Correlation of eosinophilia with clinical response in patients with advanced carcinoma treated with low-dose recombinant interleukin-2 and mitomycin C

Peritumoral eosinophils predict recurrence in colorectal cancer

In colorectal cancer, the presence and extent of eosinophil granulocyte infiltration may render important prognostic information. However, it remains unclear whether an increasing number of eosinophils might simply be linked to the overall inflammatory cell reaction or represent a self-contained, antitumoral mechanism that needs to be documented and promoted therapeutically. Peri- and intratumoral eosinophil counts were retrospectively assessed in 381 primary colorectal cancers from randomly selected patients. Tumors were diagnosed in American Joint Committee on Cancer (AJCC)/Union Internationale Contre le Cancer (UICC) stage I in 21%, stage II in 32%, stage III in 33%, and stage IV in 14%. Presence and extent of eosinophils was related to various histopathological parameters as well as patients' outcome. Overall, peri- and intratumoral eosinophils were observed in 86 and 75% cancer specimens. The peritumoral eosinophil count correlated strongly with the intratumoral eosinophil count (R=0.69; P<0.001) and with the intensity of the overall inflammatory cell reaction (R=0.318; P<0.001). Both increasing peri- and intratumoral eosinophil counts were significantly associated with lower T and N classification, better tumor differentiation, absence of vascular invasion, as well as improved progression-free and cancer-specific survival. However, only peritumoral eosinophils, but not intratumoral, were an independent prognosticator of favorable progression-free (hazard ratio 0.75; 95% confidence interval 0.58-0.98; P=0.04) and cancer-specific survival (hazard ratio 0.7; 95% confidence interval 0.52-0.93; P=0.01)-independent of the intensity of overall inflammatory cell reaction. This was also found for patients with AJCC/UICC stage II disease, wherein the presence of peritumoral eosinophils was significantly associated with favorable outcome. In conclusion, the number of peritumoral eosinophils had a significant favorable impact on prognosis of colorectal cancer patients independent of the overall tumor-associated inflammatory response. Evaluation of peritumoral eosinophils represents a promising readily assessable tool and should therefore routinely be commented on in the pathology report.

Cancer-related symptom clusters, eosinophils, and survival in hepatobiliary cancer: an exploratory study

CONTEXT

The study of symptom clusters is gaining increased attention in the field of oncology in an attempt to improve the quality of life of patients diagnosed with cancer.

OBJECTIVES

The aims of the present study were to 1) determine the prevalence and distribution of pain, fatigue, and symptoms of depression and their covariation as a cluster in people with hepatobiliary carcinoma (HBC), 2) characterize how variation in each individual symptom and/or their covariation as a cluster are associated with changes in immunity, and 3) determine if the symptom clusters, and associated biomarkers, are related to survival in people diagnosed with HBC.

METHODS

Two hundred six participants diagnosed with HBC completed a battery of standardized questionnaires measuring cancer-related symptoms. Peripheral blood leukocytes were measured at diagnosis and at three- and six-month follow-ups. Survival was measured from the date of diagnosis to death.

RESULTS

Cancer-related symptoms were prevalent and two-step hierarchical cluster analyses yielded three symptom clusters. High levels of pain, fatigue, and depression were found to be associated with elevated eosinophil percentages (F[1,78]=3.1, P=0.05) at three- and six-month follow-up using repeated-measures analysis of variance. Using multivariate latent growth curve modeling, pain was the primary symptom associated with elevated eosinophil percentages between diagnosis and six months (z=2.24, P=0.05). Using Cox regression, vascular invasion and age were negatively associated with survival (Chi-square=21.6, P=0.03). While stratifying for vascular invasion, Kaplan-Meier survival analysis was performed, and eosinophil levels above the median for the sample were found to be related to increased survival in patients with and without vascular invasion (Breslow Chi-square=4.9, P=0.03). Symptom clusters did not mediate the relationship between eosinophils and survival.

CONCLUSION

Cancer-related symptoms, particularly pain and depression, were associated with increased percentages of eosinophils. The presence of symptoms may reflect tumor cell death and be indicative of response to treatment, or other processes, in patients with HBC.

Éosinophiles et réponse antitumorale

PURPOSE

Immune response probably plays a role in the tumour control. Cytotoxic T-lymphocyte response is antigen-specific and requires previous encounter with the antigen to develop an efficient immune response. Regarding the innate immunity, natural killer (NK) cells can destroy neoplastic cells lacking HLA class I molecules. In addition to these effector cells, eosinophils are granulocytes usually involved in allergic diseases or response to parasitic infections. Many types of cancer, however, are associated with eosinophilia, either in the tumour itself and/or in peripheral blood. We will focus our attention on the putative involvement of eosinophils in the antitumour response.

CURRENT KNOWLEDGE AND KEY POINTS

Recent studies on the relationship between tumour and eosinophils have mainly focused on the << tumour-associated tissue eosinophilia >> (TATE), which seems to be more relevant than peripheral blood eosinophilia. Most studies show that TATE is a favourable prognostic marker, except in Hodgkin's disease, since eosinophils probably deliver in this case an antiapoptotic and proliferative signal for Reed-Sternberg cells via the release of soluble CD30L.

FUTURE PROSPECTS AND PROJECTS

The putative anti-tumour effect of eosinophils relies on their tight contact with tumour cells. As a consequence, future immunotherapy studies aiming at an anti-tumour eosinophilic reaction might attract and activate eosinophils within the tumour itself. This could be obtained via direct injection of cytokines (IL-3, IL-5, GM-CSF...) at tumour site or by the use of expression vectors encoding for these molecules.

Combination immunotherapy with rituximab and interleukin 2 in patients with relapsed or refractory follicular non-Hodgkin's lymphoma

Rituximab has significant activity as a single agent in the treatment of follicular non-Hodgkin's lymphoma (NHL). Interleukin 2 (IL-2) is a lymphokine that increases effector cell number. In an effort to augment antibody-dependent cell-mediated cytotoxicity (ADCC) associated with rituximab therapy, low-dose IL-2 was added to a standard rituximab regimen and patients were evaluated for safety and efficacy. Twenty patients with relapsed or refractory follicular NHL were treated with IL-2 (1.2 MIU/m(2)/d for 56 d subcutaneously) as outpatients. Rituximab (375 mg/m(2)) was given on d 15, 22, 29 and 36. The regimen was well tolerated and only three patients required dose adjustments in IL-2. Infusional toxicity associated with rituximab was not exacerbated by IL-2. Peripheral blood immunophenotyping demonstrated significant increases in circulating CD8+ and CD56+ lymphocytes in all evaluable patients (P = 0.0002). Increases in total eosinophil number were observed in all patients. Eleven patients responded to therapy, for an overall response rate of 55%. Four additional patients had stable disease. For these 15 patients, the median time to progression exceeded 13 months. We conclude concomitant cytokine therapy to enhance ADCC with monoclonal antibody therapy was well tolerated and did not exacerbate antibody-related infusional toxicity. Further studies of this rational combination are warranted and ongoing.

Adoptive cellular immunotherapy for the treatment of malignant gliomas

The median survival for adults with recurrent primary malignant gliomas is 56 weeks following surgery, radiation, and chemotherapy. Generally, reoperation can extend the median survival an additional 26-32 weeks. We have developed an aggressive treatment program that utilizes low doses of interleukin-2 (IL-2) combined with ex vivo activated killer cells (LAK) infused via an indwelling catheter placed into the surgical resection cavity. Autologous leukocytes were collected during a standard 3-4 h, outpatient leukapheresis procedure, then activated ex vivo for 4-5 days with high doses of IL-2. The treatment protocol consisted of two 2-week cycles of therapy over a 6-week period. Patients with stable disease or objective response on follow-up MRI scans were retreated at 3-month intervals. Acute and cumulative IL-2-related toxicities were observed, but limited, and included fever, headache and transient neurologic irritation. Corticosteroid levels and usage were strictly controlled during immunotherapy, although higher doses were used intermittently to mitigate toxicity. Biologic changes included lymphocytic infiltration, regional eosinophilia, tumor necrosis, and the localized production of IL-2, IFN-gamma and IL-12, demonstrated by in situ hybridization and immunohistochemistry.

SUMMARY

IL-2 plus autogeneic LAK cells can be safely administered intracavitary to treat high grade primary brain tumors with limited toxicity within the central nervous system. Six out of 28 patients had long-term survival of greater than 2 years post-reoperation plus immunotherapy with 2 patients alive over 8 years. The presence of a marked regional eosinophilia appeared to correlate with increased survival and may be predictive of a biologic and therapeutic response. Regional adoptive immune therapy was well tolerated and should be considered an option for patients with high-grade tumors refractive to standard therapeutic approaches.

Cellular localization of interleukin-5 expression in rectal carcinoma with eosinophilia

Eosinophilia often occurs in malignant diseases. This report concerns a female patient aged 76 years, diagnosed with rectal carcinoma with eosinophilia. Sera were obtained at two different periods (at diagnosis and after the operation) for the evaluation of levels of interleukin-5 (IL-5). The serum IL-5 level increased to 264 pg/mL, and returned to an undetectable level after the operation. The serum at diagnosis enhanced the viability of normal eosinophils in vitro, and this activity was inhibited by antihuman IL-5 polyclonal antibody. Immunohistochemistry and in situ hybridization revealed that stromal eosinophils contained IL-5 protein and messenger RNA (mRNA), but no IL-5 transcripts were detected in eosinophils attached to carcinoma cells. In situ detection of apoptosis showed that several eosinophils attached to tumor cells underwent apoptosis and lost their eosinophil secreted cationic protein (ECP) and major basic protein (MBP). These results may suggest that activated eosinophils by IL-5 play an important role in host defense mechanisms, releasing their toxic granule proteins on adjoining tumor cells.

Modulations of histamine release from mast cells by interleukin-2 is affected by nedocromil sodium

We have previously demonstrated that histamine release from immunologically activated mast cells (MC) is enhanced by their preincubation (1 h) with interleukin-2(IL-2), and that IL-2 induces slow-chronic histamine release by MC in long-term cultures (6 days). In the present study we assessed whether nedocromil sodium can interfere with IL-2 modulation of MC histamine release. IL-2 enhancing effects nedocromil sodium activity were studied in cocultures of rat peritoneal MC with 3T3 fibroblasts (MC/3T3). MC/3T3 were preincubated for 1 h with IL-2 (50 micrograms/ml) and activated with either rabbit anti-rat IgE or compound 48/80. In chronic experiments MC/3T3 were long-term (5-6 days) incubated with IL-2 (50 micrograms/ml). Nedocromil sodium was used at 10(-5) M. MC activation both when added during the preincubation period (no tachyphylaxis was present) and when added together with the MC activators (30-50% inhibition). Washing out IL-2 before addition of the anti-IgE antibodies did not affect its histamine-release enhancing activity. Removal of nedocromil sodium before addition of the stimulus completely abrogated its effect. Continuous presence of IL-2 in the culture medium enhanced spontaneous histamine release by 37% and this effect was completely abolished in the presence of nedocromil sodium. Furthermore, nedocromil sodium decreased MC basal histamine release by 23% in long-term cocultures. Since IL-2 is known to be elevated in some pathological conditions, our results show that nedocromil sodium inhibits MC activation in an in vitro system which may represent a close resemblance to the in vivo allergic response.

Changes in the phenotypic characteristics of eosinophils from patients receiving recombinant human interleukin-2 (rhIL-2) therapy

We have studied the properties of eosinophils from 26 patients with malignant melanoma and 16 patients with renal cell carcinoma (RCC) who were entered into a phase II clinical trial using various schedules of low-dose rhIL-2 immunotherapy. Eosinophilia was observed in 65% of melanoma patients and 100% of renal patients when receiving rhIL-2 therapy. The eosinophil count increased up to 20-fold approximately 5 d after the appearance of lymphocyte activation markers. This would be consistent with eosinophil kinetics and the release of soluble mediators, for example IL-5, from lymphocytes. Eosinophils from eosinophilic patients became hypodense compared to their pre-treatment levels as demonstrated by sedimentation through a discontinuous metrizamide density gradient; they also showed an increased expression of CD4, CD25 and CD11b cell surface activation markers. Eosinophil count could not be correlated to either patient survival or response to therapy in melanoma patients; however, patients with renal cell carcinoma demonstrated a significant correlation (P < or = 0.05) between eosinophil count and survival but not with clinical response. Therefore the maximum eosinophil count achieved during rhIL-2 therapy is of prognostic significance in patients with renal cell carcinoma.

Cytokine combinations in immunotherapy for solid tumors: a review

The use of cytokines alone or in combination with other cytokines or cytotoxic drugs has had a profound effect upon widely metastatic disease in many cases. However, despite the encouraging results in early trials, there is much room for improvement. Few responses to these combinations are complete, and toxicity has in some cases been quite severe. Changes in dose, route, or schedule of administration of the drugs, or the development of cytokine analogs may lead to more efficacious and less toxic regimens. In addition, new cytokines such as interleukin(IL)-7 and IL-12 are currently under investigation for potential use in future immunotherapy trials. These prospects and the use of cytokine combinations are promising advances in the treatment of human cancer.

Cytotoxic cell function and phenotypic analysis of peripheral blood mononuclear cells in cancer patients treated with low-dose interleukin-2 and mitomycin C

We previously found that the ability of peripheral blood mononuclear cells (PBM) of cancer patients to generate lymphokine-activated killer (LAK) cells became remarkably augmented after mitomycin C administration. On the basis of the clinical findings, we designed a treatment regimen comprised of 12 mg/m2 mitomycin C i.v. on day 1 and 700 U/m2 recombinant interleukin-2 (IL-2) i.v. every 12 h from day 4 through day 8. Of 25 patients with advanced carcinoma, 9 had a partial response and 3 had a minor response. Cytotoxic cell function, including natural killer activity, lymphokine-activated killer (LAK) activity, and the ability to generate LAK cells, and lymphocyte subsets in PBM was measured 1 day before and after either the first or second course of this therapy. The relationship between these parameters and the clinical antitumor response to this treatment was examined. Although the cytotoxic activities were significantly augmented after either the first or second treatment course, no positive correlation was observed between the changes in these cytotoxic activities and the clinical response to this therapy, when patients who either showed a partial response or whose disease remission was partial or minor were defined as responders. Further, phenotypic analysis showed a significant increase in CD2+, CD3+, CD4+ and CD4+Leu8- cells after the first course, and CD25+ cells after either the first or second course of this treatment. The percentages of CD2+ and CD25+ cells were significantly elevated only in responders but not in nonresponders, suggesting the increase in these subsets was related to clinical response.