Massive Tumor Burden Research Articles

Neuroblastoma — Linking a Common Allele to a Rare Disease

Neuroblastoma has a notorious reputation among solid tumors of childhood because of its frequently massive and widespread tumor burden. Yet stage for stage, this embryonal neoplasm of the sympathet...

Hepatic Arterial Embolization and Chemoembolization in the Management of Patients with Large-Volume Liver Metastases

The purpose of this study was to assess the role of hepatic arterial embolization (HAE) and chemoembolization (HACE) in patients with large-volume liver metastases. Patients with metastatic neuroendocrine tumors, melanomas, or gastrointestinal stromal tumors (GISTs) with >75% liver involvement who underwent HAE or HACE were included in the study. Radiologic response, progression-free survival (PFS), overall survival (OS), and postprocedure complications were assessed. Sixty patients underwent 123 treatment sessions. Of the 48 patients for whom follow-up imaging was available, partial response was seen in 12 (25%) patients, minimal response in 6 (12%), stable disease in 22 (46%), and progressive disease in 8 (17%). Median OS and PFS were 9.3 and 4.9 months, respectively. Treatment resulted in radiologic response or disease stabilization in 82% and symptomatic response in 65% of patients with neuroendocrine tumors. Patients with neuroendocrine tumors had higher response rates (44% vs. 27% and 0%; p = 0.31) and longer PFS (9.2 vs. 2.0 and 2.3 months; p < 0.0001) and OS (17.9 vs. 2.4 and 2.3 months; p < 0.0001) compared to patients with melanomas and GISTs. Major complications occurred in 21 patients after 23 (19%) of the 123 sessions. Nine of the 12 patients who developed major complications resulting in death had additional risk factors--carcinoid heart disease, sepsis, rapidly worsening performance status, or anasarca. In conclusion, in patients with neuroendocrine tumors with >75% liver involvement, HAE/HACE resulted in symptom palliation and radiologic response or disease stabilization in the majority of patients. Patients with hepatic metastases from melanomas and GISTs, however, did not show any appreciable benefit from this procedure. Patients with massive liver tumor burden, who have additional risk factors, should not be subjected to HAE/HACE because of the high risk of procedure-related mortality.

The emerging role of immunotoxins in leukemia and lymphoma

Despite important advances in conventional cancer therapy, there is still a strong need for new approaches in order to reduce cancer death rates, which have not been drastically influenced in the past ten years. Since minimal residual disease is regarded as the major cause for relapses of malignant diseases, immunotherapeutic strategies utilizing monoclonal antibodies (MoAbs) or their conjugates to target 'dormant' tumor cells have increasingly attracted scientific interest. Immunotoxins (ITs) constructed by chemically linking plant or bacterial toxins to a MoAb can selectively kill their target cells when internalized after binding to specific cell surface receptors. Many different ITs against various blood-borne as well as solid malignancies have been successfully tested in vitro and in animal models. Chemically linked ITs and recombinant fusion toxins generated by using DNA technologies are currently being evaluated for their antitumor activity in several clinical phase I/II/III trials. While serious side effects are rare, there are still many problems to be solved, such as the immunogenicity of the toxin and/or antibody moiety or the poor capacity of ITs to penetrate large solid tumors. At the moment only heavily pretreated patients with massive tumor burden are admitted to early clinical studies, so that even minor responses after IT treatment are encouraging. However, minimal residual disease is expected to be most amenable to IT therapy.

Treatment of renal cell carcinoma with renal infarction, delayed nephrectomy, medroxyprogesterone, and xenogeneic immune RNA

The authors have used xenogeneic immune ribonucleic acid (RNA) in the treatment of patients with renal cell carcinoma. This has been used in conjunction with renal artery embolization, delayed nephrectomy, and progestational therapy, using immune RNA derived from sheep cell lymphocytes immunized with patient's tumor. Four of 5 patients with Stage I disease had extremely large primary tumors. This group is alive with no evidence of disease at twelve to twenty-four months. There are no Stage II tumors in this group. One patient with Stage III tumor is alive at twenty-two months without evidence of disease. Three patients with metastases are stable at five to twenty-two months. Two patients have progressive disease at three and six months. This treatment has not been effective in patients with massive tumor burden. The results in the other groups are encouraging.