Ten publications between 1964 and 1971 suggest that tumor regression can be induced by hormone therapy in a limited number of patients with metastatic renal cancer. Subjective improvement occurs in about 50% of treated cases. Of 272 collected cases from the various reports (including a personal series of 80) who were treated with progestins or androgens, the overall objective response rate was 1596, the range being 6%-33%. I n the present author's series, if gravely-ill patients who died within 6 weeks are excluded, tumor regression was seen in 22% of cases, and in 27 of the men. Objective improvement is usually evident within 2 to 6 weeks of commencing treatment. Although the response is usually incomplete, or of limited duration, hormone therapy may offer a new lease of life to seriously ill and elderly patients for up to 2 or 3 years. Special consideration is given to spontaneous regression as a possible explanation for the responses observed during hormone administration. From the available evidence it is concluded that this treatment, and not a coincidental natural event, is responsible for the improvement.
VER THE PAST DECADE THERE HAS BEEN IN-0 creasing interest in the concept of hormonal influences in the development and progress of experimental and human kidney turnors,eJl@ and in the possibility of altering the natural history of advanced renal carcinoma by manipulating the endocrine environment of the host.6,7,10,30,37,3*,42,43 The idea of developing a hormonal treatment for patients with this disease has special appeal because of the poor results obtained in such cases with established cytotoxic drugs.lep38,45
Male predominance in cases of renal carcinoma and especially among examples of spontaneous regression; the influence of gonadal hormones on the normal kidney in experimental animals; the successful induction of renal tumors in hamsters by estrogen;20323 and the inhibition of such tumors by estrogenantagonists or endocrine ablation procedures,12.13>23 led us, in 1959, to try progestins and androgens in patients with advanced renal cancer for whom surgery and radiotherapy were no longer feasible.
Since our preliminary reports,s,6JO a number of other authors have published their experiences with gonadal hormones in the treat-