Current status and prospects of cytokine therapy for the treatment of renal cancer

In this article, we review the issues related to cytokine therapy for the treatment of renal cancer. The situation of cytokine therapy in Japan is greatly different from that in other countries. In Japan, the use of molecular targeted-based drugs has increased rapidly since 2008, with a considerable amount of cytokine agents being used. Cytokine therapy significantly extends overall survival when nephrectomy is performed, resulting in good performance status (PS 0-1), in relatively younger patients with non-bulky metastatic nests. Cytokine therapy is expected to be more effective when used as a 1st-line treatment Molecular targeted-based therapy produces fewer cases of CR than cytokine therapy. The prognosis of Japanese metastatic renal cancer patients in the cytokine era was better than that of European and American patients. As for patients in the better risk group, when comparing the prognosis with cytokine therapy to that with molecular-targeted based therapy, the indications are that cytokine therapy should be chosen. We should always consider multidisciplinary treatment including metastasectomy, and not be confined to pharmacotherapy alone. The discovery of predictive markers in cytokine therapy is likely to result in the establishment of personal-tailored therapeutic strategies. Concurrent cytokine therapy comprising IFN- α plus IL-2 is more effective when disease metastasis is limited to the lung. As regards concurrent therapy comprising molecular-targeted based plus cytokine agents, Sorafenib plus IFN- α should be very likely to be useful. It is necessary to integrate and develop all available knowledge in order to maximize the effect of such available therapeutic agents including cytokine agents.