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J R Franklin

Publications and source records attributed to J R Franklin.

7 recordsLinked to original sources
PubMed1998

Superficial bladder cancer: the role of interferon-alpha.

PURPOSE: We evaluate the clinical experience with recombinant interferon-alpha in superficial transitional cell carcinoma and discuss the most rational use of recombinant interferon-alpha in the context of current treatment options. MATERIALS AND METHODS: The available data were reviewed and discussed at a consensus conference in August 1996. The conclusions and recommendations are those of the authors based on the consensus reached at that meeting. RESULTS: While bacillus Calmette-Guerin (BCG) is recognized as the most efficacious intravesical agent in the prophylaxis and treatment of superficial transitional cell carcinoma, it is associated with significant toxicities and a 20 to 40% relapse rate. Interferons, particularly recombinant interferon-alpha, have demonstrated efficacy against primary and recurrent papillary transitional cell carcinoma and carcinoma in situ with minimal toxicity, although the response and relapse rates are inferior to BCG. Intravesical recombinant interferon-alpha therapy has also produced responses in patients who failed to respond or were refractory to BCG or chemotherapy. CONCLUSIONS: The clinical experience suggests that recombinant interferon-alpha has an important role in the treatment of superficial transitional cell carcinoma, particularly as second line therapy following failure of BCG or chemotherapy, and it may have synergistic effects when combined with chemotherapy or BCG. We propose a prospective randomized study comparing the efficacy of recombinant interferon-alpha, BCG and BCG plus recombinant interferon-alpha as maintenance following complete response to primary BCG therapy. The proposed study would also investigate the efficacy of BCG plus recombinant interferon-alpha as second line therapy following BCG failure. This study will be important to determine the most effective strategy to integrate recombinant interferon-alpha into current treatment options for superficial bladder cancer.

Administration, Intravesical↗
PubMed1996

Renal cell carcinoma: basic biology and clinical behavior.

The incidence of renal cell carcinoma (RCC) has gradually increased, and approximately 40% of all patients diagnosed with this disease will die of it. With the increasing availability of ultrasonography and computed tomography (CT) scanning, incidental renal tumors are more frequently diagnosed. Overall, conflicting evidence still exists to support a trend towards early diagnosis and/or a change in the natural history of the disease. The localization of the von Hippel-Lindau (VHL) tumor suppressor gene and other regions on chromosome 3p have contributed significantly to our understanding of the molecular genetics of both familial and sporadic RCC. Moreover, distinction between different cell types of RCC are being made at the molecular and genetic level. A relationship between environmental factors, such as cigarette smoking, and these genetic disturbances has yet to be determined. Although different determinants of nuclear grading are being proposed as prognostic factors, no convincing evidence has been identified to support the use of other molecular markers, such as the p53 tumor suppressor gene and epidermal growth factor. With regard to treatment, beyond the role of surgery in organ-confined RCC, other therapies for RCC are limited. Furthermore, immunotherapy has shown the best promise by providing durable responses in patients with advanced disease.

Carcinoma, Renal Cell↗
PubMed1996

Cytoreductive surgery in the management of metastatic renal cell carcinoma: the UCLA experience.

We assessed the role of cytoreductive surgery in patients with metastatic renal cell carcinoma (RCC) selected for interleukin-2 (IL-2)-based immunotherapy. Sixty-three consecutive newly diagnosed patients with metastatic RCC were treated at our institution between April, 1990 and October, 1994. The patients were selected based on their ability to undergo a radical nephrectomy and to receive a combination of interleukin-2 and interferon alfa (IFN-alpha). The mean age was 58.7 years (range, 34-74 years). All but one patient had an Eastern Cooperative Oncology Group performance status of 0 or 1, and presented with metastatic disease and locally advanced primary tumors. All patients successfully underwent cytoreductive nephrectomy, but 6 patients (10%) required concomitant resection of caval thrombus, 3 (5%) required partial hepatectomy, 2 (3%) needed duodenal repairs, and 1 (2%) required a splenectomy. Postoperative complications were observed in 8 patients (12.7%). There were no postoperative mortalities. Seven patients (11%) could not undergo immunotherapy because of myocardial infarctions (n = 2), no growth of tumor infiltrating lymphocytes (TILs) (n = 1), deterioration of performance status (n = 1), transient ischemic attack (n = 1), chronic renal failure (n = 1), and a diagnosis other than RCC (n = 1). Overall, 56 of 63 (88%) patients selected underwent immunotherapy. Among these 56 patients, a response rate of 33.9% [7 (12.5%) complete, and 12 (21.4%) partial] was observed. Moreover, the 2- and 3-year survival rates were 43% and 38%, respectively. Our results support the argument for an aggressive approach (surgery combined with IL-2-based immunotherapy including TILs) in the management of metastatic RCC. Further studies are needed to elucidate the individual contributions of these therapeutic processes.

Adult↗
PubMed1995

Surgery from a US perspective.

Prostate screening has made it possible to detect organ confined prostate carcinoma in men with a life expectancy of 20 years and longer. These clinically significant malignancies may be successfully eradicated by means of anatomical dissection of the prostate, which minimizes both morbidity and mortality. In a retrospective series of patients with clinically localized prostate cancer who were treated with a radical retropubic prostatectomy and lymph node dissection, 5 and 10 year crude survival rates were 96% and 86%. Survival was compromised by penetration of tumour through the prostatic capsule, and even more significantly by involvement of the seminal vesicles. The use of prostate specific antigen (PSA) concentrations to monitor disease progression before any clinical manifestation revealed that disease free survival was less than previously reported. Patients diagnosed and treated more recently had longer disease free survival than the overall group mainly because of earlier detection with PSA, with consequent lower tumour volumes and stage. In addition, 92 +/- 3(SD)% patients with pathologically organ confined tumours, without capsular or seminal vesicle invasion, are clinically disease free with non-detectable PSA at 5 years. Our data therefore show that radical prostatectomy can cure patients with organ confined prostate cancer, with acceptable morbidity. Although the need for cure may be questioned in many patients, young patients with prostate cancer almost certainly benefit from eradication of the malignancy.

Adult↗