1. PROSPECTIVE ANALYSIS OF DENDRITIC CELL(DC)THERAPY IN CANCER PATIENTS
Kananathan.R*,Khan Jamal**
*NCI Hospital,Nilai Negeri Sembilan, Malaysia
**Institute of Cellular Therapy(ICT) ,Noida,India
INTRODUCTION
Cancer is caused by mutations.
Familial
environmental
unknown etiology.
During cancer development, self-cells become non-self cells. Mutating cells acquire a shield mechanism for evading immune attack.
They may hide their antigenic nature by topographic shield or produce IL-10 for negative chemotaxis or develop an unknown hidden mechanism to evade their arrest. Once the cancer cells start proliferating, the immune mechanisms become so ineffective, that it actually starts contributing towards cancer proliferation. At this stage, cancer develops rapidly and profoundly. Otherwise cancer growth may become slower or delayed if immune system is still able to check it irregularly. The deranged immune system can be corrected passively by chemotherapy and/or surgery. If it happens this way, cancer patients become cancer survivors, or otherwise, cancer returns with vengeance making itself more resistant to chemotherapeutic drugs used earlier. Normal anti-cancer immunology can be enhanced in laboratory as well. The peripheral blood mononuclear cells are isolated from peripheral blood and cultured with specific cytokines for changing their morphology to dendritic cells.
The dendritic cells are given a basic information of cancer type, by adding tumor associated antigens (TAA) and tumor specific antigens (TSA) to the culture plates. First described by the late Professor Ralph Steinmen( picture Nobel Prize in Medicine 2011 ) in the late dendritic cells are now found to have essential roles in cancer therrapy Dendritic cells recognize the antigen feedback and respond by producing specific antigenic peptides (representation) on their surfaces. These mature dendritic cells are re-infused to the same patient after eight days of culture for generating specific anti-cancer immunity. After infusion, these dendritic cells along with specific cytokines are carried to various lymph nodes and station themselves in these lymph nodes. They start their physiological action on naïve T cells. Upon physiological contact with dendrites of DC, T cells become committed in the vicinity of dendritic cells. Each dendritic cell has the potential to mature to about T cells/hour. Dendritic cell survives on an average of 3 weeks to months, and during this period it is able to selectively transform trillions of T cells.
The robust anticancer immunology doesn’t allow new malignant cells to grow and effectively stops or delays tumor progression. Dendritic cells leading to IL-12 and TNF-alpha generation also generate humoral immunology which results in reducing cachexia.
We have a series of advance cancer patients who used DC therapy in this review.
METHODLOGY
Patients who had advance cancer who have failed ,not suitable or refuse standard therapy were given the option of DC therapy.
Sign an informed consent agreeing to under go the therapy.
Phases I
Bleeding
0.1ml of Heparin is drawn into the syringe. 20ml of fresh blood is drawn .
The drawn blood is poured into CellNute Bottle.
CellNute is a transport medium used to collect and transport blood back to ICT in India by 12hours on the same day.
At ICT ,CD14+ cells are isolated and cultured in cytokines along with desired nutritional media. These cells transform into the
immature dendritic cells .These cells are matured by exposing them to cancerous antigens on Day 6.
Phase II
The matured dendritic cells are harvested on Day 8 to be infused into the same patient.
Intravenous ondenseteron is given prior to Denvax Infusion.
RESULTS
11 patients
5 males and 6 females
Age ranged from 36 to 67years
Cancers
CA Colon(3),Hepatocellular Carcinoma(2),Ca Breast(1),CA Tongue and Nasopharyngeal (1)
CA cholangiocarcinoma(1),CA Cervix(1),CA Endometrium(1),Ca Prostate(1)
Infusions given ranged from open patient passed away 24hours before his first infusion and one patient had
6 infusion.Median is 4 infusion
No adverse event was noted post transfusioan
LLK
*Remain well till June 2009 when he developed numbness over his right lower face and wasting of his left lower neck muscles. He was examined in France and a CT scan was done that revealed no abnormality and radiotherapy was blamed for this effect. One month later he had left parotid swelling and ENT surgeons at Prince court Medical Centre attributed it to an infection. Finally he had a biopsy done by his primary ENT surgeon at Normah Kuching who detected a poorly differentiated squamous cell from the parotid. All this was happening in the presence of a negative for tumour at the primary site. He was sent for a PET scan at Singapore General that revealed a large enhancing lesion in the nasopharyngx. He was treated and post therapy he was advised to have adjuvant chemotherapy with Cisplatin and 5FU which he turned down for the second time. He wanted to try on Denvax therapy. 10 weeks post therapy he noted a large swelling on the jaw and this progressed . He had 2 infusions of Denvax that was uneventful.
Dendritic Cell therapy was well tolerated with hardly any side effects.
The efficacy was more pronounced in patients with minimal disease.
AGE
SEX
DIAGNOSIS
STAGE
SURGERY
THERAPY
DC THERAPY
OVERALL SURVIVAL
CAA 67
MALE
CA COLON IV
ANTERIOR RESECTION
FOLFOX
CHEMO RADIOTHERAPY
CRYOTHERAPY
HARVESTING DONE
PATIENT PASSED AWAY 24HOURS BEFORE INFUSION
22MONTHS
OPT 64
FEMALE
RIGHT HEMICOLECTOMY
FOLFOX WITH CETUXIMAB
FOLFIRI
CAPECITABINE
2 HARVESTING
23MONTHS
CYC 57
IIIC
OCT 2004
JUNE 2009 TOTAL COLECTOMY
FOLFOX 12 INFUSIONS OVER 6MONTHS AT NCI
JUNE 2009 FOFLFOX,.
RISING CEA ,PET REVEALED SINGLE PARA AORTIC NODES ,GIVEN RADIOTHERAPY.. REFUSE FURTHER CHEMO
3 HARVESTING
84MONTHS SINCE PRIMARY DIAGNOSIS ,
30MONTHS POST RECURRENCE.
ALIVE SJ 41
CA LIVER
PORTAL HYPERTENSION
CHILD C
III
NIL
SOREFINIB FOR 3MONTHS
ALFA FETOPROTEIN KEPT ON RISING
ALFAFETOPROTEIN DROPED FROM 480IU/L TO 220IUL
6MONTHS PASSED AWAY AFTER AN INFECTION ON RETURN FROM INDIA.
LLK
CHILDS C
WAS NOT FIT FOR LOCAL REGIONAL OR SOREFINID
DISEASE PROGRESSED
6MONTHS
DMCH* 53
CA TONGUE
NASOPHARYNGEAL
IV(June 2008)
IV (June 2009)
NOTE BELOW
CONCURRENT CETUXIMAB AND RADIOTHERAPY IMRT TO TONGUE
CONCURRENT CHEMORT FOR NPC
1 HARVESTING
24MONTHS
SAJ 45
CA CERVIX
IIIB
CONCURRENT CHEMORADIOTHERAPY
6CYCLES OF PACLITAXEL AND CARBOPLATIN
36MONTHS
17MONTHS POST RECURRENCE
YCC
CA CHOLONGIO CARCINOMA
3LINES OF THERAPY
HIFU
SIRTEX
AIET
30MONTHS AR 36
CA LEFT BREAST
TRIPLE NEGATIVE
1 LEFT MASTECTOMY WITH AXILLARY CLEARENCE
2 LOCAL EXCISION
3 RE EXCISION
1FAC AND CHEST WALL RADIOTHERAPY
2 TAXOTERE
3 RADIOTHERAPY
82MONTHS SINCE DIAGNOSIS
48MONTHS POST RECURRENCE
TCC 39
CA ENDOMETRIUM IC
TAHBSO AND PELVIC NODE SAMPLING
INTRA CAVITY BRACHYTHERAPY
2HARVESTING
53MONTHS SINCE DIAGNOSIS
26MONTHS POST RECURRENCE MM 65
CA PROSTATE
HORMONE
PALLIATIVE RADIOTHERAPY
31MONTHS
CONCLUSION
Presented at the 21st Asian Pacific Cancer Conference
10 to 12th November 2011
Dedicated to Late Dr G Selvaratnam,patients and the staff’s of NCI