RESUMO
PURPOSE/OBJECTIVES: To review standard and investigational treatments in advanced renal cell carcinoma, with a focus on thalidomide. DATA SOURCES: Published articles, conference proceedings, treatment guidelines, and textbooks. DATA SYNTHESIS: The prognosis for advanced renal cell carcinoma when treated with standard regimens is poor; therefore, new treatments are needed. CONCLUSIONS: Treatment with thalidomide, alone and in combination with other therapies, may improve survival for patients with advanced renal cell carcinoma. IMPLICATIONS FOR NURSING: Proactive management of adverse effects associated with thalidomide, alone and in combination, may increase patient tolerance and compliance.
Assuntos
Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/enfermagem , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/enfermagem , Talidomida/uso terapêutico , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Metástase Linfática , Masculino , Nefrectomia , Cuidados Paliativos , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Prognóstico , Talidomida/efeitos adversosRESUMO
OBJECTIVES: To evaluate the toxicity and activity of thalidomide in patients with advanced metastatic renal cell cancer and to measure changes of one angiogenic factor, vascular endothelial growth factor (VEGF)165, with therapy. PATIENTS AND METHODS: 29 patients were enrolled on a study of thalidomide using an intra-patient dose escalation schedule. Patients began thalidomide at 400 mg/d and escalated as tolerated to 1200 mg/d by day 54. Fifty-nine per cent of patients had had previous therapy with IL-2 and 52% were performance status 2 or 3. Systemic plasma VEGF165 levels were measured by dual monoclonal ELISA in 8 patients. RESULTS: 24 patients were evaluable for response with one partial response of 11 months duration of a patient with hepatic and pulmonary metastases (4%), one minor response, and 2 patients stable for over 6 months. Somnolence and constipation were prominent toxicities and most patients could not tolerate the 1200 mg/day dose level. Systemic plasma VEGF165 levels did not change with therapy. CONCLUSION: These results are consistent with a low level of activity of thalidomide in renal cell carcinoma. Administration of doses over 800 mg/day was difficult to achieve in this patient population, however lower doses were practical. The dose-response relationship, if any, of thalidomide for renal cell carcinoma is unclear.
