Novel cancer vaccines in combination with oxaliplatin-based chemotherapy as first-line therapy in advanced colorectal cancer: A randomized phase II study

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Background: A phase I cancer vaccination trial using five novel HLA-A24-binding peptides derived from not only three oncoantigens, RNF43 (ring finger protein 43), TOMM34 (34 kDa translocase of the outer mitochondrial membrane), and KOC1 (IMP-3; IGF-II mRNA binding protein 3) but also antiangiogenic cancer vaccine targeting VEGFR1 (vascular endothelial growth factor receptor 1) and VEGFR2 had revealed safety and immunogenicity in advanced colorectal cancer (CRC) as presented at 2011 ASCO Oral Abstract Session (No. 2510). We further performed a phase II trial to evaluate the benefit of the cancer vaccination in combination with oxaliplatin-based chemotherapy as first-line therapy. Methods: Ninety-six chemotherapy naïve CRC pts were enrolled to evaluate primarily response rates (RR), and secondarily OS and PFS. Each of the five peptides (3 mg each) was mixed with 1.5 ml of IFA and subcutaneously administered weekly for 12 weeks and after then biweekly. Chemotherapy was performed simultaneously as mFOLFOX6 or XELOX with/without bevacizumab. All enrolled pts had received the therapy without knowing HLA-A status double-blindly, and the HLA genotype were key-opened at analysis point and then, the endpoints are evaluated between HLA-A*2402 positive and HLA-A*2402 negative group. Results: Between February 2009 and November 2012, a total of 96 pts were enrolled in this study. The cutoff date for the main analysis was January 31, 2013 (median duration of follow-up of 26.5months). mFOLFOX6 and XELOX were administered to 93 and 3 pts, respectively. Bevacizumab was used for 5 pts. RR, the primary study end point, was 61.5% (CR 1, PR 58, SD 33, PD 4). It seemed superior as compared to other reports. The median duration to reach the best responses (14 weeks; range 8-69) was surprisingly long and indicated the delayed effect of vaccination. PFS and OS were 8.2 m and 20.7 m, respectively. The HLA genotype will be key-opened at March 2013 and the endpoints will be presented between HLA-A*2402 positive and negative group at the meeting. Conclusions: The phase II cancer vaccine therapy demonstrated the promising response, and warrants further clinical studies. Clinical trial information: UMIN000001791.

A new heating method with dielectric bolus using resonant cavity applicator for brain tumors

In this paper, we discuss a new method of controlling heating location in the proposed resonant cavity applicator. A dielectric bolus was used to non-invasively treat brain tumors. We have already confirmed that our heating system using resonant cavity is useful to non-invasively heat brain tumors. In order to heat tumors occurring at various locations, it is necessary to control the heating area with our heating system. First, we presented the proposed heating method and a phantom model to calculate temperature distributions. The results of temperature distributions were discussed. Second, a 3-D human head model constructed from 2-D MRI images was presented. The results of specific absorption rate distributions were discussed. From these results, it was found that the proposed heating method was useful to non-invasively treat brain tumors.

Heating properties of a new hyperthermia system for deep tumors without contact

In this paper, heating properties of the proposed hyperthermia system for non-invasive treatment of deep tumors are discussed. Our heating system is composed of a large size resonant cavity applicator. In this heating method, a human body is placed between the two inner electrodes. It is heated by electromagnetic fields stimulated in the cavity without contact between the surface of the human body and the applicator. First, we presented the experimental results of heating a cylindrical agar phantom and a cylindrical fat-agar phantom using the proposed system. From the thermal images of the heated phantoms, the center of the agar was locally heated to maximum temperature. Second, we presented the experimental results of heating a mini pig. In the heating experiment, temperature measurements were performed by using fiber-optical thermometers inserted in four locations inside the mini pig. From the results, the deepest region of the liver was heated to the highest temperature 43.3 °C.

Impact of chemotherapy for colorectal cancer on regulatory T-cells and tumor immunity

BACKGROUND

Regulatory T-cells (Tregs) actively engage in the maintenance of immunological self-tolerance and immune homeostasis. The purpose of the present study was to determine how oxaliplatin plus infusional 5-fluorouracil and leucovorin (FOLFOX) and irinotecan plus infusional 5-fluorouracil and leucovorin (FOLFIRI) affect Tregs and other immune effectors.

PATIENTS AND METHODS

A total of 27 patients with metastatic colorectal cancer received the FOLFOX (n=17) or FOLFIRI (n=10) chemotherapeutic regimen. Blood samples were collected from patients before and 7 days after chemotherapy. The prevalence of Tregs co-expressing CD4(+)FoxP3(+) was analyzed with flow cytometry.

RESULTS

The percentage and the number of CD4(+)FoxP3(+) Tregs were significantly reduced after FOLFOX and FOLFIRI in the patients who had high levels of Tregs before chemotherapy. On the other hand, the total number of lymphocytes and the population of CD4(+) T lymphocytes were unchanged.

CONCLUSION

FOLFOX and FOLFIRI may enhance antitumor immunity via suppression of Tregs.

Abstract LB-163: Immunotherapy utilizing MUC-1-messangerRNA encoding DC and MUC-1 specific CTL in combination with Gemcitabine targeting unresectable or recurrent pancreatic cancer

Background; Mucin1 (MUC1) is known as a mucin core protein expressing in inv asive ductal carcinomas of the pancreas. MUC1-specific cytotoxic T lymphocyt es (CTLs) recognize MUC1 moleculesin a HLA-unrestricted manner. We have prev iously reported that the adoptive immunotherapy (AIT) utilizing MUC1-CTLs stimulated with a MUC1-expressing human pancreatic cancer cell line, named Y PK-1, was useful and safe. We also reported the development of an AIT of MUC 1-CTLs in combination with dendritic cells (DCs) pulsed with MUC1-peptide as well.

Here we report that the therapy using DC encoding MUC1-mRNA and MUC1-CTLs targeting unresectable or recurrent pancreatic cancer is safe and effective.

Purpose; We assessed whether this immunotherapy is safe and effective.

Objective and Methods; Twenty patients with unresectable or recurrent pancreatic cancer had the therapy what we planned, one week later, peripheral blood mononuclear cells (PBMC) were harvested by leukapheresis. The PBMCs were separated and induced to be DCs and CTLs. Matured DCs received MUC-1-mRNA by electroporation, then administrated via subcutaneously. CTLs were co-cultured with YPK-1 pancreatic cancer cell line expressing MUC-1 under the stimulation with IL-2, then administrated via intravenously.

Results; Male/Female ratio was 1 to 1 (10/10), Mean age was 60.6 y.o. (37–78), Mean times of administration of cells was 3.35 (1.5–27.9), Mean number of c ells that were administrated was 46 million (DCs) and 1800 million (CTLs), Median observation period was 16.2 months (1.5–27.9). One-year survival rate was 39% (median survival time, 6.9 months). When we focus on the patients with unresectable cancer, their one-year survival rate was 54% (median surviva 1 time, 18.4 months). In addition, patients received DCs of more than 10 million had 58% of one-year survival rate, whereas no patient received less than 10 million's DCs did survive in one year (median survival time, 5.8 months) (p=0.048, Logrank). All of patients received the therapy as outpatients and showed no side effect.

Conclusion; First of all, this therapy is quit safe. Second, patients received DCs of more than 10 million had high one-year survival rate suggesting high volume DCs in this combination therapy had high potential.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr LB-163. doi:10.1158/1538-7445.AM2011-LB-163

High-dose remote afterloading intraluminal brachytherapy in the treatment of unresectable hilar or upper bile duct carcinoma

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Background: To evaluate intraluminal brachytherapy (ILBT) for the treatment of unresectable hilar or upper bile duct carcinoma.

Methods: Between 1992 and 2005, 48 patients were identified who were not indicated for surgical resections. Among them, 22 patients received only biliary drainage (group I) and 26 patients received ILBT (group II). Expandable metallic stents (EMSs) were used in 17 patients and ILBT was delivered using the Varisource 200 remote afterloading unit with a 10 Ci 192Ir or 60Co. Each treatment of ILBT delivered 6 Gy at a 1-cm depth, and was repeated weekly for 5 weeks. A total of 30 Gy was administered to each patient. Survival rates between the groups were compared using Kaplan-Meier survival curves.

Results: In group I, survival rates at 6 and 12 months were 9% and 0%, respectively. Median survival was only 2 months. In contrast, group II survival rates at 6, 12, and 24 months were 77%, 54%, and 9%, respectively, and the median survival of this group was 13 months. Improved survival with the use of ILBT was significant, particularly in clinical stages III, IVa (p<0.01), and IVb (p<0.05). ILBT helped keep the bile duct lumen patent for a long period, but was not effective for the treatment of patients with positive lymph node metastasis.

Conclusions: Although randomized controlled studies will be necessary, the results of the present study are encouraging for using high-dose ILBT in the treatment of unresectable hilar or upper bile duct carcinoma without lymph node metastasis.

No significant financial relationships to disclose.

Care by Kampo medicine for toxicities of colorectal cancer chemotherapy: Effect of goshajinkigan (TJ-107) and powdered processed aconite root (TJ-3023) on oxaliplatin-related neurotoxicity, and effect of hangeshashinto (TJ-14) on CPT-11-related diarrhea

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Background: FOLFOX is standard therapy of advanced-stage colorectal cancer. Sensory neurotoxicity (SN) with oxaliplatin is its dose-limiting toxicity. We decided to use goshajinkigan (TJ-107) for prevention of oxaliplatin-related SN. We think that the main action is the one with powdered processed aconite root (TJ-3023). FOLFIRI is standard therapy too. But watery diarrhea is severe side effect. We decided to use hangeshashinto (TJ-14) for prevention of CPT-11-related watery diarrhea.

Methods: The subjects were 66 patients with advanced-stage colorectal cancer. All 66 patients take TJ-107 (7.5g/day) every day from first oxaliptatin infusion day. Patients profiles were: Male/Female: 29/37, median age 69 years old (42∼84), PS0/1/2/3: 57/9/0/0, clinical stage IIIC/IV: 14/52. Oxaliplatin (85mg/m2) was given as FOLFOX4 (27case), mFOLFOX6 (34) and CapeOx (5). When SN was increased, TJ-3023 was added. TJ-3023 is ingredient of TJ-107. 12 patients had severe watery diarrhea due to FOLFIRI regimen. All 12 patients take TJ-14 (7.5g/day) from appearance of watery diarrhea. Patients profiles were: Male/Female: 8/4.

Results: Total course number of FOLFOX/CapeOX was 595/21, and average number of FOLFOX/CapeOX was 8.46/4.2. Relative dose intensity of oxaliplatin were 37.6mg/m2/week. Medicine compliance of TJ-107 was 89%. 20 patients had grade 3 toxcity (neutropenia 18, thrombocytopenia 2). TTP is 8.14 months. Response Evaluation Criteria is CR/PR/SD/PD/NE:1/36/11/5/13. SN occurred in 43 patients (65.1%). TJ-3023 was added to 10 patients. SN was slightly decreased by TJ-3023. There was no neurotoxicity case with functional impairment in this study. By TJ-14, all 12 patients have a change for the better from grade 2 to grade 1 or 0 of diarrhea. There was no constipation cases.

Conclusions: TJ-107 seem to prervent acute oxaliplatin-induced SN. TJ-3023 may be related to SN prervention mechanism. TJ-14 seem to prevent CPT-11-induced diarrhea. The continuance of chemotherapy for colorectal cancer can be expected by these Kampo medicine.

No significant financial relationships to disclose.

[A case of unresectable advanced gastric cancer successfully treated with chemotherapy after gastrojejunostomy]

We report a patient with unresectable advanced gastric cancer who was successfully treated with chemotherapy after gastrojejunostomy. A 64-year-old man was admitted to our hospital complaining of appetite loss and body weight loss. Abdominal enhanced CT revealed a gastric wall thickening and swelling of lymph nodes in the lesser curvature. Upper gastrointestinal endoscopy showed a gastric cancer in the antrum of the stomach. He underwent laparotomy, which revealed a T4 tumor invading the pancreas. Gastrojejunostomy was performed. After the operation, intake therapy of 80-100 mg S-1 was started for four weeks followed by two weeks rest as one course. After 2 courses of the therapy, abdominal enhanced CT showed a partial response of the lymph nodes. He is alive for 19 months after the operation. Abdominal enhanced CT showed a stable disease. This case suggested that S-1 chemotherapy after gastrojejunostomy was effective for unresectable advanced gastric cancer because of the long-term survival and an improvement of the patient's quality of life.

Basic study of brain injury mechanism

The purpose of this study is to discuss the mechanism of brain injury experimentally paying attention to the pressure changes on the surface of a brain agar phantom generated by a cavitation.

Heating properties of coaxial needle applicator made of SMA for hyperthermia treatments

This paper describes heating properties of the developed coaxial needle applicator made of a shape memory alloy (SMA) for brain tumor hyperthermia treatments to avoid undesirable hotspots. We estimated the temperature distribution inside an agar phantom by the finite element method (FEM) and heated the agar phantom with the developed needle applicator.

SAR analysis of a re-entrant resonant cavity applicator for brain tumor hyperthermia treatment with a 3-D anatomical human head model

A re-entrant resonant cavity applicator system for non-invasive brain tumor hyperthermia treatments was presented. We have already confirmed the effectiveness of the heating properties of this heating system with cylindrical agar phantoms and with computer simulations.

Heating properties of non-invasive hyperthermia treatment for abdominal deep tumors by 3-D FEM

This paper discusses the heating properties of a new type of hyperthermia system composed of a re-entrant type resonant cavity applicator for deep tumors of the abdominal region. In this method, a human body is placed in the gap of two inner electrodes and is non-invasively heated with electromagnetic fields stimulated in the cavity. Here, we calculated temperature distributions of a simple human abdominal phantom model that we constructed to examine the heating properties of the developed hyperthermia system. First, the proposed heating method and a simple abdominal model to calculate the temperature distribution are presented. Second, the computer simulation results of temperature distribution by 3-D FEM are presented. From these results, it was found that the proposed simple human abdominal phantom model composed of muscle, fat and lung was useful to test the heating properties of our heating method. Our heating method was also effective to non-invasively heat abdominal deep tumors.

Development of automatic impedance matching system for hyperthermia treatment using resonant cavity applicator

In this paper, we discuss a new system to make impedance matching automatically for a re-entrant resonant cavity applicator for brain tumor hyperthermia treatment non-invasively. We have already discussed about the effectiveness of the heating method using manual type impedance matching controller, with experiments of heating an agar phantom and computer simulations. However, it becomes difficult to perform an accurate impedance matching as resonant frequency becomes high. Here, in order to make a more accurate impedance matching, we developed the automatic impedance matching system (AIMS). We noticed that the reflected power was generated when the impedance matching was not complete. In this system, therefore, to reduce the reflected power fed back, the stepping motor to turn the dial of variable capacitors is controlled by developed software. To evaluate the developed AIMS, the experiments of heating the agar phantom were performed. From these results, we found that the temperature rise of the agar phantom by using AIMS was about 180% of using manual type controller under the same heating condition. It was found that the proposed system was very effective for hyperthermia treatment using resonant cavity applicator even when the resonant frequency was high.

Improvement of the matching speed of AIMS for development of an automatic totally tuning system for hyperthermia treatment using a resonant cavity applicator

In this paper, we discuss the improvement of the speed of AIMS (Automatic Impedance Matching System) to automatically make impedance matching for a re-entrant resonant cavity applicator for non-invasive deep brain tumors hyperthermia treatments. We have already discussed the effectiveness of the heating method using the AIMS, with experiments of heating agar phantoms. However, the operating time of AIMS was about 30 minutes. To develop the ATT System (Automatic Totally Tuning System) including the automatic frequency tuning system, we must improve this problem. Because, when using the ATTS, the AIMS is used repeatedly to find the resonant frequency. In order to improve the speed of impedance matching, we developed the new automatic impedance matching system program (AIMS2). In AIMS, the stepping motors were connected to the impedance matching unit's dials. These dials were turned to reduce the reflected power. AIMS consists of two phases: all range searching and detailed searching. We focused on the three factors affecting the operating speed and improved them. The first factor is the interval put between the turning of the motors and AD converter. The second factor is how the steps of the motor when operating all range searching. The third factor is the starting position of the motor when detail searching. We developed the simple ATT System (ATT-beta) based on the AIMS2. To evaluate the developed AIMS2 and ATT- beta, experiments with an agar phantom were performed. From these results, we found that the operating time of the AIMS2 is about 4 minutes, which was approximately 12% of AIMS. From ATT-beta results, it was shown that it is possible to tune frequency and automatically match impedance with the program based on the AIMS2.

Heating properties of the needle type applicator made of shape memory alloy by 3-D anatomical human head model

Since the human brain is protected by the skull, it is not easy to non-invasively heat deep brain tumors with electromagnetic energy for hyperthermia treatments. Generally, needle type applicators were used in clinical practice to heat brain tumors. To expand the heating area of needle type applicators, we have developed a new type of needle made of a shape memory alloy (SMA). In this paper, heating properties of the proposed SMA needle type applicator were discussed. Here, in order to apply the SMA needle type applicator clinically. First, we constructed an anatomical 3-D FEM model from MRI and X-ray CT images using 3D-CAD software. Second, we estimated electric and temperature distributions to confirm the SMA needle type applicator using the FEM soft were JMAG-Studio. From these results, it was confirmed that the proposed method can expand the heating area and control the heating of various sizes of brain tumors.

Heating properties of the re-entrant type cavity applicator for brain tumor with several resonant frequencies

We have proposed the re-entrant resonant cavity applicator system for non-invasive brain tumor hyperthermia treatment. In this method, a human head is placed in the gap of the inner electrodes. A brain tumor is heated with the electromagnetic field stimulated in the cavity without contact between the human head and the applicator. We have already presented the effectiveness of the heating properties of this system with cylinder-type agar phantoms and by computer simulations. This paper discusses the heating properties of the developed system with the human head-type agar phantom for brain tumor hyperthermia treatment. First, in order to heat deep brain tumors, we tried to heat the human head-type agar phantom by using several electromagnetic field patterns of the resonant frequency. We found that the temperature distributions can be controlled inside the agar phantom by changing the resonant frequencies. Second, to heat local and deep areas of the agar phantom, we tried to achieve heating using the two different resonant frequencies. We found distinct heating properties by changing the electromagnetic field patterns of resonant frequencies. From these results, it was found that our developed heating system can be applied to hyperthermia treatments of deep-seated brain tumors. Further, by changing resonant frequency, treatment can very correspond to the size and the position of a tumor.