Combination of Chemotherapy and Cytokine Therapy in Treatment of Cancers


Cytokine

Condition

Chemotherapy

Phase

State

Reference

Outcome

IL-2

Melanoma

Dacarbazine

II

Ongoing

NCT00553618
 
Melanoma

+Cy

II

Ongoing

NCT01833767
 
Breast cancer

+Paclitaxel

II

Ongoing

NCT01134250
 
Breast cancer

+Doxorubicin

II

Ongoing

NCT01131364
 
Pancreatic cancer

+Gemcitabine

I

Ongoing

NCT01198522
 
IL-2+ IFN-α

RCC

5FU + gemcitabine

II

Completed

NCT00003664
 
Melanoma

Cisplatin + dacarbazine + vinblastine

III

Completed

NCT00002882
 
IL-15

Metastatic melanoma

+Cy + TILs

I

Ongoing

NCT01369888
 
Skin cancer

+Flu + TILs

II

Ongoing

NCT01369888
 
IFN-α

RCC

+Vinblastine

III

Completed

72

Increased RRa similar OSa

RCC

+Cis-retinoic acid

III

Completed

73

Similar RRa Similar OSa

RCC

+Cis-retinoic acid

II/III

Completed

74

Increased OSa

RCC

+5FU

II

Completed

76

No additional side effects

HCC

+5FU + cisplatin

II

Completed

80

No additional side effects similar OSa

Ovarian carcinoma

+Carboplatin/paclitaxel

III

Completed

NCT00047632
 
Glioma

+Temozolamide

III

Ongoing

NCT01765088
 
GI, renal, and lung cancer

+5FU

II

Ongoing

NCT01658813
 
GM-CSF

Breast cancer

+FLAC

I

Completed

NCT00001269
 

5FU 5-fluorouracil, Cy cyclophosphamide, FLAC 5-fluorouracil, leucovorin, doxorubicin, cytoxan, Flu fludarabine, GI gastrointestinal carcinoma, GM-CSF granyulocyte macrophage colony-stimulating factor, HCC hepatocelullar carcinoma, NCT national clinical trial code, progression-free survival, RCC renal cell carcinoma, RR response rate, OS overall survival, TILs tumor-infiltrating lymphocytes

aCombined chemoimmunotherapy vs. chemotherapy alone



Finally, different forms of immunotherapy including cytokines should be investigated for overall clinical benefits along with conventional chemotherapy in patients at early stages of the disease such as after surgical resection with increased likelihood of recurrence. Further research is required to optimize the combination of different immunotherapy plus chemotherapy to obtain maximal clinical benefit.




11.6 Concluding Remarks


Combined immunotherapy clinical trials in cancer patients are challenging, and several strategies have been opened for clinical applications. However, the high efficacy of different immunotherapeutic strategies at eliminating tumors in animal models is in contrast with the very limited results achieved in patients. There are many explanations to why immunotherapeutic strategies fail or have little impact on patient survival. In general, for all solid tumors, the common scenario chosen to test immunotherapeutic protocols almost always involves patients with advanced diseases that precludes, or at least decreases, the possibility of success. Then, due to the advanced status of the cancer, the immune system of the majority of treated patients is deteriorated and unable to recognize tumor antigens. Thus, conventional chemotherapy could act in synergy to generate immunity against many tumors. The different forms of immunotherapy including the use of cytokines should be tested for overall clinical benefits along with conventional treatment regimens evidencing improvement in survival.


References



1.

Woude GF, Kelloff GJ, Ruddon RW, Koo HM, Sigman CC, Barrett JC, et al. Reanalysis of cancer drugs: old drugs, new tricks. Clin Cancer Res. 2004;10(11):3897–907.CrossRef


2.

Yamaguchi S, Ohguri T, Imada H, Yahara K, Moon SD, Higure A, et al. Multimodal approaches including three-dimensional conformal re-irradiation for recurrent or persistent esophageal cancer: preliminary results. J Radiat Res. 2011;52(6):812–20.PubMedCrossRef


3.

Rivoltini L, Carrabba M, Huber V, Castelli C, Novellino L, Dalerba P, et al. Immunity to cancer: attack and escape in T lymphocyte-tumor cell interaction. Immunol Rev. 2002;188:97–113.PubMedCrossRef


4.

Copier J, Dalgleish AG, Britten CM, Finke LH, Gaudernack G, Gnjatic S, et al. Improving the efficacy of cancer immunotherapy. Eur J Cancer. 2009;45(8):1424–31.PubMedCrossRef


5.

Nowak AK, Robinson BW, Lake RA. Synergy between chemotherapy and immunotherapy in the treatment of established murine solid tumors. Cancer Res. 2003;63(15):4490–6.PubMed


6.

Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–74.PubMedCrossRef


7.

Sinicrope FA, Rego RL, Ansell SM, Knutson KL, Foster NR, Sargent DJ. Intraepithelial effector (CD3+)/regulatory (FoxP3+) T-cell ratio predicts a clinical outcome of human colon carcinoma. Gastroenterology. 2009;137(4):1270–9.PubMedCentralPubMedCrossRef


8.

Gao Q, Qiu SJ, Fan J, Zhou J, Wang XY, Xiao YS, et al. Intratumoral balance of regulatory and cytotoxic T cells is associated with prognosis of hepatocellular carcinoma after resection. J Clin Oncol. 2007;25(18):2586–93.PubMedCrossRef


9.

Hohenberger P, Gretschel S. Gastric cancer. Lancet. 2003;362(9380):305–15.PubMedCrossRef


10.

Shenoy AK, Fisher RC, Butterworth EA, Pi L, Chang LJ, Appelman HD, et al. Transition from colitis to cancer: high Wnt activity sustains the tumor-initiating potential of colon cancer stem cell precursors. Cancer Res. 2012;72(19):5091–100.PubMedCentralPubMedCrossRef


11.

Lewis JS, Landers RJ, Underwood JC, Harris AL, Lewis CE. Expression of vascular endothelial growth factor by macrophages is up-regulated in poorly vascularized areas of breast carcinomas. J Pathol. 2000;192(2):150–8.PubMedPubMedCrossRef


13.

Pollard JW. Tumour-educated macrophages promote tumour progression and metastasis. Nat Rev Cancer. 2004;4(1):71–8.PubMedCrossRef


14.

Heuff G, Oldenburg HS, Boutkan H, Visser JJ, Beelen RH, Van Rooijen N, et al. Enhanced tumour growth in the rat liver after selective elimination of Kupffer cells. Cancer Immunol Immunother. 1993;37(2):125–30.PubMedCrossRef


15.

Cho Y, Miyamoto M, Kato K, Fukunaga A, Shichinohe T, Kawarada Y, et al. CD4+ and CD8+ T cells cooperate to improve prognosis of patients with esophageal squamous cell carcinoma. Cancer Res. 2003;63(7):1555–9.PubMed


16.

Clemente CG, Mihm Jr MC, Bufalino R, Zurrida S, Collini P, Cascinelli N. Prognostic value of tumor infiltrating lymphocytes in the vertical growth phase of primary cutaneous melanoma. Cancer. 1996;77(7):1303–10.PubMedPubMedCrossRef


18.

Burnet FM. The concept of immunological surveillance. Prog Exp Tumor Res. 1970;13:1–27.PubMed


19.

Dunn GP, Bruce AT, Ikeda H, Old LJ, Schreiber RD. Cancer immunoediting: from immunosurveillance to tumor escape. Nat Immunol. 2002;3(11):991–8.PubMedCrossRef


20.

Dunn GP, Old LJ, Schreiber RD. The three Es of cancer immunoediting. Annu Rev Immunol. 2004;22:329–60.PubMedCrossRef

Feb 18, 2017 | Posted by in ONCOLOGY | Comments Off on Combination of Chemotherapy and Cytokine Therapy in Treatment of Cancers

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