Granulocyte-macrophage--colony stimulating factor in metastatic renal cell carcinoma: a phase II trial.
BACKGROUND
Due to lack of success with standard chemotherapy and only modest success with immunotherapy, metastatic renal cell carcinoma (RCC) is associated with a poor prognosis. Granulocyte-macrophage-colony stimulating factor (GM-CSF) is a cytokine with potential antitumor activity, including stimulation of tumor necrosis factor (TNF) and interleukin-1 secretion. It is also a potent growth factor for and activator of antigen-presenting dendritic cells. GM-CSF toxicity may be mediated by TNF, and inhibition of TNF release by pentoxifylline (PTX) may ameliorate these toxic effects. The authors conducted a Phase II trial to determine the activity of GM-CSF in metastatic RCC and to study the effect of PTX on GM-CSF toxicity.


METHODS
Twenty-four eligible patients with metastatic RCC received 10 microg/kg of GM-CSF per day, administered subcutaneously, on a 14-days-on/14-days-off schedule. Twelve patients received concurrent PTX at a dose of 400 mg administered orally 4 times per day.


RESULTS
One patient experienced prolonged stability of disease after having progressive disease on entry. Two other patients experienced substantial slowing of their progressive disease while on study. One of these patients had rapidly progressing metastases on other immunotherapy before receiving GM-CSF. Toxicity was not diminished in patients treated with PTX; it included hyperleukocytosis, nausea, vomiting, pain, fever, skin reactions, myalgia, and fatigue.


CONCLUSIONS
GM-CSF at the dose and schedule described in this report has minor activity against metastatic RCC, and PTX does not ameliorate its side effects.
Rini
B I
BI
Section of Hematology/Oncology, University of Chicago, Illinois 60637-1470, USA.
Stadler
W M
WM
Spielberger
R T
RT
Ratain
M J
MJ
Vogelzang
N J
NJ
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000628:therapy*; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010431:Pentoxifylline / Q000008:administration & dosage / Q000009:adverse effects; D015996:Survival Rate; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects
D014665:Vasodilator Agents; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D010431:Pentoxifylline