Naoki Mitsuhata

Intravesical treatment of bladder cancer with recombinant human interferon-β : intravesical GKT-β chemotherapy research group (Chairman : Tadao Niijima)

SummaryIn order to examine its clinical efficacy, recombinant human interferon-β (rIFN-β) was instilled intravesically into 51 patients with superficial bladder cancer. Ten patients, who received intermittent intravesical instillation at a dose of (3−36) × 106 U rIFN-β on days 1–3 every week, showed no response. Thirty-two patients received intravesical instillation at a dose of (3−36) × 106 U every day for 10–20 days. Eight patients showed partial response, indicating an efficacy rate of 25%. Nine patients received divided doses of 18 × 106 U twice a day every day for 10–20 days. Six patients showed partial response, indicating an efficacy rate of 67%. This value was significantly higher than that obtained by administering divided doses. The response to intravesical instillation therapy with rIFN-β varies with treatment protocol. Frequent and longer exposure to rIFN-β may induce better regression of superficial bladder cancer. Six incidences of side-effects were found in five cases (9.8%): pollakiuria in one, pain on micturition in two, fever in two, and eruption in one case. All of these side-effects were slight and reversible after drug withdrawal. Laboratory tests showed only a few changes with low severity. Thus, rIFN-β is potentially a new drug for instillation therapy of superficial bladder cancer, in view of the absence of adverse effects.

Intra-Arterial Infusion Chemotherapy in Combination with Angiotensin II for Advanced Bladder Cancer

A combination of 50 to 80 mg. per m.2 cis-platinum and 30 to 50 mg. per m.2 doxorubicin or 30 to 50 mg. per m.2 tetrahydropyranyl-doxorubicin instead of doxorubicin was infused into the bilateral internal iliac artery for the treatment of 20 patients with T3 or T4 advanced bladder cancer. Angiotensin II was administered together with these chemotherapeutic agents by means of an infusion pump at a rate of 1.5 to 2.0 micrograms. per minute for 20 minutes for both sides. Among the 20 patients complete (9) and partial (8) responses were obtained after only 1 or 2 courses of this intra-arterial treatment. Histological examination showed severe tumor destruction with no viable cells in 6 and no tumor in 4 of the 15 evaluable cases. Selective enhancement of regional blood flow in the tumor region after intra-arterial infusion of angiotensin II was observed by continuous target arterial 81mkrypton infusion. Intra-arterial chemotherapy with combined angiotensin II may be clinically useful for treatment of primary or metastatic bladder carcinoma.

What Disease Conditions could be Considered for Potential Therapeutic Kidney Donations

We coined the term “therapeutic kidney donation” specifically in reference to donatable kidneys that have been nephrectomized due to urologic diseases and reviewed various series of reports and empirical sporadic reports. Kidneys with small renal tumors and distal ureter tumors in addition to benign kidney pathologies have historically been used for transplantation. Some ethical problems exist in cases in which therapeutic donor kidneys are used for unrelated living transplantation but not for related transplantation. Therefore, a well-organized national project, such as the OPTN policy, is awaited. Kidneys with small renal masses are an attractive source for donation, but these organs have several unsolved problems, including locally advanced stages, high histological grades, multifocality, and distant metastasis. Further clinical studies are warranted to organize and recruit proper therapeutic kidney donation for restored kidney transplantation.