Advances in the Immunology of Head and Neck Cancer

Therapeutic plasmapheresis and protein A immunoadsorption in malignancy: a brief review

Plasmapheresis is being used with considerable frequency in the management of malignant and non-malignant disorders. More recently, staphylococcal Protein A immunoadsorption has been employed in similar clinical situations. In patients with malignancy, plasmapheresis has been shown to produce alterations in plasma proteins, decrease circulating immune complexes, remove "specific" and "non-specific" blocking factors, change immune reactivity, and affect monocyte function. Partial responses have been reported in a small number of patients with carcinoma of lung, colon, and breast following plasmapheresis. In addition, there are reports of favorable responses in patients with melanoma, head and neck tumors, lymphomas, leukemias, and Kaposi's sarcoma in acquired immune deficiency. All these responses were partial and brief, and the treatment did not alter the course of the disease. Plasmapheresis has been useful in the management of hyperviscosity and occasionally of paraneoplastic syndromes. It may also have a role in the treatment of thrombotic thrombocytopenic purpura associated with mitomycin-C therapy. Protein A immunoadsorption, by which circulating immune complexes are selectively removed, can activate the complement system, increase blastogenic responses, and increase the natural killer cell activity. It has been shown to produce partial responses in breast and colon cancer, as well as Kaposi's sarcoma in acquired immune deficiency. It may have a useful role to play in the management of mitomycin-C-associated thrombotic thrombocytopenic purpura. Both plasmapheresis and Protein A immunoadsorption should be considered investigational interventions at this time. Toxicity of plasmapheresis, though uncommon, can be serious and may rarely be fatal. Toxicity of Protein A immunoadsorption is mild, consisting mainly of influenza-like symptoms and rash.

Serum immunoglobulin E levels in patients with head and neck cancer

Serum immunoglobulin E levels were estimated in 50 patients with head and neck cancer and in 25 controls. Mean serum IgE value was significantly higher in patients with various sites of cancer in the head and neck region other than carcinoma of the tonsil. The levels increased with advancement in the stage of cancer. There was, however, no difference in mean serum IgE value with respect to the character of the lesion, to the histopathological type of growth or to radiotherapy. In patients with carcinoma of the tonsil, the mean serum IgE concentration was significantly lowered.

Systemic and regional natural cytotoxicity in patients with head and neck cancer

Forty patients with squamous carcinoma of the oral cavity (head and neck cancer) were investigated for natural killer-cell (NK) activity in peripheral blood (PB) and tumour-draining lymph nodes (LNs). For measuring NK activity a 4 hrs 51Cr release assay and K 562 target cells were used. Mononuclear cells of PB (PBMNC) and LNs (LNMNC) were separated by Ficoll Hypaque gradient centrifugation. NK activity was determined before tumour surgery. LNs were obtained either at the time of surgery of the primary tumour (en bloc neck dissection)--"immediately dissected LNs (ID-LNs)" or some time after removal of the primary tumour, especially for prophylactic purposes,--"delayed dissected LNs (DD-LNs)". Preoperatively, NK activity was clearly stage-dependent, patients with stages T1-2 displaying mean values similar to those of a control group without malignant disease, whereas values were significantly lower in patients with stages T3-4. Spontaneous cytotoxicity was significantly lower in LNMNC than in PBMNC of identical donors. NK activity was significantly lower in ID-LNs than in DD-LNs. These results suggest some negative influence of the primary tumour in the spontaneous cytotoxicity in both PB and tumour-draining LNs. In vitro incubation at +37 degrees together with addition of lymphoblastoid interferon (IFN-alpha) achieved a significantly stimulation of NK activity in both PBMNC and LNMNC.

An assessment of neck node immunoreactivity in head and neck cancer

Current conventional forms of cancer treatment represent non-specific modalities that destroy not only cancerous but also non-cancerous tissue in an effort to totally eradicate the neoplasm. It was unknown in head and neck cancer whether a more specific form of treatment, as it relates to neck nodal disease, was advisable. The purpose of this investigation was to study the cervical node immunoreactivity in head and neck cancer patients as a means of determining their immunologic capabilities and thus provide information about the merits of specific vs. non-specific cancer treatment. The results demonstrated that lymphocytes arising from cervical nodes caused alterations in the tumor growth. There appeared to be no particular difference in immunoreactivity of lymphocytes arising from nodes located in different areas of the neck. The regional immune system of neck nodes in the head and neck cancer patient appears to be capable of mounting an immune response irrespective of the patient's tumor status. Usual measures of systemic immunocompetence failed to identify any patients with advanced stage disease and showed little correlation with the regional immunoreactivity. The regional nodal immunoreactivity also did not correlate with the size or the numbers of metastatic neck nodes. The results demonstrate that cervical neck nodes are capable of mounting an immune response to head and neck cancer and are not mere passive filters that are periodically involved with tumor emboli. These results support the need for the development of reliable treatments which are directed at tumor tissue only.

Immunobiologic staging of patients with carcinoma of the head and neck

For decades immunologic deficiencies have been documented in patients with carcinoma, and many investigators have attempted to utilize this information in determining prognosis more accurately. Determining prognosis more accurately would be most helpful with Stage III patients, since at present there are no useful guidelines as to which Stage III patients would benefit from aggressive surgery and/or radiation therapy and which would not. Assays of cellular immunity--such as skin testing, determining peripheral T-lymphocyte counts, and assessing lymphocyte reactivity--have achieved extremely limited clinical application. These assays are too expensive and/or too difficult to perform in the routine clinical setting. Total lymphocyte counts, however, are readily available in the clinical setting and can be helpful in determining prognosis. Other readily available clinical information, such as age and pretreatment serum immunoglobulin levels, can also be of value in determining prognosis. In this study, logistic regression was utilized to determine the prognostic implications of stage, age, and pretreatment total lymphocyte counts in 132 patients with carcinoma of the head and neck. Although each variable determined prognosis accurately less than 70% of the time, the stage, age, lymphocyte prognostic index (SALPI) accurately predicted outcome at 3 year follow-up 80% of the time (Pr. less than .0001). Discriminant function analysis was utilized to determine the prognostic implications of pretreatment serum immunoglobulins in 243 patients with head and neck carcinoma. A serum immunoglobulin prognostic index (SIPI) was derived which was based on the observations that elevated levels of immunoglobulin A (IgA) indicated a poor prognosis, while elevated levels of immunoglobulin E (IgE) and immunoglobulin D (IgD) indicated a favorable prognosis (Pr. less than .009). The SIPI was not as accurate as the SALPI in determining prognosis; however, when the indices were used simultaneously, concurring indices predicted the outcome of Stage III patients correctly 86% of the time.