Chemo-immuno-hormonal combination therapy for metastatic renal cell carcinoma

Our in vitro study verified that medroxyprogesterone acetate has a suppressive action to MDR gene expression on renal cell carcinoma cell line. This study was conducted to assess the clinical efficacy and toxicity of combination therapy using Interferon (IFN) α-2a, vinblastine (VBL) and medroxyprogesterone acetate (MPA) in the management of metastatic renal cell carcinoma (RCC). The protocol was a 4 weeks- treatment regimen (1cycle) that consisted of VBL (3mg/m2, IV every 4 weeks), IFN α-2a (6 million U/day, IM, 3 times per week), and MPA (600mg, IM, every 2 weeks) for at least 3 cycles in outpatient basis. The entries enrolled into study were 33 patients (23 males and 10 females, mean age 58.5 years). All patients were stage T3 or higher with regional lymph node (LN) or distant metastasis. We excluded the patients who showed Eastern Cooperative Oncology Group (ECOG) performance scale 4. Mean ECOG performance scale was 1.5 and an average of 6 cycles of combination therapy was conducted. Eighteen patients already underwent radical nephrectomy prior to this therapy. There were 71 measurable indicator foci (lung, liver, bone, and regional LN) including 16 tumors in unresected kidneys. Among the 71 measurable foci, 3 complete response (CR) and 19 partial response (PR) were seen. Overall response rate was 33.3% (CR in one case and PR in 10 cases). Mean survival was significantly longer in the lower ECOG scale group than that in the higher scale group. However, resection of the primary tumor did not influence the mean survival. Of 10 patients with PR, 2 patients achieved CR by pulmonary lobectomy followed by combination therapy. Side effects related to the treatment were minimal. There were no withdrawal or death related to this combination therapy. Thischemo-immuno-hormonal combination therapy is an alternative treatment modality in advanced RCC considering its efficacy and minimal side effects. However, in order to verify us usefulness, a large scale prospective randomized trial is desirable.