Cellular Immune Reactions in Patients with Bronchogenic Carcinoma before and after Radio-, Chemo-and Immunotherapy

Abstract

Cellular immunity was determined by in vivo and in vitro tests in 50 patients with lung cancer before and after X-ray, chemo- and immunotherapy (BCG and Levamisole). The following tests were performed: skin tests with ubiquitous antigens (Streptococcus, Staphylococcus, Candida, Trichophyton) and PPD, lymphocyte cultures with PHA, CONA-Sepharose and PPD. In patients with lung cancer in vivo response to antigens and lymphocyte transformation in vitro were impaired in contrast to age- and sex-matched controls. A further temporary impairment of cellular immunity was seen after X-ray and after chemotherapy. Immunotherapy with BCG or Levamisole caused increased skin reactions and lymphocytic response to PPD. In general patients with a poor prognosis had a more depressed cellular immunity than patients who survived longer.A good deal of evidence exists indicating that cell-mediated immunity is of considerable importance in resistance to tumor growth (12, 16, 18, 20). Furthermore, patients with malignancies often show defects in cell-mediated immunity against non-tumor antigens, as demonstrated in vivo by delayed-type skin reactivity to commonly encountered antigens and in vitro by lymphocyte transformation tests (1, 7, 13, 28).This impaired immune response in vivo and in vitro seems to be related to the histologic type of the tumor. Whereas in patients with certain tumor types skin reactions to common antigens and lymphocyte response to mitogens and antigens correlate well with the clinical stage (6, 21), the results in carcinoma of the lung are contradictory (3, 8, 19, 24). No reports are available on the relationship of these parameters to the subsequent course of lung cancer. Furthermore, the influence of the therapeutic regimens, such as X-ray treatment, chemotherapy and immunotherapy on cell mediated immune reactions in patients with bronchogenic carcinoma has not so far been investigated in detail.We recently initiated an immunotherapy program in X-ray treated patients with limited bronchogenic carcinoma and a polychemotherapy program in those with extended disease. The purpose of this study was to evaluate whether in vivo and in vitro immune response to non-tumor antigens and non-specific mitogens in non-treated patients correlates with the prognosis and whether the different treatment programs influence in vivo and in vitro reactivity.