Gold P J, Thompson J A, Markowitz D R, Neumann S, Fefer A
University of Washington School of Medicine, Seattle 98195-6043, USA.
Cancer J Sci Am. 1997 Dec;3 Suppl 1:S85-91.
This article undertakes to define the response rate, long-term survival, and toxicity in patients with metastatic renal cell carcinoma (MRCC) treated with high-dose continuous intravenous infusion (CIV) recombinant interleukin-2 (rIL-2) with or without lymphokine-activated killer (LAK) cells.
One hundred twenty-three consecutive patients received CIV rIL-2 (18-22 MIU/m2/day on days 1-5, and 6-8 MIU/m2/day on days 10-19) on one of five sequential protocols at the University of Washington between 1988 and 1995. The first 76 patients received LAK cells. The median age was 55 years (range, 32-76 years), and 71% had undergone prior nephrectomy.
Nine patients achieved a complete response (7.3%) and 14 patients achieved a partial response (11.4%) for an overall response rate of 19% (95% confidence interval, 12%-26%). The median survival was 19 months, and the 5-year survival was 20%. Seven of nine complete responders (78%) remain in continuing complete response at 43+ to 109+ months. Intensive care unit and vasopressor support were required in 42% and 23% of patients, respectively, who received rIL-2 + LAK cells, and in 18% and 4% of those who received rIL-2 alone. There was one treatment-related death.
We report the largest single-institution experience and the longest survival for patients with MRCC treated with CIV rIL-2. The administration of rIL-2 by CIV is associated with less frequent intensive care unit and vasopressor support than with high-dose intravenous bolus regimens, and hence may enhance the therapeutic index in patients with MRCC.
本文旨在明确接受高剂量持续静脉输注（CIV）重组白细胞介素-2（rIL-2）联合或不联合淋巴因子激活的杀伤细胞（LAK）治疗的转移性肾细胞癌（MRCC）患者的缓解率、长期生存率及毒性。
1988年至1995年间，123例连续患者在华盛顿大学按照五个连续方案之一接受了CIV rIL-2治疗（第1 - 5天为18 - 22 MIU/m²/天，第10 - 19天为6 - 8 MIU/m²/天）。前76例患者接受了LAK细胞治疗。中位年龄为55岁（范围32 - 76岁），71%的患者曾接受过肾切除术。
9例患者达到完全缓解（7.3%），14例患者达到部分缓解（11.4%），总缓解率为19%（95%置信区间，12% - 26%）。中位生存期为19个月，5年生存率为20%。9例完全缓解者中有7例（78%）在43 +至109 +个月时仍持续完全缓解。接受rIL-2 + LAK细胞治疗的患者分别有42%和23%需要重症监护病房和血管升压药支持，而仅接受rIL-2治疗的患者中这一比例分别为18%和4%。有1例与治疗相关的死亡。
我们报告了接受CIV rIL-2治疗的MRCC患者最大的单机构经验和最长的生存期。与高剂量静脉推注方案相比，CIV给予rIL-2导致重症监护病房和血管升压药支持的频率更低，因此可能提高MRCC患者的治疗指数。
