Gastric cancer is one of the most common cancers. Surgical resection of early-stage localized disease is the only curative treatment. Advanced gastric cancer is often resistant to standard cytotoxic therapy including chemotherapy and radiotherapy. On the other hand, evidence is accumulated that immune-based approaches may materially affect the course of this disease.
The inducing course of xenogeneic vaccine-based immunotherapy comprises 10 subcutaneous vaccinations and takes about 3 months. The supporting vaccination schedule is determined by both a disease stage and an overall health state of a patient. The treatment is conducted on an outpatient basis. An influenza-like syndrome as a body temperature rise up to 380 C, and musculoskeletal discomfort can occur. These symptoms are usually self-limited. The vaccine-induced, immune processes are aimed at destroying tumor cells and suppressing the development of residual disease.
Our own experience suggests that a clinical effect of various grades (complete or partial response, disease stabilization) with a duration not shorter than 6 months may be achieved in a significant proportion of stage IV patients. We suggest that the xenogeneic vaccine therapy could be still more effective if starts as early as before or immediately after surgical resection of primary tumor and its metastases.
Examples.
Case 1. A 44 year-old female patient I was diagnosed with signet ring cell gastric carcinoma. Combined gastrectomy was carried and one course of polychemotherapy was further conducted. Two months later the signs of disease progression were noted: UI revealed enlarged lymph nodes within both the gate of the liver and the retroperitoneal space. Vaccinotherapy was started at that time. At 3 months after vaccinotherapy initiation UI revealed no signs of disease. The reduction of ESR to norma and the elevation of Hb level were noted in blood analysis. In the final analysis, the patient was in good condition, no evidence for disease was observed at 2 years after immunotherapy initiation.
Case 2. A 54 year-old male patient I was diagnosed with low-grade differentiated, gastric adenocarcinoma. Multiple lesions were noted in the left lung (the condition after radiochemotherapy) . At the time of the of vacinotherapy initiation there were complains of general weakness, periodic vomiting, and low grade fever. The state of patient’s health became still worse at 3 months after immunotherapy initiation: daily vomiting, lack of appetite, significant loss of weight and intense paints within the epigastric region were noted. In spite of everything, vaccinotherapy was not stopped. Two months later the state of the patients was somewhat improved : attacks of vomiting became less frequent, blood parameters returned to norma. However, UI revealed a lesion of 15 mm diameter in the bottom pole of the right kidney. The patient’s state was stable as long as 4 months before when gastric obstruction developed and surgery (Bilrot 2 operation) was performed. UI revealed no added pathological signs. A chest x-ray did not detect any tumor signs in lungs. In the final analysis, no evidence for disease progression was observed at 2 years after vaccinotherapy initiation.
Related scientific publications:
- Phase II Trial of Adjuvant Immunotherapy with Autologous Tumor-derived Gp96 Vaccination in Patients with Gastric Cancer.
Zhang K, Peng Z, Huang X, Qiao Z, Wang X, Wang N, Xi H, Cui J, Gao Y, Huang X, Gao H, Wei B, Chen L. J Cancer. 2017 Jul 2;8(10):1826-1832. doi: 10.7150/jca.18946. eCollection 2017.
https://www.ncbi.nlm.nih.gov/pubmed/28819380 - Immunotherapy in gastrointestinal cancer: Recent results, current studies and future perspectives.
Moehler M, Delic M, Goepfert K, Aust D, Grabsch HI, Halama N, Heinrich B, Julie C, Lordick F, Lutz MP, Mauer M, Alsina Maqueda M, Schild H, Schimanski CC, Wagner AD, Roth A, Ducreux M. Eur J Cancer. 2016 May;59:160-170. doi: 10.1016/j.ejca.2016.02.020. Epub 2016 Mar 31. Review.
https://www.ncbi.nlm.nih.gov/pubmed/27039171 - Allogenic dendritic cell and tumor cell fused vaccine for targeted imaging and enhanced immunotherapeutic efficacy of gastric cancer.
Li C, Liang S, Zhang C, Liu Y, Yang M, Zhang J, Zhi X, Pan F, Cui D. Biomaterials. 2015 Jun;54:177-87. doi: 10.1016/j.biomaterials.2015.03.024. Epub 2015 Apr 9.
https://www.ncbi.nlm.nih.gov/pubmed/25907051 - Therapeutic effect of intratumoral injections of dendritic cells for locally recurrent gastric cancer: a case report.
Kobayashi M, Sakabe T, Chiba A, Nakajima A, Okamoto M, Shimodaira S, Yonemitsu Y, Shibamoto Y, Suzuki N, Nagaya M; DC-vaccine study group at the Japan Society of Innovative Cell Therapy (J-SICT). World J Surg Oncol. 2014 Dec 19;12:390. doi: 10.1186/1477-7819-12-390.
https://www.ncbi.nlm.nih.gov/pubmed/25526950 - Autologous tumor lysate-pulsed dendritic cell immunotherapy with cytokine-induced killer cells improves survival in gastric and colorectal cancer patients.
Gao D, Li C, Xie X, Zhao P, Wei X, Sun W, Liu HC, Alexandrou AT, Jones J, Zhao R, Li JJ. PLoS One. 2014 Apr 3;9(4):e93886. doi: 10.1371/journal.pone.0093886. eCollection 2014.
https://www.ncbi.nlm.nih.gov/pubmed/24699863