Effect of neo-adjuvant levamisole on local immune response in breast cancer

Abstract

Background: Immunotherapy for the treatment of malignancies is based on the concept that cancer cell might be specifically antigenic or that immune response is diminished in patients with cancer. Levamisole is a synthetic phenylimidazolthiazole that has been used in adjuvant chemoimmunotherapy in colon, rectal, stomach, and breast cancer. Only limited studies have been conducted regarding the use of immunomodulators in breast cancer. The aim of this study was to evaluate the effect of the addition of Levamisole to neo-adjuvant chemotherapy on local immune response in invasive breast cancer. Materials and Methods: A total of 27 consecutive patients with biopsy-proven breast cancer scheduled for neo-adjuvant chemotherapy were included in the study. Levamisole 50 mg thrice daily for 3 days, repeated at 2 weekly intervals, was given along with three cycles of neo-adjuvant cyclophosphamide 500 mg/m 2 , adriamycin 50 mg/m 2 , 5-FU 500 mg/m 2 (CAF) given at 3-weekly intervals. Assessment of lymphocytic infiltration of tumor stroma was done before and after completing neo-adjuvant chemoimmunotherapy. Results: There was an increase in tumor infiltrating lymphocytes in 81.48% of patients after administration of Levamisole-based neo-adjuvant chemoimmunotherapy. In 75% of patients with clinical response to neo-adjuvant chemoimmunotherapy, there was an increase in tumor-infiltrating lymphocytes. In addition, in 68.2% of patients with an increase in tumor infiltrating lymphocytes, there was a clinical response to therapy. Conclusions: Our study suggests an immunostimulatory effect of Levamisole in breast cancer when given along with neo-adjuvant chemotherapy. However, a larger series is required to determine the clinical significance of these findings and whether neo-adjuvant chemoimmunotherapy should be recommended for routine use in breast cancer.