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Biomedical subjects

F R Eilber

Publications and source records attributed to F R Eilber.

At least 91 records · Page 5Linked to original sources

Immunotherapy of cancer.

Clinical studies have indicated a close relationship between immunological competency and the growth of human cancer. Studies in animal systems have indicated that immunological mechanisms are important in host-tumor existence. A number of agents are in the process of being evaluated for their immunotherapeutic potential in patients with cancer. These include levamisole, bacille Calmette Guérin (BCG) and Corynebacterium parvum. While the precise role of these agents in the treatment of human malignancy remains to be clearly defined, they do appear to be useful as adjuncts to other forms of cancer therapy such as radiation therapy, chemotherapy and surgical operation.

BCG Vaccine↗

Pterygoid dissections for extensive cancer. An old concept revisited.

We present a series of 14 consecutive patients who received radical en bloc resections of the pterygoid and subtemporal fossa. After a median follow-up of 20 months it appears that local control has been achieved in 10 of them (71 percent), certainly an encouraging result. The addition of postoperative radiation therapy has probably contributed to this local control, and immediate reconstruction with a deltopectoral flap has improved the postoperative appearance.

Adult↗

Skeletal and soft tissue sarcomas. Treatment with adjuvant immunotherapy.

Because there is evidence for an active immunologic response against sarcoma, a clinical trial of adjuvant immunotherapy using bacillus Calmette-Guérin (BCG) and tumor cell vaccine was begun. Eleven of 18 patients with localized soft tissue sarcoma who received immunotherapy are free of disease, compared to only 5 of 15 treated by operation alone who are free of disease. Furthermore, immunotherapy also prolonged the median disease-free interval from 7.3 months to 15 months in the patients who experienced recurrence of their disease.

BCG Vaccine↗

Adjuvant immunotherapy with BCG in treatment of regional-lymph-node metastases from malignant melanoma.

Despite current surgical therapy, about 80 per cent of patients with malignant melanoma metastatic to lymph nodes succumb to systemic metastatic disease. To determine if postoperative adjuvant immunization with BCG was an effective systemic treatment in these patients with microscopic subclinical metastatic disease, the clinical course of 42 patients treated by operation alone was compared with that of 84 treated by operation and BCG. At two years, the incidence of metastasis in BCG-treated patients was half that of the control group. BCG was more effective in patients with a smaller tumor burden at the time of initial surgical treatment. In patients receiving BCG adjuvant therapy, 90 per cent with microscopic disease in one lymph node appeared free of disease as compared to 40 per cent with macroscopic disease in multiple nodes. In patients with recurrences, an immunotherapeutic effect was demonstrated by a delay of six months in the time to recurrence. Thus, BCG immunotherapy appears to have an inhibiting effect on the "micrometastases" of malignant melanoma.

Adolescent↗

Regional lymph node metastases and the level of invasion of primary melanoma.

One hundred and nineteen patients with primary malignant melanoma had their primary lesion classified according to Clark's level of invasion by Clark and the Division of Surgical Pathology at UCLA. Thirty patients had superficial melanoma (Level II) and did not undergo regional lymph node dissection (RLND). All other patients (Levels III, IV, and V) underwent regional lymph node dissection. Thirty-two percent of patients with Level III melanoma, 67% of patients with Level IV melanoma, and 66% of patients with Level V melanoma had metastases to the regional lymph nodes. These studies suggest that the level of invasion, or the thickness of the primary melanoma, is helpful for predicting regional lymph node metastases.

Female↗

Immunocompetence and spontaneous regression of metastatic renal cell carcinoma.

Spontaneous remission of pulmonary metastases from renal cell carcinoma was correlated with a positive response to dinitrochlorobenzene (DNCB). When first seen, the patient was DNCB negative and a chest radiograph showed nodular densities in the right lung and left midlung. Six months after sensitization, the patient had a positive response to DNCB and no evidence of lung metastases. Three mo later, the patient developed brain metastases although X-ray examination showed no pulmonary nodules. A diminished response to DNCB noted over the next several months and chest X ray verified the return of pulmonary metastases.

Adenocarcinoma↗

Hepatic artery ligation and 5-fluorouracil infusion for metastatic colon carcinoma and primary hepatoma.

Nine patients with extensive bilateral hepatic metastases of colorectal cancer were treated with hepatic artery ligation and continuous infusion of 5-fluorouracil (5-FU). Silastic catheters were inserted into the hepatic artery at laparotomy, and continuous perfusion was effected by a Sigmamotor pump. There was no operative mortality or morbidity, and drug toxicity was acceptable. Dosage averaged 10 mg/kg/day and average time of infusion was sixty-three days. Liver function returned to preoperative values within two weeks in all patients, and four patients had improvement of preoperative liver function for three to six months after perfusion. Two patients had palpable regressions that lasted five months or more, and one patient had a slight palpable regression for two months. Five who are dead had a mean survival of 10.4 months after therapy, with a median survival of 11.5 months. Eight of the nine patients had significant clinical improvement following treatment. Seven patients with irresectable primary liver carcinoma were treated with continuous 5-FU infusion. A Silastic catheter was placed at laparotomy into the hepatic artery via the gastroduodenal artery. Ligation of the hepatic artery was not performed. There was no operative mortality or morbidity. Dosage averaged 10 mg/kg/day and the average time of infusion was 140 days. Significant clinical improvement was noted in six of the seven patients although this did not correlate with improvement of hepatic function. All six responding patients are still living (mean survival, 14 months). Prolongation of life with hepatic artery infusion of 5-FU has been significantly better than with any previously reported chemotherapy for this disease.

Adolescent↗

Results of BCG adjuvant immunotherapy for melanoma of the head and neck.

The present study was performed to determine if postoperative systemic BCG adjuvant immunotherapy would improve survival in patients with pathologic stage II melanoma of the head and neck. Seventeen of twenty-five (68 per cent) patients treated with BCG are free of disease, whereas only seven of seventeen (40 per cent) patients treated by radical neck dissection alone are free of disease. Clark's technic for determining the level of invasion of the primary lesion was used to predict the presence of metastatic tumor in regional lymph nodes. Results indicate that patients with pathologically confirmed lymph node metastases from melanoma of the head and neck benefit from postoperative BCG adjuvant immunotherapy.

BCG Vaccine↗

BCG immunotherapy as a systemic adjunct to surgery in malignant melanoma.

Results of our study suggest that BCG systemic adjuvant immunotherapy may be effective for improving both the recurrence and survival rates in patients with regional metastases from malignant melanoma. BCG is more effective in patients with small amounts of subclinical disease. It is apparent from results of clinical trials that many of the principles derived from the study of animal tumor systems are applicable to human cancer in that immunotherapy is most effective for a small residual number of tumor cells. BCG treatment fulfills many of the ideal criteria for adjuvant treatment following surgery. It is relatively nontoxic; it is effective for disseminated melanoma; it has systemic activity in the adjuvant treatment of subclinical metastases. Hwever, until clinical trials are complete, this treatment as adjuvant therapy must be considered investigational.

Animals↗

Limb salvage from a multidisciplinary treatment approach for skeletal and soft tissue sarcomas of the extremity.

Multimodality management of extremity skeletal and soft tissue sarcomas with preoperative intra-arterial Adriamycin and radiation therapy, radical surgical resection and postoperative chemotherapy or chemo-immunotherapy has resulted in preservation of a functional extremity in 13 or 14 patients. Seven of 8 patients with Stage IIIA and IIIB soft tissue sarcomas, managed with preoperative intra-arterial Adriamycin and radiation therapy, followed by en bloc soft tissue resection and 6 patients with bone sarcomas managed by preoperative treatment, followed by bone resection and replacement with cadaver bone allografts, remained free of disease from 4 to 34 months. The results of the combined modality approach were significantly better than the results obtained in patients managed by surgical resection alone, or by combination of operation with another single modality, both in terms of short term-recurrence free survival and salvage of a functional extremity.

Bone Neoplasms↗

Adjuvant chemoimmunotherapy in advanced lesions of the head and neck.

Growth of malignant tumors of the head and neck has been associated with progressive impairment of immunologic activity. Successful control of disease has been shown to reverse this defect. Preliminary results of a nonrandomized trial reduced recurrence of head and neck cancer for a median time of 11.5 months in eight of 10 patients who received chemoimmunotherapy adjuvant to surgical resection or radiation treatment. The number of patients in the series was small and the followup time too short to determine the length of effectiveness for this treatment. Based on these results, a new protocol has been initiated to randomize patients with advanced T3 and T4 lesions into groups for comparison of adjuvant chemotherapy alone with adjuvant chemoimmunotherapy.

Adjuvants, Immunologic↗

Immunotherapy of malignancies: current status.

The results of various in vitro analyses indicate there is an active immune response against antigens associated with human malignancies. This immune response apparently can be augmented by nonspecific immunologic stimulates such as BCG. These agents are effective for destroying tumor when injected locally into intracutaneous disease but are not as effective for subcutaneous disease. Preliminary clinical trials indicated that immune stimulants are effective when administered systemically. The effect is only minimal for diseminated disease, but the therapeutic benefit is clearly augmented for patients with a minimal residual tumor burden, such as those patients with metastases to regional lymph nodes. Thus immunotherapy is a systemically active mode of therapy. Its toxicity is minimal, and it appears to be effective in a wide spectrum of the disease. However, immunotherapy is not effective for a large residual tumor burden; consequently it must be used in combination with other modes of treatment such as irradiation therapy or chemotherapy. Early experiences with BCG immunotherapy for malignant melanoma and C. parvum for oat cell carcinoma are encouraging. It is remarkable that a nonspecific immunologic stimulant does, in fact, have this effect. Immunotherapy experiments in animals suggest that in order to achieve maximal benefit. BCG must have close contact with tumor cells or must be combined with a tumor-associated antigen. If these principles are true for man, it would seem that improvements for nonspecific immunotherapy in human neoplasms would be further augmented if a tumor-related antigen could be extracted from human tumours and combined with a nonspecific immunologic stimulant.

Animals↗