Renal tumors metastatic

Indications Gastrointestinal stromal tumor, Metastatic renal cell carcinoma... 

Stain Carcinoid Tumor Paraganglioma Medullary Melanoma Renal Cell Metastatic (Thyroid CA, Carcinoma, or Lung Carcinoma)... 

Interleukin-2 has been substituted for mitomycin C in an attempt to decrease myelosuppression, a side effect of mitomycin C. Interferon-a has a direct antiprohfera-tive effect (antiangiogenic) on renal tumor cells in vitro. The co-administration of glucocorticoids improves the tolerance of intermittent high-dose interferon-a (up to 40 million lU/mVday). This study was performed at MDACC on 30 patients with metastatic renal cancer in whom the primary renal lesion was previously resected or embolized (Amato et al. 1995). 

Neeman Z, Wood BJ (2002) Radiofrequency ablation beyond the liver. Tech Vase Interv Radiol 5(3) 156-163 Ni Y, Miao Y, Mulier S et al (2000) A novel cooled-wet electrode for radiofrequency ablation. Eur Radiol 10(5) 852-854 Ogan K, Jacomides L, Dolmatch BL et al (2002) Percutaneous radiofrequency ablation of renal tumors technique limitations and morbidity. Urology 60(6) 954-958 Pacak K, Fojo T, Goldstein DS et al (2001) Radiofrequency ablation a novel approach for treatment of metastatic pheochromocytoma. J Natl Cancer Inst 93(8) 648-649 Patterson EJ, Scudamore CH, Owen DA et al (1998) Radiofrequency ablation of porcine liver in vivo effects of blood flow and treatment time on lesion size. Ann Surg 227(4) 559-565... 

Usual dose schedules of streptozotocin involve 500 mg/m2 i.v. during five consecutive days. The major toxicity is renal tubular damage. Treatment of metastatic insulinomas may result in the release of insulin from the tumor and subsequent hypoglycemic coma. Less severe toxicities include diarrhea, anemia, and mild alterations in glucose tolerance or liver function tests. 

Metastatic renal cell carcinoma has a poor prognosis and resists conventional chemotherapy. Immunotherapy with IL-2 and/or IFN-a is currently regarded as the most effective therapy with, however, modest response rates of 15-20%. Similar results are also observed in patients with metastatic melanoma and the response to IFN-a and IL-2 correlates with the occurrence of tumor-infiltrating CD4+ T-lymphocytes identified in aspirates from melanoma metastases. Determination of these cells therefore seems to be a method to predict responders prior to the initiation of cytokine therapy. 

Ratain, M., Preliminary antitumor activity of BAY 43-9006 in metastatic renal cell carcinoma and other advanced refractory solid tumors in a phase 11 randomized discontinuation trial (RDT), Proc. Am. Soc. Clin. Oncol., 22, 381, Abstr. 4501, 2004. 

Krouse RS, Royal RE, Heywood G, Weintraub BD, White DE, Steinberg SM, Rosenberg SA, Schwartzentruber DJ. Thyroid dysfunction in 281 patients with metastatic melanoma or renal carcinoma treated with interleukin-2 alone. J Immunother Emphasis Tumor Immunol 1995 18(4) 272-8. 

High-dose IL-2 is approved for the treatment of metastatic renal cell carcinoma. The tumor is intrinsically immunogenic, and can elicit a host immune response that infrequently results in spontaneous remission of disease administration of IL-2 is believed to augment the normal immune response [53]. In a Phase II study that supported the approval of high-dose IL-2 for this indication, 15% of patients achieved objective responses (8% were partial responses and 7% complete responses). In this trial, patients received IL-2 at 600 000 or 720 000 U/kg per dose. The cumulative dose and the efficacy were similar between dose groups patients receiving the higher dose tolerated fewer cycles of therapy due to toxicity. 

Rini B, Rixe O, Bukowski R, et al. (2005) AG-013736, a multitarget tyrosine kinase receptor inhibitor, demonstrates anti-tumor activity in a phase 2 study of cytokine-refractory, metastatic renal cell cancer (RCC). ASCO Proc (abstract 4509). 

IL-2 has been used in the treatment of sohd tumors such as metastatic melanoma, metastatic renal cell carcinoma, and colorectal carcinoma. Interleukin-2 infusions are associated with significant dose-dependent toxicity characterized by fevers, malaise, nausea, vomiting, diarrhea, hepatic dysfunction, pulmonary edema, somnolence, confusion, dysrhythmias, myocardial infarction, hematopoietic suppression, and renal insufficiency [10]. IL-2 has a short serum half-life of 6-10 min and a clearance of 30-60 min after bolus intravenously infusion [11]. Resultant toxicity is generally transient and reversible. It is possible that IL-2 induced renal failure only occurs in the setting of profound hypotension, prior volume depletion, concurrent administration of potentially nephrotoxic drugs, or the presence of underlying renal disease. 

Note [G] = treated for Gastrointestinal tumor [R] = treated for Metastatic renal cell carcinoma... 

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