Immunologic response in gynecologic malignancy as demonstrated by the delayed hypersensitivity reaction: clinical correlations

Immune function in malignant cervical neoplasia: a multiparameter analysis

Immunological assessment was carried out in 67 patients with various stages and histological grades of squamous cell carcinoma of the uterine cervix and compared with normal controls to discover whether any of these parameters could be used as an indicator of the patient's clinical status. The results show a gross impairment of the various lymphocyte subpopulations and anti-tumor immunity. This impairment was more pronounced in patients with high tumor load and having a histology of poorly differentiated squamous cell carcinomas. None of the parameters studied (total leukocyte numbers, lymphocyte subpopulations, leukocyte adherence inhibition test, natural killer cell activity, circulating immune complexes, and blocking effect of autologous serum) could be used as a clinical indicator, since no correlation could be noted between immune impairment and either the lymphocyte subpopulations or the circulating immune complexes.

Immunological status of trophoblastic neoplasia

Six cases of choriocarcinoma, 17 of vesicular mole, 20 normal pregnant females in the first trimester of pregnancy, and 20 normal nonpregnant women wih previous normal obstetrical history were evaluated quantitatively for cell-mediated immunity by response to 2:4 dinitrocholorobenzene and recall antigens. Serum immunoglobulins were estimated in all cases. Suppression of cell-mediated immunity was marked in choriocarcinoma as compared to vesicular mole. Serum IgG levels were significantly diminished in cases of vesicular mole, indicating diminished humoral immunity. Follow-up after 3 months of treatment with surgery and chemotherapy resulted in marked improvement of cell-mediated immunity.

Sequential evaluation of general immunocompetence in gynecologic cancer

A sequential evaluation of general immunocompetence was performed in 70 previously untreated patients with gynecologic cancer. Immunologic evaluations were made prior to any therapy and repeated every 3-4 months for 3 years or until patients died of disease. Cell-mediated immunity was investigated by delayed hypersensitivity to intradermal skin test antigens (STA) and by contact sensitization to 2,4-dinitrofluorobenzene (DNFB). Serum immunoglobulin determinations were performed to evaluate humoral immunity. Compared with age-matched controls, there was impairment of cell-mediated response to both STA and DNFB in patients with locally invasive and disseminated cancer but not in those with preinvasive cancer. There was a progressively impaired reactivity with clinical progression of disease independently of histological type of neoplasm. Sequential evaluations revealed that variations in immune reactivity occurred that also correlated with the patient's clinical course. Significant changes in immunoglobulin levels, an increase in IgG and IgA, and a decrease in IgM, were observed in the cancer groups as compared with age-matched healthy female controls. However, neither initial values nor sequential determinations of immunoglobulins were related to the clinical course of gynecologic cancer.

Pretreatment prognostic factors in carcinoma of the uterine cervix: a multivariable analysis of the effect of age, stage, histology and blood counts on survival

From January, 1953 through December, 1977, 910 previously untreated patients with invasive carcinoma of the uterine cervix (Stages IB-IVB) were seen at Yale-New Haven Medical Center and affiliated hospitals. An extensive retrospective analysis was undertaken in an attempt to identify prognostically significant pretreatment factors. The patients studied were uniformly staged according to the current FIGO recommendations and the majority of patients had been treated under standardized protocols combining external beam radiation therapy and intracavitary radium. Pretreatment parameters, including prior medical illnesses, gross tumor characteristics, histology, and blood parameters were studied, employing stepwise Cox regression analyses to identify the possible effects of all factors and all two-way interactions among factors on survival, disease-free survival and freedom from local-regional failure, controlling for stage of disease. FIGO stage, patient age at diagnosis, pretreatment neutrophil count and hematocrit, uterine position, prior subtotal hysterectomy, histology, history of diabetes mellitus and number of pregnancies were all found to have prognostic significance. When other factors including stage of disease were controlled for, increased tumor size was associated with decrease disease-free survival and local-regional control rates.

Prognostic significance of the tumor antigen TA-4 in squamous cell carcinoma of the uterine cervix

Prognostic values of a tumor antigen (TA-4) of squamous cell carcinoma were studied in 135 patients with invasive squamous cell carcinoma of the uterine cervix. In order to evaluate the host defense responses against cancer, the percentage of lymphocytes (percentages of lymphocytes in total leukocyte counts in the peripheral blood) was also determined simultaneously in each case. All patients were followed up for 2 years. Sixty patients with Stage II disease underwent a radical operative procedure, and all other cases (75 cases) were treated primarily with radiation therapy. In both groups of patients, the survival rate or disease-free rate was significantly worse in those with TA-4 levels of greater than or equal to 15 microunits/ml compared to that of those with lower levels. The prognosis was particularly poor in those patients who had TA-4 levels of greater than or equal to 15 microunits/ml and lymphocyte percentages of less than 30. It was concluded that the simultaneous determinations of serum TA-4 and lymphocyte percentages would be useful in predicting the prognosis of cervical squamous cell carcinoma.

Value of immune monitoring in gynecologic cancer patients receiving immunotherapy

Immunotherapy with nonspecific immunopotentiators such as Corynebacterium parvum is under study in several areas of gynecologic oncology. The efficacy of this new modality awaits the results of carefully done clinical trials designed to measure an improved effect on survival when this and similar agents are added to conventional therapy. This report deals with an attempt to demonstrate enhancement of the cell-mediated immune response in a small number of patients with advanced ovarian (18 patients) and cervical (12 patients) cancer who were treated with intravenous C. parvum in addition to either chemotherapy (Alkeran) or pelvic radiotherapy. Monitoring of the immune response was accomplished by skin testing, T-lymphocyte rosettes, B-lymphocyte rosettes, simulation of lymphocytes with mitogens (PHA and Con-A) and total lymphocyte counts. No distinct improvement in these parameters could be demonstrated as a result of immunotherapy with C. parvum. These results and the value of immune monitoring as currently performed are discussed.

Immunotherapy and chemotherapy of gynecologic cancers

Recurrent cervical, ovarian, and breast cancers have been treated with immunochemotherapy. Optimum chemotherapeutic agents have been determined by direct and indirect methods of sensitivity determination. The Hellström assay has been used for lymphocyte-tumor recognition and for cytotoxicity assays. Vaccines developed in this laboratory, consisting of autologous and allogeneic tumor-associated antigens, combined with BCG, have been used in immunotherapy. Objective tumor regression and notable clinical improvements have been observed. Forty-five advanced cases, including recurrent cancers of the cervix and ovary, along with sarcomas, breast malignancies, and melanomas, have been treated: 16 patients have died of their disease and 29 patients have survived for 6 months to 1 1/2 years. Some of these have shown either regression, total disappearance, or stabilization of their disease process. While the results of these preliminary studies are encouraging, the as yet unknown potential of this modality cannot be expected until it is applied earlier, at a time when residual tumor cells are minimal.