Advertisement

Adjuvante Therapie des Nierenzellkarzinoms

  • M. Goepel
  • T. Otto
Conference paper

Zusammenfassung

Die adjuvante Therapie ist eine Zusatztherapie, die nach der vollständigen Entfernung alles erkennbaren Tumorgewebes durch eine Induktionstherapie (Operation, Strahlentherapie, Chemotherapie) durchgeführt wird. Das Ziel der adjuvanten Therapie ist die Konsolidierung der kompletten Remission, das heißt, daß die Effizienz der adjuvanten Behandlung nur anhand der Rate der lokalen oder systemischen Tumorprögression sowie anhand der Überlebenszeit und Lebensqualität des Patienten gemessen werden kann. Deswegen müssen hinsichtlich der Effizienz der adjuvanten Therapie und hinsichtlich der Patientenauswahl einige Voraussetzungen erfüllt werden. Untersuchungen an Patienten mit Harnblasenkarzinom haben gezeigt, daß nur eine komplette Remission das Überleben verlängern kann. Wenn man eine langfristige, komplette Remissionsrate von 20% für eine gegebene adjuvante Behandlung annimmt, so hängt der Überlebensvorteil von der Prognose der Patienten nach der Induktionsbehandlung allein ab:
  1. 1.

    Bei Patienten mit sehr guter Prognose und einer vermuteten Überlebensrate von 80% kann die adjuvante Therapie das Überleben nur um 2% verbessern; selbst eine große prospektive randomisierte Studie unter Einbeziehung von mehreren Tausenden von Patienten könnte eine solche niedrige Verbesserungsrate nicht dokumentieren.

     
  2. 2.

    Bei Patienten mit schlechter Prognose und einer Überlebensrate von nur 10% muß die adjuvante Therapie das Überleben um 18% verbessern, damit eine statistische Signifikanz des Vorteils der adjuvanten Therapie im Vergleich zur Induktionsbehandlung allein erreicht wird; in diese randomisierte Studie müßten ungefähr 600 Patienten einbezogen werden. Unter Berücksichtigung dieser Voraussetzungen werden in dieser Arbeit Tumormerkmale ebenso wie die Effizienz einiger Behandlungsmodalitäten des Nierenkarzinoms analysiert und der Wert der adjuvanten Behandlung bei den verschiedenen Patientengruppen beurteilt.

     

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Bassil B, Dosoretz DE, Prout GR Jr (1985) Validation of the tumor, nodes and metastasis classification of renal cell carcinoma. J Urol 134: 450–454PubMedGoogle Scholar
  2. 2.
    Belldegrun A, Uppenkamp I, Rosenberg SA (1988) Anti-tumor reactivity of human lymphokine activated killer (LAK) cells against fresh and cultured preparations of renal cell cancer. J Urol 139: 150–155PubMedGoogle Scholar
  3. 3.
    Bloom HJ (1973) Proceedings: Hormone-induced and spontaneous regression of metastatic renal cancer. Cancer 32: 1066–1071PubMedCrossRefGoogle Scholar
  4. 4.
    Buzaid AC, Robertone A, Kisala C, Salmon SE (1987) Phase II study of interferon alfa-2a, recombinant (Roferon-A) in metastatic renal cell carcinoma. J Clin Oncol 5: 1083–1089PubMedGoogle Scholar
  5. 5.
    Crivellari D,Tumolo S, Frustaci S et al. (1987) Phase II study of five-day continuous infusion of vinblastine in patients with metastatic renal-cell carcinoma. Am J Clin Oncol 10: 231–233PubMedCrossRefGoogle Scholar
  6. 6.
    De Forges A, Droz JP, Ghosn M,Theodore C (1987) Phase II trial of ifosfamide/mesna in metastatic adult renal carcinoma. Cancer Treat Rep 71: 1103PubMedGoogle Scholar
  7. 7.
    Elson PJ, Earhart R H, Kvols LK et al. (1987) Phase II studies of PCNU and bisantrene in advanced renal cell carcinoma. Cancer Treat Rep 71: 331–332PubMedGoogle Scholar
  8. 8.
    Evans WK, Shepherd FA, Blackstein ME, Osoba D, Taylor D (1985) Phase II evaluation of bisantrene in patients with advanced renal cell carcinoma. Cancer Treat Rep 69: 727–728PubMedGoogle Scholar
  9. 9.
    Figlin RA, deKernion JB, Mukamel E, Palleroni AV, Itri LM, Sarna GP (1988) Recombinant interferon alfa-2a in metastatic renal cell carcinoma: assessment of antitumor activity and antiinterferon antibody formation. J Clin Oncol 6: 1604–1610PubMedGoogle Scholar
  10. 10.
    Finney R (1973) The value of radiotherapy in the treatment of hypernephroma — a clinical trial. Br J Urol 45: 258–269PubMedCrossRefGoogle Scholar
  11. 11.
    Flocks RH, Kadesky MC (1958) Malignant neoplasms of the kidney: An analysis of 353 patients followed five years or more. J Urol 79: 196–199PubMedGoogle Scholar
  12. 12.
    Fossa S, Cavalli F, Otto U et al. (1988) Randomized study or roferon-a (IFN) with or without vinblastine (VLB) in advanced or metastatic renal cell cancer. Proc Annu Meet Am Soc Clin Oncol 7: A453Google Scholar
  13. 13.
    Fowler JE Jr (1986) Failure of immunotherapy for metastatic renal cell carcinoma. J Urol 135: 22–25PubMedGoogle Scholar
  14. 14.
    Fuks JZ,Van Echo DA, Aisner J, Mitchell EP,Woolley PV,Wiernik P H (1981) Phase II trial of methyl-G (methylglyoxal bis-guanylhydrazone) in patients with metastatic renal cell carcinoma. Cancer Clin Trials 4: 411–414PubMedGoogle Scholar
  15. 15.
    Giuliani L, Giberti C, Martorana G, Rovida S (1990) Radical extensive surgery for renal cell carcinoma: long-term results and prognostic factors. J Urol 143: 468–473PubMedGoogle Scholar
  16. 16.
    Hahn RG, Temkin NR, Savlov ED et al. (1978) Phase II study of vinblastine, methyl-CCNU, and medroxyprogesterone in advanced renal cell cancer. Cancer Treat Rep 62: 1093–1095PubMedGoogle Scholar
  17. 17.
    Harris DT (1983) Hormonal therapy and chemotherapy of renal cell carcinoma. Semin Oncol 10: 422–430PubMedGoogle Scholar
  18. 18.
    Herrlinger A, Sigel A, Giedl J (1984) Methodik der radikalen transabdominalen Tumornephrektomie mit fakultativer oder systematischer Lymphdissektion und deren Ergebnisse an 381 Patienten. (Method of radical transabdominal tumor nephrectomy with facultative or systemic lymph node dissection and results in 381 patients) Urologe [A] 23: 267–274Google Scholar
  19. 19.
    Hrushesky WJ, Roemeling R, Rabatin J, Fraley E (1988) Effective, safe outpatient treatment for progressive metastatic renal cell cancer. Proc Annu Meet Am Soc Clin Oncol 7: A515Google Scholar
  20. 20.
    Hrushesky WJ, Murphy GP (1977) Current status of the therapy of advanced renal carcinoma. J Surg Oncol 9: 277–288PubMedCrossRefGoogle Scholar
  21. 21.
    Isaacs A, Lindemann V (1957) Virus interference: The Interferon. Proc R Soc Ser B Biol 147: 258–267CrossRefGoogle Scholar
  22. 22.
    Juusela H, Malmio K, Alfthan O, Oravisto KJ (1977) Preoperative irradiation in the treatment of renal adenocarcinoma. Scand J Urol Nephrol 11: 277–281PubMedCrossRefGoogle Scholar
  23. 23.
    Kinney P,Triozzi P,Young D, Drago J, Behrens B,Wise H, Rinehart J (1988) Preliminary report of a phase II trial of interferon-ß serine in metastatic renal cell carcinoma. Proc Annu Meet Am Soc Clin Oncol 7: A627Google Scholar
  24. 24.
    Kjaer M, Iversen P, Hvidt V, Bruun E, Skaarup P, Bech Hansen J, Frederiksen PL (1987) A randomized trial of postoperative radiotherapy versus observation in stage II and III renal adenocarcinoma. A study by the Copenhagen Renal Cancer Study Group. Scand J Urol Nephrol 21: 285–289PubMedCrossRefGoogle Scholar
  25. 25.
    Krown SE (1985) Therapeutic options in renal-cell carcinoma. Semin Oncol 12 (Suppl): 13–17PubMedGoogle Scholar
  26. 26.
    Kuebler JP, HoganTF,Trump DL, Bryan GT (1984) Phase II study of continuous 5-day vinblastine infusion in renal adenocarcinoma. Cancer Treat Rep 68: 925–926PubMedGoogle Scholar
  27. 27.
    Kuebler JP, Goodman PJ, BrownTD, Crawford ED, Reitz CL, Knight WA 3d, Kish JA (1990) Phase II study of continuous infusion recombinant gamma interferon in renal carcinoma. A Southwest Oncology Group study. Invest New Drugs 8: 307–309PubMedCrossRefGoogle Scholar
  28. 28.
    Kurth KH, Debruyne FM, Hall RR et al. (1987) Embolization and postinfarction nephrectomy in patients with primary metastatic renal adenocarcinoma. Eur Urol 13: 251–255PubMedGoogle Scholar
  29. 29.
    Matthews VS, Kirkman H, Bacon RL (1947) Kidney damage in golden hamsters following chronic administration of Diethylstilbestrol and sesame oil. Proc Soc Exper Biol & Med 66: 195–196Google Scholar
  30. 30.
    McNichols DW, Segura JW, DeWeerd J H (1981) Renal cell carcinoma: long-term survival and late recurrence. J Urol 126: 17–23PubMedGoogle Scholar
  31. 31.
    Muss HB (1988) The role of biological response modifiers in metastatic renal cell carcinoma. Semin Oncol 15 (Suppl): 30–34PubMedGoogle Scholar
  32. 32.
    Myers JW,Von Hoff DD, Coltman CA Jr, Kuhn JG,Van Echo D, Rivkin S, Pocelinko R (1982) Phase II evaluation of bisantrene in patients with renal cell carcinoma. Cancer Treat Rep 66: 1869–1871PubMedGoogle Scholar
  33. 33.
    Neidhart JA, Anderson SA, Harris JE et al. (1991) Vinblastine fails to improve response of renal cancer to interferon alfa-n1: High response rate in patients with pulmonary metastases. J Clin Oncol 9: 832–6PubMedGoogle Scholar
  34. 34.
    Oishi N, Berenberg J, Blumenstein BA et al. (1987) Teniposide in metastatic renal and bladder cancer: a Southwest Oncology Group Study. Cancer Treat Rep 71: 1307–1308PubMedGoogle Scholar
  35. 35.
    Peters PC, Brown GL (1980) The role of lymphadenectomy in the management of renal cell carcinoma. Urol Clin North Am 7: 705–709PubMedGoogle Scholar
  36. 36.
    Pfeifle D M (1984) Teniposide in metastatic renal cancer. Proc Annu Meet Am Soc Clin Oncol 3: 162Google Scholar
  37. 37.
    Philip T, Negrier S, Stoter G et al. (1989) Interleukin-2 with or without LAK cells in metastatic renal cell carcinoma: a report of a European multicentre study. Eur J Cancer Clin Oncol 25 (Suppl): 21–28Google Scholar
  38. 38.
    Pizzocaro G, Piva L, Di Fronzo G et al. (1987) Adjuvant medroxyprogesterone acetate to radical nephrectomy in renal cancer: 5-year results of a prospective randomized study. J Urol 138: 1379–1381PubMedGoogle Scholar
  39. 39.
    Puckett JB, Richards F, Jackson DV et al. (1981) Combination chemotherapy of advanced renal cell carcinoma with megestrol acetate, CCNU, vinblastine, and cyclophosphamide. Proc Am Assoc Cancer Res 22: 380Google Scholar
  40. 40.
    Quesada JR (1988) Biologic response modifiers in the therapy of metastatic renal cell carcinoma. Semin Oncol 15: 396–407PubMedGoogle Scholar
  41. 41.
    Quesada JR, Kurzrock R, Sherwin SA, Gutterman JU (1987) Phase II studies of recombinant human interferon gamma in metastatic renal cell carcinoma. J Biol Response Mod 6: 20–27PubMedGoogle Scholar
  42. 42.
    Ritches EW, Griffiths IH,Thackray AC (1951) New growths of the kidney and ureter. Br J Urol 23: 297CrossRefGoogle Scholar
  43. 43.
    Robson CJ, Churchill BM, Anderson W (1969) The results of radical nephrectomy for renal cell carcinoma. J Urol 101: 297–301PubMedGoogle Scholar
  44. 44.
    Rosenberg SA, Lotze MT, Muul LM et al. (1985) Observations on the systemic administration of autologous lymphokine-activated killer cells and recombinant interleukin-2 to patients with metastatic cancer. N Engl J Med 313: 1485–1492PubMedCrossRefGoogle Scholar
  45. 45.
    Rosenberg SA, Lotze MT, Muul LM et al. (1987) 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 316: 889–897PubMedCrossRefGoogle Scholar
  46. 46.
    SchaerfeT, Mueller S, Riedmiller H, Jacobi G H, Hohenfellner R (1989) Immunotherapy of metastasizing renal cell carcinoma. Results of a multicentered trial. Urol Int 44: 1–4CrossRefGoogle Scholar
  47. 47.
    Schnall SF, Davis C, Ziyadeh T et al. (1986) Treatment of metastatic renal cell carcinoma with intramuscular recombinant interferon a. Proc Annu Meet Am Soc Clin Oncol 5: 227Google Scholar
  48. 48.
    Skinner D G, Pritchett TR, Lieskovsky G, Boyd SD, Stiles QR (1989) Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg 210: 387–392PubMedCrossRefGoogle Scholar
  49. 49.
    Sommer HH, Fossa SD, Lien HH (1985) Combination chemotherapy of advanced renal cell cancer with CCNU and vinblastine. Cancer Chemother Pharmacol 14: 277–278PubMedCrossRefGoogle Scholar
  50. 50.
    Spicer D, Daniels J, Skinner D, Johnson K (1985) Phase II study of bisantrene administered weekly in patients with advanced renal cell carcinoma. Proc Am Soc Clin Oncol 4: 101Google Scholar
  51. 51.
    Swanson DA, Johnson DE, von Eschenbach AC, Chuang VP, Wallace S (1983) Angioinfarction plus nephrectomy for metastatic renal cell carcinoma — an update. J Urol 130: 449–452PubMedGoogle Scholar
  52. 52.
    TakakuT, Kumamoto Y, Koiso K et al. (1987) Phase II study of recombinant human interferon gamma on renal cell carcinoma. Cancer 60: 929–933CrossRefGoogle Scholar
  53. 53.
    Tannock IF, Evans WK (1985) Failure of 5-day vinblastine infusion in the treatment of patients with renal cell carcinoma. Cancer Treat Rep 69: 227–228PubMedGoogle Scholar
  54. 54.
    Torti FM (1983) Treatment of metastatic renal cell carcinoma. Recent Results Cancer Res 85: 123–142PubMedGoogle Scholar
  55. 55.
    Tykka H, Oravisto KJ, Lehtonen T, Sarna S, Tallberg T (1978) Active specific immunotherapy of advanced renal-cell carcinoma. Eur Urol 4: 250–258PubMedGoogle Scholar
  56. 56.
    Werf-Messing B van der (1973) Proceedings: Carcinoma of the kidney. Cancer 32: 1056–1061PubMedCrossRefGoogle Scholar
  57. 57.
    West WH,Tauer KW,Yannelli JR, Marshall GD, Orr DW,Thurman GB, Oldham RK (1987) Constant-infusion recombinant interleukin-2 in adoptive immunotherapy of advanced cancer. N Engl J Med 316: 898–905PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • M. Goepel
  • T. Otto

There are no affiliations available

Personalised recommendations