25%

35%

5%

0.15

10%

Low-dose subcutaneous and high-dose intravenous IL-2 have comparable efficacy.

Randomized studies have demonstrated a survival benefit associated with high-dose IL-2.

Newer formulations have led to better tolerability of high-dose IL-2.

Durable complete responses are seen in a small proportion of patients receiving high-dose IL-2.

IL-2 has demonstrable efficacy in clear cell as well as papillary RCC.

Absence of prior nephrectomy

Decreased hemoglobin

Elevated calcium

Karnofsky performance score greater than 80%

Elevated lactate dehydrogenase

None of the above

A 50-year-old man with an Eastern Cooperative Oncology Group (ECOG) performance status of 0, a large 12-cm right renal mass, and four small pulmonary metastases

An 81-year-old man with an asymptomatic 6╯cm right renal mass and multiple hepatic metastases who has declined systemic therapy

A 72-year-old man with an ECOG performance status of 2, a 5-cm right renal mass, and mild dyspnea associated with numerous pulmonary metastases

A 67-year-old woman with an ECOG performance status of 0, a 7-cm left renal mass, retroperitoneal adenopathy, and hepatic metastases that have doubled in size over 4 weeks

improved tolerance to cytokine therapy.

improved T-lymphocyte function.

reversal of acquired immune dysfunction.

removal of source of tumor-associated immunosuppressive factors.

removal of tumor burden.

All of the above

The combination of IL-2 and interferon leads to higher overall response rates than either agent alone.

The complete response rate with interferon-α monotherapy is 10%.

Lymphokine activated killer (LAK) cells augment the efficacy of both interferon-α and IL-2.

Randomized trials have demonstrated a significant survival advantage for combined IL-2 and interferon over either agent given as monotherapy.

Papillary carcinoma

Medullary carcinoma

Clear cell carcinoma

Collecting duct carcinoma

Chromophobe carcinoma

Biopsy of a pulmonary nodule

Mediastinoscopy followed by resection of the pulmonary nodules

Observation

Therapy with high dose IL-2

IFN-α therapy

mTOR

PDGF

c-MET

Raf-1

VEGF

15% to 20%.

less than 10%.

60% to 70%.

more than 70%.

30% to 40%.

All of the above

associated with a better quality of life compared with interferon-α.

associated with a longer progression-free survival compared with interferon-α.

None of the above

associated with a higher response rate compared with interferon-α.

Bevacizumab + interferon-α

Low-dose subcutaneous IL-2

High-dose IL-2

Axitinib

Everolimus

associated with better overall survival compared with interferon-α.

All of the above

associated with a longer progression-free survival compared with interferon-α.

None of the above

associated with a better quality of life compared with interferon-α.

Sorafenib

Temsirolimus

Sunitinib

IL-2

Interferon-α

TGF-á

raf-1

PDGF

VEGF

Glut-1