A meta-analysis of the effectiveness of mud-bath therapy on knee osteoarthritis

Objective

Osteoarthritis (OA) results from loss of cartilage in-tegrity in association with changes to the structure of the entire joint. Treatment of OA is based on different pharmaceutical and no phar-maceutical approaches and the latter include the use of spa-therapy. The biological effects of mud-bath therapy are mainly secondary to heat stimulation and to physic-chemical properties of mineral waters and mud-packs. Mud-bath therapy likely exerts its effects modulating several cytokines and other molecules involved in inflammation and cartilage degradation. Our aim was to perform an updated meta-analysis of the effectiveness of the mud-bath therapy on knee osteoarthritis and briefly to discuss the mechanisms of action of this treatment.

Materials and Methods

A MEDLINE on PubMed for articles on knee OA and spa therapy published from 1995 through up to April 2019 was performed. Then, we checked the Cochrane Central Register of Controlled Trials to find additional references included up to April 2019. Articles were included if in accordance with the eligibility cri-teria. Sample size and effect sizes were processed with the MedCalc software package.

Results

Twenty one studies met the inclusion criteria and were included in meta-analysis. We examined WOMAC Index and VAS pain. We found significant improvements in function scores and painful symptoms after mud-bath therapy in patients with knee joint osteoarthritis.

Conclusions

Spa therapy is a non-drug treatment modalities, non invasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis. It cannot substitute for conventional therapy but can integrated or alternated to it. Treatment with mud-bath therapy may relieve pain, stiffness and improve functio-nal status in patients with knee OA.

Maintenance of Primary Human Colorectal Cancer Microenvironment Using a Perfusion Bioreactor-Based 3D Culture System

Colorectal cancer (CRC) is a leading cause of cancer-related death. Conventional chemotherapeutic regimens have limited success rates, and a major challenge for the development of novel therapies is the lack of adequate in vitro models. Nonmalignant mesenchymal and immune cells of the tumor microenvironment (TME) are known to critically affect CRC progression and drug responsiveness. However, tumor drug sensitivity is still evaluated on systems, such as cell monolayers, spheroids, or tumor xenografts, which typically neglect the original TME. Here, it is investigated whether a bioreactor-based 3D culture system can preserve the main TME cellular components in primary CRC samples. Freshly excised CRC fragments are inserted between two collagen scaffolds in a "sandwich-like" format and cultured under static or perfused conditions up to 3 d. Perfused cultures maintain tumor tissue architecture and densities of proliferating tumor cells to significantly higher extents than static cultures. Stromal and immune cells are also preserved and fully viable, as indicated by their responsiveness to microenvironmental stimuli. Importantly, perfusion-based cultures prove suitable for testing the sensitivity of primary tumor cells to chemotherapies currently in use for CRC. Perfusion-based culture of primary CRC specimens recapitulates TME key features and may allow assessment of tumor drug response in a patient-specific context.

Gut microbiota modulate T cell trafficking into human colorectal cancer

OBJECTIVE

Tumour-infiltrating lymphocytes (TILs) favour survival in human colorectal cancer (CRC). Chemotactic factors underlying their recruitment remain undefined. We investigated chemokines attracting T cells into human CRCs, their cellular sources and microenvironmental triggers.

DESIGN

Expression of genes encoding immune cell markers, chemokines and bacterial 16S ribosomal RNA (16SrRNA) was assessed by quantitative reverse transcription-PCR in fresh CRC samples and corresponding tumour-free tissues. Chemokine receptor expression on TILs was evaluated by flow cytometry on cell suspensions from digested tissues. Chemokine production by CRC cells was evaluated in vitro and in vivo, on generation of intraperitoneal or intracecal tumour xenografts in immune-deficient mice. T cell trafficking was assessed on adoptive transfer of human TILs into tumour-bearing mice. Gut flora composition was analysed by 16SrRNA sequencing.

RESULTS

CRC infiltration by distinct T cell subsets was associated with defined chemokine gene signatures, including CCL5, CXCL9 and CXCL10 for cytotoxic T lymphocytes and T-helper (Th)1 cells; CCL17, CCL22 and CXCL12 for Th1 and regulatory T cells; CXCL13 for follicular Th cells; and CCL20 and CCL17 for interleukin (IL)-17-producing Th cells. These chemokines were expressed by tumour cells on exposure to gut bacteria in vitro and in vivo. Their expression was significantly higher in intracecal than in intraperitoneal xenografts and was dramatically reduced by antibiotic treatment of tumour-bearing mice. In clinical samples, abundance of defined bacteria correlated with high chemokine expression, enhanced T cell infiltration and improved survival.

CONCLUSIONS

Gut microbiota stimulate chemokine production by CRC cells, thus favouring recruitment of beneficial T cells into tumour tissues.

Abstract 4097: Maintenance of primary human colorectal cancer microenvironment using a perfusion bioreactor-based 3D culture system

Colorectal cancer (CRC) is a leading cause of cancer-related death, often diagnosed at advanced stages. Conventional chemotherapeutic regimens have limited success rates, and a major challenge is represented by the lack of adequate in vitro models predicting patient responsiveness to defined treatments, possibly guiding therapeutic decisions. Non-malignant cells, including mesenchymal and immune cells, critically affect development, progression and drug responsiveness of human CRC. However, tumor drug responses are still evaluated on culture systems, such as 2D tumor cell monocultures or on tumor xenografts, which do not preserve all cellular components of in vivo tumor microenvironment.In this work, we have investigated the suitability of a perfusion-based bioreactor for 3D culture of primary CRC samples. Freshly excised CRC specimens were cut into fragments, inserted between two collagen type I sponges in a “sandwich-like” format and cultured for three days in a perfused-based system or under static conditions.We show that cultures under perfusion result in significantly higher maintenance of tissue integrity as compared to static cultures, with preservation of whole tumor microenvironment components, including cancer cells, mesenchymal stromal cells and a fraction of immune cells. Tumor tissues cultured under perfusion displayed an almost intact architecture with viable and proliferating tumor cells. Stromal cells were also maintained in proportions similar to those of original tumors and were fully viable, as indicated by their responsiveness to microenvironmental stimuli, such as IL-17. In addition, immune cells were also partially preserved, and were capable to release effector cytokines upon activation. Importantly, perfusion-based cultures proved suitable for testing sensitivity of primary tumor cells to chemotherapies currently in use for CRC and revealed heterogeneous responsiveness across different samples.

[C.M. and M.G.M. contributed equally to this work.]

Citation Format: Celeste Manfredonia, Manuele Giuseppe Muraro, Christian Hirt, Valentina Mele, Valeria Governa, Adam Papadimitropoulos, Silvio Daester, Savas D. Soysal, Raoul A. Droeser, Robert Mechera, Daniel Oertli, Raffaele Rosso, Martin Bolli, Luigi M. Terracciano, Giulio C. Spagnoli, Ivan Martin, Giandomenica Iezzi. Maintenance of primary human colorectal cancer microenvironment using a perfusion bioreactor-based 3D culture system [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4097.

Analysis of 16 Patients with Metastatic Squamous Cell Carcinoma of the Head and Neck: Implications for Treatment

The present paper reports a retrospective analysis of 16 patients with distant metastases from squamous cell carcinoma of the head and neck observed in our Institute in the last 10 years. Nine patients out of 16 underwent chemotherapy (7 patients), chemotherapy and radiotherapy (1 patient), or an alternating chemo-radiotherapy regimen (1 patient). The remaining 7 patients were not considered for a palliative treatment because of a poor performance status. Two complete responses, 2 partial responses, 2 stable diseases and 3 progressions were observed, with an overall response rate of 44 %. Chemotherapy, when administrable, showed a temporary effectiveness, at least in patients with lung metastases. The combination of cisplatin and 5-fluorouracil seems to maintain the efficacy already shown in patients with locally relapsed disease.

A Preliminary Clinical Study of Cyclophosphamide with Reduced Glutathione Asc Uroprotector

Reduced glutathione (GSH) has been reported to be an effective protector against cyclophosphamide-induced urotoxicity in experimental models, providing protection comparable to that of mesna. This paper describes our preliminary results of the clinical use of GSH in combination with cyclophosphamide. GSH was administered i.v. in two divided doses of 2.5 g, 15 min before and 30 min after escalating doses of cyclophosphamide ranging from 1.2 up to 1.6 g/m2 (1-h infusion). GSH was well tolerated and did not produce unexpected toxicity. The lack of bladder damage, including microscopic hematuria, supports the protective role of this thiol compound.

Combination Chemotherapy with Vinblastine, Bleomycin and Methotrexate in Dtic-resistant Metastatic Melanoma

Fifteen patients with metastatic DTIC-resistant malignant melanoma were treated with vinblastine, bleomycin and methotrexate combination chemotherapy. Three patients showed an objective response (one complete response). The therapy was well tolerated and easy to administer. This combination appears to produce in DTIC-resistant patients a response rate similar to that obtained with DTIC.

Hematologic Parameters during Treatment with High-Dose Medroxyprogesterone Acetate

Blood clotting, platelet aggregation, complete blood count and lipid profile were evaluated in 12 postmenopausal patients with advanced breast cancer. Patients under treatment with high-dose MPA were considered not at risk for thomboembolic disease and were given MPA orally, 800 mg/day, for at least 3 months. Laboratory investigations were performed prior to treatment with MPA then once weekly during the first month and every 2 weeks during the following months. PTT, TEG, antithrombin III and platelet adhesiveness underwent statistically significant changes, tending towards hypercoagulability, although, on the average, they did not exceed the upper normal range. The authors conclude that a clinically relevant thrombotic activity cannot be attributed to MPA at the administered oral doses in the absence of additional risk factors.

Phase II Study of Ifosfamide Combined with Mesna Uroprotection in Advanced Non-Small-Cell Lung Carcinoma and Other Solid Tumors

Thirty six patients with advanced solid tumors (24 lung: 3 oat-cell, 14 squamous, 7 adenocarcinomas, 3 soft tissue sarcomas, 6 breast carcinomas; 1 seminoma; 2 ovarian adenocarcinomas) entered a phase II study of high-dose ifosfamide (IF) administered in combination with the uroprotective agent sodium 2-mercapto-ethane-sulfonate (Mesna). Fourteen patients had prior treatment; most patients with lung cancer (22/24) were previously untreated; all had measurable disease. The patients median age was 59 (range 31–74). IF was given at 1.8 g/m2 days 1–5 q 4 weeks. Mesna was given after each IF injection at 0, 4 and 8 h randomly, either i.v. (0.36 g/m2) or orally (0.72 g/m2). Twenty-four patients had ≥ 3 courses of therapy, 9 had 2 courses, and 3 had only 1 course; 129 courses were evaluated for toxicity. Mesna was given orally (17 patients, 57 courses) or i.v. (19 patients, 72 courses). The following side-effect were observed: no gross hematuria, microhematuria (14 courses), transitory mild proteinuria (34 courses), leukopenia grade I-II ECOG (26 courses), anemia grade I ECOG (31 courses), 1 case of pancytopenia, alopecia (31 patients), nausea (moderate, 33 courses; severe, 6 courses), vomiting (moderate, 17 courses; severe, 1 course). Five patients showed a partial response (1 oat-cell carcinoma, 2 with squamous lung cancer, 1 with ovarian carcinoma, 1 with breast carcinoma), 14 showed a minor response (2 patients with oat-cell carcinoma, 2 with lung adenocarcinoma, 5 with squamous lung cancer, 1 with seminoma, 1 with sarcoma, 1 with ovarian carcinoma), and 14 showed progression of disease (7 patients with squamous cell lung cancer, 4 with lung adenocarcinoma, 1 with sarcoma, 2 with breast carcinoma). Considering partial plus minor responses, ifosfamide produced some degree of tumor reduction (PR+MR) in 12/23 (52.1 %) lung cancer patients. The data reported support the conclusions that Mesna can prevent high-dose IF bladder toxicity, that IF is active in advanced solid tumors, including lung cancer, and that the IF + Mesna combination is a generally safe treatment procedure.

High-Dose Cisplatin in the Outpatient Clinic: A Feasibility Study

A clinical trial was undertaken to assess the feasibility of treatment with high-dose cisplatin on an outpatient basis. Eleven patients entered the study: 9 patients with squamous cell carcinoma of the head and neck, 1 patient with malignant melanoma of the skin, and 1 patient with breast cancer. All patients were pretreated. The chemotherapy scheme consisted of cisplatin, 60 mg/m2 for 3 consecutive days, every 4 weeks. We observed 5 partial responses, 4 stable diseases, and 1 progression of disease; 1 patient failed due to toxicity. The overall response rate was 45.4%. This treatment was associated with severe toxicity including nausea and vomiting, myelosuppression, neurotoxicity, nephrotoxicity and electrolyte disorders. Two patients died and 2 discontinued the treatment due to toxicity. In light of the incidence and severity of toxicity, this treatment should not be used as routine practice.

Prognostic Factors in Stage IV Ovarian Carcinoma Treated with Platinum-Based Regimens

Eight factors were analyzed for prognostic significance in univariate analyses in a series of 76 women with stage IV ovarian carcinoma treated with combination chemotherapies including cisplatin or carboplatin. The clinical objective and pathologic complete response rates were 51.2% and 27.3%, respectively. Median overall survival and progression-free survival were 15 and 7 months, respectively. No variables reached statistical significance. Trends toward better survival were noted for grades 1 and 2 for the adriamycin-containing regimen. Using progression-free survival as an end point, significant prognostic factors included complete clinical or pathologic response. Our data confirm that the standard approach is unlikely to modify the clinical outcome of stage IV ovarian cancer. New treatment modalities including high-dose-intensity regimens and neo-adjuvant chemotherapy delivered before surgery could improve clinical results. Moreover, biologic characterization of ovarian tumors may provide information to design specifically targeted treatment.

Ineffectiveness of 5-Fluorouracil and Cis-Platin as Second-Line Chemotherapy in Head and Neck Cancer

Seventeen patients with heavily pretreated head and neck squamous cell carcinoma were submitted to a combination of 5-fluorouracil, 500 mg/m2 on days 1–4, and cis-platin, 50 mg/m2 on day 5, repeated every 21 days. Before administration of 5-fluorouracil, N5,N10-methyl-tetrahydrofolate, 200 mg/m2 i.v., was given. Only 1 partial response and 4 stable disease were observed, and the median survival of the entire group was 5 months. Although all patients had been heavily pretreated and a considerable percentage (6/17, 35.2 %) of these showed resistance to first-line therapy, this combination seems to be ineffective as second-line therapy in head and neck cancer.

A Pilot Study of Mitomycin, Ifosfamide and Cisplatin as Outpatient Combination Chemotherapy for Advanced Non-Small Cell Lung Cancer

Twenty-one patients with advanced stage, non-small-cell lung carcinoma were treated with a chemotherapy regimen including: mitomycin (6 mg/m2), ifosfamide (3 g/m2), cisplatin (80 mg/m2). The regimen was administered on an outpatient basis. Two patients were lost to follow-up. Among the 29 patients evaluable for response we registered a response rate of 36.8 %; 36.8% of patients had stable disease, and 15.7 % progressed during treatment. Median duration was 8.7 months and median survival was 11 months. Toxicity was low and easily manageable on an outpatient basis.

A Randomized Trial of Chemotherapy with or without Estrogenic Recruitment in Locally Advanced Breast Cancer

The present phase III trial was carried out to verify whether a kinetic recruitment induced by low doses of diethylstilbes-trol (DES) could increase the killing efficacy of chemotherapy in patients with locally advanced breast cancer. One-hundred and seventeen untreated patients with locally advanced breast cancer (stage IIIA/IIIB) were randomized to receive 3 courses of primary chemotherapy consisting of cyclophosphamide (600 mg/m2 i.v.), doxorubicin (50 mg/m2 i.v.) and fluorouracil (600 mg/m2 i.v.) (CAF) on day 1, or DES-CAF (DES, 1 mg orally days 1-3, CAF on day 4). The courses were repeated every 3 weeks. The patients who achieved an objective response were submitted to mastectomy followed by 3 courses of CAF alternated with 3 courses of CMF (cyclophosphamide, 600 mg/m2 i.v.; methotrexate, 40 mg/m2 i.v.; fluorouracil, 600 mg/m2 i.v.), with or without DES. The two treatment arms were well balanced in terms of clinical and pathologic features. There was no significant difference in response rates to induction chemotherapy between the two treatment arms (objective response rate, 63.3% for CAF and 56.1% for DES-CAF). Median overall survival was 49 and 47 months and median progression-free survival was 24 and 21 months for CAF and DES-CAF patients, respectively. Toxicity was not significantly different in the two groups, with the exception of leukopenia: DES chemotherapy was significantly more myelotoxic than the standard treatment, which resulted in a significant reduction in the actual dose intensity. In spite of the attractive experimental evidence, we conclude that so far there is no clinical advantage in the combination of estrogen and chemotherapy. Further research is needed to investigate different schedules of chemotherapy and hor-mones, or to test the possibility of combining various mitogens.

Aminoglutethimide as Second-Line Endocrine Treatment in Metastatic Breast Cancer

Aminoglutethimide, a drug known to block adrenal steroidogenesis and peripheral aromatization of androgens to estrogens, has been found effective in the treatment of breast cancer. The drug has been used in our Institute to treat 71 consecutive metastatic breast cancer patients. Of 67 patients evaluable for response, 9 (13.4%) have achieved a partial response, 30 (44.7%) stable disease, and 28 (41.7%) progression of disease. Four patients were taken off the therapy because of drug-related toxicity.

Description of a Case of Acute Neurological Toxicity after DTIC-Adriamycin-Vincristine Therapy

A case of acute neurological toxicity was observed in a patient with a retroperitoneal fibromyxosarcoma treated with DTIC (NSC-45382), Adriamycin and Vincristine. The neurological symptoms started one hour after drug administration and rapidly declined with symptomatic therapy; no EEG and scintigraphic changes were detectable. The case is discussed in relation to central nervous system complications reported by other authors, following administration of DTIC and Adriamycin.

Failure of Second-Line Therapy to Modify Survival in Relapsed Squamous Cell Carcinoma of the Head and Neck

Between August 1979 and August 1984, 47 consecutive patients with recurrent squamous cell carcinoma of the head and neck entered one of three consecutive second-line treatments. Response rates with each treatment were very different (70 % vs 5.9 % vs 75 %), but there was no statistical difference in actuarial survival (survival: 30 % vs 29 % vs 20 %, respectively, at 260 days). In light of this observation, the efficacy of the second-line therapy appears doubtful and the survival of relapsing patients seems unrelated to the response achieved.

Esophageal Involvement in Breast Cancer. Report of Six Cases

Six case reports are described which illustrate a uniform syndrome characterized by progressive dysphagia developing in postmenopausal breast cancer patients after a long disease-free interval following mastectomy. Literature cases are reviewed and treatment strategies are discussed. The authors recommend that, when possible, radiotherapy to the mediastinum and/or chemotherapy with dilation or positioning of an endoprothesis should be considered as the treatment of choice, whereas surgical intervention should be limited.

The Antiemetic Efficacy of Methylprednisolone Compared with Metoclopramide in Outpatients Receiving Adjuvant CMF Chemotherapy for Breast Cancer: A Randomized Trial

A randomized trial was performed comparing the antiemetic efficacy of methylprednisolone (MPN) and metoclopramide (MCP) in 60 breast cancer patients eligible for outpatient adjuvant chemotherapy with cyclophosphamide, methotrexate, and 5-FU (CMF). At the time of their first chemotherapy course patients were randomized to receive either MPN 375 mg or MCP 1 mg/kg both administered in 3 equal doses, IV just prior to chemotherapy and then IM 6 and 12 hours after treatment. Patients receiving MPN experienced significantly less nausea (p < 0.0005) and vomiting (p < 0.0005) and antiemetic protection was maintained in patients receiving multiple chemotherapy courses. Complete protection (0 emesis) was observed in 58 % of patients receiving MPN as compared with 20 % of patients treated with MCP (p < 0.005). The most frequent side effects were facial flush in 38 % of patients and somnolence in 15 % of patients receiving MPN and MCP, respectively. Complete protection from CMF-induced gastrointestinal side effects was observed in two-thirds of our patients receiving antiemetic MPN treatment. In these patients administration of the maximum cumulative CMF dose was possible without impairing their quality of life. MPN, at the dose and schedule reported, is an affective antiemetic drug suitable for use in breast cancer outpatients receiving adjuvant CMF therapy.

Carboplatin (JM 8), Adriamycin and Cyclophosphamide (JAC) in Advanced Ovarian Carcinoma: A Pilot Study

Eleven untreated patients with advanced ovarian cancer were studied for tolerance and response to combination treatment with fixed doses of adriamycin (45 mg/m2) and cyclophosphamide (600 mg/m2) + escalating doses of carboplatin. At the first dose level of carboplatin (200 mg/m2), toxicity was acceptable. With carboplatin at 300 mg/m2, severe hematologic toxicity was observed. The dose-limiting toxicity was leukopenia. Although carboplatin was administered without any hydration, no patient experienced renal toxicity. Eight objective responses were observed in 9 clinically evaluable patients. At second look surgery, 3 complete responses and 4 partial responses were documented. Polychemotherapy with JAC (carboplatin, 200 mg/m2, adriamycin, 45 mg/m2, and cyclophosphamide, 600 mg/m2) is administrable with acceptable toxicity.

Medullary-like hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most frequent primary hepatic cancer. Pathological features can define the biological behavior and prognosis. Medullary-like HCC is a very rare variant that has been described only twice in literature. In the present study, we report the case of a non-cirrhotic 72-year-old man, who presented two HCC lesions on routine screening for hepatitis C virus liver disease. Radiological imaging and biopsy showed two different subtypes: one classic HCC, which was treated with chemoembolization, and a second PET/CT-positive carcinoma with a PET/CT-positive metastatic coeliac lymph node, which was resected laparoscopically with a left lateral sectionectomy and extended lymphadenectomy. Histopathology revealed a medullary-like HCC; lymph node analysis confirmed the metastatic nature of the PET/CT-positive coeliac node and showed an incidental B-cell lymphoma in the hepatic pedicle lymph nodes. To the best of our knowledge this is the third case of medullary-like HCC described in the literature, and the first associated to a concomitant typical HCC.

Dual role of tumour-infiltrating T helper 17 cells in human colorectal cancer

BACKGROUND

The immune contexture predicts prognosis in human colorectal cancer (CRC). Whereas tumour-infiltrating CD8+ T cells and myeloid CD16+ myeloperoxidase (MPO)+ cells are associated with favourable clinical outcome, interleukin (IL)-17-producing cells have been reported to correlate with severe prognosis. However, their phenotypes and functions continue to be debated.

OBJECTIVE

To investigate clinical relevance, phenotypes and functional features of CRC-infiltrating, IL-17-producing cells.

METHODS

IL-17 staining was performed by immunohistochemistry on a tissue microarray including 1148 CRCs. Phenotypes of IL-17-producing cells were evaluated by flow cytometry on cell suspensions obtained by enzymatic digestion of clinical specimens. Functions of CRC-isolated, IL-17-producing cells were assessed by in vitro and in vivo experiments.

RESULTS

IL-17+ infiltrates were not themselves predictive of an unfavourable clinical outcome, but correlated with infiltration by CD8+ T cells and CD16+ MPO+ neutrophils. Ex vivo analysis showed that tumour-infiltrating IL-17+ cells mostly consist of CD4+ T helper 17 (Th17) cells with multifaceted properties. Indeed, owing to IL-17 secretion, CRC-derived Th17 triggered the release of protumorigenic factors by tumour and tumour-associated stroma. However, on the other hand, they favoured recruitment of beneficial neutrophils through IL-8 secretion and, most importantly, they drove highly cytotoxic CCR5+CCR6+CD8+ T cells into tumour tissue, through CCL5 and CCL20 release. Consistent with these findings, the presence of intraepithelial, but not of stromal Th17 cells, positively correlated with improved survival.

CONCLUSIONS

Our study shows the dual role played by tumour-infiltrating Th17 in CRC, thus advising caution when developing new IL-17/Th17 targeted treatments.

Ultrasound screening for abdominal aortic aneurysms

QUESTIONS UNDER STUDY

This pilot study aimed to assess the feasibility, acceptance and costs of an ultrasound scan screening programme for abdominal aortic aneurysms (AAA) in the elderly male population resident in Canton Ticino, Switzerland.

METHODS

The target population were male patients aged 65-80 years who attended the outpatient clinics of the Lugano Regional Hospital in 2013. The patients showing interest were contacted by phone to verify their eligibility and fix the appointment for the ultrasound scan of the abdominal aorta. Patients with recent examinations suitable for AAA detection were excluded. Aneurysm was defined as an abdominal aorta with sagittal and/or axial diameter  30 mm. Patients' characteristics and study results were presented as descriptive statistics. The chi-squared test was used to compare categorical variables with p <0.05 as a statistical significance threshold.

RESULTS

1634 patients received the screening information leaflet and 745 (45.6%) underwent the ultrasound scan. Among the 1091 eligible patients, the acceptance rate was 68.3%. A previously unknown AAA was diagnosed in 31 patients (4.2%, 95% confidence interval 2.8-5.9%). Age and area of residence had a statistically significant impact on patient's acceptance rate (p <0.05). The mean cost per screened patient was CHF 88.

CONCLUSIONS

AAA screening of male patients aged 65-80 years is feasible with limited financial and organisational effort. Adherence might be improved by a larger community-based programme and involvement of general practitioners.

The Interplay Between Neutrophils and CD8+ T Cells Improves Survival in Human Colorectal Cancer

Purpose: Tumor infiltration by different T lymphocyte subsets is known to be associated with favorable prognosis in colorectal cancer. Still debated is the role of innate immune system. We investigated clinical relevance, phenotypes, and functional features of colorectal cancer-infiltrating CD66b⁺ neutrophils and their crosstalk with CD8⁺ T cells.Experimental Design: CD66b⁺ and CD8⁺ cell infiltration was analyzed by IHC on a tissue microarray including >650 evaluable colorectal cancer samples. Phenotypic profiles of tissue-infiltrating and peripheral blood CD66b⁺ cells were evaluated by flow cytometry. CD66b⁺/CD8⁺ cells crosstalk was investigated by in vitro experiments.Results: CD66b⁺ cell infiltration in colorectal cancer is significantly associated with increased survival. Interestingly, neutrophils frequently colocalize with CD8⁺ T cells in colorectal cancer. Functional studies indicate that although neutrophils are devoid of direct antitumor potential, coculture with peripheral blood or tumor-associated neutrophils (TAN) enhances CD8⁺ T-cell activation, proliferation, and cytokine release induced by suboptimal concentrations of anti-CD3 mAb. Moreover, under optimal activation conditions, CD8⁺ cell stimulation in the presence of CD66b⁺ cells results in increasing numbers of cells expressing CD45RO/CD62L "central memory" phenotype. Importantly, combined tumor infiltration by CD66b⁺ and CD8⁺ T lymphocytes is associated with significantly better prognosis, as compared with CD8⁺ T-cell infiltration alone.Conclusions: Neutrophils enhance the responsiveness of CD8⁺ T cells to T-cell receptor triggering. Accordingly, infiltration by neutrophils enhances the prognostic significance of colorectal cancer infiltration by CD8⁺ T cells, suggesting that they might effectively promote antitumor immunity. Clin Cancer Res; 23(14); 3847-58. ©2017 AACR.

Abstract 1582: Tumor-associated stromal cells increase malignancy of human colorectal cancers triggering EMT induction

In the last decades it has been demonstrated that the stroma surrounding tumor not only provides mechanical support, but profoundly influences the outcome of the primary tumor and its possible relapse, impacting on proliferation, metastatic progression and resistance to therapies. Major components of the stroma in most types of human carcinomas are the Tumor-Associated Stromal Cells (TASC). Different sources have been proposed for this population, ranging from the resident fibroblasts to bone marrow-derived mesenchymal stromal cells (BM-MSC) recruited to the trans-differentiated epithelial and endothelial cells, but the scenario is still unclear. Moreover, TASC have an intrinsic heterogeneity, combined also with the presence of multiple subpopulations, and they share several markers with other cell subsets of the stroma, thus making the identification of this population, based on the expression of specific markers, an arduous task.

In this intricate context, we aim to address phenotypic and functional characterization of TASC isolated from colorectal cancer specimens, and to analyze TASC-mediated effects on CRC development and progression in vivo.

TASC were characterized for phenotype and differentiation capacity. Human CRC cells were cultured in the presence or absence of TASC for five days. After co-culture tumor cells were sorted by flow cytometry and evaluated for the expression of EMT-related genes by Real Time PCR and for in vitro invasiveness by chemoinvasion assay. Furthermore, their tumorigenicity and the metastatic potential were assessed upon subcutaneous and intracoecally injection in NOD/SCID mice. Developed tumors, metastatic foci and circulating tumor cells were assessed by histology, flow cytometry and Imaging Flow Cytometry.

Our results indicate that TASC resemble BM-MSC in morphology and phenotype. They also comprise a multipotent subpopulation that is able to differentiate into adipogenic and osteogenic lineage. After co-culture with CRC cells, TASC express membrane-bound TGF-β, through which they are capable to trigger epithelial-to-mesenchymal transition (EMT). Upon subcutaneous injection in NOD/SCID mice, tumor cells co-cultured or admixed with TASC before injection, show a faster growth kinetic and develop larger tumor masses as compared to tumor cells alone. Furthermore developed tumor masses are characterized by a higher vessel density. Notably, upon intracoecal injection TASC presence or conditioning leads to a higher metastatic formation in lungs and livers and an increased number of circulating tumor cells in the peripheral blood, most importantly comprising cells undergoing EMT.

Our data clearly show that the stromal component in the human colorectal cancer microenvironment increases the malignancy of tumor cells, by providing pro-mitogenic factors and by triggering EMT initiation in vitro and in vivo, thus promoting tumorigenicity and metastasis formation in vivo.

Citation Format: Valentina Mele, Valeria Governa, Manuele G. Muraro, Jesus F. Glaus Garzon, Lubor Borsig, Silvio Daester, Raoul Droeser, Daniel Oertli, Markus Zuber, Raffaele Rosso, Giulio C. Spagnoli, Giandomenica Iezzi. Tumor-associated stromal cells increase malignancy of human colorectal cancers triggering EMT induction. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1582.

Abstract 2370: Tumor-associated stromal cells increase malignancy of human colorectal cancers triggering the induction of Epithelial-to-mesenchymal transition

During tumor formation, normal tissue microenvironment is transformed in an “altered” niche, composed of non-malignant supporting cells, which influence the homeostasis of cancer cells via paracrine regulators. Tumor-associated stromal cells (TASC) are the prominent stromal elements in most types of human carcinomas including colorectal cancer (CRC). The differentiation of TASC from other cell types, such as resident stromal cells or bone marrow-derived mesenchymal stem cells (BM-MSC) is mainly mediated by factors produced during the crosstalk with malignant cells. TASC produce various extracellular matrix proteins, chemokines, and other tumor-promoting factors which affect vascularization, proliferation, tumor cell invasiveness and survival. Emerging data suggests that they also play a critical role in determining response to therapy. For instance TASC-derived factors may contribute to the development of a protective milieu by influencing cell-cell/cell-matrix interactions, cancer cell survival, and suppression of anti-tumor immune responses. Moreover, physical contact between TASC and malignant cells supports tumor cell survival via activation of anti-apoptotic pathways or inducing epithelial-to-mesenchymal transition (EMT). We previously showed that BM-MSC are capable of triggering EMT in CRC cells, leading to increased tumor cell aggressiveness in vitro and in vivo. However, the role played by the stromal component and the processes induced on CRC cells remain to be fully elucidated. For this purpose we have addressed phenotypic and functional characterization of TASC in vitro and we have analyzed TASC-mediated effects on CRC development and progression in vivo.

TASC were characterized for phenotype and differentiation capacity. Human CRC cells were cultured in the presence or absence of TASC for five days. After co-culture tumor cells were sorted by flow cytometry and evaluated for the expression of EMT-related genes by Real Time PCR and for in vitro invasiveness by chemoinvasion assay. Furthermore, their tumorigenicity was assessed upon injection in NOD/SCID mice and developing tumors were analyzed.

Our results indicate that TASC resemble BM-MSC in morphology and phenotype. They comprise a multipotent subpopulation that is able to differentiate into adipogenic and osteogenic lineage. After co-culture with CRC cells they express membrane-bound TGF-β, through which they are capable to initiate EMT in tumor cells. Moreover CRC cells acquire a more invasive phenotype after co-culture with TASC. Upon subcutaneous injection in NOD/SCID mice, tumor cells co-cultured with TASC show a significantly faster growth kinetic and develop significantly larger tumor masses as compared to tumor cells alone.

Thus our data show that the stromal component of CRC increases the tumor cells malignancy triggering EMT induction.

Citation Format: Valentina Mele, Manuele Giuseppe Muraro, Raoul Droeser, Daniel Oertli, Markus Zuber, Raffaele Rosso, Ivan Martin, Michael Heberer, Giulio C. Spagnoli, Giandomenica Iezzi. Tumor-associated stromal cells increase malignancy of human colorectal cancers triggering the induction of Epithelial-to-mesenchymal transition. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2370. doi:10.1158/1538-7445.AM2015-2370

The management of bilateral myelolipoma: Case report and review of the literature

INTRODUCTION

Bilateral adrenal myelolipoma is a rare benign neoplasm. We presented the case of a young man affected by a bilateral myelolipoma and the analysis of the literature of bilateral cases of myelolipoma. Our purpose is to give a suggestion of clear terms of reference regarding the management of this kind of bilateral neoplasm.

PRESENTATION OF CASE

We reported the case of a 41-year-old healthy man complained of abdominal pain in the upper quadrants. No significant alterations were found in routine blood and endocrinological tests. The imaging (CT and MRI) showed a huge right adrenal mass and a smaller lesion at the left adrenal gland. The preoperative pathological characterization was suggestive for a myelolipoma. A right open adrenalectomy was performed, and a radiological surveillance was planned for the left tumor. The pathological exam confirmed the diagnosis.

DISCUSSION

In literature, there are 36 cases described. The clinical presentation consisted of symptomatic tumors, incidentally diagnosed lesions or myelolipomas in patients with an associated endocrinal disorder. Symptomatic tumors or those bigger than 7cm, because of the potential risk of rupture, are usually treated surgically. In smaller (<7cm) and asymptomatic ones the surgical treatment is not univocal.

CONCLUSION

In the setting of the surgical treatment, it is important to preserve in some way the hormonal function. For that reason, the bilateral adrenalectomy has to be reserved for symptomatic or sizeable (>7cm) cases. As far as we know, this is the first review on bilateral myelolipomas.

In-stent restenosis: mid-term results of debulking using excimer laser and drug-eluting balloons: sustained benefit?

BACKGROUND

In-stent restenosis (ISR) after endovascular treatment of stenotic and occlusive disease of the infrainguinal arteries is still a clinical challenge. The purpose of this study is to evaluate the mid-term follow-up of a combination therapy using laser debulking and drug-eluting balloons for ISR.

METHODS

A prospective cohort of 14 patients (10 female, 4 male) with clinically relevant (Rutherford 3-6) ISR who were treated with excimer-laser angioplasty and drug-eluting balloons and a clinical follow-up of at least 9 months was evaluated.

RESULTS

Mean age was 78 ± 6.5 years (range, 67-88 years). The mean lesion length treated was 133.2 ± 107.2 mm (range, 10-380 mm). The mean time to occurrence of restenosis after initial treatment was 8.6 ± 4.7 months (range, 2-18 months). Technical success was 100%. Distal embolization occurred in 2 cases, and was treated successfully by endovascular means. No other periprocedural major adverse events occurred. All patients were available for clinical follow-up and 12 patients were available with Duplex follow-up. At a mean clinical follow-up of 19.1 ± 8.7 months (range, 9-38 months), 1 target lesion revascularization was seen (at 3 years after the ISR treatment). In the patients with critical limb ischemia (n = 7), no major amputations were needed. Twelve patients had Duplex control (mean follow-up, 19.4 ± 9.4 months; range, 9-38 months). Binary restenosis (>50%) was seen in 1 case at 36 months; it was the same patient who had TLR. A 25%-50% stenosis was seen in 4 patients (mean follow-up, 25 months; range, 19-38 months). No sign of neointimal hyperplasia was demonstrated in 7 patients (mean follow-up, 14.3 months; range, 9-19 months).

CONCLUSION

These mid- to long-term data compare favorably with results obtained with standard balloon angioplasty, cutting-balloon angioplasty, and balloon angioplasty using drug-eluting balloon. Longer follow-up and randomized trials are necessary to further define the role of combined excimer-laser debulking and drug-eluting balloon angioplasty in the treatment of ISR.

A huge mucinous cystadenoma of ovarian: a rare case report and review of the literature

We report a case of a 63-years-old woman with a ten years history of increasing abdominal girth with associated abdominal pain. Abdomino-pelvic ultrasound and computed tomography scan revealed a large left ovarian cyst. The patient underwent laparotomy, resection of ovarian cyst and hysterectomy with bilateral ovarian resection. The removed huge mucinous cystadenoma, weighed 27 kg. Her post-operative course was unremarkable.

Histopathologic spectrum of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): a diagnosis that needs clinico-pathological correlation

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is characterized by an heterogeneous group of severe dermatologic manifestations and systemic involvement, due to several groups of medicaments. A series of 9 consecutive cases, observed from 2008 to 2013 in the Department of Dermatology, University of Pavia, is reported, all satisfying the clinical, hematological and systemic diagnostic criteria of DRESS. Clinically, 4 out of 9 patients had an urticarial and papular eruption, 2 an erythema-multiforme-like (EM-like) pattern, 2 erythroderma and 1 had an erythematous and macular reaction. Aim of the study was to describe the histopathologic features of DRESS and to trace a possible correlation between the four clinical recognized types of the syndrome and the histopathological patterns. Predominantly, a superficial perivascular lymphocytic infiltrate, extravasation of erythrocytes, and focal interface changes characterized DRESS cases. Less frequently, histopathology revealed the presence of necrotic keratinocytes; surprisingly, only in 2 cases the presence of rare dermal eosinophils was detected, even if all the patients had significant peripheral eosinophilia. A histopathological diagnosis of DRESS seems per se, according to our data, not feasible, since the main histopathological changes (interface changes, superficial perivascular dermatitis, focal spongiosis, lichenoid infiltrate, rare presence of necrotic keratinocytes) can be interpreted generically as a drug induced dermatitis. The above mentioned histopathological changes, however, when associated with clinical information on cutaneous and systemic involvement of the patient, allow the pathologist or the dermatopathologist to make a diagnosis of DRESS with a reliable margin of certainty.

GM-CSF Production by Tumor Cells Is Associated with Improved Survival in Colorectal Cancer

PURPOSE

Colorectal cancer infiltration by CD16(+) myeloid cells correlates with improved prognosis. We addressed mechanistic clues and gene and protein expression of cytokines potentially associated with macrophage polarization.

EXPERIMENTAL DESIGN

GM-CSF or M-CSF-stimulated peripheral blood CD14(+) cells from healthy donors were cocultured with colorectal cancer cells. Tumor cell proliferation was assessed by (3)H-thymidine incorporation. Expression of cytokine genes in colorectal cancer and autologous healthy mucosa was tested by quantitative, real-time PCR. A tumor microarray (TMA) including >1,200 colorectal cancer specimens was stained with GM-CSF- and M-CSF-specific antibodies. Clinicopathological features and overall survival were analyzed.

RESULTS

GM-CSF induced CD16 expression in 66% ± 8% of monocytes, as compared with 28% ± 1% in cells stimulated by M-CSF (P = 0.011). GM-CSF but not M-CSF-stimulated macrophages significantly (P < 0.02) inhibited colorectal cancer cell proliferation. GM-CSF gene was expressed to significantly (n = 45, P < 0.0001) higher extents in colorectal cancer than in healthy mucosa, whereas M-CSF gene expression was similar in healthy mucosa and colorectal cancer. Accordingly, IL1β and IL23 genes, typically expressed by M1 macrophages, were expressed to significantly (P < 0.001) higher extents in colorectal cancer than in healthy mucosa. TMA staining revealed that GM-CSF production by tumor cells is associated with lower T stage (P = 0.02), "pushing" growth pattern (P = 0.004) and significantly (P = 0.0002) longer survival in mismatch-repair proficient colorectal cancer. Favorable prognostic effect of GM-CSF production by colorectal cancer cells was confirmed by multivariate analysis and was independent from CD16(+) and CD8(+) cell colorectal cancer infiltration. M-CSF expression had no significant prognostic relevance.

CONCLUSIONS

GM-CSF production by tumor cells is an independent favorable prognostic factor in colorectal cancer.

Cardiac troponin I concentrations as a marker of neurodevelopmental outcome at 18 months in newborns with perinatal asphyxia

OBJECTIVE

To investigate whether creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) can be used to predict neurodevelopmental outcome at 18 months in infants with perinatal asphyxia (PA). The diagnostic value of cTnI to assess myocardial dysfunction was considered as well.

STUDY DESIGN

Retrospective study of 178 neonates admitted with PA. cTnI concentrations measured within 12 h of birth were compared with medium-term outcome assessed with the Bayley Scales of Infant Development. cTnI concentrations measured within 12 h of birth were compared with clinical grade of hypoxic-ischemic encephalopathy (HIE) and with duration of inotropic support. Two-dimensional Doppler and color Doppler findings were recorded. Fractional shortening, tricuspid and mitral regurgitation were evaluated.

RESULT

A statistically significant correlation between cTnI concentration and BSID-II score was found (mental development index r -0.69, P<0.05 and psychomotor development index r -0.39, P<0.05). There was no statistically significant correlation between CK-MB and BSID-II score (P>0.05).Serum cTnI concentrations and duration of inotropic support were significantly greater with increasing severity of PA. cTnI was negatively correlated with fraction shortening (r -0.64; P<0.05). The severity of tricuspid regurgitation was correlated with the cTnI concentration (r 0.61; P<0.05).

CONCLUSION

In asphyxiated neonates, cTnI concentrations within 12 h of birth correlate with medium-term outcome. Early cTnI concentration correlates with severity of HIE, myocardial dysfunction and with Bayley II scores at 18 months.

Post-surgical lipophagic panniculitis: a specific model of traumatic panniculitis and new histopathological findings

Aim of this work was to define the histopathological features of post-surgical panniculitis. Dermal and hypodermal changes will be analyzed in detail, to understand the cascade of events that characterize the tissue response to surgical trauma. Cutaneous re-excision specimens of cases of basal cell carcinoma, squamous cell carcinoma, and melanoma consecutively seen from January 1, 2011 to June 30, 2011 at the Department of Dermatology, University of Pavia, were included in this study. Only the cases in which the first surgical procedure included the subcutaneous fat, were considered. In addition, the time elapsed from the first surgical procedure and the re-excision had to be included in a period of time from one to three months. All the specimens were stained with hematoxylin and eosin. Thirty cutaneous re-excision specimens were studied. Histopathologic examination revealed changes of epidermis, ranging from slight atrophy to moderate hyperplasia. In two cases focal ulceration was seen, with transfollicular elimination of foreign body material. The main dermal changes observed were the: 1) scar with well defined vertical orientation along the dermal suture line; 2) rounded cicatricial areas with radial branching septa of scarring tissue; 3) foreign body granuloma formation; 4) alignment of hystiocytes at the dermo-hypodermal border; 5) traumatic neuromas. The subcutaneous fat changes included: 1) lobular panniculitis with consistent presence of foam cells; 2) striking anisocytosis with pseudocystic degeneration and necrosis of adipocytes; 3) eritrocyte extravasation, mainly at the dermo-hypodermal border; 4) deep seated phlebitis. Post-surgical panniculitis is a lobular foam cell panniculitis characterized by simultaneous dermal and hypodermal changes, expression of the multi-faceted tissue response to a surgical trauma. This type of peculiar lipophagic response puts post-surgical panniculitis into the wider chapter of lipophage tissue response seen in atherosclerosis, glomerulosclerosis and some infectious models such as Mycobacterium tuberculosis and Chlamydia pneumoniae infections. Furthermore it may be seen as a reliable and convenient model for laboratory investigation on foam cell tissue response.

High myeloperoxidase positive cell infiltration in colorectal cancer is an independent favorable prognostic factor

Background

Colorectal cancer (CRC) infiltration by adaptive immune system cells correlates with favorable prognosis. The role of the innate immune system is still debated. Here we addressed the prognostic impact of CRC infiltration by neutrophil granulocytes (NG).

Methods

A TMA including healthy mucosa and clinically annotated CRC specimens (n = 1491) was stained with MPO and CD15 specific antibodies. MPO+ and CD15+ positive immune cells were counted by three independent observers. Phenotypic profiles of CRC infiltrating MPO+ and CD15+ cells were validated by flow cytometry on cell suspensions derived from enzymatically digested surgical specimens. Survival analysis was performed by splitting randomized data in training and validation subsets.

Results

MPO+ and CD15+ cell infiltration were significantly correlated (p<0.0001; r = 0.76). However, only high density of MPO+ cell infiltration was associated with significantly improved survival in training (P = 0.038) and validation (P = 0.002) sets. In multivariate analysis including T and N stage, vascular invasion, tumor border configuration and microsatellite instability status, MPO+ cell infiltration proved an independent prognostic marker overall (P = 0.004; HR = 0.65; CI:±0.15) and in both training (P = 0.048) and validation (P = 0.036) sets. Flow-cytometry analysis of CRC cell suspensions derived from clinical specimens showed that while MPO+ cells were largely CD15+/CD66b+, sizeable percentages of CD15+ and CD66b+ cells were MPO−.

Conclusions

High density MPO+ cell infiltration is a novel independent favorable prognostic factor in CRC.

Clinical, Pathological and Immunohistochemical Effects of Arsenical-Ferruginous SPA Waters on Mild-To-Moderate Psoriatic Lesions: A Randomized Placebo-Controlled Study

Thermalism and spa treatments are traditionally considered effective in a number of dermatologic inflammatory conditions, yet there is scarce evidence about spring water effectiveness on psoriasis in a daily setting. We enrolled 34 patients with mild-to-moderate psoriasis in a double-blind, randomized, placebo-contralaterally-controlled trial, to evaluate Levico and Vetriolo arsenical-ferruginous water effectiveness on psoriatic lesions by daily 20-minute wet packing for 12 consecutive days. Clinical, histopathologic and immunohistochemical parameters were considered. A statistically significant difference between spa water-treated lesions and placebo-treated lesions in the same patients was demonstrated for histopathologic and immunohistochemical parameters. Since iron ions have an antiproliferative effect on epithelia, and magnesium ions have an anti-inflammatory effect, Levico and Vetriolo water effectiveness on psoriasis could be addressed to their content of these ions.

Clinical impact of programmed cell death ligand 1 expression in colorectal cancer

BACKGROUND

Programmed cell death 1 (PD-1) receptor triggering by PD ligand 1 (PD-L1) inhibits T cell activation. PD-L1 expression was detected in different malignancies and associated with poor prognosis. Therapeutic antibodies inhibiting PD-1/PD-L1 interaction have been developed.

MATERIALS AND METHODS

A tissue microarray (n=1491) including healthy colon mucosa and clinically annotated colorectal cancer (CRC) specimens was stained with two PD-L1 specific antibody preparations. Surgically excised CRC specimens were enzymatically digested and analysed for cluster of differentiation 8 (CD8) and PD-1 expression.

RESULTS

Strong PD-L1 expression was observed in 37% of mismatch repair (MMR)-proficient and in 29% of MMR-deficient CRC. In MMR-proficient CRC strong PD-L1 expression correlated with infiltration by CD8(+) lymphocytes (P = 0.0001) which did not express PD-1. In univariate analysis, strong PD-L1 expression in MMR-proficient CRC was significantly associated with early T stage, absence of lymph node metastases, lower tumour grade, absence of vascular invasion and significantly improved survival in training (P = 0.0001) and validation (P = 0.03) sets. A similar trend (P = 0.052) was also detectable in multivariate analysis including age, sex, T stage, N stage, tumour grade, vascular invasion, invasive margin and MMR status. Interestingly, programmed death receptor ligand 1 (PDL-1) and interferon (IFN)-γ gene expression, as detected by quantitative reverse transcriptase polymerase chain reaction (RT-PCR) in fresh frozen CRC specimens (n = 42) were found to be significantly associated (r = 0.33, P = 0.03).

CONCLUSION

PD-L1 expression is paradoxically associated with improved survival in MMR-proficient CRC.

Recombinant interleukin-2 and interferon-alpha-2a in pretreated advanced soft-tissue sarcomas

Fourteen patients with advanced soft tissue sarcomas (STS), all pre-treated with one or more chemotherapy (CT) lines, entered an outpatient phase 11 study in which subcutaneous recombinant Interleukin-2 (rIL-2) and intramuscular recombinant alpha-2a-interferon (r-alphaIFN) were concomitantly administered. Both the cytokines were given for 5 days/week for 3 consecutive weeks followed by a 2 weeks period during which only r-alphaIFN was administered. r-alphaIFN was provided at a dose of 3 x 10(6) International Units (IU), while rIL-2 was given at a dosage of 6 x 10(6)/m2/day IU (in 2 subcutaneous injections), starting from 2 x 10(6)/m2/day IU in the first week and progressively increasing to 4 and 6 x 10(6)/m2/day IU in the second and third weeks; in 4 patients the dose of 8 x 10(6)/m2/day IU was reached. Toxicity was moderate and correlated with rIL-2 dose; main side effects included changes in liver functionality tests (14/14), fever (13/14), fatigue (13/14), nausea and vomiting (9/14). In all 11 patients evaluable for response, stable disease (SD) was observed (duration 4-43 weeks; median 9 weeks); the median survival from the starting treatment was 18 weeks (range 10-52). In all treated patients, an immunological monitoring was performed: an increase in percentage (from 10 to 74%) and in absolute number (from 400 to 4.500 cells/mm3) of CD16+ lymphocytes (NK cells) was observed in the majority of cases. Our data indicate that this regimen can be administered in pre-treated and severely immunocompromised patients with minimal to moderate toxicity on ambulatory and home bases, with acceptable clinical results.