Abstract
An immunological profile has been serially studied in 72 patients with advanced breast cancer during the course of a randomized trial of chemotherapy and hormonal manipulation. DNCB+ patients were more likely to respond to either therapy, but no other test was predictive of response. In the follow-up period all chemotherapy patients had a reduction in white-cell count which was significantly greater in those responding to treatment. None of the other tests (phytohaemagglutinin response, immunoglobulins G, A and M, or Mantoux test) demonstrated changes that could be related to treatment or response, but there was a gradual unexplained fall in IgM levels in all groups the study progressed. It is concluded that the chemotherapeutic regimen (cyclophosphamide, vincristine, adriamycin and 5-fluorouracil) is relatively non-immunosuppressive, and that hormonal therapy (oophorectomy, tamoxifen or androgens) had no detectable effect on the immune response.
Highlights
PATIENTS AND METHODSWAomen with advanced breast cancer who had not had previous systemic treatment were randomly allocated to receive either endocrine manipulation or chemotherapy (Priestman et al, 1977)
Summary.-An immunological profile has been serially studied in 72 patients with advanced breast cancer during the course of a randomized trial of chemotherapy and hormonal manipulation
CHEMOTHERAPY has an established part to play in the management of breast cancer, even to the extent that it has been suggested that endocrine manipulation is obsolete (Edelstyn & Macrae, 1973)
Summary
WAomen with advanced breast cancer who had not had previous systemic treatment were randomly allocated to receive either endocrine manipulation or chemotherapy (Priestman et al, 1977). Endocrine therapy, selected on the basis of previous experience and depending on menopausal status and extent of disease, was predetermined by the protocol The profile consisted of delayed hypersensitivity reactions to a new antigen, dinitrochlorobenzene (DNCB), and a recall antigen, tuberculin, total white cell and differential count, lymphoblastogenic stimulation in response to phytohaemagglutinin (PHA) and measurements of the immunoglobulin classes G, A and M. Bolton et al (1976) have described our technique for the DNCB test but, because of the relatively small numbers in each group, responses have been reported as only negative or positive. The response to 3 doses was expressed as a response curve, which for each test is recorded as normal (positive) when there is maximal response to a dose of 0-8 mg/ml PHA, or abnormal (negative) when the maximal response is to a higher dose (4 mg/ml). Statistical analysis is by Student's t test or by Chi-square test as appropriate
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