Heinzer H, Huland E, Aalamian M, Huland H
Urologische Klinik und Poliklinik, Universitätskrankenhaus Eppendorf, Hamburg.
Urologe A. 1999 Sep;38(5):466-73. doi: 10.1007/s001200050315.
Systemic immunotherapy, notably with interleukin-2 (IL-2) and interferon-alpha (IFNalpha), has yielded a response rate of 10 % to 30 % in metastatic renal cell carcinoma. However, systemic immunotherapy is limited by severe side effects, and long-lasting response is rare. Tumor palliation and quality-of-life are important end points for evaluating the clinical benefits of immunotherapy. Experimental and clinical treatment models have proved that local IL-2 application is less toxic than systemic treatment and is therapeutically effective. Here we report long-term experience with inhalation IL-2 therapy in 188 patients who had progressive pulmonary metastatic renal cell carcinoma. High-dose inhalation of IL-2 was used with low-dose systemic IL-2 or IFNalpha. Maximal toxicity over the total treatment time was mild, and the low incidence of WHO grade 3 toxicity (24 %) allowed social activities and performance of social roles. Comedication for systemic side effects was required only in half of the patients. Inhaled IL-2 prevented progress of pulmonary metastases in 68 % of patients for a median period of 9.8 months. Median survival was 12.4 months compared with the expected 5.3 months and quality-of-life did not differ substantially from pretreatment status. Local treatment can be applied alone or in combination with systemic therapy and can increase therapeutic efficacy.
全身免疫疗法，尤其是使用白细胞介素-2（IL-2）和α干扰素（IFNα），在转移性肾细胞癌中的缓解率为10%至30%。然而，全身免疫疗法受到严重副作用的限制，且持久缓解罕见。肿瘤缓解和生活质量是评估免疫疗法临床益处的重要终点。实验和临床治疗模型已证明，局部应用IL-2的毒性低于全身治疗，且具有治疗效果。在此，我们报告了188例进行性肺转移性肾细胞癌患者吸入IL-2治疗的长期经验。采用高剂量吸入IL-2联合低剂量全身应用IL-2或IFNα。整个治疗期间的最大毒性为轻度，世界卫生组织3级毒性的发生率较低（24%），患者能够进行社交活动并履行社会角色。仅半数患者需要使用药物治疗全身副作用。吸入IL-2可使68%的患者肺部转移灶进展得到中位时间为9.8个月的控制。中位生存期为12.4个月，而预期生存期为5.3个月，生活质量与治疗前状态相比无显著差异。局部治疗可单独应用或与全身治疗联合应用，可提高治疗效果。
