Is interferon with or without vinblastine the "treatment of choice" in metastatic renal cell carcinoma? The Norwegian Radium Hospital's experience 1983-1986.

Fifty-seven of 66 patients with metastatic renal cell carcinoma (RCC) were evaluable for response after treatment with Interferon (IFN) - Alfa 2a (Roferon A, Roche) with or without Vinblastine (VB). Three different dose schedules were used in 3 subsequent trials: protocol 1: (18 evaluable patients): IFN 36 X 10(6) U tiw +/- VB 0.1-0.15 mg/kg/2-3 week; protocol 2: (13 patients): IFN 18 X 10(6) U tiw +/- VB 0.1 mg/kg/3 week; protocol 3: (26 patients): IFN 18 X 10(6) U tiw +/- VB 0.1 mg/kg/3 week. Twelve of the 57 patients obtained an objective response (CR:1; PR:11). Regarding the main indicator lesions responses were seen in lung metastases (10), lymph node metastases (1), and bone metastases (1). The median response duration was 243 days. No significant impact of the IFN/VB treatment on survival could be demonstrated. Flulike symptoms represented the main toxicity. Four patients developed mental confusion, and in 2 patients with visual disturbances retinal exudation was observed. In more than half of the patients, the drug(s) had to be reduced, delayed, or finally discontinued due to toxicity. It is concluded that IFN with or without VB yields a 15-20% response rate in metastatic RCC. Due to the considerable toxicity of the treatment and the lack of proof of survival improvement, the clinical usefulness of IFN therapy in RCC remains questionable. However, on the background of the present therapeutic nihilism in metastatic RCC, additional clinical trials using IFN in RCC are justified.