However, this study had methodological restrictions. A large portion of patients were not properly followed due to his tological incompatibilities, lost of follow up, failure in vaccine production, and staging flaws. Taking all these into account, Jocham et al check FAQ results must be viewed with great caution. Excluding this trial from analysis Inhibitors,Modulators,Libraries meta analysis did not identify a DFS gain while heterogeneity was eliminated. Immunotherapy All three trials with immunotherapy pro vided DFS data. The meta analysis was per formed with acceptable heterogeneity although no gain could be observed. Other Therapies The situation of thalidomide, chemotherapy, hormone therapy, and biotherapy was identical the systematic review identified just one trial testing each of these therapies and no study demonstrated a survival benefit of adjuvant treatment.

Naito tested adjuvant UFT, Pizzocaro tested medroxipro gesterone, Margulis tested thalidomide, and Aitchison applied 5 fluorouracil and interferon alfa interleukin 2. The meta analysis of all studies demonstrated that all agents studied did not improved DFS. There was no sig nificant heterogeneity between trials. Toxicity Inhibitors,Modulators,Libraries Eight trials presented toxicity data. Adverse event descriptions were scarce and no single toxicity was described across all trials. Vaccine and immunotherapy caused mild but frequent skin induration, injection site pain, and flu like symp toms. Just one trial, which tested vaccine therapy, described grade 3 4 neutropenia and anemia. No trial Inhibitors,Modulators,Libraries described neutropenic fever, thrombocytopenia, or grade 5 events.

Inhibitors,Modulators,Libraries Despite the absence of details, most severe toxicities were presented in each trial and therefore worst toxicity meta analysis Inhibitors,Modulators,Libraries was feasible. Table 3 depicts the number of grade 3 4 events among the patients at risk. Discussion This systematic review sought to identify all types of drug interventions used as post surgical therapy for resected renal cell cancer. The evidence indicates that the adjuvant approaches studied are not capable of improving survival of non metastatic renal cancer patients while exposing patients to unnecessary toxicity. We included a broad spectrum of interventions to be evaluated in this meta analysis immunotherapy, anti angiogenic, hormonal and cytotoxic drugs combined or not with immunotherapy. None were shown to be effec tive in what could be interpreted as an absence of activ ity for each one of these approaches in the adjuvant setting.

Among the included trials, one deserves specific atten tion. Jocham et al tested an autologous vaccine and was the only trial to present a positive DFS result. How ever, these results might have been compromised due to worrisome methodological issues discussed here and elsewhere. www.selleckchem.com/products/chir-99021-ct99021-hcl.html All this justified the exclusion of the Joc ham trial from DFS analysis. The paucity of adverse event descriptions hampered toxicity meta analyses and many important events such as febrile neutropenia, nausea, and hypotension could not be evaluated.