Delayed cutaneous hypersensitivity reactions to extracts of malignant and normal breast cells

Production of Leukocyte Migration Inhibition Factor by Lymphocytes of Larynx Cancer Patients Stimulated by Laryngeal Carcinoma Solubilized Membrane Antigens

The production of leukocyte migration inhibition factor (LIF) from lymphocytes after stimulation with 3 M KCl soluble tumor and normal mucosa extracts was investigated in 30 patients with laryngeal carcinoma at different development stages and in 30 normal donors. The experiments were performed in heterologous and autologous systems. In heterologous systems 3 M KCl tumor extracts induced LIF production by heterologous lymphocytes from patients in 91 % of the cases, and normal mucosa extracts induced LIF production by heterologous lymphocytes from patients in 73 % of the cases and from normal donors in 90 % of the cases. In autologous systems 3 M KCl tumor extracts induced LIF production by autologous lymphocytes from the same patients in 65 % of the cases, whereas the normal laryngeal mucosa extracts induced LIF production by the same autologous lymphocytes in the 6 % of the cases. The high positivity percentage of the test in heterologous systems could be related to differences in the major histocompatibility complex. The 65 % test positivity in autologous systems using tumor extracts could be related to the presence of tumor associated antigens.

Breast cancer skin test antigens of increased sensitivity prepared from vesicular stomatitis virus-infected tumor cells

Crude membrane (CM) extracts were prepared from five cultured breast tumor lines (MDA-MB-157, MDA-MB-231, ZR75-1, HS0578T, and MCF-7) which had been infected with vesicular stomatitis virus (VSV) to augment their antigenicity. In skin test trials, CM extracts of uninfected MCF-7 cells elicited positive response in 0 of 13 (0%) tests in breast cancer patients, while VSV-MCF-7 elicited positive responses in 11 of the same 13 patients (84.6%). CM extracts of VSV-ZR75-1 and VSV-MCF-7 elicited greater delayed hypersensitivity responses (mm induration at 48 hr) in breast cancer patients than in patients with lung carcinoma or melanoma. Although the sensitivity of VSV-ZR75-1 was too low (ten of 28, or 35.7% of tests positive) to be useful as a skin test antigen, VSV-MCF-7 elicited positive responses in 30 of 38 (78.9%) tests in breast cancer patients, as compared to two of 15 (13.3%) and two of 13 (15.4%) of tests in patients with lung carcinoma and melanoma, respectively. The "virus-augmented" CM extract of cultured MCF-7 cells exhibited markedly greater sensitivity as compared to control MCF-7 extracts (P less than .005), with a high degree of specificity for breast cancer patients as compared to patients with the other neoplasms (P less than .00001). The results of skin testing with VSV-MCF-7 CM extracts demonstrated antigenic cross-reactivity with a large number of breast cancer patients, a finding of great importance for any potential immunotherapy and/or immunodiagnosis.

Specific and aspecific immune responsiveness in lung cancer patients: cutaneous delayed hypersensitivity reactions to a lung cancer-associated antigen

The ability of a lung cancer-associated antigen (LCAA) to provoke specific cutaneous delayed-hypersensitivity reactions has been studied on a group of 59 lung cancer patients. Biological activity of LCAA, monitored by skin testing, was demonstrated in 32% (17 of 53) of lung cancer patients, in 48.0% with limited disease, and in 17.2% with extensive disease. All the responders were in the group of normal reactors to standard recall antigens, if three antigens were used (PPDSK-SD, candida). No correlation was found between biological activity of LCAA and level of immunocompetence evaluated by lymphocyte-blastic transformation with PHA and count of rosette E-forming cells. These studies on the capacity to evoke specific DTH reactions in lung-cancer patients will be extended to the use of assays in vitro in the perspective of a more significant evaluation of immunocompetence levels.

Skin tests with soluble melanoma antigens in patients with choroidal tumors

The cutaneous delayed hypersensitivity reactions with a soluble melanoma antigen in patients with choroidal mass lesions were studied. Ninety percent of patients with pathologically documented choroidal melanomas had positive melanoma antigen skin test responses. There did not appear to be any difference in the histologic appearance of the tumor nor in the disease status of those patients with positive versus those patients with negative skin test reactions. A 21% instance of false-positive responses with this partially purified soluble melanoma antigen in patients with simulating lesions was observed. The cause for this reactivity is unclear; however, from previous work tissue-associated antigens or fetal antigens are the most probable etiologies for the false-positive melanoma antigen skin tests observed. Further purification of the melanoma-associated antigen preparation may increase the specificity. The results of this study would mitigate against the use of this soluble melanoma antigen skin test in the primary evaluation of patients with pigmented choroidal mass lesions. Currently, the assay is being tested to ascertain its correlation with prognosis and as a means of monitoring immunotherapy.

Influence of Autologous Serum on in Vitro Reactivity of Peripheral Lymphocytes of Patients with Breast Cancer

The influence of autologous serum on DNA synthesis and phytohemagglutinin (PHA) or pokeweed mitogen (PWM) stimulation of peripheral blood lymphocytes from mammary tumor-bearing women has been studied. Blood samples were collected from patients at the 4 stages of the TNM classification who had not undergone any therapeutic treatment. Lymphocyte functions were significantly reduced only in patients with the largest tumors and in the latest stage of disease. Autologous cancer sera inhibited spontaneous DNA synthesis of lymphocytes and did not inhibit lymphocyte stimulation by mitogens. It is possible that unrecognized inhibiting and stimulating factors, possibly acting in synergism with mitogens, are present in mammary cancer sera.

Immunological monitoring and immunotherapy in carcinoma of the lung

One hundred and seven patients with carcinoma of the lung underwent immunologic testing, and 62 of these patients were randomized to an immunotherapy protocol comparing the effects of Pasteur strain BCG, either alone or combined with allogeneic tumor cells, to the effects of no immunotherapy. Patients with residual disease left at the time of surgery or with metastatic disease at the time of diagnosis showed no increase in survival as a result of this form of immunotherapy. An insufficient number of patients with less advanced disease, in whom we would expect the most beneficial effect, have been entered in this study. In general, we were unable to document substantial effects of immunotherapy on the immunologic parameters tested. Only in recall antigen skin testing was there a statistically significant increase in reactivity in the immunotherapy groups. Tests of general immune status appeared to have a predictive value in monitoring lung cancer patients. Anergic patients had a poorer prognosis than did patients who demonstrated skin test reactivity. Patients with normal percentages of lymphocytes (T cells) forming rosettes with sheep erythrocytes at 29 degrees C were generally normal in other tests of immune competence. In serial studies of rosette formation, all patients who developed recurrent disease had a pattern of depressed or falling rosette values, and these abnormalities occurred an average of 3.1 months prior to clinical detection of recurrence. Patients with large-cell anaplastic carcinoma were found to have a significantly higher incidence of depressed rosette levels than the other histologic types. Both large and small-cell anaplastic patients had significantly depressed lymphocyte proliferation by mitogens and allogeneic cells. Although lung cancer patients have been described as immunologically depressed, they are capable of recognizing tumor-associated antigens. When tested in leukocyte migration inhibition assays with tumor-associated antigens, the majority of the patients in our study were found to be reactive. The use of a 3 M KCl extract of pleural effusion cells from a patient with pulmonary adenocarcinoma has given good reactivity and specificity in lung cancer patients of all histologic types. In addition, these patients have been shown to respond in a mixed lymphocyte/tumor interaction to tumor-associated antigens (Dean, 1976b).

Immunobiology of operable breast cancer: an assessment of biologic risk by immunoparameters

The concept of whether immune function was related to risk of recurrence was examined in patients with operable breast cancer in whom careful clinical and pathologic staging had been performed. Patients were classified according to the risk of recurrence. The "low risk" group included patients with minimal breast cancer, noninfiltrating cancer, or infiltrating cancer less than 1 cm with negative nodes. The "high ridk" group included patients with lesions greater than 1 cm or who had greater than or equal to 4 nodal metastases or who had macrometastases at Level II or III (apex). In the "intermediate risk" group were patients with infiltrating cancer less than 1 cm or with less than 4 nodal metastases at I only. Immune reactivity was assessed by skin tests, by measurement of absolute lymphocyte count, T and B cells, lymphocyte stimulation by mitogens and a battery of common antigens, serum immunoglobulins and complement levels. There were 134 patients with operable breast cancer and 63 patients with benign breast lesions. The breast cancer patients showed minimal or no impairment of DNCB skin test. Only patients with nodal metastases showed a slight but not significant impairment of DNCB responses (80% were DNCB positive compared to 90% in the controls.) The lymphocyte responses to mitogens were normal in the breast cancer patients, but there was a significant depression of lymphocyte responses to certain recall antigens such as Candida albicans and E coli. The absolute lymphocyte count and the T cell counts were normal, but B cells bearing complement receptors were decreased and B cells bearing sufface immunoglobulins were increased in the breast cancer patients. Analysis of immune function according to the pathologic stage of disease "risk of recurrence" categories showed no correlation with skin tests or lymphocyte levels. A striking and paradoxical finding was the demonstration that patients with "low risk" cancer overall had markedly lower responses to the battery of stimulating mitogens and antigens than found in patients with "high risk" or "intermediate risk" disease. Only the lymphocyte responses to PHA showed a significant linear correlation with increasing pathologic stage or "risk of recurrence." Current evidence from this study suggests that PHA response is markedly influenced by the primary tumor burdenand thus indirectly reflects the risk of recurrence.

Nodal response in medullary carcinoma of the breast

From 1954 to 1970, ninety-five patients with medullary carcinoma of the breast were evaluated in terms of immunologic activity based on the histologic changes seen within the tumor and regional nodes. Each patient was studied for the degree of lymphocytic infiltration in the tumor as well as the extent of sinus histiocytosis present within the regional nodes. Contrary to what would normally be expected, those nodes with increased sinus histiocytosis were associated with the larger tumors. In addition, lymph node metastasis increased from 26 to 75 per cent as the degree of sinus histiocytosis became more pronounced. There was no evidence that increased lymphocytic infiltration in the tumor resulted in a statistically significant improvement in the five and ten year survival rates. Similarly, sinus histiocytosis activity did not seem to enhance the survival rate among this particular group of patients. There is a suggestion that a correlation exists between sinus histiocytosis and lymphocytic infiltration in the tumor and that, whatever the stimulus present, its effect is on both the lymph node and the degree of lymphocyte response within the tumor. The antigenic substance in the tumor, which initiates the immune response, possibly produces an abortive reaction, which may result in the induction of blocking factors rather then those factors necessary for destruction. It appears that histologic evidence of immunologic enhancement does not necessarily signify improved survival, at least with those patients having carcinoma of the breast.

Tumour antigenicity in ovarian cancer

The blastogenic response to a crude cell extract of ovarian cancer cells has been studied in 48 patients with ovarian cancer (9, autologous, 39 allogeneic), in 26 female controls matched for age and in 18 female patients with other types of cancer in remission from disease. The responses in ovarian cancer patients in remission and relapse were considered separately. The blastogenic responses to cell extracts of foetal ovary, foetal lung, foetal liver and normal adult ovary were also assessed in a proportion of all 3 groups. The blastogenic responses to ovarian cancer and foetal ovary cell extracts were found to be significantly greater in the ovarian cancer patients in remission than in the controls, but the responses to ovarian cancer extract were not greater in the relapse group or in patients with other cancers. As a blastogenic response to normal ovarian extract was also present in some of these patients, the data so far do not support the hypothesis of a tumour specific antigen. This tumour associated response may be occurring to determinants in foetal or adult ovarian tissue to which the patient becomes sensitized in malignant disease. The response is complex and the nature of the antigen requires further analysis.