Acta Chirurgica Austriaca

, Volume 25, Issue 1, pp 32–34 | Cite as

Immuntherapie beim Nierenzellkarzinom

  • M. Wirth
Themenschwerpunkt: Aktuelles in der Therapie Urologischer Tumoren
  • 9 Downloads

Zusammenfassung

Biologische Substanzen, wie Interferone (IFN), IL-2 und Tumornekrosefaktor (TNF-alpha), kommen in der Behandlung von Patienten mit metastasiertem Nierenzellkarzinom gegenwärtig nur innerhalb von prospektiven Studien in Frage, da für keine dieser Stoffe allgemein akzeptierte Therapieprotokolle existieren. In Deutschland ist zudem zu beachten, daß bisher nur das Interleukin-2 vom Bundesgesundheitsamt in Berlin zur Behandlung des Nierenzellkarzinoms zugelassen ist. Von den verschiedenen IFN erscheint IFN-alpha beim Nierenzellkarzinom die geeignetste Substanz zu sein. Bei Gabe von IFN-alpha sind jedoch nur in etwa 15% der Fälle objektive Remissionen zu erwarten wobei die Rate an kompletten Remissionen nur etwa 2% beträgt. Eine Monotherapie mit Interleukin-2 bringt keine signifikant besseren Behandlungsergebnisse als mit Interferon-alpha (IFN-alpha), geht jedoch mit höheren Nebenwirkungen einher. Bei der Kombination von IL-2 mit IFN-alpha lassen sich höhere Remissionsraten als bei der Monotherapie erzielen, wobei jedoch auch hier komplette Remissionen mit etwa 6% sehr selten sind. Der Tumornekrosefaktor befindet sich beim Nierenzellkarzinom noch in einem frühen Stadium der Erprobung.

Schlüsselwörter

Nierenzellkarzinom Immuntherapie Interferone Interleukin-2 

Immunotherapy in renal cell cancer

Summary

At present, biological substances such as interferones (IFN), IL-2 and tumor necrosis factor (TNF-alpha) should be used in the treatment of patients with metastasized renal cell carcinoma only in the course of prospective trials, as there are no generally accepted therapy protocols for any of these substances. In Germany, moreover, it is important to note that only Interleukin-2 has as yet been approved for the treatment of renal cell carcinoma by the Federal Department of Health in Berlin. Of the various interferones. IFN-alpha appears to be the most suitable substance for treatment of metastasized renal cell carcinoma. Nevertheless, after the administration of IFN-alpha, objective remission can be expected in only 15% of all cases, complete remission accounting for only 2% of the total. The results of monotherapy with Interleukin-2 are not significantly better than those with Interferon-alpha, although the former is accompanied by a higher incidence of side-effects. A combination of IL-2 with Interferon-alpha results in higher remission rates than in the case of monotherapy with either substance, although here too, complete remissions, which account for a more 6% of the total, are very rare. The tumor necrosis factor is still at an early stage of testing for renal cell carcinoma.

Key-words

renal cell cancer immunotherapy interferons interleukin-2 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. (1).
    Atzpodien J, Kirchner H: Cancer, cytokines, and cytotoxic cells: Interleukin-2 in the immunotherapy of human neoplasms. Klin Wschr 1990;68:1–11.PubMedCrossRefGoogle Scholar
  2. (2).
    Aulitzky W, Gastl G, Aulitzky WE, Herold M, Kemmler J, Mull B, Frick J, Huber C: Successful treatment of metastatic renal cell carcinoma with a biologically active dose of recombinant interferongamma. J Clin Oncol 1989;7:1875–1884.PubMedGoogle Scholar
  3. (3).
    Bono AV: Steroid hormones and hormonal treatment in renal cell carcinoma, in De Kernion, Pavone-Macaluso (eds): Tumors of the kidney, Vol 13. Baltimore, Williams & Wilkins, 1986, pp 205–227.Google Scholar
  4. (4).
    Debruyne FMJ: Interferons and tumor necrosis factor (BRMS) in the management of renal cell carcinoma, in: Immunobiology of renal cell carcinoma. Cleveland, 1989.Google Scholar
  5. (5).
    De Kernion JB, Sarna JB, Figlin R, Lindner A, Smith RB: The treatment of renal cell carcinoma with human leukocyte alpha-interferon. J. Urol 1983;130:1063–1066.Google Scholar
  6. (6).
    Eisenhauer E, Wierzbicki R, Venner P, Skillings J, Letendre F: Phase II trial of recombinant tumor necrosis factor (rTNF) in patients with renal cell carcinoma (RCC). Proc Am Soc Clin Oncol 1990;9:139.Google Scholar
  7. (7).
    Figlin R, De Kernion J, Sarna G, Moldawer N, Saks S: Phase II study of recombinant tumor necrosis factor (rTNF) in patients with metastatic renal cell cancer (RCCa) and malignant melanoma (MM). Proc Am Soc Clin Oncol 1988;7:169.Google Scholar
  8. (8).
    Fujita T, Asano H, Haide Y, Ono Y, Onshima S, Suzuki K, Aso Y, Ariyoshi Y, Fukushima M, Ota K: Antitumor effects of human lymphoblastoid interferom on advanced renal cell carcinoma. J Urol 1988;139: 256–258.PubMedGoogle Scholar
  9. (9).
    Goldstein D, Laszlo J: Interferon therapy in cancer: from imaginon to interferon. Cancer Res 1986;46: 4315–4329.PubMedGoogle Scholar
  10. (10).
    Grups JW, Frohmüller HG: Cyclic interferon gamma treatment of patients with metastatic renal cell carcinoma. Br J Urol 1989;64:218–220.PubMedCrossRefGoogle Scholar
  11. (11).
    Heicappell R, Ackermann R: Rationale for immunotherapy of renal cell carcinoma. Urol Res 1990;18:357–372.PubMedCrossRefGoogle Scholar
  12. (12).
    Horoszewicz JS, Murphy GP: An assessment of the current use of human interferons in therapy of urological cancers. J Urol 1989;142:1173–1180.PubMedGoogle Scholar
  13. (13).
    Huber C, Aulitzky W, Gastl G, Aulitzky WE, Herold M, Frick J: Treatment of metastasizing renal cell carcinoma with an optimum biological response modifying dose of r-IFN-gamma. J Biol Resp Modif 1989;98:335.Google Scholar
  14. (14).
    Kirkwood JM, Ernstoff MS: Interferons in the treatment of human cancer. J Clin Oncol 1984;2:336–352.PubMedGoogle Scholar
  15. (15).
    Kriegmair M, Hofstetter A: Interferontherapie in der Urologie. Urologe. A 1989;28:116–121.PubMedGoogle Scholar
  16. (16).
    Krown SE: Therapeutic options in renal cell carcinoma. Sem Oncol 1985;12 (Suppl 5): 13–17.Google Scholar
  17. (17).
    Krown SE: Interferon treatment of renal cell carcinoma: current status and future prospects. Cancer 1987;59:647–651.PubMedCrossRefGoogle Scholar
  18. (18).
    Levens W, Sohn M, Richter R, Räth U, Kempini J, Jakse G: TNF/Gamma interferon in metastatic renal cell carcinoma. Eur Urol 1990;18 (Suppl 1): 148 (abstr).Google Scholar
  19. (19).
    Morgan DA, Ruscetti FW, Gallo RC: Selective in vitro growth of T-lymphocytes from normal bone marrows. Science 1976;193:1007–1008.PubMedCrossRefGoogle Scholar
  20. (20).
    Muss HB: The role of biological response modifiers in metastatic renal cell carcinoma. Sem Oncol 19xx;15 (Suppl 15): 30–34.Google Scholar
  21. (21).
    Neidhart J, Gagen M, Kisner R, Tuttel R, Whisman J: Therapy of renal cancer with low (LD) and high (HD) dose regimens of human lymphoblastoid interferon (HBLJ: Wellferon). Proc Am Soc Clin Oncol 1984;3:60.Google Scholar
  22. (22).
    Neidhart JA, Gagen MM, Young D, Tuttle R, Melink TJ, Ziccarrelli A, Kisner D: Interferon-alpha therapy of renal cancer. Cancer Res 1984;44:4140–4143.PubMedGoogle Scholar
  23. (23).
    Otto U, Schneider A, Denkhaus H, Conrad S: Die Behandlung des metastasierten Nierenkarzinoms mit rekombinantem Alpha-2 oder Gamma-Interferon. Ergebnisse zweier klinischer Phase-II-bzw.-III-Studien. Onkologie 1988;11:185–191.Google Scholar
  24. (24).
    Otto, U., Schneider AW, Conrad S, Klosterhalfen H: Combined therapy with tumor-necrosis-factor-alpha and alpha-2a-interferon: a promising new approach to metastatic renal cell carcinoma. J Urol 1990;143:392A.Google Scholar
  25. (25).
    Quesada JR, Swanson DA, Trindade A, Gutterman JU: Renal cell carcinoma: antitumor effects of leukocyte interferon. Cancer Res 1983;43:940–947.PubMedGoogle Scholar
  26. (26).
    Quesada JR, Swanson DA, Gutterman JU: Phase II study of interferon alpha in metastatic renal cell carcinoma. J Clin Oncol 1985;3:1086–1092.PubMedGoogle Scholar
  27. (27).
    Ratliff TL, Shapiro A, Catalona WJ, in Ratliff TL, Catalona W (eds): Urologic Oncology. Boston, Nijhoff, 1984, pp 211–238.Google Scholar
  28. (28).
    Rosenberg SA: The development of new immunotherapies for the treatment of cancer using interleukin-2. A review. Ann Surg 1988;208:121–135.PubMedCrossRefGoogle Scholar
  29. (29).
    Rosenberg SA, Lotze MT, Muul LM, Chang AE, Avis FP, Leitman S, Linehan WM, Robertson CN, Lee RE, Rubin JT, Seipp CA, Simpson CG, White DE: A progress report on the treatment of 157 patients with advanced cancer using lymphokine-activated killer cells and interleukin-2 or high-dose interleukin-2 alone. N Engl J Med 1987;316:889–897.PubMedCrossRefGoogle Scholar
  30. (30).
    Wirth M: The current use of interferons, interleukin-2 and tumor necrosis factor in renal cell cancer. Urol Int 1991;47:219–230.PubMedCrossRefGoogle Scholar
  31. (31).
    Wirth M: Stellenwert der Interferone, des Interleukin-2 und des Tumornekrosefaktors in der Therapie des Nierenzellkarzinoms. Urologe A 1991;30:77–80.PubMedGoogle Scholar

Copyright information

© Verlag Brüder Hollinek 1993

Authors and Affiliations

  • M. Wirth
    • 1
  1. 1.Urologischen Klinik und Poliklinik der Medizinischen Akademie DresdenDeutschland

Personalised recommendations