ABSTRACT
The patient with metastatic renal cell carcinoma at the time of presentation have an average survival of approximately 4 months, and only 10% can be expected to survive 1 year. The treatment of metastatic renal cell carcinoma remains a major public health problem in clinical medicine. Hormonal therapies, including progestational agents, and chemotherapies as single agent or in combinations seldom result in objective tumor regression or prolongation of survival and the response are usually temporary. Immunotherapic approaches to this tumor has not demonstrated a clear impact on growth of the tumor. But alpha-interferon therapy that initiated by deKernion produced 16. 5% response rate. The following results and conclusions are obtained with combination therapy such as a-interferon. nitrosourea, vinblastine and medroxyprogesteron acetate in metastatic renal cell carcinoma. 1. From March 1988 to August 1989, 15 patients with metastatic renal cell carcinoma were studied. Average patient age was 49.3 years. There was 11 men and 4 women. The disease was confined to lung in 46.7% of the patients and a Karnofsky performance status (PS) of 100 was identified in 7%: 13.3 % had PS score <70. 2. Of 15 patients, 4(26.7%) had a complete responses, 1 (6.7%) had a partial response, 3 (20.0%) had a minimal response and 7 (46.7%) had progression with no evidence of response to treatment. Of patients with pulmonary metastases alone, 5 (71.4%) had objective response or stabilization of disease and 2 (28.6%) had progression with no evidence of response to treatment. 1 (100.0%) patient with PS of 100 had partial response and no patients with PS<70 had response to therapy. 3. Median duration of survival in the overall subjects was 47 weeks : nonresponders survived for median of 21 weeks. Median duration of survival in nonresponders with pulmonary metastasis alone was 20 weeks. All responders are alive at least 33 weeks later. 4. The most common side effects were constitutional symptoms (73.3%). Hematologic toxicity (60%), gastrointestinal toxicity (40%), hepatic toxicity (26.7%) and nephrotoxicity (6.7%) occurred. Severe toxicity was noted only in 1 patient. 5. Natural killer cell activity in responders was 35.4 % and in nonresponders was 43.0%. Increased natural killer cell in responders was noted after treatment. T Lymphocyte subletting (T3 : cytotoxic T cell, T4 : helper T cell, T8 : suppressor T cell) performed at peritreatment had no statistic significance.In spite of short-term study, combination therapies includirrg alpha-interferon cause objective more regression and prolongation of survival. Futher trial with these regimens seem warranted in the management of metastatic renal cell carcinoma.