Intralesional BCG immunotherapy of pulmonary tumors

Adjuvant treatment using transfer factor for bronchogenic carcinoma: long-term follow-up

Transfer factor, a dialyzable lymphocyte extract that may act as an immune stimulator by transferring antigen-specific immunity between genetically dissimilar individuals, was administered in a prospective, randomized study to patients with non-small cell bronchogenic carcinoma. Between 1976 and 1982, 63 patients who underwent pulmonary resection, mediastinal lymph node dissection, and, when indicated by the presence of mediastinal lymph node involvement, mediastinal irradiation were randomized into two groups. Group 1 (n = 28) received 1 mL of pooled transfer factor at 3-month intervals after operation; group 2 (n = 35 ) served as controls and received saline solution. There were no statistically significant differences between the two groups with respect to age, sex, tumor histology, stage of disease, or extent of resection. One patient was lost to follow-up at 96 months; follow-up was complete in all others through July 1990. In patients receiving transfer factor, the 2-, 5-, and 10-year survival rates were 82%, 64%, and 43% respectively, whereas in controls they were 63%, 43%, and 23%. Survival in patients receiving transfer factor was consistently better than in those receiving placebo. Furthermore, survival in patients receiving transfer factor was greater at all stages of disease for both adenocarcinoma and squamous cell carcinoma. Although these long-term results were not statistically significant using survival analysis with covariates (p = 0.08), they confirm our previously reported short-term findings suggesting that administration of transfer factor, either through nonspecific immune stimulation, enhancement of cell-mediated immunity, or an as yet undefined mechanism, can improve survival in patients with bronchogenic carcinoma.

Cytostatic and tumoricidal activities of tumor necrosis factor-treated neutrophils

When incubated with recombinant human tumor necrosis factor (TNF), polymorphonuclear neutrophils (PMN) were highly cytostatic to all three tumor cell lines tested. The cytostasis was dose-dependent for both PMN and TNF, and could be neutralized by antibodies specific for TNF. It could also be abrogated by catalase but not by superoxide dismutase (SOD), suggesting that the hydrogen peroxide generated by the TNF-activated PMN was involved in the cytostasis. TNF-treated PMN were also cytotoxic to the tumor cells. However, high level of tumor cytolysis was not evident until after long (greater than 24 h) incubation.

Immunostimulation with intrapleural BCG as adjuvant therapy in resected non-small cell lung cancer. The Ludwig Lung Cancer Study Group (LLCSG)

A prospective randomized trial was performed to evaluate the role of adjuvant local immunostimulation with bacillus Calmette-Guérin (BCG) in resected Stage I and Stage II non-small cell bronchogenic carcinoma. The patients were stratified according to extent of resection and surgical stage, and randomized to treatment or placebo. Adjuvant treatment consisted of a single dose of BCG (Tice) injected into the pleural space between days 6 and 12 postoperatively. Isoniazid was given by mouth for 12 weeks. In the control group saline was injected intrapleurally. Of 441 patients included in the study, 407 were evaluable, 198 of them in the BCG group and 209 in the control group. The average follow-up was 4.7 years. A high rate of complications was noted in the BCG group; after pneumonectomy 22% of these patients developed pleural empyema necessitating further surgical procedures, in comparison with 3% in the placebo group. There was no significant difference between the two randomized groups with respect to survival. There was, however, a significant decrease in the disease-free interval in patients who received BCG (P = 0.044). This detrimental effect with BCG was especially pronounced in pneumonectomized patients (P = 0.028). There was no significant difference between treatment and placebo in patients with lobectomies. Because of no proved benefit of regional administration of BCG (and even of detrimental effects after pneumonectomy) and a high rate of severe complications, the authors advise against the use of BCG intrapleurally as local adjuvant immunostimulation.

Histological evaluation of immunologically mediated tumor regression of the line 10 guinea pig hepatocarcinoma

The histology of immunologically mediated tumor regression was studied in the syngenic strain 2 guinea pig/line 10 hepatocellular carcinoma tumor system. Tumor regression was induced non-specifically by the intralesional injection of living Bacillus Calmette-Guérin (BCG) in 7-day-old established tumors (diameter 8-10 mm). In untreated line 10 tumors at day 7 a mild to moderate inflammatory reaction was present, which consisted mainly of small mononuclear cells; in addition large mononuclear cells and basophils were present. Intratumoral BCG-treatment induced a prominent increase in the inflammatory reaction due to an influx of small and large mononuclear cells and neutrophils. Small mononuclear cells were identified mainly as lymphocytes whereas large mononuclear cells belonged mainly to the macrophage line. Intratumoral administration of BCG resulted in a granulomatous reaction. A time-related decrease in the number of tumor cells and an increase in inflammation, associated with purulent lysis of the granulomatous tissue, was observed. Specific immune-mediated tumor rejection occurred in animals both after active immunization and after adoptive transfer of immune spleen cells. In actively immunized animals the tumor cells were rapidly rejected and from day 4 onwards no tumor cells could be detected at the injection site. Lymphocytes were the major component of the inflammatory reaction; large mononuclear cells were present to a lesser extent and basophilic granulocytes were regularly observed. After adoptive transfer of immunity with immune spleen cells given simultaneously with an intradermal innoculation of tumor cells, an essentially similar rejection reaction was found, although tumor cell rejection was delayed. Lymphocytes and large mononuclear cells were found in equal proportions, whereas basophilic granulocytes were always present in smaller numbers. After BCG-induced regression and in adoptively transferred immune rejection, a fibroblast component was more prominent than in untreated control tumors. This reaction tended to isolate smaller tumor cell areas into islets of decreasing sizes. In contrast with the fibroblast component of growing tumors, the proliferative pre-existing fibrous tissue in tumors undergoing regression or rejection showed a loosely arranged architecture and contained a marked cellular infiltrate. From the results of the present study it was concluded that the morphological expression of line 10 tumor rejection varies. Without immune cells, BCG is needed for the induction of a local inflammatory reaction, which was granulomatous in type and eventually led to complete tumor cell eradication.(ABSTRACT TRUNCATED AT 400 WORDS)

Transfer factor in the treatment of carcinoma of the lung

From 1976 to 1982, 63 patients with carcinoma of the lung underwent curative pulmonary resection, mediastinal lymph node dissection, and postoperative mediastinal irradiation when indicated. After operation, the patients were randomized by cell type and stage of disease into two groups. Beginning 1 month postoperatively, Group 1 patients (N = 28) received 1 ml of transfer factor that had been extracted from the blood of normal individuals. Subsequent doses were administered at 3-month intervals. Group 2 patients (N = 35) served as controls. There were no significant differences between the two groups with respect to age, sex, extent of resection, histological cell type, or stage of disease. Twenty of the 28 treated patients were alive and free from disease from 7 to 77 months after treatment, whereas 17 of the 35 control patients were free from disease. The 1-year survival for Group 1 was 84% and for Group 2, 81%. The 2-year survival was 78% for Group 1 and 46% for Group 2 (p = 0.045). The survival rates by stage of disease were as follows: Stage I, 15 out of 17 or 88% in Group 1 and 15 out of 23 or 65% in Group 2 (p = 0.097); Stages II and III, 5 out of 11 or 45% in Group 1 and 3 out of 12 or 25% in Group 2 (p = 0.304). The results of the study suggest that the administration of transfer factor to patients who have undergone pulmonary resection for carcinoma of the lung can have a significant impact on the prolongation of life.

Surgical results and surgical adjuvant therapy for lung cancer

Careful intraoperative surgical staging should be considered routine for all patients undergoing thoracotomy for lung cancer. In addition, conservative resection is indicated for T1N0 lesions. Surgical adjuvant immunotherapy has not proved as effective as originally hoped. However, the advent of more effective combination chemotherapy for advanced lung cancer has led to the evolution of these agents as adjuncts to surgery. The preliminary results are promising.

Surgical adjuvant therapy for lung cancer

Many patients with lung cancer have disease disseminated beyond the thorax at the time of presentation. In patients with resectable disease, the first site of recurrence following surgery is frequently outside of the thorax. Therefore, the major problem in lung cancer is control of distant metastatic disease rather than failure to control local disease. For these reasons, adjuvant therapy has been directed primarily toward the microscopic systemic disease. Immunotherapy has shown some promise as a systemic agent in lung cancer, but it is clear from the early trials that the effect of immunotherapy is marginal. Newer types of immunotherapy are being developed, and at the present time, intralesional BCG immunotherapy holds considerable promise. However, the ultimate success of immunotherapy will reply on the development of better immunotherapeutic agents and a better knowledge of the immunologic relationship between the host and the tumor. Studies evaluating chemotherapy as a systemic adjuvant to surgery have not been promising in the past. However, new combination chemotherapeutic regimens that have a response rate of 40 per cent in advanced disease and that have acceptable toxicity offer considerable promise in the area of adjuvant therapy. Certainly adjuvant chemotherapy has been successful in sarcomas, germ cell tumors of the testes, Wilms' tumors, and breast cancer, as well as other solid tumors, and its reasonable to anticipate that effective combination chemotherapy will be developed that will be useful as a surgical adjuvant in lung cancer. Several trials are currently in progress evaluating preoperative chemotherapy in advanced resectable disease and also postoperative adjuvant therapy following total resection. These studies are now in progress and the preliminary results are encouraging, but the definitive statement cannot yet be made.