DR FIGLIN: The patient’s a 57-year-old male who presented with a 7-cm right renal mass and bilateral pulmonary nodules measuring about one to one and a half centimeters, who underwent a cytoreductive nephrectomy, revealing clear cell carcinoma with 5% sarcomatoid features.
He then went on to high-dose interleukin-2, receiving 4 treatment cycles, having a 90% decrease in the size of his bilateral lung mets, and then was followed expectedly.
Ten years later, he came in with altered mental status and he had a solitary lesion to his brain, no other evidence of disease elsewhere, which was surgically resected. And he now remains free of disease for 12 years.
DR LOVE: Wow! Dave, any thoughts about this patient, this story?
DR McDERMOTT: Well, this is the kind of story that gets folks excited about the potential of immune therapy for solid tumors. Unfortunately, it’s — over the years, has not been that common a story. Needless to say, what we’ve been trying to do — and Bob, both Motzer and Figlin have been involved in this — is trying to identify folks who are more likely to be in this long-term, home-run kind of benefit group. It’s over the years, the application of IL-2 has probably decreased as far as the number of centers and the number of patients getting IL-2, but the response rates have improved, in large part because we’re getting better at identifying patients who are not likely to respond to the treatment. So that’s patients with, say, nonclear cell tumors, which is something that Bob Motzer taught us from the interferon days. Patients who have their primary tumor in place are also less likely to be getting IL-2.
Right now we don’t have a great pretreatment marker to say, “This person should definitely get the treatment,” so we can enrich the population of patients who should get these agents.