CA 125: a clinically useful tumor marker in the management of colorectal carcinoma metastatic to the liver in patients with normal carcinoembryonic antigen

Two patients with colon carcinoma metastatic to the liver had normal plasma carcinoembryonic antigen (CEA) levels (<1.0 ng/ml) but elevated CA 125 levels. Treatment of the metastatic disease with chemotherapy, plus surgery in one case, led to declines in the CA 125 levels. These decreases were associated with tumor regression, as confirmed by clinical and radiologic evidence. These findings lead us to conclude that the measurement of CA 125 for patients with normal CEA levels is useful in the management of colorectal carcinoma.

Hepatic arterial infusion of recombinant platelet factor-4 suppresses metastases to the lungs from tumors implanted into the livers of rabbits

BACKGROUND

This study evaluated the toxicity (Part I) and antitumor effects (Part II) associated with hepatic arterial infusion of recombinant platelet factor-4 (rPF4), an antiangiogenic protein.

METHODS

Healthy rabbits (Part I) and rabbits with tumors implanted in their livers (Part II) received saline or rPF4 via hepatic arterial infusion. Three saline-receiving and four rPF4-receiving animals died 2-3 days postinfusion from gastroduodenal thromboembolism. The remaining animals were necropsied 3, 7, 10, or 14 days postinfusion. Blood analyses and hepatic angiography were performed before infusion and at the time of sacrifice.

RESULTS

In Part I, focal coagulation necrosis of the hepatic parenchyma was observed in 1 of 11 rabbits that received saline and in 6 of 10 that received rPF4. In Part II, hepatic arterial infusion of rPF4 had no effect on growth of the implanted liver tumors. However, the protein significantly reduced the incidence of lung metastasis.

CONCLUSIONS

Intraarterial infusion of rPF4 significantly reduced the incidence of lung metastasis. Nonheparin systemic anticoagulation may be needed during catheterization and infusion procedures to prevent thromboemboli.

Gastrointestinal leiomyosarcoma metastatic to the liver. Durable tumor regression by hepatic chemoembolization infusion with cisplatin and vinblastine

BACKGROUND

Gastrointestinal leiomyosarcoma metastatic to the liver is considered most resistant to any combination of systemic chemotherapy containing doxorubicin and/or ifosphamide.

METHODS

Fourteen patients with gastrointestinal leiomyosarcoma metastatic to the liver were treated with hepatic chemoembolization infusion consisting of polyvinyl alcohol sponge particles mixed with cisplatin powder (150 mg) followed by an intrahepatic arterial infusion of vinblastine (10 mg/m2).

RESULTS

Ten major (> 50% regression) tumor responses were observed (70%) in patients lasting from 8 to 31+ months (median, 12 months) after an average of two hepatic chemoembolization procedures, usually 4 weeks apart. Transient side effects included right upper quadrant pain requiring narcotics, significant hepatic enzyme elevation, particularly of lactic dehydrogenase with a minimal increase in bilirubin, paralytic ileus requiring nasogastric suction up to 72 hours, urinary electrolyte losses (potassium+, magnesium++, sodium+) requiring supplements, and occasionally mild but transient leukopenia and thrombocytopenia.

CONCLUSIONS

Hepatic chemoembolization infusion appears to induce a high rate of durable tumor response in patients with notoriously chemoresistant gastrointestinal leiomyosarcoma metastatic to the liver.

Gastrointestinal leiomyosarcoma metastatic to the liver. Durable tumor regression by hepatic chemoembolization infusion with cisplatin and vinblastine

BACKGROUND

Gastrointestinal leiomyosarcoma metastatic to the liver is considered most resistant to any combination of systemic chemotherapy containing doxorubicin and/or ifosphamide.

METHODS

Fourteen patients with gastrointestinal leiomyosarcoma metastatic to the liver were treated with hepatic chemoembolization infusion consisting of polyvinyl alcohol sponge particles mixed with cisplatin powder (150 mg) followed by an intrahepatic arterial infusion of vinblastine (10 mg/m2).

RESULTS

Ten major (> 50% regression) tumor responses were observed (70%) in patients lasting from 8 to 31+ months (median, 12 months) after an average of two hepatic chemoembolization procedures, usually 4 weeks apart. Transient side effects included right upper quadrant pain requiring narcotics, significant hepatic enzyme elevation, particularly of lactic dehydrogenase with a minimal increase in bilirubin, paralytic ileus requiring nasogastric suction up to 72 hours, urinary electrolyte losses (potassium+, magnesium++, sodium+) requiring supplements, and occasionally mild but transient leukopenia and thrombocytopenia.

CONCLUSIONS

Hepatic chemoembolization infusion appears to induce a high rate of durable tumor response in patients with notoriously chemoresistant gastrointestinal leiomyosarcoma metastatic to the liver.

Durable hepatic tumor regression after arterial chemoembolization-infusion in patients with islet cell carcinoma of the pancreas metastatic to the liver

BACKGROUND

Islet cell carcinoma of the pancreas is a neuroendocrine tumor often presenting with left upper quadrant mass and radiographic evidence of liver metastases. Because survival among these patients is determined largely by the pace of metastatic events in the liver, significant palliation may be achieved by regional hepatic therapy.

METHODS

Five patients with islet cell carcinoma of the pancreas metastatic to the liver (four nonfunctional, one gastrin producing), were treated by hepatic arterial chemoembolization-infusion consisting of a mixture of polyvinyl alcohol sponge (150 mg) and cisplatin (150 mg) followed by 2-hour intraarterial infusion of vinblastine (10 mg/m2). Each patient received two such treatments, 1 month apart, requiring 3 to 6 days of hospital admission.

RESULTS

Significant tumor regression (> 50%) was observed in four of five patients, lasting from 8 to 44 months. Toxicity was limited to right upper quadrant pain, paralytic ileus requiring nasogastric suction for 24 to 72 hours, transient, mild bilirubinemia and liver enzyme elevation, hypomagnesemia and hypokalemia, and occasionally, moderate, self-limiting granulocytopenia.

CONCLUSIONS

This preliminary, albeit limited, experience with hepatic chemoembolization-infusion in patients with islet cell carcinoma metastatic to the liver emphasizes the high incidences of durable tumor regression that can be achieved with minimal iatrogenic intervention.

Regional biologic therapy. Hepatic arterial infusion of recombinant human tumor necrosis factor in patients with liver metastases

Twenty-two chemotherapy-resistant patients with liver metastases received 46 courses of recombinant human tumor necrosis factor (rhTNF) administered by 5-day continuous infusion through percutaneously inserted hepatic arterial catheters. The maximum tolerated daily dose of rhTNF was 150 micrograms/m2. This is six times the maximum tolerated daily dose of rhTNF that could be given systemically (intravenous) on the same schedule. The dose-limiting toxicity resulted in severe, although transient, hypophosphatemia (less than 1.0 mg/dl) associated with myocardial dysfunction. Objective tumor response (partial tumor response or greater) was observed in 2 of 14 patients (14%) with colorectal cancer and lasted as long as 3 months. Three additional minor responses occurred among these patients with colorectal cancer. Plasma carcinoembryonic antigen levels also decreased significantly (greater than 25%) in 7 of the 14 (50%) patients with colorectal cancer. Regional biologic therapy with rhTNF as a sole modality has definite antitumor activity in colorectal cancer metastatic to the liver and warrants additional study in previously untreated patients.

The prevalence and location of metastases from ocular melanoma: imaging study in 110 patients

Ocular melanoma is characterized by an unpredictable clinical course, during which fulminant metastatic disease may occur after a prolonged disease-free interval. The purpose of this study was to determine the pattern of metastatic involvement in this disease. The clinical and radiologic findings in 110 patients with metastatic ocular melanoma were reviewed. The 54 men and 56 women were 24-79 years old (mean, 50 years) when the primary tumor was first diagnosed. Metastases were present in three patients at the time of first diagnosis and occurred in 107 patients 2 months to 36 years later (mean, 52 months). One hundred five patients died between 1 and 38 months after the onset of metastatic disease. Hepatic metastases developed in 101 patients (92%), and in 60 (55%) of these, the liver was the only organ involved initially. Pulmonary parenchymal metastases developed in 34 patients (31%), but in only four of them were metastases confined to the lungs. Twenty-five patients (23%) had bone involvement, mostly affecting the spine. Nineteen patients (17%) had skin or subcutaneous metastases, but in only two of them was this the initial finding. Nodal involvement was shown in 15 patients (14%), almost always associated with extensive hepatic metastases. Brain and adrenal metastases were seen in five and three patients, respectively. Hepatic involvement occurs in almost all patients who develop metastatic ocular melanoma, and the liver is the most common initial site of metastatic involvement. Metastases may develop after a long disease-free interval.

Arterial chemotherapy in the management of colorectal cancer: an overview

We have discussed the role of arterial therapy in patients with various stages and types of colon cancer. Arterial therapy is probably not useful as an adjuvant therapy for Dukes' C colon cancer. It may, however, play a role among patients with incomplete resection of liver metastases (positive margins). A randomized trial is needed to determine the role of arterial therapy in patients who have undergone complete resection of liver metastasis. Arterial therapy does not seem justified for patients with recurrent pelvic tumors. For nonresectable liver metastases, hepatic arterial therapy induces a higher response rate than does intravenous treatment. It may also improve performance status and offer additional palliation to patients who have failed systemic chemotherapy. are refractory to systemic chemotherapy may be candidates for palliative hepatic arterial chemotherapy even out of the context of a clinical trial. Asymptomatic patients with nonresectable liver metastasis who are refractory to systemic chemotherapy should be enrolled in phase I-II arterial chemotherapy trials designed to identify optimal treatment regimens. Previously untreated asymptomatic patients wishing treatment may be enrolled in a new multi-institutional phase III trial being designed to compare contemporary systemic chemotherapy with less toxic arterial therapy and combined arterial and systemic therapy. Such a new trial will have to avoid any cross-over between arms to determine the true impact of arterial therapy on survival. Regional arterial chemotherapy tries to extract the "extra mile" from marginally active drugs that have a steep dose response curve by increasing tumor drug exposure. Increased drug concentrations in the tumor may be accomplished by means of the blood vessel-to-tumor concentration gradient. The technology to achieve such a gradient has involved percutaneous hepatic arterial catheters, implantable infusion pumps or ports, and external pumps. The most economic hepatic arterial delivery system for protracted arterial FUdR is an infusion pump. Despite good pharmacological rationale, an improved response rate, and good evidence for effective palliation in advanced disease, hepatic arterial therapy has not improved survival when compared with systematic intravenous treatment. Possible explanations include the following: (1) poor study design that allowed patients to cross over between arms: (2) inadequate arterial chemotherapy combination; (3) inadequate arterial chemotherapy schedule; (4) hepatobiliary toxicity levels that required cessation of hepatic arterial therapy and allowed the emergence of resistant tumor clones; and (5) systemic progression of disease. Only time will tell whether improved chemotherapy and the design of a new phase III trial will establish a beneficial role for upfront hepatic arterial therapy in asymptomatic patients with colon cancer metastatic to the liver.

Regression of hepatic metastases from gastrointestinal leiomyosarcoma after hepatic arterial chemoembolization

Two patients with gastrointestinal leiomyosarcoma metastatic to the liver were treated by hepatic chemoembolization with cisplatin and polyvinyl sponge followed by hepatic arterial infusion of vinblastine. Effective palliation in terms of durable tumor regression was achieved in both patients after two chemoembolization-infusion procedures. These results suggest that regional therapy may offer new hope for the subset of sarcoma patients who have liver metastases resistant to combination systemic chemotherapy.

Severe, symptomatic, dose-limiting hypophosphatemia induced by hepatic arterial infusion of recombinant tumor necrosis factor in patients with liver metastases

Twenty-two patients with liver metastases received 45 courses of recombinant tumor necrosis factor (rTNF) by hepatic arterial infusion in doses ranging from 12.5 to 175 micrograms/m2/d for 5 days by continuous infusion. The induction of statistically significant, dose-related, severe, albeit transient, hypophosphatemia (less than 1.0 mg/dl) associated with clinically significant, right-sided myocardial dysfunction and severe lassitude was observed. These side effects were promptly reversed after rTNF was stopped and intravenous phosphate supplementation was started. As no significant or consistent increase in urinary phosphate excretion was detected, the rTNF-induced hypophosphatemia probably resulted from an intracellular shift of phosphate. Since tumor regression was clearly associated with the lowest levels of serum phosphate, hypophosphatemia may be important in the antitumor effects of rTNF.

Increased incidence of hypersensitivity to iodine-containing radiographic contrast media after interleukin-2 administration

Eight of 28 (28%) cancer patients with liver metastases treated by either splenic (four) or hepatic (four) arterial infusion of recombinant interleukin-2 (rIL-2) developed hypersensitivity reactions to iodine-containing radiographic contrast media. These reactions consisted of fever, chills, malaise, nausea and vomiting, skin rash, diarrhea, and occasionally, hypotension. Reactions usually occurred 1 month after the initial arteriographic procedure and rIL-2 infusion, with 1-hour to 4-hour intervals between procedure and reexposure of the patient to the iodine-containing contrast medium (used in conjunction with computerized tomography or repeated arteriography for subsequent courses of rIL-2 infusions) and the onset of symptoms. Prompt administration of corticosteroids during the reaction and premedication of patients who were known to have had a reaction in the past were very effective in stopping reactions or preventing them from reoccurring. The high incidence (28%) of hypersensitivity reactions, the temporal relationship (4 hours) between the arteriographic procedure (utilizing iodine-containing contrast medium) and the initial infusion of rIL-2 (while some of the contrast medium was still present), and the absence of such hypersensitivity reactions among patients receiving systemic (intravenous) rIL-2 (not requiring the use of concomitant iodine-containing contrast medium) provide additional evidence that in the presence of a potentially immunogenic moiety, rIL-2, a potent stimulant of the human immune system, can produce an initial sensitization followed by subsequent anamnestic reaction upon reexposure of the patient to the immunogen (even without the additional rIL-2).

Splenic versus hepatic artery infusion of interleukin-2 in patients with liver metastases

In an attempt to improve the therapeutic index of recombinant interleukin-2 (rIL-2) by generating or activating lymphokine-activated killer (LAK) cells and tumor-infiltrating lymphocytes (TIL) regionally and/or in situ, we randomly assigned 28 patients with liver metastases to receive rIL-2 by continuous infusion for 5 days via either the splenic artery or the hepatic artery. Clinically significant and lasting tumor regression was observed only in two of 28 patients (7%), one in each of the two treatment arms. The maximum-tolerated daily dosage of rIL-2 was 3 x 10(6) U/m2; beyond this dosage, toxicity was excessive. Peripheral LAK cell activity measured in vitro and clinical tumor regression did not correlate. This observation, coupled with the equal distribution of regressions between the two treatment arms, raises the possibility that tumor regression, rare though it may be in response to rIL-2 administration, is largely mediated by TIL activation and not by LAK cell generation.

Hepatic arterial infusion of human recombinant tumor necrosis factor-alpha. An experimental study in dogs

Local and systemic toxicities associated with hepatic arterial infusion of human recombinant tumor necrosis factor (rTNF) were studied in healthy adult mongrel dogs. The animals received saline containing human serum albumin with or without rTNF (0.02, 0.2, or 2.0 mg/m2). Arteriograms were made, and blood samples were collected for hematologic and biochemical analyses at regular intervals. The dogs were killed at 1, 3, and 7 days postinfusion and complete necropsies were performed. Specimens were obtained from various tissues for histopathologic evaluation. Results indicated that all but the highest dose of rTNF were well tolerated. Severe histopathologic changes were found in the liver, spleen, and kidneys of the animals receiving 2.0 mg/m2 rTNF. In addition, focal tubular degeneration was found in one dog administered 0.2 mg/m2 rTNF. These data suggest that the upper dose limit for hepatic arterial infusion of rTNF is between 0.2 and 2.0 mg/m2 and that renal function should be closely monitored after infusion.

Regression of ocular melanoma metastatic to the liver after hepatic arterial chemoembolization with cisplatin and polyvinyl sponge

Thirty patients with ocular melanoma metastatic to the liver were treated by hepatic arterial chemoembolization using an admixture of cisplatin and polyvinyl sponge. Tumor regression was complete in one patient and partial (greater than 50%) in 13 patients. The total response rate was 46%. The median survival for the entire group was 11 months (95% confidence interval, nine to 18 months). Treatment-related morbidity was short-lived and included primarily severe upper right quadrant abdominal pain, transient paralytic ileus, and nonicteric hepatitis. Hepatic arterial chemoembolization provided effective palliation, with good-quality survival among 46% of patients with ocular melanoma metastatic to the liver.

Fractionated extract of Astragalus membranaceus, a Chinese medicinal herb, potentiates LAK cell cytotoxicity generated by a low dose of recombinant interleukin-2

Success with rIL-2 immunotherapy of human cancer appears to depend on the administration of high doses which are frequently associated with excessive toxicity. Future use of rIL-2 will require certain modifications based on the use of lower doses of rIL-2 without significant loss of antitumor efficacy. We tested in vitro the possibility of potentiating the activity of rIL-2 in terms of LAK cell generation. We hypothesized that co-incubation of LAK cell precursors with a Chinese herbal extract (F3) of Astragalus membranaceus, (an immune modulator currently under study in our laboratory), along with a low concentration of rIL-2, would generate levels of LAK cell activity equivalent to those generated by high concentrations of rIL-2 alone. We found (1) a 10-fold potentiation of rIL-2 activity manifested by tumor cell-killing activity of 80% resulting from LAK cell generation with F3 plus 100 u/ml of rIL-2 versus 76% generated by 1,000 u/ml of rIL-2 alone; (2) a significant reduction in the number of effector LAK cells required for equicytotoxic reaction following LAK cell generation with F3 plus rIL-2 compared to rIL-2 alone. We conclude that potentiation of antitumor activity mediated by rIL-2 in low concentrations is possible by the concomitant use of another immune modulator such as Astragalus membranaceus.

Hepatocellular carcinoma. A retrospective analysis of treatments to manage disease confined to the liver

The histories of 73 patients with hepatocellular carcinoma (HCC) confined to the liver who were seen at M. D. Anderson Hospital between January 1976 and December 1983 were reviewed. In 18 patients the tumor was resected either at the outset or after the patients' response to chemotherapy; nonsurgical treatments consisted of hepatic arterial infusion (HAI) in 10 patients and intravenous (IV) therapy in four patients. Patients who had resection were younger, and their liver functions and performance status were better than the IV and HAI groups. Their median survival was 46 months. Of the patients who had nonresectable tumors, 28 received chemotherapy by HAI and 27 received IV therapy. Of the 28 patients in the HAI treatment group, 25 received uniform infusion of floxuridine (FUDR, Roche, Australia), doxorubicin (Adriamycin), and mitomycin C (FUDRAM). Of the 27 patients in the IV treatment group, 15 received 5-fluorouracil (5-FU) and doxorubicin-containing regimens; in 11 patients 5-FU was combined with other agents. The HAI and IV treatment groups were similar in age and ethnicity, performance status, serum alpha-fetoprotein levels, liver function, presence of hepatitis B antigen, and presence or absence of cirrhosis. The median survival was 9 months for HAI-treated patients and 5 months for the IV-treated group. The statistical differences were resection versus HAI, P less than 0.01; resection versus IV, P less than 0.01; HAI versus IV, P less than 0.01. Thirteen of 18 patients who had resections, six of 28 patients treated with HAI, and two of 27 IV-treated patients survived 2 years or more. It is concluded that for patients with hepatocellular carcinoma confined to the liver, the option of tumor resection either at the beginning of treatment or after chemotherapy offers the best chances for long-term survival. The overall prognosis is poor for patients with nonresectable hepatocellular carcinoma, but arterial infusion chemotherapy may double the median survival as compared to IV chemotherapy.

Immunotherapy with Chinese medicinal herbs. II. Reversal of cyclophosphamide-induced immune suppression by administration of fractionated Astragalus membranaceus in vivo

A partially purified fraction (F3) with an estimated molecular weight of 20,000 to 25,000 derived from the traditional Chinese medicinal herb Astragalus membranaceus, was found to possess a potent immunorestorative activity in vitro. Its capacity to aborogate the local xenogeneic graft versus host reaction (XGVHR) following injection in vivo was further studied in a newly developed animal model designed for preclinical evaluation of various biological response modifiers. F3 was injected intravenously into cyclophosphamide-primed rats at varied concentrations and schedules prior to grafting of mononuclear cells from healthy normal donors. Maximal abrogation of the local XGVHR mounted by the mononuclear cells, was observed following injection of 5.55 mg of F3 daily for eight days. This abrogation of XGVHR indicates a reversal of the immunosuppressive effect of cyclophosphamide as manifested by a significant decline in the local XGVHR volume from 99.42 +/- 9.2 mm3 (positive control) to 39.78 +/- 8.3 mm3 (p less than 0.001). This reversal of cyclophosphamide-induced immunosuppression by the administration of F3 was complete, since the volume of the abrogated local XGVHR (39.78 +/- 8.3 mm3) was comparable to 34.79 +/- 5.69 mm3 (p greater than 0.1) in the negative control group (no cyclophosphamide-priming; saline injection only). These data indicate that F3 administration markedly enhances the rats' ability to reject the xenogeneic graft and therefore possesses a strong immune potentiating activity in vivo. These preclinical data also provide the rational basis for the use of extracts of Astragalus membranaceus in phase I clinical trials among patients suffering from iatrogenic or inherent immune deficiency states.

Immunotherapy with Chinese medicinal herbs. I. Immune restoration of local xenogeneic graft-versus-host reaction in cancer patients by fractionated Astragalus membranaceus in vitro

The in vitro immunomodulatory activity of fractions derived from Astragalus membranaceus, an herb commonly used in the practice of traditional Chinese medicine, was first screened by studying their individual effects on mononuclear cells (MNC) derived from healthy normal donors using the local xenogeneic graft-versus-host reaction (XGVHR). Sephacryl S-200 column-separated Fraction 3 (MW 20,000-25,000) along with its crude extract precursor, Fraction 7, and another crude extract derivative, Fraction 8, were equally augmentative (p less than 0.05) in their effect on MNC from normal donors. These three active fractions were further studied on MNC derived from 13 cancer patients. Using again the local XGVHR as a model assay for T-cell function, preincubation of MNC derived from cancer patients with Fraction 3 induced a significant increase in local XGVHR (compared to untreated cells) with a mean +/- SD of 151.34 +/- 46.02 mm3 vs 57.80 +/- 16.44 mm3; p less than 0.001. Fractions 7 and 8 likewise induced significant increases in local XGVHR (109.14 +/- 19.32 mm3 versus 50.91 +/- 17.39 mm3; p less than 0.001 and 119.74 +/- 18.33 mm3 versus 48.77 +/- 16.17 mm3; p less than 0.001, respectively). The augmented immune reactions which were induced by either Fraction 3 or Fraction 8 (but not by Fraction 7) in MNC derived from cancer patients, each significantly exceeded the local XGVHR observed in the untreated MNC derived from normal donor controls with a relative reference index (ratio) of 1.60 +/- 0.48 and 1.23 +/- 0.17 respectively; p less than 0.005.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunologic effects of cimetidine: potential uses

Suppressor T lymphocytes play a major regulatory role in the function of the immune system. Since the discovery of histamine (H2) receptors on the surface of these immune cells, studies have demonstrated that cimetidine diminishes the effect of suppressor T cells in both cellular- and humoral-mediated (antibody) immune reactions. Preliminary clinical results demonstrate that cimetidine has a beneficial effect on a variety of immune functions. An antineoplastic effect among tumor-bearing animals has also been found, suggesting the drug may be effective against certain human cancers, probably as an immune potentiator. Cimetidine has been used in the treatment of human cancer in combination with interferon or coumarin and as a single agent. Modest tumor response rates have been observed. The finding that cimetidine accelerates healing of herpesvirus infections is intriguing. These encouraging, albeit preliminary, results emphasize the need for additional studies on the drug's antiviral properties.

Abrogation of the local xenogeneic graft versus host reaction by preinjection of cimetidine to the immunosuppressed host rats: an experimental model for testing preclinical immunorestorative activity in vivo

The local xenogeneic graft-vs-host reaction (XGVHR) is mediated by competent T lymphocytes. It was effectively used as a practical bioassay to assess the in vitro immunomodulatory effects of several drugs on cells derived from cancer patients. A modified version of the XGVHR model was recently developed primarily for preclinical evaluation of in vivo immunorestoration induced by experimental biological response modifiers (BRMs). A well-defined biological response modifier, cimetidine, was injected into Cytoxan-primed rats prior to their inoculation with xenogeneic human mononuclear cells. The cimetidine treatment induced a partial abrogation of the immunosuppressive effect of Cytoxan as manifested by a significant decline in the volume of the XGVHR from 115.23 +/- 15.72 mm3 (positive control) to 67.3 +/- 11.41 mm3 (P less than 0.01). This abrogation of Cytoxan-induced immunosuppression by cimetidine was incomplete since the XGVHR without Cytoxan (negative control, saline only) was still significantly lower (45.12 +/- 4.55 mm3; P less than 0.01). The effect of cimetidine injection in vivo appeared to be dose dependent and did not exhibit any nonspecific toxic effect to the mononuclear cell inoculum. These results indicate that the model can serve as a useful tool in the preclinical evaluation of newly developed immunorestorative biological response modifiers.

Gastroduodenal mucosal injury during hepatic arterial infusion of chemotherapeutic agents. Lack of cytoprotection by prostaglandin E1 analogue

Eighteen colorectal cancer patients with liver metastases receiving hepatic arterial infusion of chemotherapeutic agents (mitomycin-C + 5-FUDR) were randomized to receive misoprostol (a prostaglandin E1 analogue) or placebo as a mode of cytoprotection against inadvertent gastroduodenal mucosal injury. Four of 10 patients on misoprostol and 3 of 8 patients on placebo developed gastroduodenal mucosal injury (p greater than 0.1), which was confirmed by endoscopy. Significant tumor responses to chemotherapy were equally distributed between the two groups. Although our sample size was small and type II error (false-negative trial) cannot be excluded, these data strongly suggest that prophylaxis with misoprostol does not prevent the acute gastroduodenal mucosal injury associated with hepatic arterial infusion of chemotherapeutic agents.

Sensitivity and resistance to chemotherapy in acute leukemia: correlation with in vitro drug uptake and lack of potentiation by verapamil

The calcium channel blocker verapamil has been reported to circumvent acquired resistance to different antitumor agents in tumor cell lines in vitro. We studied its effect on in vitro uptake of m-AMSA and adriamycin in fresh leukemic cells from 11 leukemia patients. Six previously untreated patients were sensitive to m-AMSA (obtained remission). Four were clinically resistant to m-AMSA, and two of these also to adriamycin. Leukemic cells were incubated in pharmacological doses of 14C-adriamycin and 14C-m-AMSA for up to 2 h. Samples were supplemented with verapamil (750 ng ml-1) 30 min prior to the addition of m-AMSA or adriamycin. Drug uptake was measured at 15 min intervals up to 2 h and drug retention was measured during 30 min after the end of incubation, following washing and resuspension in fresh medium without cytotoxic drugs. Adriamycin uptake was the same irrespective of verapamil in all four cell samples, two of which were derived from patients resistant to adriamycin. The cellular m-AMSA uptake was higher in cells from clinically sensitive than from resistant patients (510 +/- 155 fg cell-1 vs 275 +/- 125 fg cell-1; P less than 0.01). Retention of m-AMSA 30 min after incubation was higher in cells from sensitive compared to resistant patients (187 +/- 78 vs 25 +/- 7; P less than 0.05). Our data suggest: (1) in vitro uptake greater than or equal to 350 fg cell-1 and subsequent retention greater than 75 fg cell-1 correlate to clinical sensitivity to the drug; and (2) neither m-AMSA nor adriamycin uptake could be significantly increased by verapamil.

Adjuvant perioperative hepatic arterial mitomycin C and floxuridine combined with surgical resection of metastatic colorectal cancer in the liver

Twenty patients with colon cancer metastatic to the liver underwent successful hepatic resection and adjuvant perioperative therapy that included hepatic arterial mitomycin C and floxuridine (FUDR). The median survival for all 20 patients was 51 months: 10 are still alive with a median postoperative follow-up of 49 months; 6 are disease-free with a median postoperative follow-up of 43 months. Among 10 patients in whom the surgical margins of the specimen contained tumor cells, the median survival was 52 months. This survival was comparable to that among 10 patients in whom the surgical margins were tumor free (P = 0.22). Neither the number of metastatic liver deposits nor the disease-free interval between the primary diagnosis of colorectal carcinoma and the development of liver metastases significantly affected survival. A transient chemical hepatitis which resolved before the next scheduled treatment was associated with 50% of arterial chemotherapy cycles (approximately 70% of the patients). Gastric or duodenal ulcerations occurred in 23% of the patients. Surgical complications were either pulmonary such as pleural effusion or atelectasis, or wound infections and subphrenic abscesses. Although these results compare favorably with the results in previously published series, this aggressive adjuvant chemotherapy appears to be particularly justified in patients with tumor positive surgical margins or those with multiple tumor masses and, therefore, are characterized by a poor prognosis.

Hepatic arterial infusion with floxuridine and cisplatin: overriding importance of antitumor effect versus degree of tumor burden as determinants of survival among patients with colorectal cancer

Cisplatin (CDDP) was combined with floxuridine (FUDR) and delivered into the hepatic arteries of 29 patients as induction therapy for colorectal cancer metastatic to the liver. Mitomycin C and FUDR combination was substituted after progression or when response had peaked. Chemotherapy was delivered with an Infusaid pump (Infusaid Corp; Norwood, Mass; 14 patients), Medtronic programmable drug administration device (Medtronic, Inc, Minneapolis; two patients), or percutaneously placed catheters (13 patients). Complete disappearance of liver metastases was observed in four patients and 11 additional patients had a partial remission as determined by computed tomography (CT) scan and substantiated at times by angiography, for a total response rate of 52%. Response as determined by imaging techniques coincided with a concurrent decrease in carcinoembryonic antigen (CEA) and improvement in performance status. The severity of tumor burden was correlated with the response to therapy and survival. Among those patients who responded to arterial chemotherapy, differences in disease severity did not significantly influence survival. Median survival among responders with greater than 25% liver replacement by tumor was 14 months (P = .28), compared with 28 months for those patients with less than 25% liver replacement. In contrast, differences in tumor burden significantly affected survival among patients who failed to respond to chemotherapy; median survival among nonresponding patients with greater than 25% liver replacement was 4 months, compared with 8 months for those who had less than 25% liver replacement (P = .01). The presence of minimal extrahepatic disease at the time of initiation of intraarterial treatment did not seem to have a significant detrimental effect on survival. The study suggests that hepatic tumor response to arterial administration of CDDP and FUDR and mitomycin C and FUDR is clinically significant because it overrides the effect of tumor burden on survival among patients who have colorectal cancer with liver metastases and may offer effective palliation.

Treatment of hepatic metastases in ocular melanoma. Embolization of the hepatic artery with polyvinyl sponge and cisplatin

Patients with ocular melanoma have a high incidence of hepatic metastases, which primarily determine their length of survival. In an attempt to control the neoplastic disease in the liver, embolization of the hepatic artery with a combination of polyvinyl sponge (Ivalon) and a suspension of cisplatin was performed in two patients with hepatic metastases from ocular melanoma. Dramatic regression of the hepatic metastases, lasting 19 and six months, occurred in these two patients after one or two such treatments. Our preliminary, albeit successful, experience with this therapeutic approach suggests that it may offer relatively prolonged periods of remission and warrants further investigation.

Chronic immune stimulation by sperm alloantigens. Support for the hypothesis that spermatozoa induce immune dysregulation in homosexual males

Putative, sperm-induced allogeneic immunization was correlated with immune dysregulation in a study of 30 asymptomatic, monogamously paired homosexual males. Evidence for allogeneic immunization existed among 19 of 26 homosexual males who were anal sperm recipients. No evidence for any form of alloimmunization was found in four exclusive sperm donors. Immune dysregulation in the form of a reduced effector/suppressor T-cell ratio (Te/Ts less than 1.0) was exclusively documented in eight anal-sperm-recipient homosexual males, five of whom also manifested evidence for allogeneic immunization. In three of those, immune dysregulation was further manifested by functional T-cell deficiency in the form of a subnormal (less than 50 cu mm) local graft-v-host reaction. Similar evidence for alloimmunization was associated with a reduced Te/Ts ratio (0.85) in the female of a heterosexual couple who routinely practiced anal intercourse. Based on these findings, we suggest that chronic, repeated exposure to sperm during anal intercourse results in a high frequency of allogeneic immunization and may play an important role in the development of acquired immune dysregulation among homosexual males.

Clinical pharmacology of 99mTc-labeled liposomes in patients with cancer

The pharmacokinetics, organ distribution, and 24-hr urinary excretion of negatively charged 99mTc-labeled multilamellar liposomes, composed of dimyristoylphosphatidylcholine and dimyristoylphosphatidylglycerol in a 7:3 molar ratio, were studied in seven patients with cancer. The radiolabeled liposomes were administered i.v. in three doses: 150 mg/sq m of body surface area; 300 mg/sq m; and 450 mg/sq m of lipid. The dose of 99mTc was 4.8 to 7.6 mCi per patient. The plasma disappearance curve was biphasic (half-life alpha = 5.53 min, half-life beta = 289 min), suggesting a two-compartmental model of distribution. The calculated volume of distribution indicated considerable tissue retention of liposomes. This was confirmed by body imaging. Twenty-four hr after injection, liposomes were localized in organs rich in reticuloendothelial cells, i.e., liver [44.5 +/- 9.1% (S.E.)], spleen [25.5 +/- 7.7%], lung [14.5 +/- 4.9%], and bone marrow. Although the hepatic uptake accounted for more than 40% of the total uptake, the spleen retained liposomes at a higher density. Cumulative urinary excretion of radioactivity was 13.4 +/- 1.5% over 24 hr. Liposome administration was safe and devoid of any adverse side effects. The results provide a basis for the use of liposomes as potential target-specific and safe drug carriers in the treatment of pathological conditions that involve organs rich in reticuloendothelial cells.

Characterization of human effector and suppressor T cells by their activity in mixed lymphocyte reaction and by monoclonal antibody phenotyping

Human T effector and T suppressor cell subpopulations which are functionally operative in the local graft-versus-host reaction were enriched and separated on the basis of their respective ability to form (or not to form) rosettes with sheep red blood cells in the presence of theophylline. These subpopulations were then tested as stimulators and as responders in the allogeneic mixed lymphocyte reaction assay against the same mononuclear cells. Among 18 normal donors, theophylline resistant cells responded more vigorously to mononuclear cells (SI, 9.9 +/- 9.8) than theophylline-sensitive cells (6.7 +/- 5.7, p less than 0.08). In contrast, T-effector cells were poorer stimulators of the same MNC (SI, 4.0 +/- 5.6) when compared to the stimulatory capacity of T suppressor cells (SI, 7.1 +/- 9.8, p less than 0.05). Similar studies among 14 patients with disseminated cancer showed the same, but more pronounced differences. Thus, the theophylline-resistant T effector cells were vigorous responders (SI, 14.7 +/- 10.0) compared to the weak response of the theophylline-sensitive T suppressor cells to the same mononuclear cells (SI, 3.4 +/- 1.8, p less than 0.01). Again, in contrast, T effector cells stimulated mononuclear cells poorly (SI, 1.0 +/- 0.5) while T suppressor cells induced a weak but significant stimulation (SI, 3.2 +/- 2.1, p less than 0.05). Phenotyping of these two functionally distinct subpopulations with monoclonal antibodies to subsets of T cells (Leu I, II, III) and for the HLA-DR antigen (OKIal) showed no enrichment for any of the phenotypes as defined by these antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Leukocyte interferon-induced myeloid cytoreduction in chronic myelogenous leukemia

We investigated the antiproliferative effect of partially purified human leukocyte interferon (HuIFN-alpha) given in a dose of 9-15 X 10(6) U daily by intramuscular injection to 7 patients with chronic myelogenous leukemia (CML). Hematologic remission of the disease was obtained in 5 patients. Among the responding patients, the mean white blood cell count decreased from 97.4 X 10(3)/cu mm (range from 35 X 10(3)/cu mm to 239 X 10(3)/cu mm) to 4.2 X 10(2)/cu mm (range from 3.0 X 10(3) to 7.9 X 10(3) cu/mm). Parallel reduction occurred in serum B12, from a mean of 1,435 pg/ml to a mean of 726 pg/ml, and lactate dehydrogenase levels, from a mean of 325 mU/ml to 112 mU/ml. Enlarged spleens decreased in 3 of 3 patients. The 5 responding patients have been maintained on HuIFN-alpha, 3 X 10(6) U daily or every other day, for 6+-35+ wk.

Colorectal carcinoma. Evidence for circulating CEA-anti-CEA complexes

Significant increments in measurable plasma CEA were effected by 2.5 M MgCl2 elution from putative circulating CEA-anti-CEA complexes in 11 of 15 patients with disseminated colorectal cancer and in five of ten patients with a high probability of having subclinical disease (Dukes'C category). Following 2.5 M MgCl2 elution, IgG from a patient with a high CEA increment effected a higher specific binding to 125I-CEA than a similar IgG eluate from a patient with a negligible increment in measurable CEA. These data suggest that CEA is autoimmunogenic and may result in circulating CEA-anti-CEA complex formation. The clinical implications of such complexes in the diagnosis and monitoring of patients with colorectal cancer remain to be determined.

Immune restoration and/or augmentation of local graft versus host reaction by traditional Chinese medicinal herbs

The in vitro restorative effect of aqueous extracts from two traditional Chinese medicinal herbs were studied in 19 cancer patients and in 15 normal healthy donors. Using the local graft versus host (GVH) reaction as a test assay for T-cell function, the extract from astragalus membranaceus (10 microgram/ml) induced a restored reaction in nine of ten patients with an increase in local GVH reaction from 18.2 plus/minus 15.8 mm3 to 112.9 plus/minus 94.2 mm3 (P less than 0.01). The extract from ligustrum lucidum, likewise effected an immune restoration in nine of 13 cancer patients with an increase in local GVH reaction from 32.3 plus/minus 36.1 mm3 to 118 plus/minus 104.9 mm3 (P less than 0.01). This degree of immune restoration appears to be complete as it equals the local GVH reaction observed among untreated mononuclear cells from normal healthy donors (82.8 plus/minus 41.1 mm3, P greater than 0.1). These results suggest that both extracts of the traditional Chinese medicinal herbs contain potent immune stimulants which may provide the rational basis for their therapeutic use as biological response modifiers.

Comparative functional analysis of lymphocytes and monocytes from plateletapheresis

Large numbers (2.9 +/- 1.2 X 10(9)) of mononuclear cells can be obtained from incidental samples collected during routine plateletapheresis. We conducted studies comparing characteristics and functions of mononuclear cells derived from venous blood samples and from routine plateletapheresis in the same normal donors. Cell viability was similar in both samples (96 +/- 1% plateletapheresis vs 97 +/- 2% venous blood). Higher concentration of monocytes were observed in the plateletapheresis samples (32.3 +/- 6%) than in the venous blood (14.3 +/- 4%). The procedure of plateletapheresis does not seem to alter lymphocyte or monocyte function. Thus, the functional integrity of these cell populations was demonstrated in terms of natural killer cell activity, blastogenic response to mitogens, local graft-versus-host reactions, monocyte-mediated antibody-dependent cellular cytotoxicity against human red cells, monocyte-mediated tumor cell cytotoxicity, latex phagocytosis, and monocyte-dependent lymphocyte blastogenesis. We conclude that monocytes and lymphocytes obtained during routine plateletapheresis are functionally intact.

Hepatic arterial chemotherapy and occlusion for palliation of primary hepatocellular and unknown primary neoplasms in the liver

Eighteen patients with malignant liver disease were treated with hepatic arterial infusion (HAI) of floxuridine (FUDR), Adriamycin (doxorubicin), and mitomycin C (FUDRAM). Twelve of the patients had primary hepatocellular carcinoma and six had metastatic liver carcinoma originating from an unknown primary site. One complete remission and seven partial remissions (greater than or equal to 50% reduction in tumor size) were observed among 12 hepatocellular cancer patients, while only one partial remission was achieved among six patients with unknown primary liver neoplasms. When arterial occlusion was added to HAI of FUDRAM, a prolongation of median survival to 14 months as opposed to six months in patients with an intact arterial tree was observed (P = 0.02). Arterial occlusion had its effect on survival particularly among patients who failed to respond to HAI of FUDRAM. Thus, among nonresponding patients, the addition of arterial occlusion resulted in a median survival of 10.5 months while median survival in those without arterial occlusion was six months (P = 0.08). With procedure-related morbidity being minimal, we conclude that arterially administered FUDRAM offers a notable palliation to patients with primary hepatocellular carcinoma. In patients with unknown primary liver neoplasms and those with hepatocellular cancer who fail HAI of FUDRAM, arterial occlusion can offer additional palliation.

Partial restoration of local GVH reaction in cancer patients by depletion of theophylline-sensitive suppressor T-cells

Theophylline-resistant T-cell subpopulations were assessed in terms of numbers and function among patients with disseminated cancer, and compared to normal controls. Within the total E-rosetting T-cells (65 +/- 6.5% for normal donors versus 34 +/- 1.0% for cancer patients; P less than 0.001) the proportion of theophylline-resistant Te cells was 56 +/- 1.5% and 26.6 +/- 1.1%, respectively (P less than 0.001). This significant difference in distribution between theophylline-resistant (effector) and theophylline-sensitive (suppressor) cells in favor of the latter was also reflected by the poor performance of unseparated T-cells in the local GVH reaction. Thus, the mean GVH reaction among normal donors was 159 +/- 30 mm3 versus 44 +/- 28 mm3 among cancer patients (P less than 0.001). Removal of the theophylline-sensitive suppressor T-cells resulted in significant augmentation of the local GVH reaction among normal donors and in significant, although partial, immune restoration of the local GVH reaction in some patients but not in others. The mean local GVH reaction after removal of theophylline-sensitive suppressor T-cells was 196 +/- 89 mm3 among normal donors and 68 +/- 46 mm3 among cancer patients (P less than 0.05). This immune restoration following depletion of suppressor T-cells was only partial among cancer patients because of an apparent intrinsic defect in the capacity of their effector T-cells to exert vigorous local GVH reaction. In one small group of four patients, this intrinsic defect was so profound that even after removal of the theophylline-sensitive suppressor cells, the restoration of the local GVH reaction was negligible (12 +/- 10.8 mm3 versus 24 +/- 9.8 mm3; P greater than 0.1). The quantitative and qualitative changes in effector and suppressor T-cell distribution during the development of the malignant process and the possible interaction between them are discussed.

Immunodiagnosis of human melanoma: characterization of human melanoma antigens and their detection in sera of melanoma patients by radioimmunoassay

Double antibody radioimmunoassay (RIA), using radioiodinated melanoma-associated antigens (MAA), rabbit antiserum raised against 3 M KCl extract of human melanoma (AHMS) and goat antirabbit IgG antibody, was employed for the detection of MAA in tumors as well as in sera of melanoma patients. MAA were partially purified from crude KCl extract of melanoma tissue by affinity column chromatography using AHMS and concanavalin A. A high content of MAA was detected in all but one melanoma extract, while normal tissue and nonmelanoma tumor extracts contained MAA to a much lesser extent than did melanoma extracts. MAA were also found in melanoma patients' sera (20/45) but not in sera of normal donors (0/10) and colon cancer patients (0/10). Immunochemical data suggest that AHMS-defined MAA consist of two major glycoproteins with molecular weights of 37K and 31K daltons, which does not cross-react either with carcinoembryonic antigen or beta 2-microglobulin or with BCG.

Intraarterial cis-platinum for patients with inoperable skeletal tumors

Twenty-three patients with inoperable skeletal tumors were treated with intraarterial cis-platinum prior to attempted surgery. The antitumor effect of intraarterial cis-platinum was monitored clinically by radiologic imaging techniques, and whenever possible, evaluated histopathologically by examinatin of surgical or biopsy tumor specimens. Objective responses were noted in 12 patients (52%) and included 2 complete, 7 partial and 3 less-than-partial remissions lasting from 14 to 70 weeks. Limb-saving surgery or hemipelvectomy became subsequently feasible in four and one patients respectively. Preoperative intraarterial cis-platinum is a safe procedure which might be used effectively in combination with other, more conventioal postoperative adjuvant chemotherapy against skeletal tumors.

Immune restoration and/or augmentation of local xenogeneic graft versus host reaction by Cimetidine in vitro

The immunorestorative effect of Cimetidine in vitro on the T cell-induced local GVH reaction in vivo was studied in 43 cancer patients and 43 normal healthy donors. Both low dose (10(-5) M) and high dose (10(-4) M) Cimetidine induced significant, albeit partial, immune restoration among GVHR-negative cancer patients (p less than 0.05, p less than 0.01, respectively) with the high dose being significantly more effective (p less than 0.05). In contrast, similar Cimetidine doses induced only moderate augmentation (p greater than 0.05) among GVHR-positive cancer patients and a marginal one among normal healthy donors. In the latter 2 groups, Cimetidine was found to be occasionally detrimental in that it induced a conversion from a positive to a negative GVH reaction. These results support the concept of anti-suppressor cell activity ascribed to Cimetidine. However, the possibility of a detrimental effect should be born in mind in planning future clinical trials. We propose that the use of Cimetidine be limited to cancer patients with documented increase in suppressor cell activity associated with defective T cell function under close serial monitoring.

Immune restoration and/or augmentation of local xenogeneic graft versus host reaction by Cimetidine in vitro

The immunorestorative effect of Cimetidine in vitro on the T cell-induced local GVH reaction in vivo was studied in 43 cancer patients and 43 normal healthy donors. Both low dose (10(-5) M) and high dose (10(-4) M) Cimetidine induced significant, albeit partial, immune restoration among GVHR-negative cancer patients (p less than 0.05, p less than 0.01, respectively) with the high dose being significantly more effective (p less than 0.05). In contrast, similar Cimetidine doses induced only moderate augmentation (p greater than 0.05) among GVHR-positive cancer patients and a marginal one among normal healthy donors. In the latter 2 groups, Cimetidine was found to be occasionally detrimental in that it induced a conversion from a positive to a negative GVH reaction. These results support the concept of anti-suppressor cell activity ascribed to Cimetidine. However, the possibility of a detrimental effect should be born in mind in planning future clinical trials. We propose that the use of Cimetidine be limited to cancer patients with documented increase in suppressor cell activity associated with defective T cell function under close serial monitoring.

The palliative role of hepatic arterial infusion and arterial occlusion in colorectal carcinoma metastatic to the liver

Fifty-five patients with metastatic colorectal carcinoma confined to the liver were treated with hepatic arterial infusion of floxuridine and mitomycin C. Tumour response rate was 43.4% and median overall survival was 11 months. Prolonged survival was associated with intentional or inadvertent occlusion of the hepatic artery. The median survival of twenty-four patients with arterial occlusion (15 months) was significantly higher than that of thirty-one patients without arterial occlusion (8 months).

Surface antigenic characteristics of human melanoma cells defined by xenoantiserum raised against papain-solubilized melanoma-associated antigens

Xenoantiserum to human malignant melanoma was prepared by immunizing rabbits with melanoma associated antigens (MAA) solubilized from melanoma cell membrane by limited papain digestion. The antiserum was absorbed extensively with red cells, leukemia cells and cultured lymphoid cell lines, and was assayed for its reactivity with different human cell types by the indirect membrane immunofluorescence and radioimmunoprecipitation techniques. The data obtained suggest that there are at least two different MAA on human melanoma cells. The first is melanoma-group specific and can be detected commonly on different melanoma cell lines. The second is oncofetal and is shared by melanoma, carcinoma, and fetal cells tested thus far. Immunoprecipitated material from melanoma cell membrane that had been radioiodinated with lactoperoxidase and solubilized with a non-ionic detergent was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, which showed two major peaks with estimated molecular weights of 90,000 and 120,000 daltons. The 90,000 molecular weight component appears to be oncofetal, as it disappeared when the antiserum was absorbed with either melanoma or carcinoma cell lines.

Cellular immune modulation after a single high dose of Levamisole in patients with carcinoma

The effect of a single high dose of Levamisole (200 mg/M2) on delayed-type hypersensitivity (DTH) in vivo and on lymphocyte blastogenesis to mitogens and antigens in vitro was studied in 26 patients with carcinoma. Similar studies were conducted in 24 control patients. Levamisole had a moderate but significant enhancing effect on DTH to Dermatophytin detectable no earlier than eight hours and still present at 48 hours after the drug administration. A moderate but significant enhancing effect on lymphocyte blastogenesis to mitogens and antigens was also demonstrated during the same time sequence. Further clinical trials with Levamisole should be conducted with more attention paid to schedule of drug administration.

Cyclic nucleotide alterations in mixed leukocyte reaction: a preliminary report

Endogenous cyclic adenosine and guanosine monophosphate (cAMP, cGMP) levels were studied in human peripheral blood lymphocytes during mixed leukocyte reactions (MLR). cAMP level was consistently elevated in one-way MLR, with good correlation to 3H-thymidine uptake in these reactions. In contrast, cGMP level was practically unchanged. Irradiation of reacting cell populations resulted in inhibition of cyclic nucleotide phosphodiesterase (PDE) activity. These results suggest that metabolic alterations in cAMP may be associated with immune reactions of cellular recognition.

Indomethacin-induced, monocyte-dependent restoration of local graft-versus-host reaction among cells from cancer patients

Peripheral blood mononuclear cells from 16 of 17 cancer patients known to have a negative local graft-versus-host (GVH) reaction (T-cell function deficiency) were pharmacologically immunorestored by treatment with indomethacin. The restorative effect of the indomethacin was exerted directly on nonadherent lymphocytes. This process of desuppression required for its completion the presence of glass-adherent monocytes. The immune restorative effect of indomethacin in terms of local GVH reaction did not appear to be mediated by inhibition of prostaglandin synthesis. Pharmacologic immune restoration may be an important therapeutic modality in cancer patients.

Percutaneous hepatic arterial infusion (HAI) of mitomycin C and floxuridine (FUDR): an effective treatment for metastatic colorectal carcinoma in the liver

The response rate of metastatic colorectal carcinoma confined to the liver to HAI of FUDR alone is at the range of 50% and to mitomycin C by hepatic arterial infusion (HAI) at the range of 35%. Mitomycin C was added to FUDR by continuous infusion and given by HAI to 12 patients with colorectal cancer confined to the liver. Catheters were placed subselectively in the hepatic artery, and infusion continued for five to six days when the catheter was removed. Cycles were repeated every 30 days. Chemotherapy consisted of mitomycin C 15 mg/m2 administered on day 1 followed by FUDR 100 mg/m2 by continuous infusion daily for five days. Response to treatment was evaluated by serial determinations of plasma CEA and by imaging techniques consisting of a computerized tomography, sonography, and radionuclide scanning of liver as well as by angiography. In 2 patients, complete remission was achieved; in 4 patients a 75% and in another 4 patients a 50% decrease in liver metastasis was observed, while 2 patients had stable disease. Thus, a response rate of 83% with a median duration of six to seven months was achieved. The median survival of the these patients was 16 months. Eight of the 12 patients have failed previous, i.v. 5-FU containing regimens. Complications related to 45 treatment cycles were the following: catheter displacement in 11.1%, an intimal tear, usually in the hepatic artery in 4.4%, gastric ulcerations in 5.4%, and septicemia in 2.7% of the cycles. In addition, aneurysmal dilation of the hepatic artery occurred in 4 patients (8.8% of the treatment cycles), all of whom continued treatment. Chemotherapy-related complications included primarily thrombocytopenia and stomatitis. Mitomycin C + FUDR by hepatic arterial infusion is an effective treatment for colorectal carcinoma metastatic to the liver. The high response rate justifies the adjuvant treatment of Dukes class C colon cancer patients with this treatment.