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In recent years, interest has grown in the potential for using biologic response modifiers in the treatment of cancer. Biologic response modifiers are a group of various substances used by the body to control changes in cells and tissues, often those of the immune system. Interleukin-2 (IL-2) has been widely studied due to its ability in the laboratory to promote the killing of tumors by cells of the immune system. However, the use of IL-2 in larger doses causes several serious side effects including gastrointestinal toxicity, which results in nausea, vomiting, diarrhea, and abnormal liver function. However, interleukin-2 treatment by itself has never been observed to cause colonic ischemia. In colonic ischemia, the blood flow to portions of the colon is restricted, damaging the tissue. The condition is accompanied by cramp-like pain and bright red blood in the feces within a day. Evidence is now accumulating to suggest that colonic ischemia may occur as a complication when cancer patients are treated with both IL-2 and interferon-alpha, even though neither of these drugs produces the condition alone. Of 141 patients being treated with high-dose interleukin-2, only 21 received interferon-alpha in addition. Colonic ischemia developed in three of these 21 patients, and in none of the 120 patients who received high-dose IL-2 without the interferon. Severe diarrhea, as well, occurred more often among the 21 patients treated with both substances than in those treated only with IL-2. Three case reports are included. As biologic response modifiers become more commonly used therapeutically, physicians must become more alert to the side effects they may cause. (Consumer Summary produced by Reliance Medical Information, Inc.)

Wilms' tumor, or nephroblastoma, is a cancer of primitive embryonal cells of the kidney. It is the fourth most common childhood tumor. About 350 cases of Wilms' tumor are diagnosed each year in the United States. Wilms' tumor may also afflict adults, but this is quite rare and the entire medical literature on adult Wilms' tumor consists of about 200 cases. When cancers are this infrequent, there is usually insufficient experience and data upon which to base an informed therapeutic decision. It is clear, however, that the prognosis of adult Wilms' tumor is poor, and that a child with a nephroblastoma of equivalent size and stage enjoys a better prognosis. Recently, however, attempts to treat Wilms' tumor in a 61-year-old woman achieved a complete remission. The patient presented with abdominal pain and blood in her urine; CT scan revealed a 12 centimeter necrotic mass in her left kidney. The mass was surgically removed and pathologic examination revealed that the tumor was consistent with the diagnosis of anaplastic Wilms' tumor. Another CT scan one year later revealed a mass and further enlargement of lymph nodes. The patient was treated with dactinomycin, doxorubicin, and vincristine, which failed to halt the progression of the cancer. However, a complete remission was achieved after treatment with cisplatin and etoposide. The patient has been monitored regularly with further CT scans, and at 18 months after completing chemotherapy she continues to be free of disease. This excellent response in an adult patient with an unfavorable histologic type of tumor suggests that the combination of cisplatin and etoposide warrants further scrutiny in the treatment of Wilms' tumor in adults. (Consumer Summary produced by Reliance Medical Information, Inc.)

Somewhat ironically, the rapid death of cancer cells in a patient undergoing chemotherapy may be a life-threatening condition, and even a cause of sudden death. The condition, called acute tumor lysis syndrome, begins when many cancer cells disintegrate and release their contents into the patient's body. The result is a rapid increase in potassium, calcium, uric acid, phosphate, and lactic acid in the blood. Kidney failure may result. Acute tumor lysis is most common among patients with high-grade lymphomas such as Burkitt's lymphoma or lymphoblastic lymphoma, and with acute lymphocytic leukemia. While the condition is most likely to result from treatment with cytotoxic drugs, a case was recently seen in which the tumor lysis resulted from treatment with corticosteroids. A 19-year-old man with a high-grade non-Hodgkin's lymphoma was treated for apparent spinal cord compression with an emergency injection of dexamethasone. Within 12 hours, changes in the blood chemistry indicative of acute tumor lysis appeared. The patient was appropriately treated; within two days the abdominal lymphoma was no longer palpable. Two other cases have appeared in the medical literature describing acute tumor lysis resulting from corticosteroid treatment. One of the three cases now reported indicates that acute tumor lysis may result even from moderate corticosteroid doses. However, all three cases were high-grade lymphomas, which suggests that the patients susceptible to acute tumor lysis syndrome from corticosteroids are probably similar to those susceptible from cytotoxic drug treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)