[The clinical study of local treatment of ocular malignant tumors with IL-2 LAK cells]

The authors reported the method of treatment of ocular malignant tumors at early and middle stages with local injections of self lymphokine-activated killing (LAK) cells which were induced by gamma IL-2 in vitro. Satisfactory therapeutic results were obtained. Among the 25 cases of ocular malignant tumors, 10 cases were treated only with IL-2 LAK cells, nine of them got complete regression (CR) and one got partial regression (PR); the other 15 cases were treated with operation and IL-2 LAK cells and they all obtained complete remission. In the follow-up, except the contact of 1 case with PR was lost, all the other 24 cases did not relapse after 1-5 years of observation. The above results show that the treatment of malignant tumors with local injection of self IL-2 LAK cells is a very effective immunotherapy.

[Mechanisms of enhanced accumulation of transferred LAK cells into tumor sites after chemotherapy]

We have previously reported that cancer chemotherapy prior to lymphokine activated-killer (LAK) cell-transfer gave synergistic increase in therapeutic effects of LAK adoptive immunotherapy on transplanted tumors, BMT-11 fibrosarcoma and 3LL lung carcinoma, in C57 BL/6 mice, and that transferred LAK cell-accumulation into tumor tissues was enhanced by treatment with anti-cancer drugs. The author tried to analyze mechanisms responsible for the enhanced LAK cell-accumulation into tumor tissues after chemotherapy by under agarose migration assay and LAK migration inhibitory assay. The author detected a chemotactic factor for LAK cells (LAK-attractant) and a migration inhibitory factor for LAK cells (LAK-MIF) in the conditioned medium of tumor tissues from mice treated with various anti-cancer drugs, which was not found in that of untreated tumor tissues. Since mRNA expression for transforming growth factor-beta 1 (TGF-beta 1) was found to enhance in tumor tissues after chemotherapy through RT-PCR, the author examined a possible participation of TGF-beta 1 as LAK-attractant in tumor tissues of mice treated with cyclophosphamide. Recombinant human TGF-beta 1 showed LAK-attractant activity, and anti-TGF-beta 1 antibody inhibited LAK-attractant activity in the conditioned medium. These findings indicate that TGF-beta 1 produced in tumor tissues of mice treated with anti-cancer drugs may be one of LAK-attractants. On the other hand, LAK-MIF activity was concentrated in the fraction of less than 3kDa which is a smaller molecule than that of TGF-beta 1. These findings suggest that both TGF-beta 1 and LAK-MIF produced in tumor tissues after chemotherapy contributed to the enhanced accumulation of transferred LAK cells into tumor tissues after the chemotherapy.

[Intrapleural administration of LAK cells combined with rIL2 in the treatment of advanced lung cancer with malignant pleural effusion]

Thirty-three patients with malignant pleural effusions due to advanced lung cancer were treated by intrapleural administration of LAK cells combined with rIL2. The pleural effusions disappeared in 18 patients and significantly decreased in 12. Three patients did not respond to the treatment. No serious side effect was found in 33 patients. The results indicate that transfer of LAK cells combined with rIL2 in the treatment of patients with malignant pleural effusions due to advanced lung cancer is effective and safe.

[Treatment of metastatic kidney neoplasms with a new interleukin 2 protocol: The experience of the Gustave-Roussy Institute]

Treatment of metastatic renal cell carcinoma with interleukin 2 (IL2) remains controversial despite the authorization from the French government for IL2 with the West schedule in this disease. We report herein the study of the Institute Gustave-Roussy of 73 patients, who received from 1989 to 1991 a new schedule of high dose IL2. Seventy three patients received high dose IL2 according to the following schedule: IL2 by continuous infusion at 24.10(6) IU/m2/d, on 2 consecutive days per week, during 5 weeks. This treatment was associated in the first 33 patients with gamma interferon at a dose of 5.10(6) IU/m2/d subcutaneously the days of IL2 infusion, during the 5 weeks of therapy. Immunotherapy was further continued in responding patients, either as an association of IL2 and LANAK (lymphokine-activated natural killer) cells, or as IL2 alone. Finally, when possible, surgery was performed on residual masses. Twenty five percent of objective responses (PR + CR) have been observed. Moreover, 12.3% CR has been obtained after the overall therapy. The global mean survival is 15 months, with a mean survival of 8, 18 and 24+ months depending on the status of the disease (progressive, stable or responding) after initial treatment with IL2. Tolerance of this schedule was good with an actual received dose of 90% of the planned doses, and patients could leave the hospital within 2 hours after the end of IL2 in 87% of the cycles. No toxic death was observed. Among the parameters observed for correlation with the clinical response, only performance status and level of sTNF-alpha R were significantly associated with the response.

Longer local retention of adoptively transferred T-LAK cells correlates with lesser adhesion molecule expression than NK-LAK cells

The local retention of adoptively transferred lymphokine (IL-2)-activated killer (LAK) cells was examined in 11 patients with head and neck carcinoma. Unseparated lymphocytes, T and natural killer (NK) cells isolated from patients were cultured with IL-2 for 7 days, labelled with 99mTc-HMPAO, and immediately injected back into the respective donors via the superficial temporal artery or locally into the tumour tissue. The injected LAK cells were periodically traced using a gamma camera, and the LAK cell retention rate was calculated from the radioactivity. One hour after the injection, about 70% of the locally infiltrated LAK cells remained in the tumour tissue, while about half of the LAK cells transferred via the regional artery were dislodged from the tissue. LAK cells induced from T cells (T-LAK) were retained in the tissue for a longer time than LAK cells induced from NK cells (NK-LAK). T-LAK were less chemotactic and less adherent to human umbilical vein endothelial cells (EC), and showed lesser migration through EC. Flow cytometric analysis revealed higher expression of CD11a, CD11b, CD18 and CD49d on NK-LAK compared with T-LAK. MoAbs against these adhesion molecules suppressed adhesion and migration of LAK cells. These results indicate that the rapid disappearance of NK-LAK from the tissue is associated with their greater chemotactic and adhesive as well as migratory activities depending on differing expression of adhesion molecules.

[Treatment with autologous tumor-infiltrating lymphocytes and recombinant interleukin-2 in patients with lung carcinoma]

In 16 patients with lung cancer tumor infiltrating Lymphocytes (TIL) and peripheral blood lymphocytes (PBL) and their antitumor activities after IL-2 activation and were tested by 3H-TdR releasing assay. The results showed that the cytolytic activity of TIL against autologous tumor cells was lower than of IL-2 activated PBL (LAK cells) at the early incubation period but become markedly higher than that of LAK cells when the incubation lasted for 20 to 25 days. The subjectively most patients received systemic TIL treatment felt better and their immune functions were improved. Transiant Low-grade fever occurred in cases and drop of arterial blood pressure in 1. No potentially fatal toxic effect was observed.

Antitumor activities of subsets of human IL-2-activated natural killer cells in solid tissues

Human NK cells can be separated into two functionally distinct subpopulations based on the ability to rapidly respond to IL-2 by adherence to solid surfaces. To determine functions of the NK cell subsets in solid tumor tissues, adherent (A) and nonadherent (NA) NK cells were evaluated for their ability to infiltrate multicellular tumor spheroids in vitro, to kill carcinoma (CA) cell targets in these spheroids, and to mediate antitumor activity in vivo. A-NK cells were less cytolytic than NA-NK cells against CA targets in single cell suspensions or in monolayers. However, A-NK cells showed a significantly better ability than NA-NK cells to infiltrate tumor tissues and kill tumor cells in spheroids of human squamous cell CA of the head and neck or breast CA. Perilesional delivery of human A-NK cells and IL-2 resulted in regression of established human squamous cell carcinoma of the head and neck tumors growing subcutaneously in immunosuppressed nude mice. Similarly, in a xenograft model of human gastric CA metastatic to liver of nude mice, a single intrasplenic injection of A-NK cells in combination with i.p. infusions of IL-2 significantly reduced the number of established hepatic metastases (p < 0.007) and prolonged survival of the mice (p < 0.003). In contrast, NA-NK cells were ineffective in either of the in vivo xenograft tumor models. These findings demonstrate that A-NK cells represent a biologically unique and important subset of NK cells that, in contrast to the rest of NK cells, function as effector cells in solid tumor tissues and, consequently, have a great antitumor therapeutic potential.

[The effects of combined hepatectomy and immuno-chemotherapy on postoperative recurrence rate of primary liver cancer]

121 cases with primary liver cancer were divided into four groups: OP: resection only (30 cases); OC: combined operative resection and chemotherapy (27 cases); OI: combined operative resection and immunotherapy (31 cases); OI: combined operative resection and immuno-chemotherapy (33 cases). The results showed that one year recurrence rate was 56.7%, 40.7%, 32.3% and 27.3%, respectively. The recurrence rate of group OI and group OIC were significantly lower than that of group OP and group OC. It indicated that combined operation and immuno-chemotherapy is useful in preventing post operative recurrence.

[Generation and activation of tumor-infiltrating lymphocytes (TIL) within the scope of lymphokine activated killer cell therapy (LAK-TIL therapy) in patients with advanced breast and ovarian carcinoma]

In this study we examined a combined immunotherapy using lymphokine activated tumor infiltrating lymphocytes and active specific immunotherapy with virus-modified tumor cells in disseminated breast and ovarian cancer patients. During the therapy a significant increase in cytotoxicity could be observed, which nevertheless could not be maintained after the end of therapy. In an ongoing prospective randomized study we are using antigen specific stimulated cytotoxic T-lymphocytes to extend this effect.

Effect of lymphokine-activated killer cells with or without radiation therapy against malignant brain tumors

The use of autologous lymphokine-activated killer (LAK) cells to treat malignant brain tumors was evaluated in 10 patients, one with metastatic malignant melanoma and nine with malignant glioma. LAK cells were obtained by culturing autologous peripheral blood lymphocytes with human recombinant interleukin-2 (rIL-2) for 7-28 days. All patients underwent surgery to remove as much tumor as possible and an Ommaya reservoir was implaced in the tumor cavity. Two of the 10 patients had received radiotherapy elsewhere, so were treated with LAK cells alone. Eight patients were treated with a combination of LAK cells and radiotherapy, using 1.8-2.0 Gy fractions given five times a week with a total dosage between 54 and 65 Gy. LAK cells and rIL-2 were injected to the tumor cavity via the Ommaya reservoir once a week for inpatients and once a month for outpatients. The duration of the LAK therapy ranged from 3 to 23 months (mean 13.7 mos). Neuroimaging evaluation revealed two complete responses, three partial responses, four no changes, and one progressive disease. In one patient with pontine glioma, the Karnofsky performance score was raised from 20 to 60. There were no side effects after the injection of LAK cells and rIL-2. The results suggest low-dose LAK therapy is a useful and safe treatment modality for malignant brain tumors.

A study of the cytotoxicity of malignant pleural effusion lymphocytes and LAK cells against autologous tumor cells

The cytotoxicity of malignant pleural effusion lymphocytes (MPEL) against autologous tumor cells (ATC) were compared with that of peripheral blood lymphocytes (PBL). It was demonstrated that the cytotoxicity of PBL was higher than that of MPEL (P < 0.001), but the cytotoxicity and expansion of MPEL-activated by rIL-2 was much higher than that of PBL activated by rIL-2 (LAK cells) (P < 0.001). This shows that local immune reaction of the pleural cavity of patients with malignant pleural effusion was in the state of suppression. MPEL activated are better effector cells than LAK cells in tumor adoptive immunotherapy.

Interleukin 2 treatment in colorectal cancer: current results and future prospects

Recent interest in the treatment of advanced colorectal cancer with immunotherapy has focused on the use of recombinant interleukin 2 (rIL2). These studies have shown that rIL2 used alone, in combination with lymphokine-activated killer (LAK) cells or tumour-infiltrating lymphocytes (TILs), has little anti-tumour activity, with low, short-lived clinical responses being documented. However, phase I and II studies evaluating rIL2 in combination with 5-fluorouracil (5FU) or 5FU and leucovorin (LV) have been more encouraging, with response rates of up to 46% being reported. Only one randomized, controlled study, however, has compared rIL2 combined with 5FU/LV vs 5FU/LV alone. Although there was no difference in tumour response rates between the two groups, there was a doubling in the median survival of those patients in the poor performance status group (ECOG 1). Also, studies have evaluated the effects of rIL2, given in the peri-operative period, on reversing the immunosuppression that occurs following 'curative' resection for colorectal cancer. These studies have shown an abrogation of immune suppression induced by surgery and an enhancement of host anti-tumour defence mechanisms in the peri-operative period, a time when active tumour dissemination has been shown to occur. These results may have important implications for the management of those patients with malignant disease who are undergoing major curative surgery.

Evaluation of the antitumor activity of human IL-4 by in vitro and in vivo assays

The characteristics of rhuIL-4 induced cytotoxicity was detected in vitro by using 51Cr release assay and the anti-tumor activity of rhuIL-4 induced killer cell was evaluated in vivo by using a human tumor model in nude mice. huIL-4 can induce LAK activity from peripheral blood lymphocytes (PBMC) stimulated with phytohemagglutinin (PHA). Compared with the LAK activity induced by rhuIL-2, the cytotoxicity of the killer cells induced by rhuIL-4 to K562 and Raji cells was lower, but that to TBL-E, a human lymphoid leukemia cell line established in our laboratory, and PHA-activated blast cells (PHA-blasts) was of similar magnitude. In the cytotoxicity assay using PHA-blasts, the addition of PHA increased the IL-4-induced killer cell cytotoxicity by 131%, but had no effect on IL-2-induced killer cell cytotoxicity. This implies that IL-4 mainly induces CTL-like activity, while IL-2 mainly induces NK-like activity. An experimental human tumor model in nude mice was established by injection of TBL-E human leukemia cells. The anti-tumor activity of rhuIL-4 was evaluated by injection of human LAK cells induced from PHA-blasts by rhuIL-2+rhuIL-4 and human cytokines into tumor-bearing nude mice. The results showed that human LAK cells effectively inhibit the tumorigenicity of TBL-E cells in nude mice with an inhibition rate of 61%. The antitumor effect of rhuIL-2 was better than that of rIL-4, and the antitumor effect of rhuIL-2+rhuIL-4 was similar to that of rhuIL-2, though the former delayed the occurrence of tumors. Our data imply the potential application of human IL-4 in clinic, and provide an animal model to evaluate the anti-tumor activity of human cytokine(s) with species specificity.

[Observation of the effects of LAK/IL-2 therapy combining with Lycium barbarum polysaccharides in the treatment of 75 cancer patients]

Seventy nine advanced cancer patients in a clinical trial were treated with LAK/IL-2 combining with Lycium Barbarum polysaccharides (LBP). Initial results of the treatment from 75 evaluable patients indicated that objective regression of cancer was achieved in patients with malignant melanoma, renal cell carcinoma, colorectal carcinoma, lung cancer, nasopharyngeal carcinoma, malignant hydrothorax. The response rate of patients treated with LAK/IL-2 plus LBP was 40.9% while that of patients treated with LAK/IL-2 was 16.1% (P < 0.05). The mean remission in patients treated with LAK/IL-2 plus LBP also lasted significantly longer. LAK/IL-2 plus LBP treatment led to more marked increase in NK and LAK cell activity than LAK/IL-2 without LBP. The results indicate that LBP can be used as an adjuvant in the biotherapy of cancer.

Phase II trials of high-dose interleukin-2 and lymphokine-activated killer cells in advanced breast carcinoma and carcinoma of the lung, ovary, and pancreas and other tumors

Treatment with interleukin-2 (IL-2) used alone or in combination with lymphokine-activated killer (LAK) cells is known to be an active therapy for patients with advanced renal cell carcinoma and melanoma. To further explore the activity of IL-2/LAK cell therapy in patients with advanced cancer of various primary sites, the Extramural IL-2/LAK Working Group (ILWG) initiated two phase II trials of high-dose IL-2/LAK therapy: one in patients with advanced breast carcinoma, and one in patients with advanced cancer arising in other sites. Patients with advanced renal cell carcinoma, melanoma, colorectal carcinoma, and lymphoma (Hodgkin's and B-cell non-Hodgkin's) were not eligible for the latter trial, but were treated on other ILWG trials that have been reported previously. Sixty-nine patients received high-dose IL-2 (600,000 IU/kg administered by a 15-min intravenous infusion every 8 h) on days 1-5 and days 11-15. Leukapheresis was performed for collection and ex vivo expansion of LAK cells on days 7-10, and the LAK cells were reinfused on days 11, 12, and 14. The studies were designed to determine whether treatment with IL-2/LAK resulted in at least a 40% response rate, a level of activity that was believed to be sufficient to justify the toxicity and cost of IL-2/LAK therapy. An adequate number of patients with carcinoma of the breast (N = 12), pancreas (N = 8), ovary (N = 7), and lung (non-small cell; N = 6) were accrued to assess response; most of these patients had prior chemotherapy that had failed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of LAK cells and BRM on the growth of pancreatic cancer cells injected into nude mice]

Effect of lymphokine activated killer (LAK) cells induced by in vitro or in vivo stimulation with biological response modifier (BRM) such as recombinant interleukin-2 (rIL-2) or OK-432 on the growth of pancreatic cancer cells injected into nude mice were studied. Human rIL-2 stimulated spleen cells from BALB/c nu/nu mice were used as effector LAK cells. Human pancreatic cancer cell lines PK-1 and PK-9 were used as target for cytolytic activities against pancreatic cancer. Cytolysis was estimated by 51Cr release assay in vitro, and tumor growth inhibition was estimated by Winn assay in vivo. NK, LAK and pancreatic cancer cell killing activities of LAK cells were elevated to significantly high level of 82%, 70% 51% (PK-1) and 33% (PK-9) respectively on the 2nd day after cultivation with rIL-2. Significantly high level of tumor inhibition rate (98%) was obtained when PK-1 cells were injected into nude mice subcutaneously with LAK cells compared with injection of PK-1 cells only (control). Spleen cells induced from nude mice injected intraperitoneally with rIL-2 or OK-432 showed significantly high cytolytic activities. These results indicate that LAK cells induced by in vitro or in vivo stimulation with BRM could inhibit the growth of pancreatic cancer.

[The anti-pancreatic cancer efficacy of LAK cells mediated by YPC3 monoclonal antibody in vitro and in vivo]

The purpose of this study was to investigate a new form of specific targeting immunotherapy for human pancreatic carcinoma. In 4hr 51Cr release assays, the cytolysis of Capan-2 human pancreatic carcinoma cells by LAK cells was enhanced with pancreatic cancer-specific monoclonal antibody (YPC3 McAb). This antibody-dependent cellular cytotoxicity (ADCC) of the LAK cells was more evident while increasing the concentration of YPC3 McAb. The cytotoxic effects of the LAK cells on target cells increased about 60% when 50 micrograms/ml of YPC3 McAb was used. No cytotoxic effect of the LAK cells was found in the presence of irrelevant monoclonal antibody. Experimentally, the growth rate of Capan-2 human pancreatic carcinoma cell line in nude mice was 25%, 100%, and 100% after the injection of LAK cells, splenocytes and YPC3 McAb, respectively. However, simultaneous injection of YPC3 McAb and LAK cells completely inhibited the growth of the cell line. These results suggest that LAK cells in combination with YPC3 McAb might be useful for the treatment of human pancreatic carcinoma.

Phase Ib trial of pentoxifylline and ciprofloxacin in patients treated with interleukin-2 and lymphokine-activated killer cell therapy for metastatic renal cell carcinoma

The dose of interleukin 2 (IL-2) which can be administered to cancer patients is limited largely by a capillary leak syndrome. Pentoxifylline (PTX) is a methylxanthine which reduces IL-2 toxicity in animals. Ciprofloxacin (Cipro) modifies the metabolism of methylxanthines and, when coadministered with PTX, increases levels of PTX and certain of its metabolites. We conducted a phase Ib trial in patients receiving IL-2 and lymphokine-activated killer cell (LAK) cell therapy for metastatic renal cell carcinoma to identify the maximum tolerated dose of PTX which could be coadministered with Cipro in this setting. Eighteen patients received IL-2 (Roche) by continuous infusion at 6 x 10(6) units/m2/day on days 1-5 and underwent leukapheresis on days 7-9. LAK cells were infused on days 12-14. IL-2 was administered at 2 x 10(6) units/m2/day on days 10-20. Cohorts of patients received PTX at 2.5 (n = 3), 3.1 (n = 6), 3.9 (n = 6), and 4.9 (n = 3) mg/kg by 30 min i.v. infusion every 4 h on days 0-5 and 10-20 and Cipro (500 mg p.o. every 12 h) on days 1-5 and 10-20. Toxicity was compared with that observed in 33 historical control patients who received 37 cycles of an identical regimen of IL-2/LAK without PTX/Cipro. PTX at 2.5-3.9 mg/kg and Cipro were well tolerated. The maximum tolerated dose of PTX was 3.9 mg/kg. Dose-limiting emesis (n = 1) and atrial fibrillation (n = 2) occurred at 4.9 mg/kg and were reversible. Two complete, one partial and one minor, responses were observed. Patients treated with 3.9 mg/kg PTX received 95.0% of the planned dose of IL-2 as compared to 72.8% in the control patients (P < 0.025), primarily due to a lower incidence of azotemia and metabolic acidosis in PTX/Cipro recipients than had been seen in the historical control patients. The results of this study demonstrate that PTX/Cipro can be administered to patients receiving IL-2/LAK without apparent loss of therapeutic efficacy. Moreover, PTX/Cipro recipients exhibited less toxicity than historical controls. Therefore, treatment with PTX/Cipro may allow delivery of higher doses of IL-2, which might induce more responses in IL-2-responsive tumors and regression of tumors unresponsive to conventional doses of IL-2.