Interferon-alfa in the treatment of patients with inoperable locally advanced or metastatic renal cell carcinoma: a systematic review
A systematic review was undertaken to determine whether interferon-
alfa (IFN-α) is an effective treatment for patients with inoperable
locally advanced or metastatic renal cell carcinoma (mRCC).
MEDLINE, EMBASE, the Cochrane Library, guideline databases
and relevant meeting proceedings were searched. Randomized
clinical trials (RCTs) or meta-analyses comparing IFN-α-containing
regimens to placebo or non-immunotherapy controls, and that
reported response rate, survival, toxicity or quality of life data were
eligible. Two systematic reviews and eight RCTs met the selection
criteria. A Cochrane review updated in 2005 reported higher response
rates and reduced one-year mortality based on 4 RCTs in patients
who received IFN-α. Of the eight RCTs, three reporting objective
response rate showed significant differences favouring IFN-α. Two
of five trials reporting survival data showed longer median survival
in the IFN-α group. Adverse effects of IFN-α were consistent
across the trials with increased intensity and frequency concordant
with increased IFN-α dose. Meta-analyses of seven RCTs for
objective response and six RCTs for mortality favoured IFN-α: odds
ratio 6.87 (95% Confidence Interval [CI], 3.29 to 14.35) and hazard
ratio 0.79 (95% CI, 0.69 to 0.91), respectively. The effectiveness
of IFN-α in mRCC has been subject to skepticism. As IFN-α
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