Quality of Life in Advanced Renal Cell Carcinoma: Effect of Treatment with Cytokine Therapy and Targeted Agents

  • S. Shah
  • K. Gondek
Reference work entry


Renal Cell Carcinoma (RCC) is the most common type of kidney cancer and its’ incidence is increasing steadily worldwide. Due to the asymptomatic nature of the disease it is often diagnosed in advanced stages and treatment options have been limited. Symptoms of the advanced disease along with side-effects of available treatment options can greatly affect a patients’ everyday living. The goal of therapeutic interventions in such advanced diseases is not only to increase survival but maintain or improve  quality of life and functioning.

Cytokine therapy has been effective in only a select group of patients and has been associated with poor quality of life. A review of literature on quality of life in patients in advanced RCC treated with cytokine therapy revealed the use of cytokine therapy was associated with decrease in overall quality of life. Also a comparison of quality of life of patients treated with cytokine therapy with general population showed that patients treated with cytokine therapy had lower quality of life. Limited efficacy of cytokine therapies along with deterioration in QoL has led to use of these drugs in only select population.

 Targeted agents such as sorafenib and sunitinib have improved efficacy. In addition these agents have an overall better QoL and improved kidney-cancer symptoms and concerns as compared to interferon. Another targeted agent temsirolimus had significantly greater quality-adjusted survival than interferon.

The current trend in the management of advanced renal cell carcinoma is the utilization of these targeted agents either alone or in combination with other agents. Targeted agents have shown efficacy and safety, and maintenance or improvement of quality of life in patients with advanced renal cell carcinoma.


Vascular Endothelial Growth Factor Overall Survival Renal Cell Carcinoma Objective Response Rate Kidney Cancer 

List of Abbreviations:


 complete response


European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30


EuroQoL-5 Dimensions


functional assessment of cancer therapy


functional assessment of cancer therapy – biologic response modifier


functional assessment of cancer therapy –, general


functional assessment of cancer therapy – kidney symptom index


health related quality of life






 mammalian target of rapamycin


 overall response rate


 overall survival


platelet driven  growth factor


 progression free survival


 partial response


patient reported outcomes


quality of life


quality-adjusted time without symptoms and toxicity


renal cell carcinoma


response rate


Short Form-12 Health Survey


Short Form-36 Health Survey


time without symptoms and toxicity


United States


vascular endothelial growth factor


von Hippel-Lindau gene


  1. Aass N, De Mulder PH, Mickisch GH, Mulders P, van Oosterom AT, van Poppel H, Fossa SD, de aPrijck L, Sylvester RJ. (2005). J Clin Oncol. 23: 4172–4178.PubMedCrossRefGoogle Scholar
  2. Albers P. (2008). Eur Urol. Supplements 7: 36–45.CrossRefGoogle Scholar
  3. Atkins MB, Sparano J, Fisher RI, et al. (1993). J Clin Oncol. 11: 661–670.PubMedGoogle Scholar
  4. Atzpodien J, Kuchler T, Wandert T, Reitz M. (2003). Br J Cancer. 89: 50–54.PubMedCrossRefGoogle Scholar
  5. American Cancer Society. (2006). http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf (accessed Feb2008).
  6. Bacik J, Fairclough D, Murphy B, Cella D, Mariani T, Mazumdar M, Motzer R. (2000). In: Paper presented at: ASCO Annual meeting Proceeding 2000; abstract 1377.Google Scholar
  7. Bukowski RM, Eisen T, Szczylik C, Stadler WM, Simantov R, Shan M, Elting J, Pena C, Escudier B. (2007a). J Clin Oncol. 25: 5023.CrossRefGoogle Scholar
  8. Bukowski R, Cella D, Gondek K, Escudier B, Sorafenib TARGETs Clinical Trial Group. (2007b). Am J Clin Oncol. 30: 220–227.PubMedCrossRefGoogle Scholar
  9. Cella D, Yount S, Du H, Dhanda R, Gondek K, Langefeld K, George J, Bro WP, Kelly C, Bukowski R. (2006). J Support Oncol. 4: 191–199.PubMedGoogle Scholar
  10. Cole BF, McDermott D, Parker R, Youmans A, Connolly C, Ernstoff M, Atkins MB, for the Cytokine Working Group. (2003). Proc Am Soc Clin Oncol. 22: (abstr 1555).Google Scholar
  11. Coppin C, Porzsolt F, Awa A, Kumpf J, Coldman A, Wilt T. (2005). Cochrane Database Syst Rev. 1: CD001425.PubMedGoogle Scholar
  12. Costa LJ, Drabkin HA. (2007). Oncologist. 12: 1404–1415.PubMedCrossRefGoogle Scholar
  13. Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M, Negrier S, Chevreau C, Solska E, Desai AA, Rolland F, Demkow T, Hutson TE, Gore M, Freeman S, Schwartz B, Shan M, Simantov R, Bukowski RM, TARGET Study Group. (2007). N Engl J Med. 356: 125–134.PubMedCrossRefGoogle Scholar
  14. Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC, Caton JR Jr., Munshi N, Crawford ED. (2001). N Engl J Med. 345: 1655–1659.PubMedCrossRefGoogle Scholar
  15. Fyfe G, Fisher RI, Rosenberg SA, Sznol M, Parkinson DR, Louie AC. (1995). J Clin Oncol. 13: 688–696.PubMedGoogle Scholar
  16. Gupta K, Miller JD, Li JZ, Russell MW, Charbonneau C. (2008). Cancer Treat Rev. 34: 193–205.PubMedCrossRefGoogle Scholar
  17. Heinzer H, Mir TS, Huland E, Huland H. (1999). J Clin Oncol. 17: 3612–3620.PubMedGoogle Scholar
  18. Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, Staroslawska E, Sosman J, McDermott D, Bodrogi I, Kovacevic Z, Lesovoy V, Schmidt-Wolf IG, Barbarash O, Gokmen E, O’Toole T, Lustgarten S, Moore L, Motzer RJ, Global ARCC Trial. (2007). N Engl J Med. 356: 2271–2281.PubMedCrossRefGoogle Scholar
  19. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ. (2006). Cancer J Clin. 56: 106–130.CrossRefGoogle Scholar
  20. Kondagunta G, Bacik J, Ishill N, Reuter V, Schwartz LH, Korkola J, Deluca J, Sweeney S, Chaganti RSK, Motzer RJ. (2006). In: Paper presented at: ASCO Annual Meeting Proceedings 2006; abstract 4528.Google Scholar
  21. Kroger MJ, Menzel T, Gschwend JE, Bergmann L. (1999). Anticancer Res. 19: 1553–1555.PubMedGoogle Scholar
  22. Lam JS, Leppert JT, Belldegrun AS, Figlin RA. (2005). World J Urol. 23: 202–212.PubMedCrossRefGoogle Scholar
  23. Lipscomb J, Gotay CC, Snyder CF. (2007). CA Cancer J Clin. 57: 278–300.PubMedCrossRefGoogle Scholar
  24. Litwin MS, Fine JT, Dorey F, Figlin RA, Belldegrun AS. (1997). J Urol. 157: 1608–1612.PubMedCrossRefGoogle Scholar
  25. McDermott DF, Regan MM, Clark JI, et al. (2005). J Clin Oncol. 23: 133–141.PubMedCrossRefGoogle Scholar
  26. Medical Research Council Renal Cancer Collaborators. (1999). Lancet. 353: 14–17.CrossRefGoogle Scholar
  27. Melichar B, Koralewski P, Ravaud A, Pluzanska A, Bracarda S, Szczylik C, Chevreau C, Filipek M, Delva R, Sevin E, Négrier S, McKendrick J, Santoro A, Pisa P, Escudier B. (2008). Ann Oncol. Apr 11 [Epub ahead of print].Google Scholar
  28. Motzer RJ, Bander NH, Nanus DM. (1996). N Engl J Med. 335: 865–875.PubMedCrossRefGoogle Scholar
  29. Motzer RJ, Murphy BA, Bacik J, Schwartz LH, Nanus DM, Mariani T, Loehrer P, Wilding G, Fairclough DL, Cella D, Mazumdar M. (2000). J Clin Oncol. 18: 2972–2980.PubMedGoogle Scholar
  30. Motzer RJ, Michaelson MD, Redman BG, Hudes GR, Wilding G, Figlin RA, Ginsberg MS, Kim ST, Baum CM, DePrimo SE, Li JZ, Bello CL, Theuer CP, George DJ, Rini BI. (2006a). J Clin Oncol. 24: 16–24.PubMedCrossRefGoogle Scholar
  31. Motzer RJ, Rini BI, Bukowski RM, Curti BD, George DJ, Hudes GR, Redman BG, Margolin KA, Merchan JR, Wilding G, Ginsberg MS, Bacik J, Kim ST, Baum CM, Michaelson MD. (2006b). JAMA. 295: 2516–2524.PubMedCrossRefGoogle Scholar
  32. Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, Oudard S, Negrier S, Szczylik C, Kim ST, Chen I, Bycott PW, Baum CM, Figlin RA. (2007). N Engl J Med. 356: 115–124.PubMedCrossRefGoogle Scholar
  33. Motzer RJ, Escudier B, Oudard S, Porta C, Hutson TE, Bracarda S, Hollaender N, Urbanowitz G, Kay A, Ravaud A. (2008). J Clin Oncol. 26: abstr LBA5026.Google Scholar
  34. Negrier S, Perol D, Ravaud A. (2006). J Clin Oncol. 24: 225s (abstr 4536).Google Scholar
  35. Neidhart JA, Anderson SA, Harris JE, Rinehart JJ, Laszlo J, Dexeus FH, Einhorn LH, Trump DL, Benedetto PW, Tuttle RL, Smalley RV. (1991). J Clin Oncol. 9: 832–836.PubMedGoogle Scholar
  36. Parasuraman S, Hudes G, Levy D, Strahs A, Moore L, DeMarinis R, Zbrozek AS. (2007). J Clin Oncol. 25: Abstr 5049.Google Scholar
  37. Parton M, Gore M, Eisen T. (2006). J Clin Oncol. 24: 5584–5592.PubMedCrossRefGoogle Scholar
  38. Phan G, Morton K, Liewehr D, Steinberg S, Rosenberg S, Yang J. (2002). In: Paper presented at: ASCO Annual Meeting Proceedings 2002; abstract 95.Google Scholar
  39. Plasse T, Goss T, Dutcher J, Logan T, Gordon M, Clark J, Weiss G, Margolin K, Atkins M. (1998). In: Paper presented at: ASCO Annual Meeting Proceedings 1998; abstract 260.Google Scholar
  40. Snow RM, Schellhammer PF. (1982). Urology. 20: 177–181.PubMedCrossRefGoogle Scholar
  41. Szczylik C, Demkow T, Staehler M, Rolland F, Negrier S, Hutson TE, Bukowski RM, Scheuring UJ, Burk K, Escudier B. (2007). J Clin Oncol. 25: 5025.Google Scholar
  42. van Spronsen DJ, de Weijer KJ, Mulders PF, De Mulder PH. (2005). Anticancer Drugs. 16: 709–717.PubMedCrossRefGoogle Scholar
  43. Waters JS, Moss C, Pyle L, James M, Hackett S, A'hern R, Gore M, Eisen T. (2004). Br J Cancer. 91: 1453–1458.PubMedCrossRefGoogle Scholar
  44. Wong M, Goldstein D, Woo H, Testa G, Gurney H. (2002). Int Med J. 32: 158–162.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • S. Shah
    • 1
  • K. Gondek
    • 1
  1. 1.Global Health Economics, Outcomes and ReimbursementBayer HealthCare PharmaceuticalsMontvilleUSA

Personalised recommendations