Early experience with targeted therapy and dendritic cell vaccine in metastatic renal cell carcinoma after nephrectomy

• Published in: International Brazilian journal of urology Vol. 37; no. 2; pp. 180 - 186
• Main Authors: Dall'Oglio, Marcos F, Sousa-Canavez, Juliana M, Tanno, Fabio Y, Tiseo, Bruno C, Crippa, Alexandre, Dos Reis, Sabrina T, Leite, Katia R M, Srougi, Miguel
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Urologia 01-04-2011
• Subjects: Antineoplastic Agents - therapeutic use; Cancer Vaccines - therapeutic use; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - surgery; Combined Modality Therapy - methods; dendritic cells; Dendritic Cells - immunology; Humans; Indoles - therapeutic use; Kidney Neoplasms - drug therapy; Kidney Neoplasms - surgery; Male; Middle Aged; Neoplasm Metastasis; Nephrectomy; Pyrroles - therapeutic use; renal cell carcinoma; Sunitinib; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1677-5538; 1677-6119; 1677-5538
• DOI: 10.1590/S1677-55382011000200004

Metastatic renal cell carcinoma (RCC) is one of the most treatment-resistant malignancies and nephrectomy, isolated or combined with systemic chemotherapy typically has limited or no effectiveness. We report our initial results in patients treated with the association of molecular targeted therapy, nephrectomy, and hybrid dendritic-tumor cell (DC) vaccine.
Two male patients diagnosed with metastatic RCC were selected for the study. They were treated with the triple strategy, in which sunitinib (50 mg per day) was given for 4 weeks, followed by radical nephrectomy after two weeks. DC vaccine was initiated immediately after surgery and repeated monthly. Sunitinib was restarted daily after 2 to 3 weeks of surgery with a 7-day interval every 4 weeks.
Both patients had complete adherence to the proposed treatment with DC vaccine therapy combined with sunitinib. Follow-up in these patients at 9 and 10 months demonstrated a stable disease in both, as shown by imaging and clinical findings, with no further treatment required.
The immune response obtained with DC vaccine combined with the antiangiogenic effect of sunitinib and the potential benefits of cytoreductive nephrectomy in advanced disease could represent a new option in the treatment of metastatic RCC. Further prospective trials are needed not only to elucidate the ideal dosing and schedule, but also to better define the proof-of-concept proposed in this report and its role in clinical practice.