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

Abstract

SUMMARY.-Eighty patients with advanced metastatic renal cancer have been treated with hormones, chiefly medroxyprogesterone acetate (Provera). This progestational compound is remarkably free from side-effects and can be given in high dosage for long periods without serious complications. Ninety per cent of cases had multiple metastases: in 76% more than one organ was involved and nearly 50% were seriously ill or " terminal ".Subjective improvement occurred in at least 55%. BETWEEN 75% and 80% of patients treated for renal cell carcinoma will die within 10 years of their primary treatment, the majority with distant metastases. In a few of these cases the natural history of the disease will be unusual. For example, growth of metastases may be exceptionally slow or, following removal of a solitary lesion, the patient may live for a number of years without further recurrence. Very rarely spontaneous regression of pulmonary deposits may occur. For the vast majority of cases, however, the onset of clinical metastases heralds death within a year or two. The treatment of advanced renal cancer with cytotoxic drugs has been disappointing. Woodruff et al. (1967) reviewed the literature on this subject, and of 243 collected cases treated with 33 different non-hormonal agents only 10% showed signs of objective improvement: in most instances this was slight or of brief duration. Talley et al. (1969) have published their personal experience with various cytotoxic drugs against metastatic hypernephroma. Of 57 patients treated with 15 different non-hormonal compounds, chiefly alkylating agents, antimetabolites and vinblastine, objective improvement was seen in only two cases (3.50 %). Apart from these poor results, the agents employed are highly toxic and have a relatively small margin of safety.

Determination of Androgen, Progestin and Estrogen Receptors with Two Different Assays in Renal Cell Carcinoma

“…In classical experiments, Kirkman and Bacon [ 1 ] could induce renal tumors in male Syrian hamsters by treatment with estro gens. In a first clinical study, Bloom [2] reported a 14% objective response rate in 80 patients with metastatic renal cell carcinoma treated with medroxyprogesterone acetate. The beneficial effect of hormonal treatment was confirmed by several authors [3,4], However, other reports claimed that the therapy was ineffective in reduc ing tumor size [5,6].…”

Comparison of steroid receptor levels in renal‐cell carcinoma and autologous normal kidney

“…Bloom (1971Bloom ( , 1973 initially reported on the hormonal responsiveness of renal-cell carcinoma to Medroxyprogesterone acetate. Although repeated attempts to reproduce the initial response rate of this tumor to hormonal manipulation have been unsuccessful, definite responses were documented by a nmber of other investigators (Bracci et al, 1973;Okamoto et al, 1973).…”

Current status of the therapy of advanced renal carcinoma

“…Each of these nine studies includes a progestational agent, except that of Jenkin (13), wluch used androgens alone. The studies range in size There are nine studies in the literature prior to 1971 (2,13,18,22,23,25,(31)(32)(33) or androgenic hormonal therapy (1,7,16,17,30). Two of these studies are randomized ECOG studies (7,16) as is the study of Alberto and Senn (1).…”