25%

10%

0.15

5%

35%

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

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

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

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

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

Karnofsky performance score greater than 80%

Elevated calcium

Absence of prior nephrectomy

Elevated lactate dehydrogenase

Decreased hemoglobin

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

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

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

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

None of the above

improved tolerance to cytokine therapy.

removal of tumor burden.

removal of source of tumor-associated immunosuppressive factors.

reversal of acquired immune dysfunction.

improved T-lymphocyte function.

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.

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%.

Medullary carcinoma

Papillary carcinoma

Clear cell carcinoma

Collecting duct carcinoma

Chromophobe carcinoma

IFN-α therapy

Therapy with high dose IL-2

Mediastinoscopy followed by resection of the pulmonary nodules

Observation

Biopsy of a pulmonary nodule

c-MET

PDGF

mTOR

Raf-1

VEGF

more than 70%.

15% to 20%.

less than 10%.

60% to 70%.

30% to 40%.

None of the above

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

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

All of the above

associated with a better quality of life 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.

None of the above

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

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

All of the above

Sorafenib

Sunitinib

IL-2

Temsirolimus

Interferon-α

VEGF

Glut-1

TGF-á

PDGF

raf-1