Nephrectomy combined with perioperative alpha-interferon in the treatment of advanced local and minimally metastatic renal cell cancer.
alpha-Interferon produces a 15% response lasting on average 4-6 months in renal cell carcinoma, providing little justification for use as adjuvant treatment. Two observations, however, suggest that the benefits might be greater than predicted. In our studies in patients with small volume lung disease 59% responded (2 + 8/17) compared to 3% (0 + 2/64) for more advanced disease. Secondly, an animal intravenous metastasis model has shown a critical window of 24 h around the time of injection of tumour cells when treatment with interferon Ca produces durable complete remissions. In an attempt to capitalise on this observation, a feasibility study has been initiated to establish the safety of perioperative interferon. Patients received 3 MU daily for 3 days prior to operation and for 2 weeks after operation. Thirteen patients have been treated and all except one were discharged from hospital within 2 weeks. There have been two serious problems in the immediate post-operative period, one developed septicaemia and one had an episode of hypotension secondary to post-operative blood loss. One partial remission and one minor response was noted in the 9 patients with metastases and none showed accelerated tumour growth post-operatively. It is concluded that this approach is safe enough to be included in a randomised trial.
Cockerell
O C
OC
London Hospital Medical College, UK.
Oliver
R T
RT
Nethersall
A
A
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007370:Interferon Type I / Q000009:adverse effects / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications; D018805:Sepsis / Q000209:etiology; D012771:Shock, Hemorrhagic / Q000209:etiology
D007370:Interferon Type I