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Stereotactic body radiation therapy of thoracic tumors close to the central airways implies risk of severe toxicity. We report a prospective multicenter phase 2 trial for tumors located less than or equal to 1 cm from the proximal bronchial tree with primary end point of local control and secondary end point of toxicity.

A patient with malignant glioblastoma was treated with intratumoral infusions of the murine MAb425 (IgG2A) directed against the epidermal growth factor receptor. At the 10th infusion, the patient developed somnolence, fever and headache. The symptoms increased during the subsequent 48 hr but then gradually disappeared within a week. The cerebrospinal fluid (CSF) contained increased concentrations of interleukin-2. The main CSF cell subset was CD4 T-cells. A marked blood lymphocyte proliferative response against mouse IgG2A was noted. The reactive T-cell epitope(s) could be localized to a 14 amino acid (RGPTIKPCPPCKCP) long peptide of the hinge region. A B-cell response (IgG antibodies) against this peptide was also induced. Int. J. Cancer 73:790–794, 1997. © 1997 Wiley-Liss, Inc.

Summary Human peripheral blood mononuclear cells (lymphocytes and monocytes) (PBMC) were preincubated for 0–24 h with human recombinant interleukin-4 (IL-4) and used as effector cells in an 18 h antibody-dependent cellular cytotoxicity (ADCC) assay with mAb 17-1A (mouse IgG2A) against SW948 (a human colorectal carcinoma cell line). A statistically significant increase in the lytic capability was noted after 2–24 h of preactivation. IL-4 at 1 ng/ml induced the highest cell lysis while higher and lower concentrations were inferior or had no effect at all. Preactivation for 24 h induced a more effective lytic cell population than 2 h prestimulation: 63 LU (lytic units)/106 cells vs 42 LU/106 cells. Pretreatment with 1 ng/ml IL-4 for 2 h induced a statistically significant increase in the ADCC activity of PBMC (P <0.05), of monocytes (P <0.01) and E-rosette-negative cells (natural killer cells) (P <0.05) compared to non-activated cells. IL-4 did not induce lymphokine-activated killer activity of PBMC against SW948. The spontaneous cytotoxicity against K562 was, however, increased after stimulation with 1 ng/ml IL-4 for 2 h of E-rosette-negative non-adherent cells.

Renal cell cancer (RCC) represents an unusual solid tumor for which no treatment other than surgical therapy has been effective. This tumor demonstrates a remarkably heterogeneous behaviour and rare reports of spontaneous regressions suggest an unusual sensitivity to host immunologie control. In recent years the rapid development in molecular genetics, growth factors and cytokine - lymphocyte interactions have increased the interest and possibilities for immunotherapy of RCC. Interleukin- 2 (IL- 2) or Interferon alpha (IFNα) alone are only marginally active in RCC. Their different modes of action and their synergistic effects when used in experimental murine models prompted the investigation of combined DL- 2/INFa therapy in advanced RCC. The advantage of a combination of EL- 2 and IFNα treatment as compared to LAK cell treatment seems to be that EL- 2 and IFNα can be given at lower dosages without compromising the results in an outpatient setting. This article reviews the use of IL- 2 and IFNα in combination for treatment of RCC and discusses the current problems and future challenges in this field.

A group of 86 patients with advanced colorectal carcinoma were treated with the mouse (m) (IgG2A) or chimeric (c) monoclonal antibody (mAb) 17-1A. Prior to therapy, no patient had detectable levels of antibodies to mAb17-1A. All mmAb17-1A-treated patients (n=76) developed antibodies against both idiotypic and isotypic determinants. Addition of granulocyte/macrophage-colony-stimulating factor (GM-CSF) to mmAb17-1A significantly enhanced the induction of anti-idiotypic (ab2) as well as anti-isotypic antibodies. Of the mmAb17-1A-treated patients, 16 developed type I allergic reactions. These patients had significantly higher concentrations of anti-(mouse Ig) antibodies than patients without type I reactions. Of these 16 patients, 5 had received mmAb17-1A alone; they constituted 9% of this group (5/56). The remaining 11 patients had been given mmAb17-1A together with GM-CSF, and represented 55% of this treatment group (11/20). The difference was statistically significant (P<0.001). Of 10 patients, 9 (90%) treated with cmAb17-1A and GM-CSF developed ab2. The ab2 concentration in this patient group was significantly lower compared to those treated with mmAb-17A. Anti-(mouse Ig) antibodies caused clinical symptoms requiring therapeutic intervention in fewer than 10% of the patients treated with mmAb17-1A alone. With the addition of GM-CSF, the antibody concentration as well as the frequency of allergic side-effects calling for medical action increased significantly. Significantly more patients with a high ab2 concentration (at least 15µg/ml) 1 month after completion of mAb therapy responded to mAb treatment as compared to those with a low ab2 concentration (P<0.05). Moreover, patients with a high ab2 concentration (at least 15 µg/ml) had a median survival time of 15 months while those with a lower concentration survived for a median time of 9 months (P=0.01).

Summary Blood lymphocytes stimulated for 96 h with interleukin-2 (IL-2; 100 BRMP U/ml) (lymphokine-activated killer, LAK, cells) or granulocyte-monocyte colonystimulating-factor (GM-CSF) (10 ng/ml) became cytotoxic for Daudi cells. IL-2 was significantly more effective than GM-CSF. Only IL-2-activated cells killed SW948 (a human colorectal carcinoma cell line) while GM-CSF-stimulated cell did not. GM-CSF and IL-2 acted synergistically in a dose-dependent fashion for induction of a highly effective cytotoxic cell population (IL-2/GM-CSF cells). Il-2/GM-CSF cells were statistically significantly more effective than LAK cells in lysing Daudi cells and SW948 (P <0.05). The enhancing effect was most pronounced during the first 48–96 h of activation. Incubation periods longer than 192 h did not contribute to augmented cytotoxicity. The combination of IL-2 and GM-CSF significantly increased the number of CD25+ cells compared to IL-2 and GM-CSF alone. Furthermore, IL-2/GM-CSF cells were significantly more effective in antibody-dependent cellular cytotoxicity assays (SW948 + mAb 17-1A) than LAK cells. The chimeric mAb 17-1A was significantly more effective in tumor cell lysis than the mouse mAb. Thus, combination of various biological therapeutics might be a way to enhance their antitumoral effects.

Immunologic monitoring of cancer patients treated with IL-2 might help to determine functions of significance for the clinical outcome. Some immune functions in patients with advanced renal cell carcinoma were studied during treatment with low dose cyclophosphamide,α-interferon and IL-2. Cyclophosphamide (500 mg m−2) was given day 1, andα-interferon (3×106u i.m.) and continuous infusion of IL-2 (18×106u m−2day−1) for days 4–9. The cycle interval was 3 weeks. Two to six cycles were given. Eleven patients entered the study. One patient achieved a partial remission, two patients had a minor response and four had a stable disease (‘responding patients’). NK cell activity (K562) increased in all patients while LAK cell activity (against a renal cell carcinoma cell line, A498) was significantly augmented only in responding patients. In the responder group, there was a significant increase in CD3+/HLA-DR+T-cells. In parallel, there was a significant decrease in CD45RA+cells as well as in the CD4/CD8 ratio. These data might indicate an expansion of activated T cells with a reduction of cells with a suppressor phenotype in responding patients. The results corroborate the importance of activation of LAK cells and T cells during IL-2 therapy of cancer patients.

More than 50% of the patients with large bowel cancer develop disseminated disease and invariably succumb. Adjuvant chemotherapy with 5-FU and levamisole have been shown to be more efficient than 5-FU alone or in combination with cytostatics. The combination of 5-FU, leukovorin and methotrexate induces prolonged survival with a good quality of life in metastatic colorectal cancer (CRC). During the last decade tumor immunotherapy has been an alternative facilitated by isolation and large scale production of cytokines and monoclonal antibodies. The mouse monoclonal antibody (MAb) 17-1A recognizes a tumor-associated antigen (TAA), present in high concentrations on the surface of gastrointestinal tumor cells. Injections of MAb 17-1A in patients with metastatic CRC induced generation of anti-idiotypic (ab2) in 90% and anti-anti-idiotypic (ab3) antibodies in 47% of the treated patients. The development of ab3correlated significantly with survival (mean 80 weeks) while ab3-patients survive only 38 weeks. One of 52 patients treated with MAb 17-1A is a complete remission after 66 months, 3 had minor regression and 6 had a stable disease (19% RR). Based onin vitrofindings showing increased antibody-dependent cellular cytotoxicity (ADCC) by the combination of granulocyte-macrophage colony stimulating factor (GM-CSF) and MAb 17-1A, 16 CRC patients have been treated with subcutaneously injections of GM-CSF for 10 days and intravenous infusions of MAb 17-1A at day 3. Two of 16 are in CR, 1 in MR and 3 in SD (37.5% RR). Minor side-effects were registered. A further development of immunotherapy of CRC might imply vaccination by injection of specific human anti-idiotypic antibodies (ab2) which mimics the nominal antigen, in order to induce a specific immunity.

A statistically-significant (p<0.01) decrease in the incidence of lung cancer has been observed amongst men in larger Swedish cities, but not in the country as a whole. The decrease is foremostly attributable to changes within the group of older men (i. e,>65 years). The investigation is based on the Swedish Cancer Registry and covers the period 1975-1989.