Effects of celecoxib, medroxyprogesterone, and dietary intervention on systemic syndromes in patients with advanced lung adenocarcinoma: a pilot study.

Systemic syndromes characterized by a persistent activity of circulating mediators (cytokines) are frequently present with advanced cancer. We grouped under the general heading of "Systemic Immune-Metabolic Syndrome (SIMS)" a particular variety of distressing systemic syndrome characterized by dysregulation of the psycho-neuro-immune-endocrine homeostasis, with overlapping clinical manifestations. SIMS may include cachexia, anorexia, nausea, early satiety, fatigue, tumor fever, cognitive changes and superinfection. The aim of this study was to ameliorate some of the SIMS symptoms in a homogeneous group of lung adenocarcinoma patients using a multitargeted therapy. Fifteen patients with evidence of SIMS were studied. SIMS was defined as the presence of weight loss, anorexia, fatigue performance status>/=2 and acute-phase protein response. Patients received medroxyprogesterone (MPA) (500 mg twice daily), celecoxib (200 mg twice daily), plus oral food supplementation for 6 weeks. After treatment, 13 patients either had stable weight (+/- 1%) or had gained weight. There were significant differences in improvement of body-weight-change rate, nausea, early satiety, fatigue, appetite and performance status. Patients who had any kind of lung infection showed higher levels of IL-10 compared to non-infected patients (P=0.039). Our results suggest that patients with advanced lung adenocarcinoma, treated with MPA, celecoxib and dietary intervention, might have considerable improvement in certain SIMS outcomes. This multitargeted symptomatic approach deserves further study.

Inhibition of tumor progression and paraneoplastic syndrome development in a murine lung adenocarcinoma by medroxyprogesterone acetate and indomethacin.

Mice bearing LP07 lung adenocarcinoma present some characteristics similar to those shown in patients with several malignant diseases. LP07 tumor bearers develop paraneoplastic syndromes such as cachexia, leukocytosis, and hypercalcemia, partly due to a systemic inflammatory response. We analyzed some of the mechanisms involved in the effectiveness of the association of the appetite-stimulant medroxiprogesterone acetate (MPA) and the nonselective cyclooxigenase (COX) inhibitor indomethacin (INDO) in LP07 tumor bearing mice. INDO and INDO plus MPA treatments significantly inhibited tumor growth, which was not inhibited by MPA. The number of lung metastatic nodules was decreased with all treatments, being most effective INDO alone and INDO plus MPA. A significant decrease of plasmatic levels of the matrix metalloproteinases MMP-9 and MMP-2 correlated with these results. Paraneoplastic syndromes, leukocytosis, and cachexia were abolished by all treatments. We determined effects of the treatments on circulating cytokines shown to regulate cachexia and inflammation. Both treatments alone, and INDO plus MPA, reduced circulating IL-6 throughout tumor evolution. A pronounced increase in serum IL-1ss levels was detected in untreated tumor bearers. These levels decreased and were closer to normal serum values when LP07 mice were treated with INDO plus MPA. The combination of a nonsteroidal antiinflammatory drug as INDO and MPA showed to be effective in inhibiting tumor and metastatic growth and diminishing paraneoplastic symptoms and SIR. A variety of specific molecules are implicated as playing a role in cancer-induced cachexia and hematological alterations.

Reduction of tumor progression and paraneoplastic syndrome development in murine lung adenocarcinoma by nonsteroidal antiinflammatory drugs.

Mice bearing LP07 lung adenocarcinoma show some characteristics that are similar to those present in patients with NSCLC. LP07 tumor-bearing mice develop the paraneoplastic syndromes of cachexia, leukocytosis and hypercalcemia. These symptoms may be partly due to a systemic inflammatory response. Our aim was to determine if treatment with NSAIDs would lower tumor and metastasis growth and their accompanying syndromes. The nonselective COX inhibitor indomethacin and the selective COX-2 inhibitor celecoxib reduced tumor growth and metastasis outcome in s.c. LP07 tumor-bearing mice. Both drugs also inhibited the development of leukocytosis and the weight loss associated with LP07 progression. Serum levels of the inflammatory cytokines IL-1beta and IL-6, mediators of cachexia, were modulated by NSAIDs. Inhibition of in vitro migration and invasion and reduction in angiogenesis were attained when cells were treated with either indomethacin or celecoxib. MMP-9 activity was also reduced in conditioned media from LP07 cells treated with celecoxib. These data suggest that several processes implicated in tumor progression can be modulated with NSAID treatment. Improvement in performance status through modulation of cachexia may offer a possibility for combining anti-inflammatory treatments with more aggressive therapies.

Azúcar y macrófagos: activación de la fagocitosis inespecífica en macrófagos peritoneales de ratón inducidos por inyección IP de una solución concentrada de sacarosa / Sugar and macrophages: unspecific phagocytosis activation in mice peritoneal macrophages induced by intraperitoneal (ip) injection of a concentrated sucrose solution

En el tratamiento de heridas infectadas con azúcar se demostró la inhibición del crecimiento bacteriano por modificación del microambiente, observándose un intenso flujo de macrófagos (MÝs) hacia la cavidad tratada. En este trabajo demostramos que una única inyección ip de una solución concentrada de sacarosa (SCS) a ratones BALB/c normales induce exudados peritoneales con gran rendimiento de MÝs. En MÝs obtenidos 4 días después del tratamiento con SCS, se observó un incremento significativo de otras etapas de la función fagocítica inespecífica: adherencia a superficies y velocidad de ingestión de gotas de aceite mineral opsonizadas. El estudio hematológico reveló un efecto sistémico transitorio, granulocitosis y linfopenia relativas, 24 horas después de la inyección ip de SCS que se revierte rápidamente. Se concluye que la acumulación local de una población de MÝs funcionalmente diferente, por efecto del azúcar y sus soluciones concentradas, es un evento favorable en la resistencia huésped a la infección

Inmunorregulación del crecimiento tumoral en un sistema murino / Immunoregulation of tumor growth in a murine model

Estudiamos la regulación del crecimiento tumoral y metastásico tanto por el propio tumor como por el sistema inmune, en un modelo murino. Sobrenadantes de cultivo de esplenocitos de portadores de tumor exacerban el crecimiento del propio tumor. Esta actividad desaparece luego de la cirugía tumoral pero con una cinética diferente dependendo de si el tumor es precoz o avanzado al tiempo de la cirugía. Las poblaciones esplénicas involucradas en la exacerbación varían durante el crecimiento del tumor mientras que las responsables de inducción de angiogénesis son siempre de naturaleza T. Con respecto de la autorregulación tumoral, encontramos que diferentes formas de antígenos tumorales (extractos tumorales, sobrenadantes de cultivo de células tumorales, células tumorales formolizadas) aumentan la diseminación metastásica, pero esta actividad está mediada por el sistema inmune del huésped. Por el contrario, sobrenadantes de cultivo de células tumorales no inducen exacerbación del tumor primario. Las células tumorales fueron tratadas con un modificador de membrana con la expectativa de alterar la respuesta inmune antitumoral