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The goal of biologic therapy is to boost the body's immune
system to fight off or destroy cancer cells more effectively. Until
recently, this was the most common first-line therapy for advanced
kidney cancer, and it may still be helpful for some people. Because
biologic therapy can be hard to give and can cause serious side
effects, some doctors now reserve it for people whose cancers don't
respond to targeted therapies.
The main immunotherapy drugs used in kidney cancer are
cytokines (proteins that activate the immune system). The 2 cytokines
most often used are interleukin-2 (IL-2) and interferon-alpha. Both
cytokines cause these cancers to shrink to less than half their
original size in about 10% to 20% of patients. Patients who respond to
IL-2 tend to have lasting responses. IL-2 is the only therapy that
appears to result in long-lasting responses, although only a small
percentage of patients respond. A cancer has certain characteristics
that may help predict if IL-2 will be helpful, and more studies are
being done to see which characteristics are most helpful..
Combining low doses of both cytokines was once thought to be
as effective as high-dose IL-2, with fewer and less severe side
effects, but recent studies have not supported this idea. Most doctors
think that high-dose IL-2 has a better chance of shrinking the cancer.
High dose IL-2 is only given in certain centers, because it can be very
toxic and special skills are needed to recognize and treat side
effects.
The possible side effects of cytokine therapy, especially
high-dose IL-2, include:
- extreme fatigue
- low blood pressure
- fluid buildup in the lungs
- trouble breathing
- kidney damage
- heart attacks
- intestinal bleeding
- diarrhea or abdominal pain
- high fever and chills
- rapid heart beat
- mental changes
These side effects are often severe and, rarely, can be fatal.
For this reason, cytokine therapy is not used in people who are in poor
overall health to begin with. Only doctors experienced in the use of
these cytokines should give this treatment. .
Cytokines can also be used as part of some experimental
immunotherapy techniques. These are described in the section, "What's
new in kidney cancer research and treatment?"
Last Medical Review: 02/18/2009
Last Revised: 05/14/2009
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