ORIGINAL ARTICLES   

Minerva Urologica e Nefrologica 2002 June;54(2):113-7

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: Italian

Immunotherapy in the management of metastatic renal carcinoma

Fischetti G., Cuzari S., Leone P., De Martino P., Musy M., Mariani S., Fraioli A., Valentini M. A.

Università degli Studi di Roma «La Sapienza» - Roma Policlinico «Umberto I» Dipartimento di Urologia «U. Bracci»

Back­ground. ­Renal ­cell car­ci­no­ma (RCC) is a rel­a­tive­ly ­rare ­tumor rep­re­sent­ing 2-3% of all neo­pla­sias. Approx­i­mate­ly 30% of ­patients diag­nosed as hav­ing RCC ­present metas­ta­ses: ­mean sur­vi­val rang­es ­between 6 and 10 ­months, ­whilst 10-20% ­present a 2-­year sur­vi­val ­rate. Treat­ment of ­patients ­with met­a­stat­ic RCC is a dif­fi­cult chal­lenge. Hor­mones and chem­o­ther­a­py, ­either ­alone or asso­ciat­ed ­with sur­gi­cal resec­tion of the pri­mary ­lesion ­have ­been ­used. In our expe­ri­ence, IL-2 + IFN-α has ­been ­shown to be an encour­ag­ing ­form of treat­ment.
Meth­ods. Dur­ing the peri­od ­between Octo­ber 1997 and Decem­ber 1999, 5 ­patients (3 ­males, 2 ­females), ­mean age 52.5 ­years, ­with met­a­stat­ic RCC, ­came to our atten­tion. TC ­revealed a cir­cum­scribed ­area the mar­gins of ­which ­were not ­well ­defined, in a mid-­renal local­iza­tion, pos­i­tive ­inter aor­ta ­caval and obtu­ra­tor ­lymph ­nodes, but no ­lung, ­brain or hepat­ic involve­ment. ­Patients ­were sub­mit­ted to neph­rec­to­my and lym­phad­e­nec­to­my fol­lowed lat­er by immu­no­ther­a­py ­with IFN-α (3 Mil ­twice a ­week) + low ­dose IL-2 (1 Mil/m2/12 h): treat­ment was giv­en for 4 con­sec­u­tive ­weeks and ­then repeat­ed eve­ry 3 ­weeks for 1 ­year.
­Results. At 30 ­months’ fol­low-up all ­patients ­showed regres­sion of the dis­ease (100% of cas­es) and in ­none of the cas­es ­there was evi­dence of metas­ta­ses. ­Only one ­patient (20%) pre­sent­ed ­side-­effects (nau­sea, vom­it­ing, ­slight ­rise in tem­per­a­ture) all of ­which dis­ap­peared at the end of the ­first ­week of treat­ment.
Con­clu­sions. ­These ­results, ­even if on a lim­it­ed num­ber of ­patients and for a lim­it­ed fol­low-up peri­od, ­show ­that in ­some ­patients ­with met­a­stat­ic ­renal ­cell car­ci­no­ma, treat­ment ­with IL-2 and IFN-α fol­low­ing neph­rec­to­my and lym­phad­e­nec­to­my ­should be con­sid­ered the ther­a­py of ­choice.