3% of cancer occurs in the kidney, with around 12,000 renal-cancer deaths a year in the USA. Removal of part or all of the kidney (nephrectomy) is the standard treatment for renal cancer, although other treatments after surgery (eg, radiotherapy, chemotherapy) are not effective. Around half of patients with renal cancer will have disease recurrence within 5 years.
Dieter Jocham from the University of Lubeck Medical School, Germany, and colleagues studied 558 patients from 55 medical centres in Germany with a renal tumour scheduled for nephrectomy. Before surgery, all patients were randomised to receive autologous renal tumour cell vaccine (six injections in the upper arm at 4-week intervals after surgery; the vaccine group) or no additional treatment (the control group).
Data were available for 379 patients. 5-year progression-free survival rates were 77% in the vaccine group and 68% in the control group. The vaccine was well tolerated, with only 12 adverse events associated with the treatment. The authors conclude that the vaccine can now be considered for renal cancer patients with tumours larger than 2.5 cm who have undergone nephrectomy.
Referring to Jocham and colleagues' study as an "immunological breakthrough", Mayer Fishman and Scott Antonia from H Lee Moffitt Cancer Center and Research Institute, Tampa, USA, state in an accompanying Commentary (p 583):"[Jocham and colleagues] carefully collected data are part of a broadening base of clinical observations of the potential to affect the biology of a solid tumour with non-toxic readministration of autologous tumour-derived materials. The key milestone is the suggestion of a fixed point-a non-toxic vaccine with a biological clinically relevant effect in T2-3N0 renal cancer-around which innovations can be built. Such a milestone can serve as a concrete step towards making adjuvant treatment of renal cancer a routine and effective intervention."
Contact:
Dr Dieter Jocham, Department of Urology, University of Lubeck Medical School, Ratzeburger Allee 160, 23538 Lubeck, Germany. T) 49-451-500-6113; F) 49-451-500-4666; E) prof.jocham.MUL@t-online.de
Dr Mayer Fishman, Department of Interdisciplinary Oncology, H Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; T) 1-813-972-8400 x8200; E) FishmaMN@moffitt.usf.edu
Embargoed 0001 h (London time) 20 February 2004. In North America the embargo for Lancet press material is 6:30pm ET Thursday 19 February 2004.
Journal
The Lancet