Tumor-targeted chemotherapy with SMANCS in Lipiodol for renal cell carcinoma: Longer survival with larger size tumors

Objectives. To evaluate the anticancer effects of a lipophilic macromolecul ar anticancer agent, poly(styreneco-maleic acid)-conjugated neocarzinostati n (SMANCS), dissolved in a lipid contrast medium (Lipiodol) given via the r enal artery to patients with renal cell carcinoma. Methods, Among 467 patients with renal cell carcinoma treated between April 1984 and March 1993, 191 were treated with SMANCS dissolved in a lipid con trast medium (a 3:2 mixture of Lipiodol F and Lipiodol Ultrafluid; Lpd). Se lective arterial infusion of SMANCS/Lpd was performed at a dose of 1.0 or 1 .5 mg/mL. The infusion was repeated at intervals of about 2 weeks or longer , but the doses and the total number of infusions varied among patients, ac cording to results of computed tomography analysis. Results. Statistical analysis was performed for 415 patients who met the cr iteria of this study. Twenty-six surgical patients with metastases who unde rwent infusion therapy of SMANCS/Lpd for primary lesions showed 3 and 5-yea r survival rates of 23.0% and 12.8%, respectively; the rates were 19.3% and 9.7% in 31 patients who did not receive SMANCS infusion therapy. In 125 su rgical patients without metastases who underwent SMANCS/Lpd infusion, the 5 and 10-year survival rates were 83.0% and 75.2%, respectively, whereas rat es of 84.6% and 78.9% were observed in 199 surgical patients whose median t umor size was significantly smaller, however, than the SMANCS/Lpd infusion group. The maximal tumor diameter at the beginning of treatment was signifi cantly larger (mean diameter 70.8 mm) in the SMANCS/Lpd infusion group than in the noninfusion group (59.1 mm). The survival rate was statistically be tter for patients with tumors of 100 mm diameter or larger in the SMANCS/Lp d infusion group (P <0.05): 5 and 10-year survival rates were 70.4% and 61. 6%, respectively, for the infusion group and 64.6% and 50.9% for the group receiving no drug. In patients with larger tumor (greater than 110 mm), the survival rate at 13 years was 75% in the SMANCS/Lpd infusion group and 0% in the surgery group. Conclusions. Arterial infusion therapy with SMANCS/Lpd appears to be effect ive for large renal cell carcinoma without metastases in conjunction with s urgery. UROLOGY 55: 495-500, 2000. (C) 2000, Elsevier Science Inc.