Latest Articles
- A proper role for organized medicine in a new era
Medical societies often fail to understand the needs of the new breed of physician.
- Chronic hepatitis C: a clinical overview
Testing and treatment options for this increasingly common infection and current thinking about the various prognostic factors.
- Digoxin’s effect on mortality and hospitalization in heart failure: implications of the DIG study
Results of the world’s largest clinical trial resting the utility of digoxin in treating heart failure.
- A live-virus “suicide” vaccine for human immunodeficiency virus
Because other AIDS vaccines have failed, the concept of a live-virus vaccine is gaining acceptance.
- Troglitazone: a new antihyperglycemic agent
Indications for and use of the newest oral drug for the treatment of type II diabetes.
- Clinical practice guidelines: renal cell carcinoma
BACKGROUND Renal cell carcinoma (RCC) is the most common renal malignancy and is increasing at an annual rate of approximately 2% worldwide. Metastatic RCC is among the more chemotherapy-refractory malignancies, with a 5-year survival rate less than 2%. A variety of therapies are currently under investigation for the treatment of metastatic RCC, particularly involving immunotherapeutic agents such as interferon alfa.
OBJECTIVES To review and compare historical and current data that define practice guidelines in the treatment of RCC.
DISCUSSION Of the various treatment modalities available for RCC, only surgery with complete removal of tumor burden can be considered as potentially curative, since the tumor is resistant to chemotherapy, hormonal therapy, and radiation therapy. However, biologic response modifiers (BRMs)—particularly immunotherapeutic agents such as interferon alfa—have been extensively studied and appear to produce objective tumor regression in selected patients with advanced disease.
CONCLUSIONS In patients with metastatic RCC, performance status is the most important predictor of outcome, and should therefore be utilized for therapeutic decision making. Immunotherapy with BRMs such as recombinant interferon alfa and recombinant interleukin-2 has been associated with meaningful antitumor responses in selected patients. Combination therapy with recombinant interferon alfa, recombinant interleukin-2, and 5-fluorouracil may offer considerable promise, and the subcutaneous administration of recombinant interferon alfa and recombinant interleukin-2 may improve the tolerability and convenience of these cancer treatments by reducing side effects and permitting outpatient administration. As treatment expectations for metastatic RCC are limited, experimental approaches are warranted.
- A 34-year-old woman with odynophagia and weight loss
On the basis of the clinical picture and laboratory data, what is the most likely diagnosis?
- How to tell patients bad news: the strategy of “forecasting”
How does one tell a patient that he or she has cancer, or new parents that their child has a birth defect?