A Cochrane review [Abstract] 1 [withdrawn from publication] included 58 studies with a total of 6880 subjects. Interferon-alpha was superior to controls (OR for death at one year = 0.56, 95% confidence interval 0.40 to 0.77; 4 studies, n=644). The pooled overall hazard ratio for death was 0.74 (95% CI 0.63 to 0.88). The weighted average median improvement in survival was 3.8 months. The optimal dose and duration of interferon-alfa remains to be elucidated. The addition of a variety of enhancers, including lower dose intravenous or subcutaneous interleukin-2, has failed to improve survival compared to interferon-alfa alone. Initial nephrectomy prior to interferon-alfa therapy in highly selected fit patients improved median survival by 4.8 months over interferon-alfa alone (2 studies). Combined data for a variety of immunotherapies gave an overall chance of partial or complete remission of only 12.4% (99 study arms), compared to 2.4% in 10 non-immunotherapy control arms.
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