Hrushesky W J, Von Roemeling R, Fraley E E, Rabatin J T
Department of Oncology, University of Minnesota Hospital and Clinic, Minneapolis 55455.
Semin Surg Oncol. 1988;4(2):110-5.
We treated 25 patients with progressive metastatic renal cell carcinoma with continuous infusion of 5-fluoro-2-deoxyuridine (FUDR) by implanted pump. FUDR was infused for 14 days at monthly intervals. Starting dose was 0.15 mg/kg/day intravenous or 0.25 mg/kg/day intra-arterial; intravenous doses were increased or decreased in increments of 0.025 mg/kg/day as permitted by toxicity. Circadian time modification of the infusion shape (sinusoidal with the peak centered around 6 p.m.) significantly lowered serious intravenous infusion-associated toxicity, allowing higher dose intensity. In 24 evaluable patients, two complete responses (8%), six partial responses (25%), and one minor response were seen. One secondary partial response was observed after infusional velban (total objective response rate 37.5%). Previously progressive disease was controlled in greater than 80% of our patients. During a median follow-up period of 8 months (range of 2-26 months), the overall survival for all 25 patients is 75%. Our results indicate that metastatic renal cell cancer responds to infusional chemotherapy and that the circadian shape of infusion markedly affects our ability to deliver effective doses.
我们使用植入式泵持续输注5-氟-2-脱氧尿苷（FUDR）治疗了25例进展期转移性肾细胞癌患者。FUDR以每月一次的间隔输注14天。起始剂量为静脉注射0.15mg/kg/天或动脉注射0.25mg/kg/天；静脉注射剂量根据毒性情况以0.025mg/kg/天的增量增加或减少。输注方式的昼夜时间调整（呈正弦曲线，峰值集中在下午6点左右）显著降低了严重的静脉输注相关毒性，从而允许更高的剂量强度。在24例可评估患者中，观察到2例完全缓解（8%）、6例部分缓解（25%）和1例轻度缓解。在输注长春花碱后观察到1例继发性部分缓解（总客观缓解率37.5%）。我们超过80%的患者之前进展性疾病得到了控制。在中位随访期8个月（范围为2 - 26个月）期间，所有25例患者的总生存率为75%。我们的结果表明，转移性肾细胞癌对输注化疗有反应，且输注的昼夜模式显著影响我们给予有效剂量的能力。
