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Kareemaghay S, Tavassoli M. Clinical immunotherapeutic approaches for the treatment of head and neck cancer. Int J Oral Maxillofac Surg 2018; 48:419-436. [PMID: 30401512 DOI: 10.1016/j.ijom.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/08/2018] [Accepted: 10/19/2018] [Indexed: 12/12/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide, accounting for more than 550,000 cases and 380,000 deaths annually. The primary risk factors associated with HNSCC are tobacco use and alcohol consumption; nevertheless genetic predisposition and oncogenic viruses also play important roles in the development of these malignancies. The current treatments for HNSCC patients include surgery, chemotherapy, radiotherapy, and cetuximab, and combinations of these. However, these treatments are associated with significant toxicity, and many patients are either refractory to the treatment or relapse after a short period. Despite improvements in the treatment of patients with HNSCC, the clinical outcomes of those who have been treated with standard therapies have remained unchanged for over three decades and the 5-year overall survival rate in these patients remains around 40-50%. Therefore, more specific and less toxic therapies are needed in order to improve patient outcomes. The tumour microenvironment of HNSCC is immunosuppressive; therefore immunotherapy strategies that can overcome the immunosuppressive environment and produce long-term tumour immunosurveillance will have a significant therapeutic impact in these patients. This review focuses on the current immunological treatment options under investigation or available for clinical use in patients with HNSCC.
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Affiliation(s)
- S Kareemaghay
- Department of Molecular Oncology, King's College London, London, UK
| | - M Tavassoli
- Department of Molecular Oncology, King's College London, London, UK.
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2
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El Jamal SM, Taylor EB, Abd Elmageed ZY, Alamodi AA, Selimovic D, Alkhateeb A, Hannig M, Hassan SY, Santourlidis S, Friedlander PL, Haikel Y, Vijaykumar S, Kandil E, Hassan M. Interferon gamma-induced apoptosis of head and neck squamous cell carcinoma is connected to indoleamine-2,3-dioxygenase via mitochondrial and ER stress-associated pathways. Cell Div 2016; 11:11. [PMID: 27486476 PMCID: PMC4969639 DOI: 10.1186/s13008-016-0023-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/15/2016] [Indexed: 12/25/2022] Open
Abstract
Background Tumor response to immunotherapy is the consequence of a concerted crosstalk between cytokines and effector cells. Interferon gamma (IFNγ) is one of the common cytokines coordinating tumor immune response and the associated biological consequences. Although the role of IFNγ in the modulation of tumor immunity has been widely documented, the mechanisms regulating IFNγ-induced cell death, during the course of immune therapy, is not described in detail. Results IFNγ triggered apoptosis of CLS-354 and RPMI 2650 cells, enhanced the protein expression and activation of indoleamine 2,3-dioxygenase (IDO), and suppressed the basal expression of heme oxygenase-1(HO-1). Interestingly, IFNγ induced the loss of mitochondrial membrane potential (Δψm) and increased accumulation of reactive oxygen species (ROS). The cytokine also induced the activation of Janus kinase (JAK)/Signal Transducer and Activator of Transcription (STAT)1, apoptosis signal-regulating kinase 1 (ASK1), p38, c-jun-N-terminal kinase (JNK) and NF-κB pathways and the transcription factors STAT1, interferon regulatory factor 1 (IRF1), AP-1, ATF-2, NF-κB and p53, and expression of Noxa protein. Furthermore, IFNγ was found to trigger endoplasmic reticulum (ER) stress as evidenced by the cleavage of caspase-4 and activation of protein kinase RNA-like endoplasmic reticulum kinase (PERK) and inositol-requiring-1α (IRE1α) pathways. Using specific inhibitors, we identified a potential role for IDO as apoptotic mediator in the regulation of IFNγ-induced apoptosis of head and neck squamous cell carcinoma (HNSCC) cells via Noxa-mediated mitochondrial dysregulation and ER stress. Conclusion In addition to the elucidation of the role of IDO in the modulation of apoptosis, our study provides new insights into the molecular mechanisms of IFNγ-induced apoptosis of HNSCC cells during the course of immune therapy.
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Affiliation(s)
- Siraj M El Jamal
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - Erin B Taylor
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | | | - Abdulhadi A Alamodi
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - Denis Selimovic
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Kirrberger Str. 100, 66421 Homburg/Saar, Germany ; Division of Oral Health Science, Department of Restorative Dentistry, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Abdulaziz Alkhateeb
- Clinic of Dermatology, University Hospital of Aachen, Puwelstrasse 30, Aachen, Germany ; College of Medicine, King Faisal University, Alhofuf, Saudi Arabia
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Kirrberger Str. 100, 66421 Homburg/Saar, Germany
| | - Sofie Y Hassan
- Clinic of Dermatology, University Hospital of Aachen, Puwelstrasse 30, Aachen, Germany
| | - Simeon Santourlidis
- Epigenetics Core Laboratory, Institute of Transplantation Diagnostics and Cell Therapeutics, University Hospital of Duesseldorf, Heinrich-Heine-University of Duesseldorf, Mooren Str.5, 40225 Duesseldorf, Germany
| | - Paul L Friedlander
- Departments of Surgery, Tulane University School of Medicine, New Orleans, LA 70112 USA
| | - Youssef Haikel
- Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, 67000 Strasbourg, France ; Department of Operative Dentistry and Endodontics, Dental Faculty, University of Strasbourg, 67000 Strasbourg, France
| | - Srinivasan Vijaykumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS 39216 USA ; Cancer Institute, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - Emad Kandil
- Departments of Surgery, Tulane University School of Medicine, New Orleans, LA 70112 USA
| | - Mohamed Hassan
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS 39216 USA ; Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Kirrberger Str. 100, 66421 Homburg/Saar, Germany ; Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, 67000 Strasbourg, France ; Cancer Institute, University of Mississippi Medical Center, Jackson, MS 39216 USA
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Hoesli RC, Moyer JS. Immunotherapy for Head and Neck Squamous Cell Carcinoma. CURRENT ORAL HEALTH REPORTS 2016; 3:74-81. [PMID: 27398287 PMCID: PMC4936409 DOI: 10.1007/s40496-016-0082-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Head and neck squamous cell carcinoma has been found to be an immunosuppressive malignancy, with many defects in the host immune system contributing to the progression of disease. A greater understanding of these defects has lead to the identification and investigation of new therapeutic strategies, targeting immune system dysfunction in an effort to improve the outcomes of this disease. This article provides a brief review of the knowledge regarding the immune defects present in head and neck cancer, as well as a review of the current therapeutic strategies being investigated for use.
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Affiliation(s)
- Rebecca C Hoesli
- University of Michigan, 1500 East Medical Center Drive - SPC 5312, Ann Arbor, MI 48109
| | - Jeffrey S Moyer
- University of Michigan, 1500 East Medical Center Drive - SPC 5312, Ann Arbor, MI 48109
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4
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Francis HW, Papel I, Lina I, Koch W, Tunkel D, Fuchs P, Lin S, Kennedy D, Ruben R, Linthicum F, Marsh B, Best S, Carey J, Lane A, Byrne P, Flint P, Eisele DW. Otolaryngology-head and neck surgery at Johns Hopkins: The first 100 years (1914-2014). Laryngoscope 2015; 125 Suppl 9:S1-35. [PMID: 26297867 PMCID: PMC4696071 DOI: 10.1002/lary.25490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Howard W Francis
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ira Papel
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Ioan Lina
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - David Tunkel
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Paul Fuchs
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Sandra Lin
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - David Kennedy
- the Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Ruben
- the Departments ofOtorhinolaryngology-Head and Neck Surgery and Pediatrics, Albert Einstein College of Medicine Montefiore Medical Center, New York, New York
| | - Fred Linthicum
- the Department of Otolaryngology-Head and Neck Surgery, University of California at Los Angeles, Los Angeles, California
| | - Bernard Marsh
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Simon Best
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - John Carey
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Andrew Lane
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Patrick Byrne
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Paul Flint
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, U.S.A
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
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5
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Kuroda K, Azuma K, Mori T, Kawamoto K, Murahata Y, Tsuka T, Osaki T, Ito N, Imagawa T, Itoh F, Okamoto Y. The Safety and Anti-Tumor Effects of Ozonated Water in Vivo. Int J Mol Sci 2015; 16:25108-20. [PMID: 26506343 PMCID: PMC4632793 DOI: 10.3390/ijms161025108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/05/2015] [Accepted: 10/12/2015] [Indexed: 01/05/2023] Open
Abstract
Ozonated water is easier to handle than ozone gas. However, there have been no previous reports on the biological effects of ozonated water. We conducted a study on the safety of ozonated water and its anti-tumor effects using a tumor-bearing mouse model and normal controls. Local administration of ozonated water (208 mM) was not associated with any detrimental effects in normal tissues. On the other hand, local administration of ozonated water (20.8, 41.6, 104, or 208 mM) directly into the tumor tissue induced necrosis and inhibited proliferation of tumor cells. There was no significant difference in the number of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling (TUNEL)-positive cells following administration of ozonated water. The size of the necrotic areas was dependent on the concentration of ozonated water. These results indicate that ozonated water does not affect normal tissue and damages only the tumor tissue by selectively inducing necrosis. There is a possibility that it exerts through the production of reaction oxygen species (ROS). In addition, the induction of necrosis rather than apoptosis is very useful in tumor immunity. Based on these results, we believe that administration of ozonated water is a safe and potentially simple adjunct or alternative to existing antineoplastic treatments.
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Affiliation(s)
- Kohei Kuroda
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Kazuo Azuma
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Takuro Mori
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Kinya Kawamoto
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Yusuke Murahata
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Takeshi Tsuka
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Tomohiro Osaki
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Norihiko Ito
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Tomohiro Imagawa
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
| | - Fumio Itoh
- Department of Technical Development, Sakuragawa Pump Co., Ltd., Osaka 567-0005, Japan.
| | - Yoshiharu Okamoto
- Department of Clinical Medicine, Joint School of Veterinary Medicine, Faculty of Agriculture, Tottori University, Tottori 680-8553, Japan.
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Li Q, Prince MEP, Moyer JS. Immunotherapy for head and neck squamous cell carcinoma. Oral Oncol 2015; 51:299-304. [PMID: 25624094 DOI: 10.1016/j.oraloncology.2014.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 11/24/2014] [Accepted: 12/10/2014] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To review the current state of immunotherapy of head and neck squamous cell carcinoma. MATERIALS AND METHODS Review of the literature with emphasis on clinical trial data. RESULTS Patients with head and neck squamous cell carcinoma (HNSCC) have long been known to be immunosuppressed. This impairment of the immune system is believed, at least in part, to underlie the poor outcomes in this patient population. Modulating the immune system to improve cancer outcomes is an attractive concept in this difficult to treat population. CONCLUSION New studies have started to unravel the mechanisms of immunosuppression and new therapies are being developed to exploit this new information.
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Affiliation(s)
- Qiao Li
- University of Michigan Comprehensive Cancer Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Mark E P Prince
- University of Michigan Comprehensive Cancer Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Jeffrey S Moyer
- University of Michigan Comprehensive Cancer Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109, United States.
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7
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The immune system and head and neck squamous cell carcinoma: from carcinogenesis to new therapeutic opportunities. Immunol Res 2014; 57:52-69. [PMID: 24218361 DOI: 10.1007/s12026-013-8462-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Head and neck squamous cell carcinomas (HNSCCs) exhibit complex interactions with the host immune system that may simultaneously explain resistance to various therapeutic modalities and that may also provide opportunities for therapeutic intervention. Discoveries in immunologic research over the last decade have led to an increased understanding of these interactions as well as the development of a multitude of investigational immunotherapies. Here, we describe the interaction between HNSCC and the immune system, including a discussion of immune cells involved with tumor carcinogenesis and the role of immune-modulating factors derived from tumors. We also describe the current immunotherapeutic approaches being investigated for HNSCC, including a discussion of the successes and limitations. With this review, we hope to present HNSCC as a model to guide future research in cancer immunology.
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Gildener-Leapman N, Ferris RL, Bauman JE. Promising systemic immunotherapies in head and neck squamous cell carcinoma. Oral Oncol 2013; 49:1089-96. [PMID: 24126223 DOI: 10.1016/j.oraloncology.2013.09.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 01/11/2023]
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) demonstrate poor survival and significant treatment morbidity with standard therapy. The immune profile in HNSCC, whether caused by carcinogen exposure or human papillomavirus (HPV), is notably immunosuppressive. Early clinical trials of immunotherapy in HNSCC were troubled by systemic toxicity or difficulties in local administration. Now, interest in immunotherapy has been revitalized by mechanistic insights into immune evasion by HNSCC, coupled to ongoing development of novel immunotherapies. This review will summarize immune escape mechanisms in HNSCC, namely downregulation of tumor antigen (TA) presentation, aberrant regulation of the signal transducer and activator of transcription (STAT) family, the immunosuppressive cytokine milieu, and dysregulation of immune effector cells. Therapeutic strategies hypothesized to specifically counter HNSCC immunosuppression will then be discussed. We will survey TA- targeted monoclonal antibodies (mAb), including the prototype cetuximab, as well as adjunctive strategies to enhance antibody-dependent cell-mediated cytotoxicity. We will review immunomodulation to restore STAT1/STAT3 activation balance. Examples of mAb therapy to block immunosuppressive cytokines, such as interleukin-6 or VEGF, will be provided. mAbs which release co-inhibitory T cell receptors such as CTLA-4 and PD-1, overexpressed in HNSCC, also hold therapeutic promise. Finally, we will describe principles for therapeutic vaccination in HPV-associated HNSCC, where non-host TAs such as viral oncoproteins represent ideal targets, and HPV-negative HNSCC, where p53 is a promising target. Insights into immunosuppression in HNSCC have elucidated mechanistic targets for immunotherapy. Rational clinical investigation may lead to effective stand alone or combinatorial treatment approaches.
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MESH Headings
- Antibodies, Monoclonal/pharmacology
- Antigens, Neoplasm/drug effects
- Antigens, Neoplasm/immunology
- B-Lymphocyte Subsets/drug effects
- B-Lymphocyte Subsets/immunology
- Carcinoma, Squamous Cell/immunology
- Carcinoma, Squamous Cell/therapy
- Cytokines/drug effects
- Cytokines/immunology
- Genes, p53/drug effects
- Genes, p53/immunology
- Head and Neck Neoplasms/immunology
- Head and Neck Neoplasms/therapy
- Humans
- Immunotherapy/methods
- Papillomaviridae/drug effects
- Papillomaviridae/immunology
- Receptors, Antigen, T-Cell/drug effects
- Receptors, Antigen, T-Cell/immunology
- STAT Transcription Factors/drug effects
- STAT Transcription Factors/immunology
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Affiliation(s)
- Neil Gildener-Leapman
- Department of Otolaryngology, University of Pittsburgh Eye and Ear Institute, 203 Lothrop Street, Pittsburgh, PA 15213, United States
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Hoffmann TK. Systemic therapy strategies for head-neck carcinomas: Current status. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc03. [PMID: 23320055 PMCID: PMC3544206 DOI: 10.3205/cto000085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Head and neck cancers, most of which are squamous cell tumours, have an unsatisfactory prognosis despite intensive local treatment. This can be attributed, among other factors, to tumour recurrences inside or outside the treated area, and metastases at more distal locations. These tumours therefore require not only the standard surgical and radiation treatments, but also effective systemic modalities. The main option here is antineoplastic chemotherapy, which is firmly established in the palliative treatment of recurrent or metastatic stages of disease, and is used with curative intent in the form of combined simultaneous or adjuvant chemoradiotherapy in patients with inoperable or advanced tumour stages. Neoadjuvant treatment strategies for tumour reduction before surgery have yet to gain acceptance. Induction chemotherapy protocols before radiotherapy have to date been used in patients at high risk of distant metastases or as an aid for decision-making ("chemoselection") in those with extensive laryngeal cancers, prior to definitive chemoradiotherapy or laryngectomy. Triple-combination induction therapy (taxanes, cisplatin, 5-fluorouracil) shows high remission rates with significant toxicity and, in combination with (chemo-)radiotherapy, is currently being compared with simultaneous chemoradiotherapy; the current gold standard with regards to efficacy and long-term toxicity.A further systemic treatment strategy, called "targeted therapy", has been developed to help increase specificity and reduce toxicity. An example of targeted therapy, EGFR-specific antibodies, can be used in palliative settings and, in combination with radiotherapy, to treat advanced head and neck cancers. A series of other novel biologicals such as signal cascade inhibitors, genetic agents, or immunotherapies, are currently being evaluated in large-scale clinical studies, and could prove useful in patients with advanced, recurring or metastatic head and neck cancers. When developing a lasting, individualised systemic tumour therapy, the critical evaluation criteria are not only efficacy and acute toxicity but also (long-term) quality-of-life and the identification of dedicated predictive biomarkers.
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Schuler PJ, Hoffmann TK, Gauler TC, Bergmann C, Brandau S, Lang S. [Immunotherapy of head and neck cancer. Current developments]. HNO 2012; 61:559-72. [PMID: 23247754 DOI: 10.1007/s00106-012-2635-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In order to improve the prognosis for patients with head and neck squamous cell cancer (HNSCC) the introduction of new therapeutic strategies is necessary. The concept of immunotherapy has been applied and improved for several years and recent studies have used tumor-specific antigens which facilitates targeted oncologic therapy. However, immunotherapy is hampered by the fact that immunosuppressive mechanisms are pronounced and relevant effector cells are suppressed, especially in patients with HNSCC. Successful immunotherapy could induce an antitumor immune response by restitution of these cell populations. Current anti-tumor immunotherapy includes unspecific immune stimulation, genetic modification of tumor and immune cells, the use of monoclonal antibodies, e.g. cetuximab, adoptive cell transfer and tumor vaccination. In the future, these biologic therapies alone or in combination with conventional therapeutic regimens could present a valuable therapeutic option for HNSCC patients.
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Affiliation(s)
- P J Schuler
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, Universität Duisburg-Essen.
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Allen CT, Judd NP, Bui JD, Uppaluri R. The clinical implications of antitumor immunity in head and neck cancer. Laryngoscope 2011; 122:144-57. [DOI: 10.1002/lary.21913] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
The concept of immunotherapy as a treatment for cancer patients has been in existence for decades. However, more recent immune therapeutic approaches have involved targeting of tumor-specific antigens. Although improvements have been made in using such immune stimulatory treatment strategies for a variety of solid cancers, the use of these strategies for patients with head and neck squamous cell carcinoma (HNSCC) is lagging behind. Immunotherapeutic approaches for HNSCC are particularly complicated by the profound immune suppression that is induced by HNSCC, which potentially decreases the effectiveness of immune stimulatory efforts. Trials involving patients with various solid cancers have shown the enhanced effectiveness of combining various immunotherapeutic approaches or combining immunotherapy with chemotherapy or radiation therapy. Treatment of HNSCC with such combination approaches has not been extensively investigated and has the added challenge of the need to overcome the HNSCC-induced immune suppression. This study focuses on clinical trials that have tested immunotherapeutic approaches for HNSCC patients and the challenges associated with such approaches. In addition, it will call attention to immunotherapeutic strategies that have been shown to be successful in the treatment of other solid cancers to identify potential strategies that may apply to the treatment of HNSCC.
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Shibuya TY, Kim S, Nguyen K, Parikh P, Wadhwa A, Brockardt C, Do J. Covalent linking of proteins and cytokines to suture: Enhancing the immune response of head and neck cancer patients. Laryngoscope 2010; 113:1870-84. [PMID: 14603040 DOI: 10.1097/00005537-200311000-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The immune system of advanced stage head and neck cancer patients is frequently suppressed. Poor immune function has been correlated with poor clinical outcome. Immunotherapeutic strategies have been previously attempted in an effort to enhance immune function and improve survival. Previous studies have shown surgical suture can be transformed into an immune stimulant capable of activating the T lymphocytes of cancer patients. The development of a process for covalently linking proteins and cytokines to suture could have enormous potential for the in vivo manipulation of the immune system. HYPOTHESIS We hypothesize proteins and cytokines can be covalently linked to surgical suture while preserving their functional properties. STUDY DESIGN Prospective study testing normal donor and head and neck squamous cell carcinoma (HNSCC) patient lymphocytes. METHOD Polyester suture was acid hydrolyzed followed by reacting with 1-ethyl-3(-3-dimethylamino propyl carbodiimide) (EDAC) to create a suture-EDAC intermediate. Next, selected proteins (horseradish peroxidase [HRP] or bovine serum albumin [BSA]) or cytokines (interleukin [IL]-2 or interferon [IFN]-gamma) were reacted with the suture-EDAC intermediate to test the covalent linkage of the selected protein or cytokine to suture. Functional activity of the linked proteins was measured spectrophotometrically. The linking of cytokines to suture was tested by stimulating normal donor peripheral blood lymphocytes (PBL) or HNSCC patients' lymphocytes. The functional activity was confirmed by proliferation, enzyme linked immunoadsorbent assay (ELISA), and phenotype expression of T cells. RESULTS The conditions for optimally linking a protein to polyester suture were defined using HRP as a model protein. HRP retained its enzymatic activity. The optimal conditions for linking IL-2 or IFN-gamma were defined. The covalently linked cytokines retained their immune enhancing properties for stimulating PBL and lymph node lymphocytes (LNL) from HNSCC patients to proliferate, generate a TH1 immunologic profile of cytokines (IL-2, IL-12, IFN-gamma), and stimulate T lymphocytes. CONCLUSION This is the first report to demonstrate that cytokines can be covalently linked to surgical sutures and retain their immune-stimulating properties. Proteins linked to suture also retained their enzymatic activity. The clinical implications of functionally active cytokines or proteins linked to surgical suture may be very significant in the future for manipulating the immune system in vivo or enhancing wound healing.
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Affiliation(s)
- Terry Y Shibuya
- Department of Otolaryngology/Head and Neck Surgery, University of California Irvine College of Medicine, Orange 92868, USA.
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15
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Immunotherapy of head and neck cancer: current and future considerations. JOURNAL OF ONCOLOGY 2009; 2009:346345. [PMID: 19680453 PMCID: PMC2723756 DOI: 10.1155/2009/346345] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 06/15/2009] [Indexed: 01/09/2023]
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) are at considerable risk for death, with 5-year relative survival rates of approximately 60%. The profound multifaceted deficiencies in cell-mediated immunity that persist in most patients after treatment may be related to the high rates of treatment failure and second primary malignancies. Radiotherapy and chemoradiotherapy commonly have severe acute and long-term side effects on immune responses. The development of immunotherapies reflects growing awareness that certain immune system deficiencies specific to HNSCC and some other cancers may contribute to the poor long-term outcomes. Systemic cell-mediated immunotherapy is intended to activate the entire immune system and mount a systemic and/or locoregional antitumor response. The delivery of cytokines, either by single cytokines, for example, interleukin-2, interleukin-12, interferon-γ, interferon-α, or by a biologic mix of multiple cytokines, such as IRX-2, may result in tumor rejection and durable immune responses. Targeted immunotherapy makes use of monoclonal antibodies or vaccines. All immunotherapies for HNSCC except cetuximab remain investigational, but a number of agents whose efficacy and tolerability are promising have entered phase 2 or phase 3 development.
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16
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Leibowitz MS, Nayak JV, Ferris RL. Head and neck cancer immunotherapy: clinical evaluation. Curr Oncol Rep 2008; 10:162-9. [PMID: 18377830 DOI: 10.1007/s11912-008-0025-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Overall survival for patients with squamous cell carcinoma of the head and neck (SCCHN) has not improved appreciably over the past few decades. Because standard treatments have not controlled this disease with sufficiently high success rates, novel therapeutic approaches, such as immunotherapy, are under investigation. Cancer immunotherapy involves various techniques used to expand and activate the immune system to control tumor growth in vivo; to date, clinical evaluation has demonstrated low toxicity. An emerging form of SCCHN immunotherapy involves the use of antibodies that target growth factor receptors (where immune activation appears to enhance tumor lysis), resulting in improved clinical outcome. So far, immunotherapy appears to have the most applicability after other therapeutic interventions; however, its vast potential clinical value has yet to be fully explored. This article reviews immunotherapeutic strategies currently in clinical trials or under development for patients with SCCHN.
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Affiliation(s)
- Michael S Leibowitz
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Hillman Cancer Center Research Pavilion, 5117 Centre Avenue, Suite 2.26, Pittsburgh, PA 15213, USA
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Ferris RL, Whiteside TL, Ferrone S. Immune escape associated with functional defects in antigen-processing machinery in head and neck cancer. Clin Cancer Res 2007; 12:3890-5. [PMID: 16818683 DOI: 10.1158/1078-0432.ccr-05-2750] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent revival of interest in the role of immune surveillance in the pathogenesis and control of malignant diseases has focused attention on escape mechanisms used by tumor cells to evade immune recognition. Defects in the host's tumor antigen-specific immune responses and abnormalities in tumor cell expression of HLA class I molecules and tumor antigen are known to contribute to tumor progression. However, the mechanism(s) responsible for the lack of tumor cell recognition by functional HLA class I antigen-restricted, tumor antigen-specific CTLs despite expression of the restricting HLA class I allele and targeted tumor antigen by tumor cells remain(s) unexplained. In squamous cell carcinomas of the head and neck (SCCHN), this type of tumor escape is a rule rather than the exception. Here, we discuss evidence pointing to functional defects in the antigen-processing machinery as one mechanism underlying resistance of SCCHN cells to recognition and lysis by HLA class I antigen-restricted, tumor antigen-specific CTL. In addition, based on the restoration by IFN-gamma of SCCHN cell sensitivity to recognition by these CTL, we suggest strategies that may improve the clinical course of the disease by enhancing susceptibility of malignant cells to immune recognition.
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Affiliation(s)
- Robert L Ferris
- University of Pittsburgh Cancer Institute and Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Hathaway B, Landsittel DP, Gooding W, Whiteside TL, Grandis JR, Siegfried JM, Bigbee WL, Ferris RL. Multiplexed Analysis of Serum Cytokines as Biomarkers in Squamous Cell Carcinoma of the Head and Neck Patients. Laryngoscope 2005; 115:522-7. [PMID: 15744170 DOI: 10.1097/01.mlg.0000157850.16649.b8] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our objective was to characterize cytokine profiles in the systemic circulation of patients with active squamous cell carcinoma of the head and neck (SCCHN) compared with long-term tobacco smokers as controls. Furthermore, we hypothesized that persistent immune dysregulation in patients cured of their disease may be reflected in altered cytokine profiles in the systemic circulation. STUDY DESIGN Retrospective, case-control study. METHODS Using three well-defined clinical cohorts of SCCHN patients and smoker controls, we analyzed 100 microL of serum for a panel of 10 cytokines to determine whether serum cytokine profiles could distinguish clinically defined groups of SCCHN patients. Statistical analysis of multiplexed cytokine profiles was applied to classify three clinically defined groups: active SCCHN patients, treated SCCHN patients with no evidence of disease for over 3 years, and matched disease-free controls. Discrimination of outcome status was accomplished using classification trees, and 10-fold cross-validation was implemented to assess classification accuracy using independent data. RESULTS We show that multiplexed cytokine and chemokine profiling may be performed to reflect the immune status of SCCHN patients. Selected cytokine profiles indicate that immunologic responses to carcinogenesis may not normalize even in the absence of tumor for over 3 years. CONCLUSION Multiplexed serum cytokine profiles may be applicable to early detection, for screening those at high risk for SCCHN, and as clinically predictive biomarkers of disease status in successfully treated patients.
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Affiliation(s)
- Bridget Hathaway
- Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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Abstract
Biologic therapies able to induce or up-regulate anti-tumor immune responses could represent a complementary approach to improve the conventional treatment of squamous cell carcinomas of the head and neck (SCCHN). Patients with SCCHN are frequently immunocompromised due to the elimination and dysfunction of critical immune effector cells. Therefore, it might be necessary to restore these immune functions to allow for the generation of effective anti-tumor host responses. Simultaneously, to prevent tumor escape from immunological recognition and destruction, it might also be necessary to alter antigenic and immunogenic attributes of the malignant cells. The present overview summarizes general aspects, historical data, and recent advances in the field of immunotherapy of SCCHN, including non-specific immune stimulation, transfer of immunocompetent cells, gene therapy, use of monoclonal antibodies, and anti-cancer vaccines.
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Affiliation(s)
- T K Hoffmann
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten der Universität Düsseldorf.
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Hoffmann TK, Bier H, Whiteside TL. Targeting the immune system: novel therapeutic approaches in squamous cell carcinoma of the head and neck. Cancer Immunol Immunother 2004; 53:1055-67. [PMID: 15095020 PMCID: PMC11032895 DOI: 10.1007/s00262-004-0530-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2003] [Accepted: 03/06/2004] [Indexed: 11/28/2022]
Abstract
Despite advances in surgery, radiotherapy, and chemotherapy, the overall survival rates for patients with squamous cell carcinoma of the head and neck (SCCHN) have not changed over the last decades. Clearly, novel therapeutic strategies are needed for this cancer, which is highly immunosuppressive. Therefore, biologic therapies able to induce and/or up-regulate antitumor immune responses could represent a complementary approach to conventional treatments. Because patients with SCCHN are frequently immunocompromised due to the elimination or dysfunction of critical effector cells of the immune system, it might be necessary to restore these immune functions to allow for the generation of more effective antitumor host responses. Simultaneously, to prevent tumor escape, it might be necessary to alter attributes of the malignant cells. The present review summarizes recent advances in the field of immunotherapy of SCCHN, including techniques of nonspecific immune stimulation, the use of monoclonal antibodies, advances in adoptive immunotherapy and genetic engineering, as well as anticancer vaccines. These biologic therapies, alone or in combination with conventional treatment, are likely to develop into useful future treatment options for patients with SCCHN.
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Affiliation(s)
- Thomas K Hoffmann
- Department of Otorhinolaryngology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany.
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Abstract
The development of head and neck cancer (HNC) is strongly influenced by the host immune system. Immunoselection of tumors resistant to immune attack and the ability of established tumors to disarm or eliminate immune cells favor tumor progression. Recent evidence for local as well as systemic apoptosis of T lymphocytes, the paucity of dendritic cells (DC) at the tumor site, or the presence of signaling defects in T lymphocytes of patients with HNC emphasizes the fact that their antitumor responses are compromised. The clinical and biologic importance of these immune biomarkers is revealed by the finding that they appear to independently predict 5-year survival in patients with oral carcinoma. Whereas the mechanisms responsible for immune dysfunction in HNC are being investigated, new immunotherapeutic strategies, including antitumor vaccines and DC-based interventions, aim at the restoration of tumor-targeted immune responses. These novel biologic therapies, alone or in combination with conventional therapies, might be expected to protect immune cells from dysfunction or death and to enhance their antitumor activity.
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Affiliation(s)
- T L Whiteside
- University of Pittsburgh Cancer Institute and Department of Pathology, University of Pittsburgh School of Medicine, W1041 Biomedical Science Tower, 211 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
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Hadden JW. The immunopharmacology of head and neck cancer: an update. INTERNATIONAL JOURNAL OF IMMUNOPHARMACOLOGY 1997; 19:629-44. [PMID: 9669203 DOI: 10.1016/s0192-0561(97)00063-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with head and neck squamous cell cancer have cell-mediated immune defects and anergy, which progress with disease. T-lymphocytopenia and dysfunction, monocyte dysfunction, prostaglandins, antigen-antibody complexes, serum and cell suppressive factors, radiation therapy and poor nutrition with zinc deficiency all contribute. Nevertheless, cell-mediated immunoreactivity to tumor is manifest in the majority of the patient's blood and regional nodes, and in the tumor itself by tumor-infiltrating lymphocytes. Lymphocytes from these sources cloned in the presence of interleukin-2 +/- tumor extracts show relatively specific cytotoxicity against squamous cell cancer. Humoral immunity is intact, and increased IgA and IgE levels and antibodies reactive to tumor antigens are common. Tumor-associated antigens detected in serum and tumor include carcinoembryonic antigen, tumor polypeptide antigen, squamous cell cancer antigens, tumor antigen-4 and various mucin antigens. The mucin antigens, in particular, can elicit T-cell responses. Humoral reactivity to such antigens is manifest in circulating immune complexes and immunoglobulin coating of tumor surfaces. Immunotherapeutic efforts in head and neck squamous cell cancer should logically employ T-cell adjuvants, contrasuppression and immunorestoration. Non-specific stimulation with bacille Calmette-Guerin (BCG), levamisole and other agents has not been successful. Encouraging results have been observed in limited trials with indomethacin and plasmapheresis. Early trials with local administration of low dosages of interferon-alpha, natural interleukin-2 and a natural interleukin mixture have produced partial and complete regressions with no toxicity and with intense leukocyte infiltration indicating cellular immunity. Efforts are needed to define the mechanisms and the antigens involved in these reactions. On the contrary, treatments with high dosages of recombinant interferon-alpha and interleukin-2 have yielded few responses and considerable toxicity. Combination strategies are discussed which may improve upon these initial immunotherapeutic effects of these low dose trials.
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Affiliation(s)
- J W Hadden
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612, USA
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Nikolaou AC, Fountzilas G, Daniilidis I. Treatment of unresectable recurrent head and neck carcinoma with 13-cis-retinoic acid and interferon-alpha. A phase II study. J Laryngol Otol 1996; 110:857-61. [PMID: 8949297 DOI: 10.1017/s0022215100135169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sixteen patients with unresectable recurrent head and neck carcinomas were treated with 13-cis-retinoic acid and interferon-alpha. All patients had presented with recurrences after having been treated primarily with surgery and radiotherapy, while two of them had also received induction chemotherapy. The site of relapse was strictly locoregional in all cases (only at the primary site in three cases, at the cervical lymph nodes only in four cases and both at the primary site and the neck in the remaining nine cases. Two patients were female, and 14 male, with an age range of 47-72 years (median 61 years). Interferon-alpha was administered subcutaneously at a dose of 3 x 10(6) IU every second day. The dose of retinoids was 40 mg per os every day. The duration of treatment was two to 14 months (median seven months). There were two cases of partial response (tumour regression > 50 per cent), eight cases of stable disease lasting for three to seven months (median four months) and six cases presented with progressive disease. All patients died after a survival of three to 17 months (median 9.5 months). Toxicity was generally minimal. We believe that the results are not encouraging, but also not disappointing. The fact that toxicity was indeed mild, with not a single case of life-threatening sequellae even after prolonged administration of the two agents, allows us to conclude that an increase of the dose of IFN-alpha might be more beneficial. Selection of patients with more 'favourable' recurrences will give a better chance to the treatment combination to prove its real efficacy. Larger numbers of patients have to be treated and evaluated before definite conclusions can be reached.
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Affiliation(s)
- A C Nikolaou
- University Department of Otorhinolaryngology, Aristotle University Medical School, Thessaloniki, Greece
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Sung MW, Johnson JT, Van Dongen G, Whiteside TL. Protective effects of interferon-gamma on squamous-cell carcinoma of head and neck targets in antibody-dependent cellular cytotoxicity mediated by human natural killer cells. Int J Cancer 1996; 66:393-9. [PMID: 8621263 DOI: 10.1002/(sici)1097-0215(19960503)66:3<393::aid-ijc21>3.0.co;2-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An in vitro model of antibody-dependent cellular cytotoxicity (ADCC) was established, using squamous-cell carcinoma of the head and neck (SCCHN) targets,human/mouse chimeric monoclonal antibodies (cMAbs) SF-25 and 323/A3 and human peripheral blood mononuclear cells (PBMC). We previously showed that natural killer (NK) cells are the main effector population mediating ADCC in the presence of the cMAbs. ADCC was significantly inhibited by the overnight pre-treatment of SCCHN targets with exogenous interferon-gamma (IFN-gamma). This inhibition was dose-dependent, reproducible and consistently observed with various SCCHN cell lines. SCCHN cells pre-treated with IFN-gamma had a significantly higher expression of intercellular adhesion molecule-I (ICAM-I) and major histocompatibility complex (MHC) class I antigens compared with untreated target cells. No differences in expression of the SCCHN-associated antigens on these targets or in the formation of NK-SCCHN conjugates were found, using flow cytometry. IFN-gamma-pre-treated SCCHN cells were less effective in competing with untreated targets in cold target inhibition assays and in inducing cytokine production from NK cells in co-incubation experiments. Protective effects of IFN-gamma on target cell sensitivity to lysis were blocked by pre-treatment of target cells with actinomycin-D or cycloheximide. The susceptibility of the target cells was restored by removal of MHC class I antigens from their surface by acid stripping before ADCC. Our results suggest that the decreased ADCC seen with SCCHN targets pre-treated with IFN-gamma is related to post-binding events, possibly altered signaling from targets to effector cells, and requires protein synthesis in the target cells.
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Affiliation(s)
- M W Sung
- Department of Otolaryngology, University of Pittsburgh School of Medicine, PA, USA
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Abstract
The use of cytokines in head and neck cancer is increasingly under investigation. Clinical trials have tested the interferons, interleukin-2 and other cytokines as single agents and in various combinations. The addition of interferon to the cisplatin and 5-fluorouracil (5-FU) regimens (with and without leucovorin) has been explored. A randomized international trial comparing cisplatin and 5-FU with cisplatin, 5-FU and interferon-alpha 2b is in progress.
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Affiliation(s)
- V K Hamasaki
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
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Shaw EG, Deming RL, Creagan ET, Nair S, Su JQ, Levitt R, Steen PD, Wiesenfeld M, Mailliard JA. Pilot study of human recombinant interferon gamma and accelerated hyperfractionated thoracic radiation therapy in patients with unresectable stage IIIA/B nonsmall cell lung cancer. Int J Radiat Oncol Biol Phys 1995; 31:827-31. [PMID: 7860395 DOI: 10.1016/0360-3016(94)00462-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Gamma interferon has a wide range of properties, including the ability to sensitize solid tumor cells to the effects of ionizing radiation. The North Central Cancer Treatment Group has previously completed pilot studies of accelerated hyperfractionated thoracic radiation therapy (AHTRT) in patients with unresectable Stage IIIA/B nonsmall cell lung cancer (NSCLC). This Phase I study was designed to assess the toxicity of concomitant gamma interferon and AHTRT in a similar patient population. METHODS AND MATERIALS Between December 1991 and May 1992, 18 patients with unresectable Stage IIIA/B NSCLC were treated with daily gamma interferon (0.2 mg subcutaneously) concomitant with AHTRT (60 Gy given in 1.5 Gy twice daily fractions). All patients had an Eastern Cooperative Oncology Group performance status of 0 or 1 with weight loss < 5%. Eight patients had Stage IIIA and 10 had Stage IIIB disease. RESULTS Nine patients (50%) experienced severe, life-threatening, or fatal toxicities. Eight of the patients (44%) developed significant radiation pneumonitis, which was severe in six patients and fatal in two patients (11% treatment-related mortality). Two patients (11%) developed severe radiation esophagitis. With follow-up of 15-21 months, 2 patients are alive, and 16 have died. The median survival time and 1-year survival rate is 7.8 months and 38%, respectively. CONCLUSION Gamma interferon appeared to sensitize normal lung tissue to the effects of radiation, as demonstrated by the high incidence of severe or fatal radiation pneumonitis. We do not recommend pursuing gamma interferon as a radiosensitizer in this setting.
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Affiliation(s)
- E G Shaw
- North Central Cancer Treatment Group, Mayo Clinic, Rochester, MN 55905
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Pinto HA, Jacobs C. Distant metastases from head and neck squamous cancer: the role of adjuvant chemotherapy. Cancer Treat Res 1995; 74:243-262. [PMID: 7779619 DOI: 10.1007/978-1-4615-2023-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- H A Pinto
- Division of Medical Oncology, Stanford University Medical Center, CA 94505, USA
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Scully C. Oral precancer: preventive and medical approaches to management. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1995; 31B:16-26. [PMID: 7627082 DOI: 10.1016/0964-1955(94)00049-a] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Leukoplakias are among the most common potentially malignant oral lesions. Some are idiopathic, others are related to habits such as tobacco and/or alcohol use. Medical management includes reducing or abandoning these habits, increasing the intake of fruit and vegetables in the diet, and possibly the use of active agents. Retinoids, carotenoids and topical cytotoxic agents show promise, and newer therapies are on the horizon.
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Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral Healthcare Sciences, London, U.K
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Cortesina G, De Stefani A, Sacchi M, Rosso S, Galeazzi E. Immunomodulation therapy for squamous cell carcinoma of the head and neck. Head Neck 1993; 15:266-70. [PMID: 8491593 DOI: 10.1002/hed.2880150318] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The role of the immune system in the pathogenesis and treatment of cancer is currently a popular area of research. An underlying fundamental concept of cancer immunology is the supposition that tumor cells express antigens differently than normal cells, both qualitatively and quantitatively. Understanding tumor-host interactions may suggest opportunities to modify these relationships to obtain antitumor effects. There is growing evidence that the immune system plays an important role in the pathogenesis of squamous cell carcinoma of the head and neck (SCCHN). Based on this evidence, trials studying the therapeutic efficacy of biologic response modifiers (BRMs) have been undertaken. These trials have had variable success, but continued efforts incorporating newer cytokines are underway.
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