereas 8 received additional systemic immunotherapy in conjunction. Median patient age was 62 years, and the median time from diagnosis of RCC to metastatic disease was 13 months. Overall, 94.1% of patients had a prior nephrectomy, and 94.1% had received prior systemic immunotherapy. The overall objective response rate was 13.7% and an additional 15.7% had stable disease on therapy, such that 29.4% derived "clinical benefit" from the therapy. Toxicity requiring dose reduction or interruption was noted in 21.6%. The main toxicities noted were fatigue and cough. The median progression free survival was 8.6 months and the median overall survival was 23 months.

Inhaled IL-2 appears to provide limited benefit to patients with metastatic RCC. Administration through the inhalational route appears to limit toxicity associated with therapy and provide limited disease response. In light of the improved responses seen with targeted therapies, the role of this technology in the treatment of patients with metastatic RCC remains to be determined.

Emilio Esteban-González; Joaquín Carballido; Víctor Navas; Zoila Torregrosa; Antonio Muñoz; Melchor Álvarez de Mon; on behalf of PortugueseSpanish Inhaled IL-2 Group

Anti-Cancer Drugs 18(3): 291-296, 2007
Reviewed by UroToday Contributing Editor Christopher G. Wood, MD, FACS

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