Methotrexate-citrovorum factor used alone and in combination chemotherapy for advanced hypernephromas

Methotrexate-citrovorum factor (MTX-CF) therapy was administered to 20 patients with advanced renal cell carcinoma. Eight patients were treated with MTX-CF only. Two patients who received short-term rescue showed partial remissions along with severe toxicity including gastrointestinal symptoms and bone marrow depression. Twelve patients were treated with a combination of MTX-CF, vincristine, bleomycin, and an alkylating agent (either peptichemio or cyclophosphamide). In this latter group, patients with a glomerular filtration rate of greater than 70 ml/minute received 150-400 mg/m2/cycle of MTX. Patients with decreased renal function (less than 70 ml/minute) received 35-100 mg/m2/cycle of MTX. Two of seven patients with a decreased glomerular filtration rate showed partial remissions and four patients had static disease. One patient in the group of five with normal renal function showed static disease. None showed objective improvement. The median survival time was 25 months for patients with partial remission and static disease and 4.75 months for patients with progression. This difference is highly significant (P less than 0.0005). These results seem to justify further investigations of MTX-CF therapy in hypernephromas, even in the presence of impaired renal function.