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By Robert H. Carlson
Special to DG News
NEW ORLEANS, LA -- May 25, 2000 -- The first randomized trial in metastatic renal-cell carcinoma comparing biological therapy alone against biological therapy plus surgery showed a 50-percent survival advantage with the combination.
Investigator Robert Flanigan, MD, Loyola University Stritch School of Medicine, in Maywood, IL, said this was the largest study of its kind. A total of 246 patients were recruited, and randomized to either surgical removal of the cancerous kidney followed by the immune boosting agent interferon-alfa-2b, or to interferon-alfa-2b treatment alone.
The purpose of surgery is cytoreduction, reducing the tumor burden to the patient, while the biological therapy bolsters the immune system.
Dr. Flanigan described the study, which was conducted throughout North America by the cooperative Southwest Oncology Group, at the 36th annual meeting of the American Society of Clinical Oncology, in New Orleans, LA.
He said patients who received the combination lived an average of 12 months, compared with eight months in those treated with immune therapy alone. All patients had very advanced cancers and they had received no previous treatment.
While the average length of improved survival was still short, Dr. Flanigan said some patients did much better than the average. Patients who had complete responses to therapy have experienced survivals of seven and eight years, he said.
"Based on this work, we believe there is a potential for an algorithm shift in the way we handle patients with metastatic renal cell cancer," Dr. Flanigan said. "In the future, we will probably advise patients to have their kidneys surgically removed, if it is feasible, prior to the onset of biological therapy."
He added that the option would probably be reserved for good-risk patients, that is, those with good performance status, minimal or no symptoms from the primary tumor in the kidney, and metastases only in the lungs.
Dr. Flanigan also said newer immune agents are now available, such as interleukin-2, which may offer even more of a survival benefit.
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