Nephrectomy before interleukin-2 therapy for patients with metastatic renal cell carcinoma
Nephrectomy before interleukin-2 therapy for patients with metastatic renal cell carcinoma
复制标题
DOI：
10.1016/s0022-5347(01)64097-7
复制
发表时间：
1997-11-01
影响因子：
6.6
通讯作者：
Atkins, MB
中科院分区：
文献类型：
--
作者：
Fallick, ML;McDermott, DF;Atkins, MB
目的：转移性肾细胞癌的治疗仍然具有挑战性和争议性。有一些证据表明，在系统治疗前接受肾切除术的患者中，对基于白细胞介素-2（IL-2）的免疫治疗的反应有所改善。然而，最近的报告表明，在免疫治疗之前进行手术可能不是一种有效的策略，因为许多患者在肾切除术后将无法接受系统治疗。我们描述了我们的标准，以确定哪些患者是候选人肾切除术前免疫治疗，并提出了我们的一系列患者治疗这种方法。材料和方法：基于我们对基于IL-2的免疫疗法的初步经验，我们制定了用初始肾切除术继之以全身免疫疗法治疗的某些入选标准，包括可能的肿瘤负荷减积大于75%，无中枢神经系统，骨或肝转移，足够的肺和心脏功能，东部肿瘤协作组体能状态为0或1。此外，排除活检显示主要透明细胞型组织学以外的患者。从1991年到1996年，28例患者符合这些标准，并采用这种方法进行治疗。患者进行了随访，以确定接受免疫治疗的人数以及总体反应和生存率。1例患者在肾切除术后1个月死于疾病进展导致的呼吸衰竭。另一例患者肺功能较差，因此接受替代细胞因子治疗。其余26例患者（93%）接受了至少1个疗程的IL-2治疗。肾切除术和开始免疫治疗之间的中位间隔为1.5个月（范围1至3）。总缓解率为39%，其中5例完全缓解（18%），6例部分缓解（21%）。从治疗开始，整个组的精算中位生存期为20.5个月（范围1至66）。目前13例患者还活着，其中8人是疾病和/或progression-free.Conclusions：使用这些严格的标准肾切除术可以有效地进行免疫治疗前，不影响患者将接受系统治疗的可能性。用这种方法治疗的患者中IL-2的活性是令人鼓舞的，并且证明在适当选择的患者中考虑它是合理的。
Purpose: The management of metastatic renal cell carcinoma remains challenging and controversial. There is some evidence of improved response to interleukin-2 (IL-2) based immunotherapy in patients who undergo nephrectomy before systemic treatment. However, recent reports have suggested that surgery prior to immunotherapy may not be an efficient strategy, since many patients will not be able to receive systemic treatment after nephrectomy. We describe our criteria for determining which patients are candidates for nephrectomy before immunotherapy and present our series of patients treated with this approach.Materials and Methods: Based on our initial experience with IL-2 based immunotherapy we developed certain inclusion criteria for treatment with initial nephrectomy followed by systemic immunotherapy, including greater than 75% debulking of tumor burden possible, no central nervous system, bone or liver metastases, adequate pulmonary and cardiac function, and Eastern Cooperative Oncology Group performance status of 0 or 1. In addition, patients in whom biopsies show other than predominantly clear cell type histology are excluded. From 1991 through 1996, 28 patients met these criteria and were treated with this approach. Patients were followed to determine the number receiving immunotherapy as well as overall response and survival rates.Results: Radical nephrectomy was performed in all patients. One patient died of respiratory failure from disease progression 1 month after nephrectomy. Another patient had poor pulmonary function and, therefore, was treated with an alternative cytokine therapy. The remaining 26 patients (93%) received at least 1 course of IL-2. Median interval between nephrectomy and initiation of immunotherapy was 1.5 months (range 1 to 3). Overall response rate was 39% with 5 complete (18%) and 6 partial (21%) responses. Actuarial median survival of the entire group was 20.5 months (range 1 to 66) from the initiation of treatment. Currently 13 patients are alive, including 8 who are disease and/or progression-free.Conclusions: Using these strict criteria nephrectomy can be effectively performed before immunotherapy without compromising the likelihood that patients will receive systemic treatment. The activity of IL-2 in patients treated with this approach is encouraging and justifies its consideration in properly selected patients.