An abscopal effect in a case of concomitant treatment of locally and peritoneally recurrent gastric cancer using adoptive T-cell immunotherapy and radiotherapy

Hiro Sato, Yoshiyuki Suzuki, Yuya Yoshimoto, Shin-Ei Noda, Kazutoshi Murata, Yosuke Takakusagi, Atsushi Okazaki, Tetsuo Sekihara, Takashi Nakano, Hiro Sato, Yoshiyuki Suzuki, Yuya Yoshimoto, Shin-Ei Noda, Kazutoshi Murata, Yosuke Takakusagi, Atsushi Okazaki, Tetsuo Sekihara, Takashi Nakano

Abstract

The mechanism of abscopal effect is becoming clear by the progress of cancer immunology. A 54-year-old male with recurrent gastric cancer presented an abscopal effect after radiotherapy with concurrent adoptive T-cell immunotherapy (immunoradiotherapy). Immunoradiotherapy has potential to induce abscopal effect by strengthening systemic antitumor immunity even in recurrent cancer.

Keywords: Abscopal effect; adoptive T‐cell immunotherapy; gastric cancer; peritoneal dissemination; radiotherapy.

Figures

Figure 1
Figure 1
Dose distribution of radiotherapy. (A) Radiotherapy (48 Gy in 24 fractions) using the IMRT method was prescribed for local recurrent tumor, which includes the pancreas and the left kidney. (B) The metastatic peritoneal tumor in which the abscopal effect was observed was not included in the irradiated field.
Figure 2
Figure 2
CT images of local recurrence and peritoneal dissemination before, during, and after immunoradiotherapy. (A) CT images before immunoradiotherapy: 2 months after the first paclitaxel treatment followed by immunotherapy. Progression of the local recurrence lesion and peritoneal dissemination was confirmed. (B) CT image was acquired during immunoradiotherapy at 44 Gy in 22 fractions point. Shrinkage of the locally reoccurred tumor (red arrow) and progression in peritoneal dissemination (red circle) were observed. (C) CT image was taken 2 months after the start of the therapy. A complete remission of the locally recurrent tumor and an abscopal effect were observed. IRT, immunoradiotherapy.
Figure 3
Figure 3
The clinical time course and corresponding changes in the serum tumor marker after postoperative recurrence. CA19‐9 temporally decreased in response to complete remission of the locally recurrent tumor and abscopal effect after immunoradiotherapy, whereas CEA steadily increased. However, both of tumor markers were eventually uncontrolled. PTX, paclitaxel; DC, dendritic cell; RT, radiotherapy; IRT, immunoradiotherapy.

References

    1. Siva, S. , MacManus M. P., Martin R. F., and Martin O. A.. 2015. Abscopal effects of radiation therapy: a clinical review for the radiobiologist. Cancer Lett. 356:82–90.
    1. Postow, M. A. , Callahan M. K., Barker C. A., Yamada Y., Yuan J., Kitano S., et al. 2012. Immunologic correlates of the abscopal effect in a patient with melanoma. N. Engl. J. Med. 366:925–931.
    1. Lee, Y. , Auh S. L., Wang Y., Burnette B., Wang Y., Meng Y., et al. 2009. Therapeutic effects of ablative radiation on local tumor require CD8 + T cells: changing strategies for cancer treatment. Blood 114:589–595.
    1. Reits, E. A. , Hodge J. W., Herberts C. A., Groothuis T. A., Chakraborty M., Wansley E. K., et al. 2006. Radiation modulates the peptide repertoire, enhances MHC class I expression, and induces successful antitumor immunotherapy. J. Exp. Med. 203:1259–1271.
    1. Teng, F. , Kong L., Meng X., Yang J., and Yu J.. 2015. Radiotherapy combined with immune checkpoint blockade immunotherapy: achievements and challenges. Cancer Lett. 365:23–29.
    1. Grimaldi, A. M. , Simeone E., Giannarelli D., Muto P., Falivene S., Borzillo V., et al. 2014. Abscopal effects of radiotherapy on advanced melanoma patients who progressed after ipilimumab immunotherapy. Oncoimmunology 3:e28780.
    1. Golden, E. B. , Demaria S., Schiff P. B., Chachoua A., and Formenti S. C.. 2013. An abscopal response to radiation and ipilimumab in a patient with metastatic non‐small cell lung cancer. Cancer Immunol. Res. 1:365–372.
    1. Golden, E. B. , Chhabra A., Chachoua A., Adams S., Donach M., Fenton‐Kerimian M., et al. 2015. Local radiotherapy and granulocyte‐macrophage colony‐stimulating factor to generate abscopal responses in patients with metastatic solid tumours: a proof‐of‐principle trial. Lancet Oncol. 16:795–803.
    1. Goto, S. , Kaneko T., Miyamoto Y., Eriguchi M., Kato A., Akeyama T., et al. 2005. Combined immunocell therapy using activated lymphocytes and monocyte‐derived dendritic cells for malignant melanoma. Anticancer Res. 25:3741–3746.
    1. Newton, A. D. , Datta J., Loaiza‐Bonilla A., Karakousis G. C., and Roses R. E.. 2015. Neoadjuvant therapy for gastric cancer: current evidence and future directions. J. Gastrointest. Oncol. 6:534–543.
    1. Reynders, K. , Illidge T., Siva S., Chang J. Y., and De Ruysscher D.. 2015. The abscopal effect of local radiotherapy: using immunotherapy to make a rare event clinically relevant. Cancer Treat. Rev. 41:503–510.
    1. Dunn, G. P. , Bruce A. T., Ikeda H., Old L. J., and Schreiber R. D.. 2002. Cancer immunoediting: from immunosurveillance to tumor escape. Nat. Immunol. 3:991–998.
    1. Kim, Y. J. , Lim J., Kang J. S., Kim H. M., Lee H. K., Ryu H. S., et al. 2010. Adoptive immunotherapy of human gastric cancer with ex vivo expanded T cells. Arch. Pharmacal Res. 33:1789–1795.
    1. Perez, C. A. , Fu A., Onishko H., Hallahan D. E., and Geng L.. 2009. Radiation induces an antitumour immune response to mouse melanoma. Int. J. Radiat. Biol. 85:1126–1136.
    1. Gameiro, S. R. , Jammeh M. L., Wattenberg M. M., Tsang K. Y., Ferrone S., and Hodge J. W.. 2014. Radiation‐induced immunogenic modulation of tumor enhances antigen processing and calreticulin exposure, resulting in enhanced T‐cell killing. Oncotarget 5:403–416.
    1. Suzuki, Y. , Mimura K., Yoshimoto Y., Watanabe M., Ohkubo Y., Izawa S., et al. 2012. Immunogenic tumor cell death induced by chemoradiotherapy in patients with esophageal squamous cell carcinoma. Cancer Res. 72:3967–3976.
    1. Sato, H. , Suzuki Y., Ide M., Katoh T., Noda S. E., Ando K., et al. 2014. HLA class I expression and its alteration by preoperative hyperthermo‐chemoradiotherapy in patients with rectal cancer. PLoS ONE 9:e108122.
    1. Deng, J. , Liang H., Wang D., Sun D., Pan Y., and Liu Y.. 2011. Investigation of the recurrence patterns of gastric cancer following a curative resection. Surg. Today 41:210–215.
    1. Spolverato, G. , Ejaz A., Kim Y., Squires M. H., Poultsides G. A., Fields R. C., et al. 2014. Rates and patterns of recurrence after curative intent resection for gastric cancer: a United States multi‐institutional analysis. J. Am. Coll. Surg. 219:664–675.
    1. Yang, S. , Feng R., Pan Z. C., Jiang T., Xu Q., and Chen Q.. 2015. A comparison of intravenous plus intraperitoneal chemotherapy with intravenous chemotherapy alone for the treatment of gastric cancer: a meta‐analysis. Sci. Rep. 5:12538.
    1. Robert, C. , Long G. V., Brady B., Dutriaux C., Maio M., Mortier L., et al. 2015. Nivolumab in previously untreated melanoma without BRAF mutation. N. Engl. J. Med. 372:320–330.
    1. Brahmer, J. , Reckamp K. L., Baas P., Crino L., Eberhardt W. E., Poddubskaya E., et al. 2015. Nivolumab versus docetaxel in advanced squamous‐cell non‐small‐cell Lung cancer. N. Engl. J. Med. 373:123–135.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel