Isolated perfusion of the kidney with tumor necrosis factor for localized renal-cell carcinoma.
Patients with localized renal-cell carcinoma who are candidates for renal parenchymal sparing surgery are being treated with isolated renal perfusion with recombinant human tumor necrosis factor (TNF). Isolated organ perfusion is a surgical technique that allows a cancer-bearing organ or region of the body to be treated with high doses of chemotherapy or biologic, agents that would not be tolerated systemically. In patients with in-transit melanoma or unresectable sarcoma, treatment with hyperthermic isolated limb perfusion using TNF, interferon-gamma, and melphalan has resulted in response rates exceeding 90%. Because preclinical studies suggest that TNF may induce regression of tumors by causing hemorrhagic necrosis mediated by effects on tumor-related vascular endothelium, a vascular tumor such as renal-cell carcinoma could potentially be very responsive. A phase I study of escalating TNF doses delivered via isolated renal perfusion is currently being conducted.
Walther
M M
MM
Urologic Oncology Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
Jennings
S B
SB
Choyke
P L
PL
Andrich
M
M
Hurley
K
K
Linehan
W M
WM
Rosenberg
S A
SA
Alexander
R B
RB
D000818:Animals; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D011379:Prognosis; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage / Q000627:therapeutic use*
D014409:Tumor Necrosis Factor-alpha