Adjuvant treatment in resected lung cancer

Adjuvant immunotherapy with interleukin 2 and lymphokine-activated killer cells after noncurative resection of primary lung cancer

A randomized controlled study of immunotherapy with interleukin 2 (IL-2) and lymphokine-activated killer (LAK) cells was conducted in 105 patients after noncurative resection of primary lung cancer. Half the patients received only the standard postoperative radiation therapy or chemotherapy (control group). The other half received immunotherapy with IL-2 and LAK cells in addition to the standard therapy (immunotherapy group). The primary endpoint was survival. The 7-year survival rate was greater in the immunotherapy group than in the control group (39.1% vs. 12.7%, P < 0.01). Among patients with squamous cell carcinoma, there was no statistical difference in outcome. In contrast, the 7-year survival rate among patients with adenocarcinoma in the control group was only 5.2% but for those in the immunotherapy group it was 38.9% (P < 0.05). If resection was noncurative because of pulmonary metastasis, residual cancer or incomplete resection of lymph nodes, then immunotherapy was effective. If resection was noncurative because of residual cancer in the chest wall or diaphragm, or because of carcinomatous pleuritis or pleural dissemination, then there was no statistical difference in survival between the control group and the immunotherapy group.

Isolation and in vitro expansion of lymphocytes infiltrating non-small cell lung carcinoma: functional and molecular characterisation for their use in adoptive immunotherapy

Tumour infiltrating lymphocytes (TIL) have the capability of recognising and lysing autologous cancer cells, both in vitro and in vivo. Advanced non-small cell lung carcinoma (NSCLC) is partially insensitive to chemo radiotherapy and has a poor prognosis: thus, for this, an immunotherapeutic approach could be attempted. We expanded in vitro 46 out of 70 samples of TIL derived from NSCLC. From proliferating TILS, a number varying from 10 to 50 x 10(9) cells was obtained. These lymphocytes belonged to the T cell lineage, had the capability of growing for 45-60 days and lysed autologous better than allogeneic cancer cells. In addition, analysis of the restriction maps of T cell receptor (TRC)-beta, demonstrated that an oligoclonal population of T cells was preselected in vivo, near the tumour site, and might be expanded in vivo, using phytohaemagglutin and interleukin 2 while maintaining the same characteristics of the original population. These results give a clear rationale for the use of in vitro expanded TIL from NSCLC in protocols of adoptive immunotherapy in patients with residual disease following surgery.