Chemotherapy of advanced renal cell carcinoma with vinblastine and CCNU

The role of systemic chemotherapy in the treatment of kidney cancer

Traditional cytotoxic chemotherapy has been considered to be ineffective in renal cell carcinoma, likely due to multiple mechanisms of high-level drug resistance proteins such as p-glycoprotein expressed by these cancers. Nonetheless, low level activity of several nucleoside analogues and the elucidation of critical molecular pathways and targets in this disease, such as the angiogenic pathway, provide hope that important advances can and will be made.

The role and value of surgery in metastatic renal adenocarcinoma: a retrospective clinical study of 106 nephrectomized cases

The results of treatment of 106 consecutive nephrectomized cases with metastatic renal adenocarcinoma were analyzed. Over 50% of the patients were dead at 1 year and more than 80% at 2 years from the first metastases. The corresponding 5-year survival rate was 7.3%. Fourteen patients demonstrated a response to radiotherapy, hormonal therapy, cytotoxic drugs, or active specific immunotherapy. The 5-year survival rate of the responders was 14.3% from the first metastases. The 5-year survival rate for 22 patients presenting with only one metastasis was 32%. The corresponding figure for patients presenting with multiple metastases was 1%. Complete excision of metastases was possible in 12 patients, whose 5-year survival rate was 58.3%. All patients with solitary metachronous metastases completely excised lived 5 years or more. It seems that a small number of metastatic renal adenocarcinomas are slow-growing tumors that may simulate a favorable effect of a therapy, but at the same time such disease with nephrectomy, usually with minor tumor burden, in fact may also react better to the treatment, and this feature can cause difficulties in judging the value of any therapy in metastatic renal adenocarcinoma.

Renal disease in the geriatric patient

Although there are physiologic and anatomic changes of the kidney that occur almost universally with aging, no specific kidney disease that is totally confined to the geriatric population has been identified. Kidney diseases that predominate in the elderly include vascular and atheroembolic diseases, obstructive nephropathies, nephropathies secondary to certain systemic diseases, and intrinsic kidney disease. An understanding of the age-related changes of renal architecture and function is necessary to distinguish them from actual diseases that affect the aged kidney. These changes and their probable consequences for the geriatric patient are reviewed. We then discuss particular aspects of renal diseases that occur more commonly or have unique age-related manifestations in the elderly.

Chemotherapy of advanced transitional cell carcinoma of the renal pelvis: report of 3 cases treated with vinblastine and chloroethyl-cyclohexyl-nitrosourea

Three patients with advanced transitional cell carcinoma of the renal pelvis were treated with 5 mg./m.2 body surface vinblastine intravenously weekly and 130 mg./m.2 chloroethyl-cyclohexyl-nitrosourea orally with 6-week intervals. One patient had a partial remission for 1.5 months and 2 had stationary disease for 6 and 2 months.

Follow-up of patients after nephrectomy for renal cell carcinoma

Follow-up of patients after nephrectomy for renal cell carcinoma is often inadequate. The sooner secondary lesions are identified and treated the better. Routine annual admission of these patients is urged for abdominal angiography, bone scan, chest roentgenograms, and specialized diagnostic procedures as indicated.

Current status of the therapy of advanced renal carcinoma

A preclinical murine renal model system is available for evaluation of the effectiveness of therapeutic agents. Clinical review reveals that objective response rates to hormonal agents reported since 1971 have been substantially lower than those reported prior to 1971. Many chemotherapeutic agents have not been adequately evaluated clinically or with the experimental model. Vinblastine to date may be the most active single agent with a 25% objective response rate. At the present time, it is uncertain whether combination chemotherapy or hormonal chemotherapy add to response rates obtained with single agents. There is some evidence that immunotherapy may be of some adjuvant benefit and, thus may provide an additional avenue of investigation.

Nonhormonal chemotherapy for disseminated renal cell carcinoma

Twenty-five patients with disseminated renal cell carcinoma have been followed for eleven months. These patients have been treated with CCNU, bleomycin, methotrexate, and platinum in various combinations. The results have been discussed in light of other studies using chemotherapeutic agents against this disease process.