Levamisole in the treatment of non-invasive and invasive bladder cancer: a preliminary report

We have done a double-blind, randomized, controlled study on 37 patients with transitional cell carcinoma in which levamisole was used as an immune adjuvant in addition to the standard therapy for non-invasive and invasive bladder cancer. Levamisole is administered easily and is well tolerated, especially when compared to other immune adjuvants, such as bacillus Calmette-Guérin or Corynecbacterium parvum. Recall antigens, dinitrochlorobenzene reactivity and total lymphocyte count demonstrated little correlation to the initial stage of disease. Monocyte chemotaxis was increased significantly in patients receiving levamisole. Since our study is ongoing on data exist as yet to make any statement regarding the efficacy of levamisole in the treatment of bladder cancer.

Epstein-Barr virus-determined nuclear antigen in malignant epithelial cells of nasopharyngeal carcinoma

Tumor tissue from lymph node metastasis of nasopharyngeal carcinoma (NPC) was successfully heterotransplanted into an athymic nude mouse and the tumor grown in the nude mouse was identical in its morphology to that form the patient by optical and electron microscopy. Tumor cells at passage 2 were dispersed in vitro by enzymic digestion and smeared. Epstein-Barr virus-determined nuclear antigen (EBNA) was demonstrated in malignant epithelial cells of the smear.

Cellular cytotoxicity in transitional cell carcinoma of the human urinary bladder - a summary

The cytoxicity in vitro fo peripheral blood lymphocytes from patients with carcinoma of the urinary bladder (TCC-bladder) against allogeneic target cells from established cell lines was studied by the 51Cr-release assay. Lymphocytes from both untreated and treated TCC-bladder patients have a significantly elevated mean cytotoxicity to TCC-bladder target cells. Tumour cell destruction by lymphocytes from TCC-bladder patients shows a clear disease related specificity. In TCC-bladder patients a superimposed cytotoxicity exists, probably reflecting reactions against one or several tumour - associated antigens. In treated patients this cytotoxicity may be masked by higher incidence of cross reaction.

The cell surface antigen A, B or O(H) as an indicator of malignant potential in stage A bladder carcinoma: preliminary report

The presence or absence of cell surface antigens (A,B and H) on the cell surface of bladder tumors has been studied. The major blood group antigens A, B or O(H) are present on normal bladder epithelium but are not present on some low grade and low stage papillary transitional cell carcinomas of the bladder. We have demonstrated that of 5 stage A bladder tumors that have not recurred in at least 5 years 3 retained the cell surface antigens, while tumors that have recurred locally, invaded or metastasized had lost these cell surface antigens on the original stage A tumor.

Tissue blood-group antigens and prognosis in low stage transitional cell carcinoma of the bladder

The loss of A, B or H blood-group antigens from the surface of neoplastic epithelial cells has been correlated with aggressive tumor behavior. We examined this phenomenon in low stage transitional cell carcinoma of the bladder. In an analysis of biopsy material from 37 patients the absence of these antigens on the original or recurrent tumors correlated with the subsequent development of invasive disease (stage B or greater), while the presence of antigens correlated with failure to develop invasive disease. Analysis of transitional cell surface antigens may help improve the therapy of bladder cancer.

Lymphocyte response to transitional cell carcinoma: peripheral cytotoxicity and local tumor infiltration

The cytotoxicity of peripheral lymphocytes from patients with transitional cell carcinoma was evaluated and the results were compared to the degree of local lymphocytic infiltration in the bed of the primary tumor. Although a clear correlation was not established local lymphocytic infiltration was associated more commonly with tumor-related peripheral lymphocyte cytotoxicity.

Laryngeal carcinoma associated with multiple additional primary tumors. Immunologic studies

Four malignant tumors and one benign in a 76-year-old man appeared. Three of the neoplasms were in the respiratory system, and one was a bladder carcinoma; all were linked to heavy smoking habits. The patient underwent immunologic investigations consisting of in vivo testing for cutaneous reactivity, in vitro lymphocyte blastogenesis studies, T- and B-cell level studies, and serum immunoglobulin level studies. The studies have demonstrated anergy to recall antigens, decreased lymphocyte responses to phytohemagglutinin, and low levels of peripheral T-lymphocytes. The serum immunoglobulins were at the upper limit of the normal. The relationship between the patient's immunologic status and the occurrence of multiple primary neoplasms is discussed.

Classification of the bladder cancer patient based on in vitro measurements of the immune response

In vitro measurements of the immune response in patients with cancer can be divided into those that estimate nonspecific and those that estimate tumor-specific immune responses. Contained herein is a review of these measurements, especially as they relate to studies that have been reported in patients with transitional cell carcinoma (TCC). In vitro tumor-specific immunity has been extensively examined in TCC using the lymphocyte-mediated microcytotoxicity assay, but subsequent observations on this assay have seriously jeopardized the validity of those early findings. Recent modifications of this assay have permitted longitudinal studies of lymphocyte cytotoxicity in TCC patients, and clinical correlations suggest that this modified assay may detect important immunological events. To date, however, a clinically useful classification of the TCC patient based on in vitro measurement of immune responses has not been achieved, although many promising areas still require investigation.

Immunological responsiveness in patients with bladder cancer

Delayed cutaneous hypersensitivity tests, especially skin tests with dinitrochlorobenzene, are impaired increasingly as the amount of tumor increases. Recall antigens are less sensitive indicators of disease. Therapy, especially radiotherapy, also depresses cell-mediated immunity. Removal of tumor, however, allows these tests to return to normal. Dinitrochlorobenzene skin testing can contribute significantly to prognostic evaluation. An important facet of the tumor-host relationship is measured, and this reflects factors that are independent of tumor staging. Combination of tumor staging and dinitrochlorobenzene-delayed hypersensitivity testing can provide a strong indication of the clinical course, especially for the year following initial treatment of invasive or metastatic transitional cell carcinoma of the bladder.

Lack of specificity of lymphocyte-mediated cytotoxicity against the bladder cancer cell line, T24

We evaluated in vitro lymphocyte-mediated cytotoxicity against the T24 transitional carcinoma cell line and a control melanoma cell line (H894) in a double-blind study involving 25 bladder cancer patients, 19 patients with non-transitional carcinoma and 9 patients with benign conditions using a tritiated proline-labeled tumor cell assay. We found selective reactivity against T24 cells in 16 per cent of bladder cancer patients, 11 per cent of patients with non-transitional cell tumors and 22 per cent of patients with benign conditions. We found no significant differences with respect to the patterns of cytotoxic reactivity among the various patient groups. The use of different methods of lymphocyte purification and different lymphocyte to target cell ratios did not enhance the degree of specificity observed. Prior exposure to alloantigens did not account for the lack of specificity.

Cryopreservation of immunological memory and other lymphoid cell functions

The following components of the immune response by mouse spleen cells were retained after cryopreservation at --110 degrees C: direct and indirect plaque formation, avidity of antibody secreted by plaque forming cells, and induction of primary or secondary adoptive transfer responses. Human peripheral blood lymphocytes retained the capacity to mediate antibody-dependent cytotoxicity and cell mediated immunity to tumor in vitro.

K cell mediated lysis of cultured colon carcinoma and urinary bladder carcinoma cells induced by monospecific antisera against carcinoembryonic antigen (CEA) and two CEA-related normal glycoproteins

Antibody dependent lymphocyte (K cell) mediated lysis of tumor cells in vitro was used to assay for cell surface associated carcinoembryonic antigen (CEA) and two CEA-related normal tissue components, "normal glycoprotein" (NGP) and biliary glycoprotein I (BGP I). Three tumor cell lines were used as target cells. These were HT-29, colon carcinoma, T-24, urinary bladder transitional cell carcinoma and Mel-1, malignant melanoma. To induce lysis we used the IgG-fraction of specific rabbit and monkey anti-CEA sera and of specific rabbit anti-NGP and anti-BGP I sera, respectively. Purified human lymphocytes were used as effector cells. HT-29 was efficiently killed by low concentrations of rabbit anti-CEA and less efficiently by monkey anti-CEA. T-24 and Mel-1 were not lysed by anti-CEA, HT-29 and T-24 were lysed by low concentrations of anti-BGP I. In contrast only HT-29 was lysed by anti-NGP. Only a fraction of the tumor cells was killed by the different antisera although kinetic studies showed that the lytic reaction was complete well before the end of the eighteen hour incubation period used in the assay. Anti-CEA and anti-BGP I gave 30-40% corrected lysis of HT-29. With anti-NGP the corresponding figure was 10-20%.

A 51chromium isotope release assay for detecting cytotoxicity to human bladder carcinoma

A 51chromium isotope release assay is described for measuring in vitro cytotoxicity reactions against allogenetic target cells. Lymphoid cells from some patients with localized transitional cell carcinoma (TCC) were shown to selectively lyse targets derived from two long-term cell lines of TCC. The effector cells in this reaction did not form E rosettes. Cytotoxicity was successfully recovered after cryopreservation.

A cell line from an anaplastic transitional cell carcinoma of human urinary bladder

A cell line, TCCSUP, derived from an undifferentiated, Grade IV transitional cell carcinoma is described. The karyotype showed an abnormal distribution of chromosomes, with no obvious modal number. Distinct marker chromosomes were observed in both early and late in vitro passages. These cells have been subcultured over 50 times during a 20-month period. TCCSUP differs in certain morphological and immunological features from other cell lines from transitional cell carcinomas.

Evaluation of the immunocompetance of patients with transitional cell carcinoma of the bladder

The cellular immunocompetence was examined by means of the quantitative DNCB hypersensitivity reaction in 152 patients with transitional cell carcinomas of the bladder of Broders grades 1-4. Against a control group of 367 normal controls of both sexes, 85 patients with transitional cell carcinomas of grades 1 and 2 showed a normal DNCB reactivity, irrespective of the frequency of tumour recurrence. In 9 patients of this group, an increase of malignancy from grade 2 to grade 3 was observed; the simultaneous deterioration of immunocompetence, however, was not statistically significant. On the other hand, with transitional cell carcinomas of grades 3 and 4, significant impairment of immunocompetence correlating with the tumour stage was noted.

Correlation between tumour stage, tumour grade, and immunocompetence in patients with carcinoma of the bladder and prostate

The cellular immunocompetence was examined in 132 patients with transitional cell carcinoma of the bladder and 85 patients with carcinoma of the prostate with reference to the tumour stage and grade. In both groups a significant correlation between tumour stage and grade was found. These two parameters were also correlated with the reduction of immunocompetence. The results are discussed and compared with those in the literature.

Antigen(s) on human transitional cell carcinoma detected by a xenogeneic antiserum

In studies concerning human bladder cancer, antisera were raised in rabbits against human tumours, normal tissue, and cell lines derived from human tumours and were analysed by absorption and complement dependent microcytotoxicity tests. No significant selective cytotoxicity was discernible with any unabsorbed antisera. After absorption of A53, (an antiserum against the transitional cell carcinoma derived cell line T24) with peripheral blood cells and normal adult tissues, it was cytotoxic to two bladder cancer cell lines (T24 and J82) but not to four other cell lines. This activity was removed by absorption with each of two specimens of transitional cell carcinoma but not by normal bladder and by absorption with T24 or J82 but not with four other non-bladder cell lines. This functional specificity for transitional cell carcinomas could be due to a tumour associated antigen, a significant quantitative difference between tumour and normal cells, or an embryonic specificity re-expressed on the tumor. Further experiments are necessary to investigate these alternatives.

Intracavitary Bacillus Calmette-Guerin in the treatment of superficial bladder tumors

Patients with recurrent superficial bladder tumors have been treated by vesical and intradermal administration of Bacillus Calmette-Guerin. The pattern of recurrence in 9 patients has been altered favorably. Although the findings are still preliminary they appear to hold promise of a new therapeutic approach to the treatment of a group of neoplasms for which effective therapy is still lacking.