title: Early experience with targeted therapy and dendritic cell vaccine in metastatic renal cell carcinoma after nephrectomy.
abstract: OBJECTIVE
  Metastatic renal cell carcinoma (RCC) is one of the most treatment-resistant malignancies and nephrectomy, isolated or combined with systemic chemotherapy typically has limited or no effectiveness. We report our initial results in patients treated with the association of molecular targeted therapy, nephrectomy, and hybrid dendritic-tumor cell (DC) vaccine.
  
  
  METHODS
  Two male patients diagnosed with metastatic RCC were selected for the study. They were treated with the triple strategy, in which sunitinib (50 mg per day) was given for 4 weeks, followed by radical nephrectomy after two weeks. DC vaccine was initiated immediately after surgery and repeated monthly. Sunitinib was restarted daily after 2 to 3 weeks of surgery with a 7-day interval every 4 weeks.
  
  
  RESULTS
  Both patients had complete adherence to the proposed treatment with DC vaccine therapy combined with sunitinib. Follow-up in these patients at 9 and 10 months demonstrated a stable disease in both, as shown by imaging and clinical findings, with no further treatment required.
  
  
  CONCLUSIONS
  The immune response obtained with DC vaccine combined with the antiangiogenic effect of sunitinib and the potential benefits of cytoreductive nephrectomy in advanced disease could represent a new option in the treatment of metastatic RCC. Further prospective trials are needed not only to elucidate the ideal dosing and schedule, but also to better define the proof-of-concept proposed in this report and its role in clinical practice.
authors.affiliation: Division of Urology, Medical School, University of Sao Paulo, Sao Paulo, Brazil. marcosdallogliouro@terra.com.br
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Dall'Oglio
authors.forename: Juliana M
authors.initials: JM
authors.lastname: Sousa-Canavez
authors.forename: Fabio Y
authors.initials: FY
authors.lastname: Tanno
authors.forename: Bruno C
authors.initials: BC
authors.lastname: Tiseo
authors.forename: Alexandre
authors.initials: A
authors.lastname: Crippa
authors.forename: Sabrina T
authors.initials: ST
authors.lastname: Dos Reis
authors.forename: Katia R M
authors.initials: KR
authors.lastname: Leite
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019496:Cancer Vaccines / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D003713:Dendritic Cells / Q000276:immunology*; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009392:Nephrectomy; D011758:Pyrroles / Q000627:therapeutic use*; D000077210:Sunitinib; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019496:Cancer Vaccines; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib