Treatment of metastatic renal cell carcinoma with constant-rate floxuridine infusion pins recombinant α2b-interferon

Abstract

Background: Floxuridine (FUDR) and α-interferon (IFN) are active agents in advanced renal cell carcinoma, with different dose-limiting toxic effects and antitumor synergism in experimental models. The main purpose of this phase II study was to assess the activity and toxic effects of a combination of FUDR and α2b-IFN in metastatic renal cell carcinoma. Patients ann methods: Metastatic renal cell carcinoma patients with measurable disease entered the study. FUDR was administered as a constant-rate continuous infusion for 14 days every 28 days at a starting daily dose of 0.1 mg/kg and with dose escalations of 0.025 mg/kg/day at each subsequent cycle if WHO ≤2 toxicity had not occurred. IFN-α2b 10 x 106 I.U. was administered intramuscularly 3 times per week. Results: Forty-two patients entered the study and a total of 272 cycles of FUDR + α2b-IFN were administered. In 41 evaluable patients WHO grade III-IV toxic effects included nausea and vomiting (22%), diarrhea (32%), stomatitis (12%), fatigue (27%) and anorexia (12%). It was possible to increase the initial FUDR does in 21 (50%) patients; the median FUDR dose intensity was 0.35 mg/kg/week (range 0.18-0.54). Among 39 evaluable patients, 3 (7.5%) complete and 10 (25.5%) partial responses were observed (response rate 33%, 95% confidence interval (CI) 19%-50%) which lasted a median of 13 months (5.5-40+). Responses also occurred in liver (2), in patients pretreated with systemic therapy (5) and in patients who had other unfavourable prognostic characteristics (7). Median progression-free and survival times were 9 and 16 months, respectively Conclusions: In this study FUDR + α2b-IFN demonstrated interesting activity in metastatic renal cell. carcinoma, showing promise also in patients with unfavourable prognostic characteristics. The antitumor activity of FUDR and α2b-IFN seems to be cumulative, but cumulative toxicity is also observed. These results require confirmation in randomised trials.