転移性腎細胞癌に対するInterferon-α,Interleukin-2,Gemcitabine 3剤併用免疫化学療法の経験

Abstract

interferon-α(IFNα), interleukin-2(IL-2), gemcitabineによる3剤併用免疫化学療法を施行した転移性腎細胞癌4例の治療成績について検討した.症例1(35歳男):IFNα, IL-2投与に抵抗性の傍大動脈リンパ節転移があり, 3剤併用免疫化学療法にて収縮率99%以上を獲得した.その後, 転移巣の増大は認めていない.症例2(51歳女):IFNα抵抗性の肺転移があり, 3剤併用免疫化学療法にて31%の縮小を得たが, 6ヵ月後に転移巣の増大を認めた.症例3(51歳男):IFNα投与が困難な皮膚転移, 対側腎の多発転移があり, 悪心嘔吐のため3剤併用投与は中止した.治療開始12ヵ月後, 対側腎転移に変化はない.症例4(52歳女):IFNα, IL-2抵抗性の肺転移があり, 進行性腎細胞癌の予後不良因子4項目以上を有した.転移巣が増大し, 発熱が強く, 3剤併用免疫化学療法は中止した.治療開始後6ヵ月で癌死した.副作用として発熱, 悪心嘔吐, 白血球減少, 貧血を認めたが, 3剤併用免疫化学療法は転移性腎細胞癌の有効な治療法でありうることが示唆された

Immunochemotherapy consisting of interferon-alpha (IFN-alpha), interleukin-2 (IL-2), and gemcitabine (GEM) for metastatic renal cell carcinoma. A partial response maintained for 15 months, was obtained in one case resistant to IFN-alpha and IL-2 of para-aortic lymph node metastases (case 1). A minor response with 30% reduction of lung metastasis was obtained in one IFN-alpha resistant case, and the duration was 6 months (case 2). In one case, in contra-lateral renal metastasis, no disease progression was obtained for 6 months (case 3). One case with resistance to IFN-alpha and IL-2, and who had preoperative abnormalities of corrected serum calcium, serum c-reactive protein and hemoglobin, had progressive disease and died of cancer after 6 months (case 4). Grade 3 toxicity was noted in leucopenia (4/4), anemia (1/4), and nausea/ vomiting (1/4). Although the response duration was short, the combination immunochemotherapy consisting of IFN-alpha, IL-2 and GEM may be a promising salvage regimen for the patients with metastatic renal cell carcinoma.