Palliative and adjuvant chemotherapy of metastatic renal cancer.

Despite the prevalent scepticism regarding its value, chemotherapy for metastatic renal cell cancer was used in 45 patients, of whom 44 were nephrectomized, aged between 34 and 75 yr with a mean age of 57.3 yr. In 32 patients chemotherapy was used as palliative treatment because of the presence of their often multiple metastases or in 13 patients following surgical removal of metastases and/or histologically high-grade malignancy, as adjuvant treatment. Our treatment schedule consisted on day 1 of vinblastine 5 mg/m2 to a maximum of 10 mg provided intravenously in 1 or 2 to 3 week intervals X 6 and CCNU 130 mg/m2 orally each 6th week. This treatment schedule was supported by an intensive antiemetic regimen. Gastrointestinal side effects were well tolerated while 30% hematological depression necessitated extension of treatment intervals. The mean number of cycles was 2.5-3.7, respectively, with a maximum of 6. Palliative treatment resulted in 19% complete plus partial remission, 62% stabilization, and 19% progression, while adjuvant therapy proved to be superior with 10 of 13 patients in remission at 3-21 months, and 1 of 3 patients with metastatic recurrence in further remission for 20 months; two of three patients died. Palliative chemotherapy with CCNU-vinblastine acted successfully by blocking cancer progression, while adjuvant treatment together with surgical extirpation of metastases may have prolonged tumor-free remission.