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J Korean Soc Ther Radiol Oncol > Volume 26(2); 2008 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2008;26(2): 104-112. doi: https://doi.org/10.3857/JKSTRO.2008.26.2.104
A Phase I/II Trial of DCVac/IR(R) Dendritic Cell Immunotherapy Combined with Irradiation in Cases of Refractory Colorectal Cancer with Multiple Liver Metastases
Youngmin Choi, Hyung Sik Lee, Hyuk Chan Kwon, Sang Young Han, Jong Cheol Choi, Ju Seop Chung, Chang Won Kim, Dong Won Kim, Chi Duk Kang
1Department of Radiation Oncology, Dong-A University School of Medicine, Busan, Korea. hyslee@dau.ac.kr
2Department of Hemato-oncology, Dong-A University School of Medicine, Busan, Korea.
3Department of Gastroenterology, Dong-A University School of Medicine, Busan, Korea.
4Department of Radiology, Dong-A University School of Medicine, Busan, Korea.
5Department of Hemato-oncology, Busan National University School of Medicine, Busan, Korea.
6Department of Radiology, Busan National University School of Medicine, Busan, Korea.
7Department of Radiation Oncology, Busan National University School of Medicine, Busan, Korea.
8Department of Biochemistry, Busan National University School of Medicine, Busan, Korea.
ABSTRACT
PURPOSE:
To assess the toxicity and tumor response induced by DCVac/IR(R) dendritic cell (DC) immunotherapy combined with irradiation for refractory colorectal cancer patients with multiple liver metastases.
MATERIALS AND METHODS:
Between May 2004 and November 2006, applicants from a pool of refractory colorectal cancer patients with multiple liver metastases were enrolled. The patients were registered after having signed the informed consent form, which had been approved by the Institutional Review Board from the Dong-A University and Busan National University Hospital. DCs were obtained from peripheral blood of each patient, and then cultured in vitro. A total of 6x10(6) DCs were packed into a vial (DCVac/IR(R), 0.5 ml) at the convenience of each patient's schedule. On the day before and on the day of each vaccination, each patient received a 4 Gy radiation dose to the target tumor. On the day of vaccination, the indicated dose of autologous DCs was injected into the irradiated tumor using ultrasound-guided needle injection procedures. A total of four vaccinations were scheduled at three 2-week intervals and one 4 week interval at the Dong-A University and Busan National University Hospital. If the tumor status was deemed to be stable or responding to therapy, an additional vaccination dose or two was approved at 4 week intervals beyond the fourth immunization. A tolerance test for DCs was conducted by injecting a range of doses (3x10(6) to 12x10(6) DCs) after the 3rd injection. Moreover, the maximal tolerable dose was applied to additional patients. Treatment safety was evaluated in all patients who had at least one injection. Treatment feasibility was evaluated by the 10th week by assessing the response of patients having at least 4 injections. For systemic toxicities, the evaluation was performed using the National Cancer Institute Common Toxicity Criteria, whereas adverse effects were recorded using common WHO toxicity criteria.
RESULTS:
Of the 24 registered patients, 22 received the DCs injections. Moreover, of the 14 patients that applied for the tolerance test, only 11 patients completed it because 3 patients withdrew their testing agreement. A grade 3 or more side effect, which was possibly related to the DC injection, did not occur in additional patients. The 12x10(6) DC injection was identified as the maximum tolerable dose, and was then injected in an additional 8 patients. Patients tolerated the injection fairly well, with no fatal side effects. In order to assess the feasibility of DC immunotherapy, the response was evaluated in other hepatic lesions outside of the targeted hepatic lesion. The response evaluation was performed in 15 of the 17 patients who received at least 4 injections. Stable and progressive disease was found in 4 and 11 patients, respectively.
CONCLUSION:
The DC-based immunotherapy and radiotherapy is theoretically synergistic for the local control and systemic control. The DCVac/IR(R) immunotherapy combined with irradiation was tolerable and safe in the evaluated cases of refractory colorectal cancer with multiple liver metastases. Future work should include well designed a phase II clinical trials.
Key Words: Dendritic cell immunotherapy, Radiotherapy, Colorectal cancer with multiple liver metastases
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