Platelet-T cell aggregates in lung cancer patients: Implications for thrombosis

Platelet-leukocyte aggregates (PLAs) are associated with increased thrombosis risk. The influence of PLA formation is especially important for cancer patients, since thrombosis accounts for approximately 10% of cancer-associated deaths. Our objective was to characterize and quantify PLAs in whole blood samples from lung cancer patients compared to healthy volunteers with the intent to analyze PLA formation in the context of lung cancer-associated thrombosis. Consenting lung cancer patients (57) and healthy volunteers (56) were enrolled at the Dana Cancer Center at the University of Toledo Health Science Campus. Peripheral blood samples were analyzed by flow cytometry. Patient medical history was reviewed through electronic medical records. Most importantly, we found lung cancer patients to have higher percentages of platelet-T cell aggregates (PTCAs) than healthy volunteers among both CD4+ T lymphocyte and CD8+ T lymphocyte populations. Our findings demonstrate that characterization of PTCAs may have clinical utility in differentiating lung cancer patients from healthy volunteers and stratifying lung cancer patients by history of thrombosis.

Increased activated platelet binding to T cells in lung cancer patients is correlated with history of thrombosis

This study aimed to characterize the role of platelet-leukocyte aggregation in lung cancer patients in context of history of thrombosis. Whole blood from lung cancer patients and healthy volunteers was labeled with fluorescently-conjugated antibodies, then fixed prior to flow cytometry. Platelet-leukocyte aggregates were quantified by detecting the number of platelets within all leukocyte-positive events.

Platelet-CD4 T cell and platelet-CD8 T cell aggregates were both significantly increased in lung cancer patients (both p < 0.0001). Lung cancer patients had significantly more CD4 and CD8 T cells aggregated with activated platelets compared to healthy volunteers (p < 0.01 and p < 0.001, respectively). Lung cancer patients were then separated into groups based on history of thrombosis: No previous thrombosis, arterial thrombotic event (ATE), and venous thromboembolism (VTE). ATE patients had significantly more CD8 T cells aggregated with platelets than patients with no history of thrombosis (p < 0.05). VTE patients had significantly higher expression of platelet activation markers in CD4 and CD8 T cell aggregates than patients with no history of thrombosis (p < 0.01 and p < 0.001, respectively) and ATE patients (p < 0.05 and p < 0.001, respectively).

Platelet-T cell aggregates were significantly increased in lung cancer patients compared to healthy volunteers, and platelet activation within aggregates was significantly correlated with history of VTE in patients with lung cancer. These findings indicate that interactions between platelets and T cells in cancer patients may contribute to a procoagulant phenotype.

Review of the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction

BACKGROUND

Topical capsaicin is known to be a safe and effective pain management adjunct for rheumatoid arthritis, osteoarthritis, neuralgias, and diabetic neuropathy. However, studies and case reports in the literature have indicated that other conditions may also benefit from capsaicin: painful or itching cutaneous disorders from operations, injuries, or tumors; neural dysfunction; or inflammation of the airways and urinary tract.

METHODS

To determine the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction, the authors analyzed data from 33 reports (MEDLINE search of 1966-96) on the efficacy of capsaicin. Outcome measures consisted of the response rate and degree of pain relief. Results from placebo-controlled trials were pooled when possible; effect of treatment was estimated by the method of DerSimonian and Laird.

RESULTS

Pain relief for postmastectomy syndrome and cluster headache was greater with capsaicin than with placebo; also, psoriasis and pruritus responded better to capsaicin. Uncontrolled studies and case reports have indicated that pain or dysfunction was less at the end of capsaicin therapy for neck pain, loin pain/hematuria syndrome, oral mucositis, rhinopathy, reflex sympathetic dystrophy syndrome, detrusor hyperreflexia, and cutaneous pain due to tumor of the skin.

CONCLUSIONS

Capsaicin is effective for psoriasis, pruritus, and cluster headache; it is often helpful for the itching and pain of postmastectomy pain syndrome, oral mucositis, cutaneous allergy, loin pain/hematuria syndrome, neck pain, amputation stump pain, and skin tumor; and it may be beneficial for neural dysfunction (detrusor hyperreflexia, reflex sympathetic dystrophy, and rhinopathy). A universal problem for many of the studies analyzed was the absence of a "burning placebo" such as camphor.

Cyclophosphamide plus cis-platinum in combination: treatment program for stage III or IV ovarian carcinoma

A randomized prospective comparison of treatment with cyclophosphamide and that with cyclophosphamide and cisplatinum, each in 21 patients with advanced ovarian cancer, has shown that the time to progression of tumor and the duration of survival were markedly improved in the patients receiving the combination chemotherapy. Cytoreductive surgery was performed in most of the patients in the study before the chemotherapy regimen was initiated. Second-look surgery was performed after a year of chemotherapy. The chemotherapy was administered on an outpatient basis, without excessive toxicity. At 2 years, 52.4% of the patients receiving combination therapy had no progression of tumor, whereas 9.5% had no progression of tumor inthe group of patients receiving a single alkylating agent. Survival at 2 years was 61.9% for the combination chemotherapy group and 19.0% for those treated with cyclophosphamide alone. The study demonstrates a striking superiority of combination chemotherapy over single-agent chemotherapy in patients with advanced ovarian cancer.