Medroxyprogesterone acetate in the treatment of renal cell carcinoma (hypernephroma)

Abstract

Medroxyprogesterone acetate, a potent synthetic progestational steroid, was administered to 23 patients with metastatic renal cell carcinoma. Seven patients received 300 mg/d orally. Six patients received 100 mg/d intramuscularly of the commercial preparation Provera. Ten patients were given 400 mg/w intramuscularly of an investigational preparation. Twenty‐one patients completed a minimum treatment period of 6 weeks and were considered evaluable. There were one complete and two partial objective remissions to the parenteral preparations. No responses were observed with the oral preparation. The dose to response varied from 5.2 to 9.0 Gm and the duration of response from 4 to 30+ months. There did not appear to be a correlation of response with age, duration of disease, or histologic grade or cell type. A “symptom status” indicating severe disability from disease did adversely affect response. Minimal side effects were weakness in two patients, loss of libido in one male patient and minimal signs of virilism in one female patient. Eleven patients who showed progressive disease after an adequate trial of medroxyprogesterone acetate received further treatment with testosterone. There was one partial objective response of 5 months' duration. These results are superior to those obtained with chemotherapy.

Oestrogen-Binding Components in Human Renal Cell Carcinoma

“…In this situation Between 70 and 80 per cent of all malignant kidney Bloom (4), Samuels (5), Paine (6) and Brühl(l) have tumours are renal cell carcinomas (1). Even if at the time drawn attention to the possibility of achieving significant of nephrectomy no distant metastases can be detected, tumour regression in a limited number of patients with about 50 per cent of the patients die within 5 years after renal carcinoma by administering steroid hormones.…”

Medroxyprogesterone Acetate (Provera) in the Treatment of Metastatic Renal Cancer

“…Compared with advanced cases not treated with hormones this is a conservative figure, since the duration of life in the present series had been measured from the onset of hormone therapy which in many patients was introduced some time after the appearance of recurrent tumour. It appears that an objective response of renal carcinoma to hormone therapy is accompanied by prolongation of life, a conclusion also reached by Samuels et al (1968).…”

“…It is interesting to note that progestin-induced histological changes in cases of endometrial cancer were observed within only 4 weeks in 75% of responding cases: in the remaining 25% such changes were delayed for 8-12 weeks (Sherman, 1966). On the other hand, experience elsewhere with renal cancer has indicated that signs of improvement may not appear until 2 months after starting hormone therapy (Samuels et al, 1968;Paine et al, 1970). Talley and his colleagues (1969) had to wait as long as 5 and 8 months before observing regression in their two cases.…”

“…This concept is strongly supported by the short interval between commencing or changing hormone treatment and observing clinical or radiological signs of improvement. Furthermore, there are now reports of similar experience from other centres (Melander et al, 1967;Samuels et al, 1968;Talley et al, 1969;Paine et al, 1970).…”

“…The best results in the present series, including the total disappearance of large metastatic or recurrent tumours, have been confined to men. On the other hand, Samuels et al (1968) refer to a woman aged 56 with complete regression of an abdominal recurrence during treatment with Provera and in whom the response was still maintained at 30 months.…”