Feasibility study of postoperative intraperitoneal hyperthermochemotherapy by radiofrequency capacitive heating system for advanced gastric cancer with peritoneal seeding

Pulsing Addition to Modulated Electro-Hyperthermia

Numerous preclinical results have been verified, and clinical results have validated the advantages of modulated electro-hyperthermia (mEHT). This method uses the nonthermal effects of the electric field in addition to thermal energy absorption. Modulation helps with precisely targeting and immunogenically destroying malignant cells, which could have a vaccination-like abscopal effect. A new additional modulation (high-power pulsing) further develops the abilities of the mEHT. My objective is to present the advantages of pulsed treatment and how it fits into the mEHT therapy. Pulsed treatment increases the efficacy of destroying the selected tumor cells; it is active deeper in the body, at least tripling the penetration of the energy delivery. Due to the constant pulse amplitude, the dosing of the absorbed energy is more controllable. The induced blood flow for reoxygenation and drug delivery is high enough but not as high as increasing the risk of the dissemination of malignant cells. The short pulses have reduced surface absorption, making the treatment safer, and the increased power in the pulses allows the reduction of the treatment time needed to provide the necessary dose.

Combination therapy with radiation and hyperthermia-induced clinical complete response of small cell carcinoma of prostate

INTRODUCTION

Small cell carcinoma of the prostate has a poor prognosis even with standard systemic chemotherapy. We report a case, in which combination therapy with radiation and hyperthermia-induced clinical complete response.

CASE PRESENTATION

An 87-year-old man complaining of dysuria was referred to our hospital. Based on magnetic resonance imaging findings and a history of prostate cancer, a prostate biopsy was performed, and small cell carcinoma of the prostate was diagnosed. Whole-pelvis radiation therapy was administered with an additional dose to the prostate; eight cycles of hyperthermia treatment (8 MHz radiofrequency capacitive regional hyperthermia) were administered concurrently. Normalized neuron-specific enolase levels and magnetic resonance imaging confirmed a complete response. A few cancer cells were seen in the post-treatment biopsy specimen, which demonstrated positive immunostaining for heat shock protein 70 and HIKESHI.

CONCLUSION

In this case, small cell carcinoma of the prostate was effectively treated with combined radiation and hyperthermia therapy.

Immune correlates of clinical benefit in a phase I study of hyperthermia with adoptive T cell immunotherapy in patients with solid tumors

Purpose: To characterize the T cell receptor (TCR) repertoire, serum cytokine levels, peripheral blood T lymphocyte populations, safety, and clinical efficacy of hyperthermia (HT) combined with autologous adoptive cell therapy (ACT) and either salvage chemotherapy (CT) or anti-PD-1 antibody in patients with previously treated advanced solid tumors.Materials and methods: Thirty-three (33) patients with ovarian, pancreatic, gastric, colorectal, cervical, or endometrial cancer were recruited into the following therapeutic groups: HT + ACT (n = 10), HT + ACT + anti-PD-1 inhibitor (pembrolizumab) (n = 11) and HT + ACT + CT (n = 12). Peripheral blood was collected to analyze TCR repertoire, measurements of cytokines levels and lymphocyte sub-populations before and after treatment.Results: The objective response rate (ORR) was 30% (10/33), including three complete responses (CR) (9.1%) and seven partial responses (PR) (21.2%) and a disease control rate (DCR = CR + PR + SD) of 66.7% (22 of 33). The most common adverse reactions, blistering, subcutaneous fat induration, local heat-related pain, vomiting and sinus tachycardia, were observed in association with HT. IL-2, IL-4, TNF-α, and IFN-γ levels in peripheral blood were significantly increased among the clinical responders (p < 0.05) while IL-6 and IL-10 were elevated among those with progressive disease (p < 0.05). Peripheral blood CD8⁺/CD28⁺ T cells increased (p = 0.002), while the CD4⁺/CD25⁺/CD127⁺Treg cells decreased after therapy (p = 0.012). TCR diversity was substantially increased among the clinical responders.Conclusions: Combining HT with ACT plus either CT or anti-PD-1 antibody was safe, generated clinical responses in previously treated advanced cancers, and promoted TCR repertoire diversity and favorable changes in serum IL-2, IL-4, TNF-α, and IFN-γ levels in clinical responders.

CHIPOFIL: A pilot study assessing the feasibility of HIPEC without extracorporeal circuit

Background

Heated intraperitoneal chemotherapy (HIPEC) is currently performed using an external circuit including a heating device and a pump. Available devices have several drawbacks in terms of costs, technique (flow surges due to blocked tubes) and staff safety, hindering a wider use. In a previous preclinical study conducted in animals, we placed a heating wire within the abdomen to achieve and maintain hyperthermia. Our results showed this technique is safe and effective. The present pilot study was conceived as the first use of such a device in humans, aiming to confirm its safety and efficacy.

Methods

This was a pilot study designed to include 13 patients undergoing HIPEC. Two sets of the prototype were placed within the abdominal cavity, one in the supramesocolic and one in the inframesocolic space. The target temperature was 42–43 °C during 30–90 min according to the protocol defined for each patient. The time to set up, heat and dismantle was measured. All complications were recorded during the first postoperative year and evaluated by an independent committee.

Results

Nine women and four men were included. The median time to set on the device was 25 min. The target temperature was obtained in a median of 14 min and maintained uniform and homogeneously distributed within the abdomen for the scheduled duration. A permanent stirring of the viscera was performed. No thermal injury or device-related complications were observed. There were two anastomotic leaks (only one requiring reoperation), two hemoperitoneum requiring reoperation, one evisceration and one gastroparesia.

Conclusions

A heating cable within the peritoneal cavity can achieve safe, simple, fast and efficient HIPEC.

Nuclear heat shock protein 110 expression is associated with poor prognosis and hyperthermo-chemotherapy resistance in gastric cancer patients with peritoneal metastasis

AIM

To investigate the significance of heat shock protein 110 (HSP110) in gastric cancer (GC) patients with peritoneal metastasis undergoing hyperthermo-chemotherapy.

METHODS

Primary GC patients (n = 14) with peritoneal metastasis or positive peritoneal lavage cytology who underwent distal or total gastrectomy between April 2000 and December 2011 were enrolled in this study. The patients underwent postoperative intraperitoneal hyperthermo-chemotherapy using a Thermotron RF-8 heating device two weeks after surgery. We analyzed nuclear HSP110 expression in surgically resected tumors using immunohistochemistry. Additionally, the effect of HSP110 suppression on hyptherthermo-chemosensitivity was assessed in vitro in the MKN45 GC cell line using the HSP inhibitor KNK437.

RESULTS

HSP110 immnohistochemical staining in 14 GC patients showed that five (35.7%) samples belonged to the low expression group, and nine (64.3%) samples belonged to the high expression group. Progression-free survival was significantly shorter in the HSP110 high-expression group than in the low-expression group (P = 0.0313). However, no significant relationships were identified between HSP110 expression and the clinicopathological characteristics of patients. Furthermore, high HSP110 expression was not an independent prognostic factor in GC patients with peritoneal metastasis (P = 0.0625). HSP110 expression in MKN45 cells was suppressed by KNK437 at the hyperthermic temperature of 43 °C in vitro. Comparison of MKN45 cell proliferation in the presence and absence of KNK437 at 43 °C, revealed that proliferation was significantly decreased when HSP110 was inhibited by KNK437. Additionally, HSP110 suppression via HSP inhibitor treatment increased cellular sensitivity to hyperthermo-chemotherapy in vitro.

CONCLUSION

The expression of nuclear HSP110 in GC patients might be a new marker of chemosensitivity and a therapeutic target for patients who are tolerant to existing hyperthermo-chemotherapies.

Heat shock-induced HIKESHI protects cell viability via nuclear translocation of heat shock protein 70

Heat shock proteins (HSPs), particularly HSP70, help restore normal cellular function following damage caused by stressors. HSP expression in tumor tissues indicates cancer progression, and while the development of HSP inhibitors is progressing, these substances are not widely used to treat cancer. HIKESHI (C11orf73) does not control the intracellular movement of HSP70 at normal temperatures; however, it does regulate the function and movements of HSP70 during heat shock. In this study, we examined the intracellular movement of HSP70 during heat shock to investigate the significance of HIKESHI expression in gastric cancer (GC) and determine if HIKESHI inhibition has cytotoxic effects. We examined HIKESHI using GC cell lines and immunostaining in 207 GC tissue samples. HIKESHI expression in GC tissues was associated with the progression of lymphatic invasion. Suppressing HIKESHI using siRNA did not affect cell viability at normal temperatures. However, suppressing HIKESHI during heat shock inhibited HSP70 nuclear transport and suppressed cell viability. Our results suggest that HIKESHI is a marker of cancer progression and that the combination of HIKESHI inhibition and hyperthermia is a therapeutic tool for refractory GC.

Advances in treatment of gastric cancer

Surgery is the first choice of treatment for gastric cancer. The development of micro-invasive surgery brings new challenges to gastric cancer therapy. The limited data indicate that laparoscopy operation can achieve the same therapeutic efficacy as laparotomy. New adjuvant chemotherapy contributes to the removal of statge Ⅲb or Ⅳ gastric cancer. Abdominal cavity heat therapy for gastric cancer has also achieved rather satisfactory therapeutic results. Study on microcosmic field of gastric cancer will provide more data on early diagnosis and treatment of gastric cancer. No standard treatment modalities for gastric cancer are available, though there are many. Therefore, further study is needed.