Continuous versus split-course irradiation for lung cancer. Immunological implications.

The therapeutical irradiation for lung cancer causes profound disturbances of host's general immunocompetence, the cellular immunodepression being the dominant finding. It is thought that split-course technique holds certain advantage over the continuous irradiation, since the former includes an interruption of 4 week duration, thus allowing the lymphopoietic system to recover to a certain degree. In this report, we compared the radiotherapy-due alterations of several parameters of cellular immunity (the number and function of total T cells, active T cells and the cells of monocyte/macrophage lineage), immediately after the completion of therapy in either continuously (n = 13) or split-course-irradiated (n = 12) lung cancer patients. All patients had received the total dose of 60 Gy. Both therapeutical techniques caused alterations of the parameters tested: the significant decrease of the total and active T cells and their proliferative responses, while the phagocytic activity and the number of mononuclear phagocytes were increased, the latter being affected to a lesser extent in split-course-treated patients. Our results suggest that both techniques have similar immunodepressant effect on the cellular immunity of lung cancer patients.

Immunosuppressive and cytogenetic effects of pelvic irradiation on the peripheral lymphocytes of patients with cervical cancer. One year follow-up.

The circulating lymphocytes of patients treated for cervical cancer were examined by four independent manners: by evaluation of T-cell proportion in peripheral blood, proliferative response upon PHA stimulation, PHA-induced leukocyte migration inhibition, and by concomitant chromosome aberration frequency. The immediate and longer-term effects of pelvic irradiation on T lymphocytes were investigated in 19 patients prior to, during, and immediately after radiotherapy, and then at subsequent intervals of two, three and five months. Radiotherapy caused profound depression of already diminished T-cell number and their proliferative response; both parameters gradually recovered during post-treatment period, and achieved their pretreatment values at the end of follow-up. The leukocyte migration inhibition was much less affected; it slightly deteriorated in the middle of post-treatment period, but reached the pretreatment level at the end of monitoring. The chromosome aberration frequency increased during irradiation in dose-dependent manner; it decreased gradually thereafter, but remained high during follow-up. Their elimination rate correlated with the recovery of T-cell number and proliferative response. However, at the end of monitoring, when all immunological parameters were completely recovered from harmful effect of irradiation, the percentage of chromosome aberrations remained high (12.5%), although significantly lower than the post-treatment one.

Radio- and chemotherapy variably affect the general immunocompetence of lung cancer patients.

OBJECTIVE: The evaluation of the effects of radiotherapy and chemotherapy on the immune status of lung cancer patients. EXPERIMENTAL DESIGN: Prospective nonrandomized study. SETTING: Hospitalized care. PATIENTS: 121 patients with unresectable non-small-cell lung cancer (Stage IIIb or IV), who were planned for radiotherapy (n = 81) or chemotherapy (n = 40). MEASURES: The relative and absolute numbers of blood T lymphocytes and monocytes, as well as the mitogen-induced proliferative response of the former, and phagocyting capacity of the latter cell subpopulation, were determined in patients before starting any therapy. In radiotherapy (RT)-treated group, the immune parameters were evaluated after 45 Gy and 60 Gy had been given. In chemotherapy (ChT)-treated group, the same parameters were determined three weeks after the 2nd and 4th cycle of ChT. RESULTS: The number and proliferative response of T lymphocytes were significantly (p < 0.001) lower, while the number and phagocyting capacity of monocytes were significantly (p < 0.001) higher in all patients before therapy, in comparison to the controls. After RT, the T cell number and proliferative response were significantly (p < 0.001) decreased, while the number of monocytes and their phagocyting capacity remained unchanged, when compared to the pretreatment values. Unlike RT, chemotherapy did not change any investigated parameter, except for the phagocyting activity of monocytes, which was significantly (p < 0.02) decreased, in comparison to the pretreatment value, after four cycles of ChT only. CONCLUSIONS: Two cancer treatment modalities--radio- and chemotherapy--variably affect the immune status of lung cancer patients. The initial great disturbances of general immunity parameters are further aggravated by radiotherapy. Unlike RT, chemotherapy exerts no suppression at all; on the contrary, it tends to normalize some of the parameters of cellular immunity of lung cancer patients.

Effect of T-activin therapy on indomethacin modulation of lymphoproliferative response in vitro of melanoma patients.

BACKGROUND: Several studies showed that PGE-mediated immunosuppression in cancer patients may be differentially affected by conventional oncologic therapy. METHODS: Since there is little evidence about the action of immunotherapy on this suppression mechanism, we investigated the effect of therapy with a thymic agent-T-activin, on in vitro modulation of lymphoproliferative response (LPR) by indomethacin. RESULTS: The results demonstrated that indomethacin added in vitro enhanced LPR in early stage melanoma patients before therapy. T-activin therapy as an adjunct to surgery improved this lymphocyte function; the post-therapy in vitro addition of indomethacin did not significantly affect mitogen response. However, in those patients whose LPR was insufficiently enhanced by immunotherapy (3/8), indomethacin had improved their lymphocyte response. In the control patient group treated by surgery alone, indomethacin significantly enhanced LPR in vitro six months after operation. Although obtained in a small number of patients, our results indicate that the enhancing effect of T-activin therapy on lymphoproliferative response may be, at least in part, due to the effect on PGE-mediated suppressor cell activity. CONCLUSIONS: Furthermore, post-therapy in vitro testing may indicate a possible usefulness of this drug combination in some of the early stage melanoma patients.

Immune reactive proteins in renal cell carcinoma patients treated by IFN alpha alone or in combination with vinblastine.

Immunoreactive proteins--serum immunoglobulins and immune complexes were evaluated in renal cell carcinoma (RCC) patients. The analyses were done after radical nephrectomy before, at the end, and six months after the therapy, with IFN alpha alone (in patients in Stage II) or IFN alpha in the combination with vinblastine (in patients in Stage III and IV of the disease). Data obtained before immuno- or immunochemotherapy show significant increase in IgG and IgA concentrations in RCC patients in all stages of the disease investigated--in comparison to controls, while circulating immune complexes were significantly elevated only in patients in the advanced Stages of the disease (III and IV). The unchanged IgM level was found in all untreated RCC patients regarding the controls. Immuno- or immunochemotherapy did not affect the immunoreactive proteins (Ig and CIC) in the investigated patients, without respect to their clinical response to the applied therapy.

In vitro effect of indomethacin on mitogen-induced lymphoproliferative response in lung cancer patients.

There is some evidence that prostaglandin (PGE)-secreting cells may have a role in immunosuppression in cancer patients. In this work we investigated the effects of indomethacin--a PGE synthesis inhibitor, on PHA-induced lymphoproliferative response in vitro. Twenty patients with lung cancer before therapy were included in this study. When compared to controls, the patients had significant decrease of T cell number and proliferative response to PHA (p less than 0.001) and increased number of mononuclear phagocyting cells (p less than 0.001). The degree of depression of lymphocyte response did not correlate with the number of mononuclear phagocytes. The presence of indomethacin in the culture induced significant (p less than 0.01) improvement of the reactivity in high percentage (75%) of patients with diminished lymphoproliferative response to PHA. In the patients with normal lymphocyte response, indomethacin did not change reactivity to PHA. These results indicate that PGE-secreting cells may contribute to the immune depression in lung cancer patients, and that indomethacin may have therapeutical potential in some patients.

The protective activity of Thymex L against radiotherapeutically-induced cellular immunodepression in lung cancer patients.

In order to prevent the radiotherapeutically-induced aggravation of initial immunodeficiency, a thymic preparation (Thymex L) was given to lung cancer patients simultaneously with irradiation. The parameters of both cellular and humoral nonspecific immunity were evaluated in two groups of patients: one was treated with radiotherapy only (60 Gy in 30 fractions); the other one received Thymex L (100 mg 3 times a week, total dose 1800 mg, i.m.) simultaneously with radiotherapy. The significant decrease of B and T cell number, and decreased lymphoproliferative response to PHA were found in all patients before therapy; the number and phagocyting capacity of blood monocytes, as well as the concentrations of circulating IgG, IgA and immunocomplexes, were all significantly increased. Immediately after irradiation the patients had even lower number of T and B cells, diminished reactivity to PHA and higher number of mononuclear phagocytes when compared to the values before therapy. In patients treated with Thymex L, the number of B and T cells and PHA-induced proliferative response were significantly higher than in those treated with radiotherapy only. No effect of this therapy was seen on active T cells, on high number and function of mononuclear phagocytes and on elevated concentrations of serum immunoglobulins and immune complexes. Our results indicate that Thymex L can successfully prevent the harmful effect of radiation therapy on cellular immunity in a majority of lung cancer patients.

Clinical and immunologic effects of T-activin therapy in early stage melanoma patients.

We investigated the clinical and immunological effects of T-activin therapy in early stage melanoma patients. Several immune parameters (the number of T cells-E-RFC and CD3+, their subsets-CD4+ and CD8+, the number of CD38+ and CD16+ cells, and mitogen-induced lymphoproliferative response-LPR) were analyzed in relation to the clinical course of the disease in patients treated by T-activin in addition to the surgery (n = 8), and in control patients treated by the surgery alone (n = 9). Immunological tests were performed before therapy and one month after the last (6th) cycle of T-activin, i.e. six months after surgery in controls. The patients were followed-up from February 1991 to August 1995. Clinical evaluation showed that disease-free interval for observed period was similar in both groups of patients (17.5 and 13 months), while the survival time was longer in T-activin-treated patients than in controls (40 vs. 24 months), although this difference was not significant. The phenotyping analysis of peripheral blood lymphocytes showed no changes of the pretreatment values of total T cells and their subpopulations regardless the clinical course of the disease in both groups of patients. The number of NK cells (CD16+) was significantly increased after T-activin therapy, but this increase was not associated with clinical benefit, since it was seen in patients with the progression of the disease. In control patients, the initial number of CD16+ cells did not change significantly, irrespective of the clinical course. The lymphoproliferative response increased significantly in 4 out of 5 T-activin-treated patients with the progression of the disease, while a slight increase of this lymphocyte function was seen in 3 disease-free patients. In patients treated by surgery alone, especially those with disease progression, the LPR was significantly decreased six months after tumor excision. These findings, although obtained in small number of patients, suggest an immunomodulatory action of T-activin therapy in early stage melanoma patients, which did not correlate with the clinical course of the disease. On the other hand, an almost doubled survival time in T-activin-treated patients in comparison to the controls, may indicate a possible effect of T-activin therapy on some other immune functions not evaluated in this study. Further investigations in a larger number of patients is needed for assessment of the true effectiveness of such therapy.

The influence of surgery and anesthesia on lymphocyte functions in breast cancer patients: in vitro effects of indomethacin.

Surgical trauma and anesthesia may lead to the postoperative immunosuppression, the exact mechanism of which is still unresolved. Among various factors, the role of prostaglandine PGE2-mediated suppression was also proposed. We investigated the influence of surgery and two anesthetic regimes on lymphoproliferative response (LPR) to PHA and on NK cell activity (MTT) in breast cancer patients, as well as the effect of indomethacin, a PGE2 synthesis inhibitor, on these lymphocyte functions in vitro. In 36 previously untreated patients the lymphocyte functions were assayed before, 24 hours and seven days after the surgery. In regard to LPR, three distinct response patterns were observed: a) significant (p < 0.05) increase of initially lowered LPR; b) significant (p < 0.001) decrease of initially normal LPR 24 hours after operation, followed by normalization after seven days; c) no change of initially normal LPR. Indomethacin in vitro significantly (p < 0.05) enhanced the diminished LPR only before surgery, no effect being seen after the operation. The NK cell function was unaffected by surgery regardless the initial level of activity. Indomethacin had no effect on this lymphocyte function. There was no difference between the patient groups submitted to the different anesthetic regimes. In conclusion, our results show that surgical trauma variably affect the lymphocyte functions of cancer patients, the effect not being related to the particular anesthetic regime used. The PGE2-mediated suppression is not likely to be involved in postoperative immune function impairment.

Lyophilized whole human melanoma cells stimulate human PBMC proliferation and enhance suppressive action of PBMC toward survival of the same malignant cell line in vitro.

The goal of this work was to determine: a) do lyophilized human melanoma BG or Fem-X cells affect the proliferative capacity of normal human peripheral blood mononuclear cells (PBMC) and b) does the PBMC six-days preincubation in nutrient medium with FBS with, or without lyophilized human melanoma BG or Fem-x cells, affect their suppressive action on the survival of the same malignant cell line in vitro. In the aim to avoid any stimulating effect of FBS, other group of experiments were done in nutrient medium with human AB serum in order to determine: c) does the PBMC six-day-preincubation with lyophilized human melanoma BG or Fem-x cells affect their antiproliferative action on the corresponding malignant cell line in vitro and d) does the PBMC six-day preincubation with lyophilized normal PBMC, obtained from healthy volunteer (as a source of allogenous, but not of tumor antigens), affect their suppressive action on the survival of both melanoma BG and Fern-x cell lines in vitro. Results obtained in the presence of FBS in nutrient medium, showed that lyophilized BG cells induced a proliferation of the healthy PBMC, depending on the number of stimulating lyophilized cells. Lyophilized Fem-x cells induced healthy PBMC proliferation in lesser degree than lyophilized BG cells. This stimulation was almost constant, not dependent on the number of stimulating lyophilized Fem-x cells. Six-day stimulation in vitro by both lyophilized melanoma cells enhanced the suppressive action of PBMC on the survival of the corresponding malignant cell line. Experiments done in nutrient medium with normal human AB serum showed that six-day stimulation with lyophilized melanoma cells enhanced, again, the suppressive action of PBMC on the survival of the corresponding malignant cell line. Contrary, six day preincubation of normal PBMC with the lyophilized healthy PBMC (obtained from other healthy person) inhibited their suppressive action on the survival of both malignant cell lines in vitro.

Antimelanoma immunity in vitiligo and melanoma patients.

Cutaneous melanoma and vitiligo are diseases etiology of which evolves around melanocytes. The nature of immunological disturbances associated with these diseases is not elucidated. The experiments performed in this work were aimed to determine antimelanoma immunotoxicity in patients with melanoma and patients with vitiligo. Twelve patients with melanoma, ten patients with vitiligo and seventeen healthy volunteers were studied. The cytotoxicity of PBMC was evaluated indirectly through determination of target melanoma (Fem-x) or control tumor (HeLa) cell survival, in the presence of 15% of AB or autologous sera, by MTT test. The mean values of antimelanoma cytotoxicity in AB serum were similar in both patients groups and in controls. However, the frequency of patients with the enhanced cytotoxicity against melanoma cells, in relation to control tumor cells, was lower in both patients groups than in controls. The intensity of antimelanoma cell-mediated cytotoxicity in melanoma patients, in the presence of autologous serum, was significantly lower in comparison to that found in control subjects and vitiligo patients (p<0.014, in both cases). This indicates that some factors from melanoma patient's sera contribute to impairment of the cytotoxicity of autologous PBMC, while other factors from the serum of vitiligo patients and control subjects enhanced their PBMC antimelanoma cytotoxicity.

Immunomodulation in vitro. The predictive value of in vitro testing of lung cancer patients' lymphocyte responsiveness to stimulation by Thymex L. A preliminary report.

Eleven lung cancer patients were selected for combined radio and immunotherapy with a thymic agent-Thymex L. The selection criteria included the pre-therapy testing of patients' immunocompetence and the responsiveness of their lymphocytes to the in vitro addition of Thymex L: only patients with a significant degree of immunodepression, whose depressed cellular immunity parameters (the number of total and active T cells and their mitogen-induced lymphoproliferative response) were significantly increased upon this agent's action in vitro, entered the study. The results of the pre-therapy in vitro stimulation correlated with those obtained after completion of radioimmunotherapy: the administration of Thymex L along with radiotherapy seances prevented iatrogenic deterioration of initial depression of general immunocompetence and enabled to overcome it to a certain degree. This indicates that pre-therapy in vitro testing has a true predictive value. However, the initial immune disturbances were not normalized by immunotherapy; the post-therapy testing of the patients' lymphocytes to the addition of Thymex L in vitro showed that these cells possessed a residual potential to respond by a significant increase of the active T cell number and proliferative capacity, suggesting that immunotherapy could be prolonged in order to potentiate cellular immunity in immunodepressed lung cancer patients.

Effects of X-ray irradiation on the overexpression of HER-2/Erb-B2 on breast cancer cell lines.

Irradiation is the conventional treatment modality for cancer patients. However, besides its cytotoxic effects on malignant cells it might also affect the biology of surviving cells. Since overexpression of HER-2 receptors on malignant cells is a prerequisite for the therapeutic efficacy of Herceptin, it seems important to know whether previous irradiation changes their overexpression. The experiments performed in this work were aimed to determine whether X-ray irradiation of MDA-MB-361 and MDA-MB-453 breast carcinoma cell lines, besides its cytotoxic action, affects the overexpression of HER-2 protein. Determination of the cytotoxic effect of X-ray irradiation was done using trypan blue test. The breast carcinoma cell responsiveness to herceptin treatment in the presence of 10% fresh human serum (from healthy volunteer's) in the presence or absence of 25 microg/ml of herceptin, in vitro before and after cell-irradiation, was evaluated by MTT test. The degree of HER-2 overexpression was determined by immunocytochemistry, using DAKO HercepTest. Preliminary results obtained in this work showed that X-ray irradiation, besides its cytotoxic effect on malignant cells, could lead to overexpression of HER-2 receptors on (initially by immunocytochemistry, HER-2 negative) tumor cells, indicating change in biology of treated tumor cells. Further investigation in this direction will probably be helpful to elucidate this task in order to improve the selection of irradiated patients for Herceptin therapy.

Cyclooxygenase inhibitors in the chemoprevention of colorectal cancer.

The long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a decreased risk for colorectal cancer. A major molecular target for cancer chemoprevention by these agents is the cyclooxygenase- 2 (COX-2) isoenzyme, although other molecular pathways can not be excluded. Data from both human and animal studies suggest that COX-2 is an early event of colorectal carcinogenesis. The NSAIDs, in the particular the newly developed COX-2 selective inhibitors, suppress colorectal tumor development in rodents and significantly reduce the number of colorectal polyps in patients suffering from familial adenomatous polyposis coli. In this paper current opinions regarding the role of COX inhibitors in colorectal cancer prevention are reviewed. Some perspectives derived from experimental and clinical studies, that might improve future approaches in the prevention of this malignancy, are also considered.

Lymphocyte reactivity in Imuran-treated guinea-pigs and in vitro effect of colchicine.

Imuran treatment significantly diminished macrophage migration inhibition in immunized guinea-pigs and the percentage of E-rosette forming cells in all treated animals. 10(-6) M colchicine in vitro significantly increased the percentage of E-rosette forming cells in Imuran-treated animals. The results suggest possible alteration of the lymphocyte receptors after treatment with Imuran.

Enhancement of phytohemagglutinin-induced lymphoproliferative response by indomethacin, Thymex L or their combination in lung cancer patients.

Several studies showed that thymic factors and prostaglandin synthesis inhibitors enhance in vitro lymphoproliferative response (LPR) to mitogens in cancer patients. In this study we investigated whether indomethacin and thymic extract (Thymex L), applied in combination, may in a synergistic pattern influence phytohemagglutinin-induced LPR in lung cancer patients. The results demonstrate that the use of the investigated agents enhances LPR to a similar level in hyporeactive patients before, as well as after, therapy. However, this drug combination exerts an additive effect on LPR, but only in patients who underwent cytoreductive radiation therapy, indicating the potential usefulness of this drug combination as an adjuvant treatment of these patients.

[Immunologic reactivity in patients with breast carcinoma treated with interferon alpha]. / Imunoloska reaktivnost bolesnica od karcinoma dojke lecenih interferonom alfa.

We investigated the influence of the natural interferon alpha (IFN-alpha) on the nonspecific immune competence in the early stage of breast cancer. The IFN therapy, which started one month after surgery, lasted four months. Control group of patients received no therapy after surgical removal of the tumor. The immunological parameters (the number and function of T and B cells and mononuclear phagocytes) were monitored once a month during five months. In the course of IFN therapy the values of total and active T cells, as well as their proliferative response to PHA, were slightly decreased, while the number of mononuclear phagocytes and their activity was increased. These values returned into normal range at the end of monitoring. Only the phagocyting activity remained at high level. There was no significant difference between two groups of patients, indicating no effect of IFN therapy on the immunological parameters tested.

[Immunomodulating effect of thymus protein fraction on disorders of general immunity in patients with lung carcinoma]. / Imunomodulatorna dejstva proteinske frakcije timusa na poremecaj opste imunosti u bolesnika sa karcinomom pluca.

The parameters of both cellular and humoral non-specific immunity were evaluated in non-small lung cancer patients (n = 26) prior to therapy, in 13 of them after radiotherapy (45 Gy in 22 fractions) and in 13 patients after combined radio-and immunotherapy (Thymex L, 1800 mg in 12 injections á 150 mg i.m., three times a week). Several parameters of general immunocompetence were altered in patients even before any therapy. The radiotherapy caused more severe immunologic disturbances, the cellular immunity being affected more profoundly. Thymex L., when given simultaneously with radiotherapy, prevented this deterioration in a majority of patients.

[In vitro reactivity of lymphocytes after the addition of immunostimulatory drugs]. / Reaktivnosti limfocita in vitro na dodavanje imunostimulacionih sredstava.

The in vitro immunomodulating, effects of two thymic extracts--Thymex L and Thymomodulin--on lymphocytes of lung cancer patients, were studied. The number of total and active T cell and PHA-induced lymphoproliferative response were evaluated before and after the addition of two different concentrations (5 mg/ml and 0.5 mg/ml) of these agents. The in vitro incubation with Thymex L and Thymomodulin had no effect on the number of total T lymphocytes, but the active T cells and proliferative responses were significantly higher. This increases was observed in the majority of patients with diminished baseline values. These results indicated that several immunological parameters should be used in vitro testing of an immunomodulatory drug. They also indicated the need for in vitro testing selection of candidates for immunotherapy among immunodepressed cancer patients.