Impaired immunoresponsiveness in tumor patients

A robust immune system conditions the response to abagovomab (anti-idiotypic monoclonal antibody mimicking the CA125 protein) vaccination in ovarian cancer patients

INTRODUCTION

Despite encouraging phase I and II study results, vaccination of ovarian cancer patients with abagovomab - an anti-idiotypic mAb that mimics the ovarian cancer CA125 protein - failed to demonstrate efficacy in the phase III trial named MIMOSA (NCT00418574). We postulated that in this trial patients with a more robust immune system did respond to abagovomab but went undetected among a larger number of non-responders. We also postulated that assessment of the immune system status ahead of abagovomab administration might predict patients' propensity to respond to abagovomab.

MATERIALS AND METHODS

The immune system status was assessed as percentage and absolute count of CD8⁺ T cells producing IFN-γ after stimulation with Staphylococcal Enterotoxin B (SEB) in 80 patients on abagovomab and 31 patients on placebo from the MIMOSA trial ahead of treatment. Optimal cutoffs of the two variables were calculated by the web application "Cutoff Finder" as the points with most significant (log-rank test) splits based on relapse-free survival (RFS). The Kaplan-Meier curves and log-rank test served to estimate and compare RFS in patients with percentage and absolute count of IFN-γ producing CD8⁺ T cells around the cutoffs.

RESULTS

Patients on abagovomab with IFN-γ producing CD8⁺T cell percentage above the cutoff had a better RFS (p=0.042) than those with IFN-γ producing CD8⁺T cell percentage below the cutoff. Patients on abagovomab with IFN-γ producing CD8⁺T cell absolute count above the cutoff had a better RFS (p=0.019) than those with IFN-γ producing CD8⁺T cell absolute counts below the cutoff. Consistently, the RFS of patients on abagovomab with IFN-γ producing CD8⁺T cell percentage and absolute counts values below the respective cutoffs was identical to that of patients on placebo. Neither the percentage nor the absolute count of IFN-γ producing CD8⁺T cells correlated with RFS in patients on placebo.

CONCLUSIONS

A robust immune system is essential to obtain a clinical response in OC patients undergoing abagovomab immunotherapy whereas a robust immune system does not confer per se a survival advantage. Further work will clarify whether the results shown here apply only in the present setting or extend to other types of cancer and/or immunotherapeutic agents.

Changes of lymphocyte subsets in peripheral blood before and after operation of patients with advanced ovarian carcinoma

Comparison was made between lymphocyte subsets in peripheral blood from patients with benign ovarian tumor and those with advanced ovarian carcinoma. In addition, changes of lymphocyte subsets of patients with ovarian carcinoma before and after operation were also examined. The percentage and absolute number of CD3-/HLA-DR+ (B cells) in peripheral blood from patients with advanced ovarian carcinoma were significantly lower than values from patients with benign ovarian tumor, whereas both percentage and absolute number of CD3-/HLA-DR- (null cells) cells in patients with advanced ovarian carcinoma were significantly higher. Although there was no significant difference in natural killer (NK) cell subsets (CD57+ CD16- and CD57+ CD16+ cells) between patients with benign ovarian tumor and ovarian carcinoma, the percentage and absolute number of CD57-/CD16+ (highly differentiated NK cells) cells in patients with ovarian carcinoma were significantly higher than those in patients with benign ovarian tumor. Both the absolute number and percentage of CD3+/HLA-DR+ (activated T cells) cells in ovarian cancer patients with minimal residual tumors after operation were significantly increased, compared to the levels before operation, while the values in the patients with large residual tumors were significantly decreased. In addition, the percentage and absolute number of CD3-/HLA-DR- (null cells) cells in the patients with minimal residual tumors were significantly decreased after operation, while values in the patients with large residual tumors remained unchanged before and after operation. The patients with minimal residual tumors after operation were characterized by a significant increase in the percentage of CD57- CD16+ (highly differentiated NK cells) cells. On the other hand, in the patients with large residual tumors no change of the NK cell subsets was observed before and after operation.

Effects of cimetidine on interleukin-2 production by peripheral blood lymphocytes in advanced ovarian carcinoma

The present study was designed to elucidate the effect of cimetidine on CD4 and CD8 positive cells, interleukin-2 (IL-2) production and IL-2 receptor expression in peripheral blood lymphocytes (PBL) from patients with advanced ovarian carcinoma during the course of combination chemotherapy. The absolute number of CD8 (but not CD4) positive cells in PBL from patients with advanced ovarian carcinoma before surgery was significantly higher than that with benign ovarian tumor, while the IL-2 productivity was significantly lower. However, the IL-2 receptor expression was comparable to that with benign ovarian tumor. When a combination chemotherapy consisting of cisplatin, adriamycin and cyclophosphamide was given to these ovarian cancer patients, the IL-2 production was markedly depressed. If cimetidine was given with the combination chemotherapy, the inhibition of IL-2 production by chemotherapy was significantly diminished with a significant increase of CD4 positive cells. On the other hand, the IL-2 receptor expression was not affected by this treatment. When treatment with cimetidine was initiated after completion of chemotherapy, the depressed IL-2 production was restored to the level of control patients with benign ovarian tumor. The restoration seemed to result from an increase in proportion of CD4 positive cells. However, the expression of IL-2 receptor remained unchanged even if cimetidine was given.

Neutrophil function in sheep experimentally infected with bovine leukemia virus

In vitro neutrophil adherence, random migration, chemotaxis, resting and phagocytosis-associated oxygen consumption and bactericidal responses were assessed in sheep experimentally infected with bovine leukemia virus (BLV). Neutrophil function was examined in two groups of 9 control and 9 BLV-infected sheep at 0, 1, 2, 3, 5, 7, 11 and 15 weeks post-infection. Enhanced neutrophil adherence, chemotaxis and resting oxygen consumption responses were found in the infected group at 2, 11 and 15 weeks respectively. Significant alterations between groups were not demonstrated during the other time intervals.

Augmented natural killer activity in ovarian cancer patients treated with cimetidine

The effect of cimetidine on natural killer (NK) activity of peripheral blood lymphocytes (PBL) was studied in 37 post-operative patients with ovarian cancer. There was no significant difference in the NK activities between normal healthy women and patients with no residual tumor after surgery, while those in patients with large residual tumor after surgery were suppressed to less than a half of those in normal healthy women. Cimetidine augmented the NK activities in patients with no residual tumor but not in normal healthy women. Particularly, the NK activities in patients with low baseline NK status before cimetidine treatment was markedly enhanced. Furthermore, the NK boosting by cimetidine was more effective in patients with large residual tumor than in patients with no residual tumor. The NK activity in PBL from such patients was also enhanced by in vitro exposure to cimetidine. These findings suggest that cimetidine may be used as an immunorestorative-therapy for ovarian cancer patients with depressed NK activity.

The predictive value of 2,-4, dinitrochlorobenzene skin testing in patients with bilharzial bladder cancer

A group of 40 patients with bilharzial bladder cancer underwent quantitative skin testing with dinitrochlorobenzene and purified protein derivative of tuberculin before radical surgery. Correlations were made between various clinical parameters, patient outcome, skin test results and pathologic changes in the resected bladder and draining lymph nodes. Striking associations between dinitrochlorobenzene responses and tumor stage, tumor recurrence and several specific parameters of lymph node stimulation were found, while no correlations were made with the pathologic grade, size or type of tumor, degree of schistosomal infestation or tumor bed inflammation. Purified protein derivative responses showed no correlation with any parameter examined. Patient outcome also showed a good correlation with tumor stage and draining lymph node reaction. These findings indicate that dinitrochlorobenzene skin testing as a presumptive test of cell-mediated immunity may represent a good predictor of clinical outcome in patients with bilharzial bladder cancer, and correlates well with draining lymph node stimulation.

Cell membrane markers and phytohemagglutinin reactivity of circulating lymphocytes from chronic myelocytic leukemia patients

Lymphocytes from 22 patients with chronic myeloid leukemia (CML), 13 treated with polychemotherapy, eight by monochemotherapy, and one untreated, were analyzed for the presence of classic T and B cell surface markers (E-rosette, EAC-rosette, surface immunoglobulins) and for their ability to respond to phytohemagglutinin (PHA). The absolute number and percentage of E-rosetting cells (T-cells), EAC-rosetting cells and cells staining for surface immunoglobulins (B cells) were all significantly lower than controls (P less than or equal to 0.025). The response to PHA was also significantly lower in patients than in controls at the smaller concentrations of the mitogen (3.75 micrograms/ml, 30 micrograms/ml) tested (P less than or equal to 0.01); at a higher PHA concentration (120 micrograms/ml) the decrease in PHA stimulation approached significance (P = 0.07). These lymphocyte abnormalities support the concept that CML lymphocytes may be derived from the leukemic clone.

Antibody response to influenza immunization in adult patients with malignant disease

Eight-two patients with solid tumors and lymphomas were immunized with New Jersey, Hong Kong, and Victoria influenza vaccines. Patients were divided into groups according to treatment: chemotherapy, radiotherapy, or no treatment. Four parameters were examined to assess the response to immunization: seroconversion, protective titer level, geometric mean titer, and response to multiple vaccines. Patients with lymphoma showed the lowest antibody response. Patients with solid tumors had antibody responses which were not significantly different from controls but were superior to lymphoma patients (p less than .01). Timing of chemotherapy, immunoglobulin levels, and lymphocyte counts did not appear to play a major role in determining the antibody response. Patients with neoplastic diseases should be immunized against the prevailing influenza virus. Patients with lymphoma should also receive antiviral prophylactic therapy during influenza epidemics.

A syndrome resembling idiopathic thrombocytopenic purpura in 10 patients with diverse forms of cancer

Ten patients with diverse forms of carcinoma (six patients) and of cancer in the lymphoid system (four patients) presented with or subsequently had a syndrome resembling idiopathic thrombocytopenic purpura (ITP). These patients were older than patients who had ITP alone. ITP was coincident with a diagnosis of cancer (three patients), preceded a diagnosis of cancer (three patients) or followed a diagnosis of cancer (four patients). No patients responded to steroid therapy permanently. Therefore, the course of our patients was fairly typical of ITP in the adult. Since we found nine patients with cancer in a survey of 52 consecutive patients with ITP in the adult population admitted to one hospital, this diagnosis may be missed with some frequency; the development of thrombocytopenia being attributed to other causes.

Comparison of the effects of single versus multiple agent chemotherapy on lymphocytes assayed by the rosette technique

The percentage of peripheral blood Total T, Active T and B-Rosette Forming Cells (RFC) were determined serially (Day 0, 1, 2, 7, and 21) following administration of single (SAT) versus multiple (MAT) agent chemotherapy. SAT caused essentially a decrease in the percentage of B-RFC. MAT resulted in profound decrease of Active T and B-RFC and to a lesser degree of Total T-RFC percentages with nadirs being reached in 48 hours. The most striking decrease involved the percentage of Active T-RFC which remained 15% below pretreatment level 7th posttreatment day. The posttreatment changes in the absolute numbers of Total T, Active T and B-RFCs following MAT were similar to that noted on the RFC percentage. Effects of the two most commonly used multiple agent treatments (COBAM and DOMF) were comparable. MAT causes a more profound decrease in the percentage of various RFCs than SAT. The differences between the nadirs of various RFC reached Day 1 and 2 with MAT versus SAT are statistically significant (p less than .001). We conclude that the effects of chemotherapy on peripheral RFC may be best evidenced by serial determination of their percentage rather than their absolute numbers. Subpopulation of the T-RFC which has been labeled Active T-RFC appears to be the best indicator of the chemotherapy effects on the lymphocyte population since they demonstrate the most profound and persistent changes.

Modification of lymphocyte response to phytomitogens by polycations and polyanions

The stimulating effect on mitogen-induced lymphocyte response by polycationic compounds such as polylysine, DEAE dextran protamine and methylated albumin, is studied at different serum-protein concentrations and mitogen concentrations. It is suggested that the polar interaction between polycationic compounds and glycoproteins are of major importance for reactivity of lymphocytes to mitogens.

Immunologic dysfunction in the myeloproliferative disorders

Forty patients with various types of myeloproliferative disorders were evaluated immunologically. Serum immunoglobulin levels were within the normal range in most patients and no monoclonal gammopathies were detected. Serum C'3 levels were decreased in 19 of 40 (48%) patients. The response of peripheral blood lymphocytes to phytohemagglutinin was decreased in 26 of 40 (65%) and to pokeweed mitogen in 18 of 28 (64%) patients studied. Lymphocytes from patients with polycythemia vera were least affected. Unstimulated lymphocytes from some patients demonstrated markedly increased thymidine uptake activity. Despite the diminished mitogenic response, only 2 of 33 patients (6%) were anergic by intradermal skin testing. There was no association between depressed lymphocyte response and recent chemotherapy except in chronic myelogenous leukemia where 6 of 8 patients were receiving cytotoxic therapy when studied. These observations suggest that most of our patients with myeloproliferative disorders have abnormal cellular responses in vitro, but that delayed hypersensitivity and humoral responses are minimally affected.

Impaired general cell-mediated immune functions in vivo and in vitro in patients with nasopharyngeal carcinoma

General cell-mediated immune (CMI) functions in NPC patients were investigated by the in vivo Mantoux and in vitro lymphocyte response to PHA assays. Thirty-eight (50%) of 76 untreated NPC patients were hyporesponsive in the Mantoux assay compared to 27 (25%) of 110 control patients. Forty-three (65.2%) of 66 untreated NPC patients also showed lymphocyte hyporesponsiveness to PHA compared to 15 (15.5%) of 97 control patients. Combined deficiencies were observed in 35 (42.2%) of 83 NPC patients compared to only 2 (3.3%) of 61 control patients. No difference in the frequency of immunodeficiency was observed between "early" and "late" disease patients. CMI functions of treated "remission" NPC patients were found to be impaired to the same extent as those of untreated NPC patients.

The effect of immunosuppressive chemotherapy on immune function in patients with malignant disease

This paper reviews studies previously conducted on the effect of anticancer drugs on immune function in man. It provides new data reporting on the effect of short intensive courses of cytotoxic drug therapy on B-lymphocyte and T-lymphocyte number in cancer patients. Both types of lymphocyte were found in this investigation to be equally sensitive to cytotoxic drugs. The degree of absolute cell number reduction and rate of recovery were similar for T-lymphocytes and B-lymphocytes. Other workers have demonstrated, however, that with prolonged administration of cytotoxic drugs B-lymphocyte number and function are more adversely affected than are T-lymphocyte number and function. Immune function which had been suppressed by continuous programs of chemotherapy for periods of up to 2-3 years will, in certain groups of patients, recover to normal or almost normal levels of function. Short courses of combination drug chemotherapy may be followed by "rebound-overshoot" recovery of immune function. This has been associated with a more favorable clinical course than in situations where it does not occur. Chemotherapy and chemoimmunotherapy programs in clinical oncology ought ideally to be initially evaluated for the effect that they have on immune function. This will permit the development of drug dose and time schedules which allow for recovery of immune function and may possibly lead to augmented antitumor responses.

The effect of thymosin on human T-cells from cancer patients

The effect of thymosin on in vitro reactivity of peripheral lymphocytes to phytohemagglutinin, concanavalin A, and the formation of spontaneous E-rosettes in 54 patients with metastatic carcinomas has been studied. Thymosin increased lymphocyte responses to PHA and Con A in only 10 patients, with predominant effect seen with Con A. Twenty patients showed depressed baseline levels of E-rosettes which were increased to normal or subnormal levels after incubation with thymosin. No distinct correlation was noted between the clinical stage of the disease and the ability of lymphocytes to form E-rosettes. Although the exact mechanism by which the thymus exerts its influence on host resistance is not clearly defined, present evidence supports the concept that the thymic hormone, thymosin, may be an important addition in treatment of cancer patients by increasing cell-mediated immunity.

Medullary carcinoma of the thyroid. Cellular immune response to tumor antigen in a heritable human cancer

We have found inhibition of mononuclear leukocyte migration in response to tumor antigen in a group of patients with medullary carcinoma of the thyroid, a cancer inherited as an autosomal dominant. This immune response was not present in a group of family members who do not have cancer.

Cellular immunocompetence in melanoma: effect of extent of disease and immunotherapy

Cell mediated immunocompetence was measured serially in 35 patients with malignant melanoma in order to determine the effect of extent of disease and prognosis as well as the influence of BCG immunotherapy on immune reactivity. Compared with normal adult controls, statistically significant lymphopenia occurred only in patients with widespread disease. Seventeen of 21 patients with negative pre-therapy PPD skin test converted to skin test positivity. PHA blastogenesis was depressed only in patients in the pre-terminal stages of their disease using optimal mitogen concentrations for stimulation. Threshold concentrations of this mitogen more clearly demonstrated a depressed responsiveness which correlated in severity with extent of disease. PPD induced blastogenesis was normal or increased in the majority of patients; however, the degree of stimulation by PPD was less in the BCG induced convertors than in those patients who were skin test positive before BCG treatment. Comparison of the pre- and post BCG assessments reveals no significant differences except in relation to PPD conversion. We conclude that using threshold concentrations of PHA, impaired responses are regularly associated with disease beyond the regional lymph nodes. Routine assessment of lymphocyte function by these parameters did not provide information that was not available from clinical evaluation.

Reduced monocyte phagocytosis in patients with advanced Hodgkin's disease and lymphosarcoma

The monocytes of 7 patients with advanced Hdgkin's disease (stages III and IV) and of two patients with generalized lymphosarcoma exhibited a highly significant impairment of the phagocytosis of IgG-coated red cells, regardless of receiving therapy or not. In contrast three patients with M. Hodgkin, stage II B, and one with lymphosarcoma in complete remission showed a rather elevated monocyte phagocytic acitivity. The nitroblue tetrazolium reduction by monocytes in the mean was significantly enhanced in all patients investigated, compared with normal persons, although only in one patient a bacterial infection was apparent at the time of the test. The possible implication of the findings in the well known immunodeficiency present in M. Hodgkin and lymphosarcoma is discussed.