[Questionnaire Survey on Adjuvant Chemotherapy for Colorectal Cancer in Yamaguchi Prefecture].

A questionnaire survey on postoperative chemotherapy for colorectal cancer was conducted in 22 hospitals in Yamaguchi Prefecture. Adjuvant chemotherapy was performed in<95% of Stage Ⅲ cancer, and oxaliplatin(OX)combination therapy was selected depending on the risk of recurrence. However, the proportion of OX combination therapy was lower than that in other prefectures, which was 24% in Stage Ⅲa, 44% in Ⅲb, and 76% in Ⅲc. In addition, among the OX combination therapy regimens(FOLFOX or CAPOX), the proportion of FOLFOX administration was higher in Yamaguchi Prefecture than in other prefectures. In Stage Ⅱ, most hospitals set up high-risk factors for recurrence and underwent adjuvant chemotherapy. FU-based monotherapy was selected in 80% of hospitals. A few hospitals decided the requirement of OX combination therapy based on age alone. In Yamaguchi Prefecture, the indication of postoperative adjuvant chemotherapy for colorectal cancer was almost standard; however, the rate of administering OX combination therapy was low.

Impact of chemotherapy for colorectal cancer on regulatory T-cells and tumor immunity.

BACKGROUND: Regulatory T-cells (Tregs) actively engage in the maintenance of immunological self-tolerance and immune homeostasis. The purpose of the present study was to determine how oxaliplatin plus infusional 5-fluorouracil and leucovorin (FOLFOX) and irinotecan plus infusional 5-fluorouracil and leucovorin (FOLFIRI) affect Tregs and other immune effectors. PATIENTS AND METHODS: A total of 27 patients with metastatic colorectal cancer received the FOLFOX (n=17) or FOLFIRI (n=10) chemotherapeutic regimen. Blood samples were collected from patients before and 7 days after chemotherapy. The prevalence of Tregs co-expressing CD4(+)FoxP3(+) was analyzed with flow cytometry. RESULTS: The percentage and the number of CD4(+)FoxP3(+) Tregs were significantly reduced after FOLFOX and FOLFIRI in the patients who had high levels of Tregs before chemotherapy. On the other hand, the total number of lymphocytes and the population of CD4(+) T lymphocytes were unchanged. CONCLUSION: FOLFOX and FOLFIRI may enhance antitumor immunity via suppression of Tregs.

Increased prevalence of regulatory T-cells in the peripheral blood of patients with gastrointestinal cancer.

BACKGROUND: Although recent studies have shown that FoxP3 represent the most specific Treg marker only a few studies have reported on the presence of FoxP3(+)Treg in peripheral blood. PATIENTS AND METHODS: Peripheral blood mononuclear cells (PBMC) were harvested from 37 healthy volunteers and 94 patients with gastrointestinal cancer. The prevalence of Treg co-expressing CD4(+)FoxP3(+) was analyzed using flow cytometry. RESULTS: The prevalence of Treg in the peripheral blood of gastrointestinal cancer patients was significantly higher than that in healthy volunteers (p=0.012). In early stage I cancer, Treg levels tended to be higher than those in healthy volunteers (p=0.069); these levels were significantly reduced after tumor resection (p=0.0027). CONCLUSION: The prevalence of Treg was increased in patients with gastrointestinal cancer, even in the early stages of the disease. Since Treg levels decreased after curative resection, it is possible that tumor cells may have induced and expanded the Treg pool.

Concomitant overexpression of heat-shock protein 70 and HLA class-I in hepatitis C virus-related hepatocellular carcinoma.

BACKGROUND: Human leukocyte antigen (HLA) class I expression is reportedly frequently reduced in cancer. We examined heat-shock protein (HSP) expression in hepatocellular carcinoma (HCC). PATIENTS AND METHODS: HCV-related HCC was examined in 73 patients who had undergone hepatectomy, and the relationship between HSP70 and HLA class I expressions, clinicopathological factors and survival was evaluated. RESULTS: Immunohistochemically positive results for HSP70 and HLA class I were seen in 67 (92%) and 43 cases (59%), respectively, while 38 patients (52%) were positive for both. Increased HSP70 immunoreactivity was significantly associated with high histological grade of tumor differentiation (p = 0.0179), whereas reduced HLA class I immunoreactivity was significantly associated with large tumor size (p = 0.0082). No differences were apparent between disease-free and overall survival in regard to expression levels. CONCLUSION: These results suggest that HSP70 expression may be related to tumor differentiation and HLA class I loss may occur with tumor growth in HCV-related HCC.

Adoptive immunotherapy for pancreatic cancer using MUC1 peptide-pulsed dendritic cells and activated T lymphocytes.

BACKGROUND: Pancreatic cancer has a poor prognosis. The clinical efficacy of immunotherapy using both dendritic cells pulsed with MUC1 peptide (MUC1-DC) and, cytotoxic T lymphocyte (CTL) sensitized with a pancreatic cancer, YPK-1, expressing MUC1 (MUC1-CTL) was evaluated. PATIENTS AND METHODS: Twenty patients with unresectable or recurrent pancreatic cancer were enrolled. Peripheral blood mononuclear cells (PBMCs) were separated into adherent cells for induction of MUC1-DCs and floating cells for MUC1-CTLs. MUC1-DCs were generated by culture with granulocyte monocyte colony stimulating factor (GM-CSF) and interleukin-4 (IL-4) and then exposed to MUC1 peptide and TNF-alpha. MUC1-CTLs were induced by co-culture with YPK-1 and then with interleukin-2 (IL-2). MUC1-DCs were injected intradermally and MUC1-CTLs were given intravenously. RESULTS: Patients were treated from 2 to 15 times. One patient with multiple lung metastases experienced a complete response. Five patients had stable disease. The mean survival time was 9.8 months. No grade II-IV toxicity was observed. CONCLUSION: Adoptive immunotherapy with MUC1-DC and MUC1-CTL may be feasible and effective for pancreatic cancer.

[A clinical study of esophagectomy after chemo-radiation therapy for advanced esophageal carcinoma].

The aim of this study was to evaluate the efficacy of preoperative neoadjuvant therapy (NAT) including chemo-radiation or radiation in patients with T3/T4 advanced esophageal squamous cell carcinoma. We reviewed 115 patients with T3/T4 tumors from January 1994 through August 2006. Forty-seven patients received NAT, and the remaining 68 patients had surgery alone. Of these 47 patients, 14 patients underwent esophagectomy following NAT, and 33 patients underwent consecutive chemoradiation. Patients treated with esophagectomy following NAT had a better two-year survival (45.5%) and the median survival time (486 days) was compared with patients treated with chemo-radiation only (10.4%, 242 days) (p = 0.026). Of these patients treated with esophagectomy following NAT, the patients undergone curative resection had a better one-year survival rate (83.3%) and the median survival time (2,055 days) was compared with the patients received with non-curative resection (20.0%, 273 days) (p = 0.042). Two patients having grade 3 effect by NAT had a long disease free survival. There was no significant difference in postoperative morbidity and mortality rate between the patients received NAT and the patients treated with surgery alone. These results suggest that NAT may be useful for advanced esophageal cancer.