Unspecific cellular immunity before therapy in patients with squamous cell carcinoma of head and neck

Immunotherapy: The Fourth Domain in Oral Cancer Therapeutics

Owing to high global prevalence, incidence and associated mortality, cancer of head and neck particularly oral cancer remains a cardinal domain for research and trials. Immune-modulatory therapies that employ patients own immune system for therapeutic benefits in oral cancer seems promising. The aim of this review is to gauge the potential of immunotherapy as fourth domain of Oral cancer therapeutics. Articles were searched using suitable search terms in MEDLINE and Google Scholar database to include clinical trials, meta-analyses, and research in humans/animals/cell lines published in peer reviewed journals. A total of 97 articles were included in this review. Literature has several studies and trials where different types of immunotherapies has been attempted but it is crucial to identify precise biomarkers of genome based targeted agents and to find parameters to select patients who might benefit from immunotherapy. Also further research is required to estimate predictive value of tumor mutational burden and mutational signatures so as to aid in personalized prediction of oral cancer therapeutic response.

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.

Nonspecific immunity and head and neck cancer: blastogenesis reviewed and revisited

The present study suggests a correlation between concanavalin A-driven blastogenesis and the clinical course of head and neck cancer. Blastogenesis assays were conducted on peripheral blood lymphocytes from controls and from patients with squamous cell carcinoma (SCC) of the head and neck. Our results indicated that 3H-thymidine incorporation in response to concanavalin A and phytohemagglutinin stimulation were significantly lower for patients' than for controls' lymphocytes, whereas PWM stimulation was not statistically different in these two groups. Differences between patients and controls were most notable with concanavalin A stimulation. Five of seventeen patients had a response to concanavalin A stimulation that was in the normal range when expressed as relative to control values. The clinical course of these five patients seems to point to a better prognosis than that of the remaining patients who had below-normal mitogenic responses.

The doubtful relevance of nonspecific immune reactivity in patients with squamous cell carcinoma of the head and neck region

Nonspecific immune reactivity (lymphocyte stimulation with PHA, PWM; % T-cells; absolute T-cell levels; skin reactivity to DNCB) was determined in 30 patients with squamous cell carcinoma of the head and neck region and in 30 age- and sex-matched healthy controls. The tests were carried out in each patient at 4-week intervals for at least 1 year. The tumor patients were regularly controlled over a period of 5 years. A reduced nonspecific immune reactivity was detected for tumor patients as compared with healthy controls. However, there was no correlation between the follow-up tests on unspecific immune reactivity and the clinical course of the disease. Moreover it was not possible--on the basis of pretherapeutic unspecific immune reactivity and 5 years' clinical follow-up--to make any prognostic statement for the tumor patients tested.

Immunology and oral cancer

This paper summarises the evidence for the involvement of the immune response in the development of neoplasia, discusses the immunological abnormalities found in patients with head and neck carcinoma, and outlines recent attempts at treatment of patients with head and neck carcinoma by modulation of the immune response (immunotherapy).

Intratumoral BCG therapy of transplanted head and neck tumors in strain 2 guinea pigs

The generally unfavorable prognosis associated with advanced squamous cell carcinoma in the head and neck region in humans led us to immunotherapeutic experiments with bacillus Calmette-Guerin (BCG) in inbred guinea pigs with solid growing and lymphogenous metastasizing tumors. The injection of live BCG or BCG cell wall preparation (CWP) into the planum buccale in the guinea pig led to a pronounced local inflammatory reaction. If live BCG or BCG CWP were injected into the planum buccale together with line 10 tumor cells, no growth of the tumor could be observed. Animals treated in this manner developed a tumor-specific immunity. Guinea pigs treated intratumorally with live BCG or BCG CWP in established, 6-day-old tumors of the planum buccale showed regression of the primary tumor and prevention of the development of lymph node metastases. These cured animals also developed a tumor-specific immunity. Guinea pigs with 6-day-old tumors of the planum buccale remained tumor free after surgical removal of the primary tumor and the draining submandibular and cervical lymph nodes (radical operation) whereas locally operated animals (primary tumor excision) developed lymph node metastases. Animals that were tumor free after radical surgery did not develop tumor-specific immunity. Despite insufficiently clarified mechanisms for the induction and effect of BCG immunotherapy, we can state that, with intratumoral BCG therapy, a tumor experimentally placed in the head and neck region is eliminated, regionally manifest metastases are eliminated, and specific tumor immunity can be demonstrated in successfully treated animals.

[Investigations of unspecific immune reactivity in patients with head and neck carcinoma (author's transl)]

Unspecific cellular immune reactivity in 30 patients with squamous cell carcinoma of the head and neck was compared with those in 30 healthy controls. Assays were performed in vitro to evaluate the blastogenic response of lymphocytes to the mitogens PHA (phytohemagglutinin), Con A (Concanavalin A) and PWM (pokeweed mitogen) and to quantify T-rosette-forming lymphocytes. The in vivo assay used was the delayed cutaneous hypersensitivity reaction to DNCB (dinitro-chlor-benzene). Tests were performed in all patients every 4 weeks either for a total of 1 year or until death. Tumor patients were followed up to 5 years. Compared to healthy controls tumor patients demonstrated significant impairment of unspecific immune reactivity. Surgery, chemotherapy, and radiotherapy led temporarily to a further decrease of immune reactivity. There was no correlation between unspecific immune reactivity and tumor stage, course of the disease, and prognosis. It was not possible to give any useful statement for patients with squamous cell carcinoma of the head and neck by determining their unspecific immune reactivity.