[New concepts in systemic chemotherapy]

The availability of sufficient amounts of cytokines for clinical use has opened new opportunities in the systemic treatment of malignant diseases. The two haematopoetic growth factors G-CSF and GM-CSF, used either alone or in combination with separation and retransfusion of peripheral haematopoetic progenitor cells, have allowed dose escalations of cytostatic agents for which myelosuppression is a dose-limiting toxicity. This has implications especially for the treatment of relapsed and very advanced testicular carcinomas. High-dose chemotherapy followed by autologous blood progenitor cells and haematopoetic growth factors seems to produce significantly better therapeutic results than standard-dosed chemotherapy in these situations. The immunomodulating agents IL2 and IL4 are currently undergoing clinical trials and seem to have direct cytotoxic activities, especially in renal cancer. A new, potentially promising therapeutic modality is becoming available with the ability to transfer genetic material directly into either tumour or immunomodulatory effector cells (gene therapy). The insertion of certain genes coding for the production of cytokines or surface molecules can produce systemic antitumour reactions when these genetically altered cells are reimplanted into the host. All these subjects are currently subjects of detailed investigation and may change the therapeutic options for the treatment of advanced urological malignancies.