Great progress has been made in the field of tumor immunology in the past decade, but optimism about the clinical application of currently available cancer vaccine approaches is based more on surrogate endpoints than on clinical tumor regression. In our cancer vaccine trials of 440 patients, the objective response rate was low (2.6%), and comparable to the results obtained by others. We consider here results in cancer vaccine trials and highlight alternate strategies that mediate cancer regression in preclinical and clinical models.

/pdf/cancer-immunotherapy-moving-beyond-current-vaccines-37qufn3ryj.pdf

Cancer immunotherapy: moving beyond current vaccines.

We report here the adoptive transfer, to patients with metastatic melanoma, of highly selected tumor-reactive T cells directed against overexpressed self-derived differentiation antigens after a nonmyeloablative conditioning regimen. This approach resulted in the persistent clonal repopulation of T cells in those cancer patients, with the transferred cells proliferating in vivo, displaying functional activity, and trafficking to tumor sites. This led to regression of the patients' metastatic melanoma as well as to the onset of autoimmune melanocyte destruction. This approach presents new possibilities for the treatment of patients with cancer as well as patients with human immunodeficiency virus-related acquired immunodeficiency syndrome and other infectious diseases.

/pdf/cancer-regression-and-autoimmunity-in-patients-after-clonal-2lfydbn0hx.pdf

Cancer Regression and Autoimmunity in Patients After Clonal Repopulation with Antitumor Lymphocytes

We studied the effects of adoptive immunotherapy with lymphokine-activated killer (LAK) cells plus interleukin-2 or therapy with high-dose interleukin-2 alone in 157 patients with metastatic cancer for whom standard therapy had proved ineffective or no standard effective treatment was available. One hundred eight patients were treated with 127 courses of LAK cells plus interleukin-2, and 49 patients were treated with 53 courses of high-dose interleukin-2 alone. Of 106 evaluable patients receiving LAK cells plus interleukin-2, 8 had complete responses, 15 had partial responses, and 10 had minor responses. The median duration of response was 10 months among those with complete responses and 6 months among those with partial responses; the patient with the longest complete response was still in remission 22 months after treatment. Of 46 evaluable patients treated with high-dose interleukin-2 alone, 1 had a complete response (remission greater than 4 months), 5 had partial responses (2, greater than 3, greater than 5, 7, and greater than 11 months), and 1 had a minor response. Seven of the total of nine complete responses still remain in remission. Hypotension, weight gain, oliguria, and elevation of bilirubin and creatinine levels were common, but these side effects resolved promptly after interleukin-2 administration was stopped. There have been four treatment-related deaths among these 157 patients. This immunotherapeutic approach can result in marked tumor regression in some patients for whom no other effective therapy is available at present. Determining its ultimate role in cancer therapy awaits further attempts to increase the therapeutic efficacy of treatment and decrease its toxicity and complexity.

A progress report on the treatment of 157 patients with advanced cancer using lymphokine-activated killer cells and interleukin-2 or high-dose interleukin-2 alone.

We describe here the preliminary results of the systemic administration of autologous lymphokine-activated killer (LAK) cells and the recombinant-derived lymphokine interleukin-2 to patients with advanced cancer This regimen was based on animal models in which the systemic administration of LAK cells plus interleukin-2 mediated the regression of established pulmonary and hepatic metastases from a variety of murine tumors in several strains of mice We treated 25 patients with metastatic cancer in whom standard therapy had failed Patients received both 18 to 184 X 10(10) autologous LAK cells, generated from lymphocytes obtained through multiple leukaphereses, and up to 90 doses of interleukin-2 Objective regression of cancer (more than 50 per cent of volume) was observed in 11 of the 25 patients: complete tumor regression occurred in one patient with metastatic melanoma and has been sustained for up to 10 months after therapy, and partial responses occurred in nine patients with pulmonary or hepatic metastases from melanoma, colon cancer, or renal-cell cancer and in one patient with a primary unresectable lung adenocarcinoma Severe fluid retention was the major side effect of therapy, although all side effects resolved after interleukin-2 administration was stopped Further development of this approach and additional patient follow-up are required before conclusions about its therapeutic value can be drawn

Observations on the Systemic Administration of Autologous Lymphokine-Activated Killer Cells and Recombinant Interleukin-2 to Patients with Metastatic Cancer

Lymphocytes extracted from freshly resected melanomas can be expanded in vitro and can often mediate specific lysis of autologous tumor cells but not allogeneic tumor or autologous normal cells. We treated 20 patients with metastatic melanoma by means of adoptive transfer of these tumor-infiltrating lymphocytes and interleukin-2, after the patients had received a single intravenous dose of cyclophosphamide. Objective regression of the cancer was observed in 9 of 15 patients (60 percent) who had not previously been treated with interleukin-2 and in 2 of 5 patients (40 percent) in whom previous therapy with interleukin-2 had failed. Regression of cancer occurred in the lungs, liver, bone, skin, and subcutaneous sites and lasted from 2 to more than 13 months. Toxic effects of interleukin-2 occurred, although the treatment course was short (five days); these side effects were reversible. It appears that in patients with metastatic melanoma, this experimental treatment regimen can produce higher response rates than those achieved with interleukin-2 administered alone or with lymphokine-activated killer cells. It is too early to determine whether this new form of immunotherapy can improve survival, but further trials seem warranted.

Use of tumor-infiltrating lymphocytes and interleukin-2 in the immunotherapy of patients with metastatic melanoma. A preliminary report.

We have studied the ability of immunized lymphoid cells expanded in IL-2 to mediate the cure of mice with localized and disseminated syngeneic lymphoma. Mice received 500 rad total-body irradiation before injection of tumor into the footpad. Mice were treated 5 d later when a palpable local tumor and disseminated metastases were present. Intravenous injection of in vivo immune lymphocytes cured 93% of all mice, significantly better than any control group (P less than 0.0005). Immune cells, secondarily sensitized to the FBL-3 tumor in vitro, also conferred significant survival benefit (P less than 0.005) when injected intravenously, curing 79% of the animals treated. When these in vitro sensitized cells were expanded in IL-2, 8-10-fold over 7 d, 93% of the animals thus treated were cured, (P less than 0.005). When these cells were grown for multiple generations in IL-2 they retained their ability to cure mice (56% cured, P less than 0.01). This is the first demonstration that intravenous injection of sensitized cells grown in long term culture in IL-2 is capable of curing mice of established local and disseminated syngeneic tumor.

Regression of a disseminated syngeneic solid tumor by systemic transfer of lymphoid cells expanded in interleukin 2

We have investigated the subpopulations of T cells necessary to mediate the cure of established tumors in two models of successful adoptive immunotherapy. In C57BL/6 mice bearing palpable and disseminated FBL-3 lymphoma, both Lyt-1+ and Lyt-2+ cells played a major role in mediating the regression and permanent cure of mice, whereas in BALB/c mice bearing the Meth A sarcoma the adoptive transfer of Lyt-1+2+ cells played a major role in mediating the regression of tumors and the curing of disease. Identical experiments performed in hybrid (BALB/c X C57BL/6) mice yielded similar results, further supporting our initial observation and indicating that in these two adoptive transfer model systems it is the tumor and not the variable expression of Lyt antigens by the host that determines which T cell subpopulation is required to cure mice of tumors.

Adoptive immunotherapy of established syngeneic solid tumors: role of T lymphoid subpopulations.

Development of long-term cell lines and lymphoid clones reactive against murine and human tumors: A new approach to the adoptive immunotherapy of cancer

Studies were undertaken to elucidate the cellular basis of skin allograft rejection mediated by long-term cultured cell lines and clones. The adoptive transfer, in vivo, of in-vitro-sensitized cells, from B6AF1 anti B10.BR or from C57BL/6 anti DBA/2 cultures, and expanded eight-fold to ten-fold for one week in lectin-free interleukin 2 (LF-IL-2) were able to mediate specific skin allograft rejection. These same cells lost the ability to mediate accelerated skin graft rejection when they were expanded more than 100-fold during three weeks of culture in LF-IL-2 even though these cultures mediated high levels of specific in vitro cytotoxicity for the appropriate allosensitizing cells. When Lyt-2+ cells were depleted using monoclonal antibodies and complement prior to in vitro sensitization and expansion in LF-IL-2, these cells lines retained the ability to mediate skin allograft rejection in vivo when expanded more than 100-fold for three culture generations in vitro. These latter lines were greatly enriched for Lyt-1+2- cells and had little or no cytolytic activity, but they retained specific in vitro proliferative responses to the sensitizing alloantigen. Several Lyt-1-2+ cloned long-term lymphoid cell lines with high levels of specific cytolytic activity against the sensitizing alloantigen were derived and none was capable of mediating the accelerated rejection of skin grafts in vivo. However, cloned lymphoid cell lines that were phenotypically Lyt-1+2- and were capable of proliferating when in contact with specific alloantigen, but were not cytolytic, were capable of mediating the accelerated rejection of skin grafts in vivo both in irradiated mice and in nude mice. These studies demonstrate that skin allograft rejection can be mediated by Lyt-1+2- cell lines with specific in vitro proliferative activity to alloantigen although Lyt-1-2+ cell lines with cytolytic but not proliferative activity to alloantigen in vitro are ineffective in mediating graft rejection in vivo. Specific proliferative activity and no cytolysis appears to be a good in vitro correlate of the in vivo activity of long-term cultured cell lines.

Clonal analysis of the lymphoid cells mediating skin allograft rejection. Mediation of graft rejection in vivo by cloned Lyt-1+2- proliferative, noncytotoxic long-term cell lines.

Successful systemic adoptive immunotherapy of a disseminated solid syngeneic murine tumor with long-term cultured t cells.

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