Preoperative treatment of murine C1300-neuroblastoma (C1300) with triple immunotherapy using low-dose cyclophosphamide (CY), retinyl palmitate (RP), and interleukin-2 (IL2), followed by tumor resection leads to significant initial tumor control and prolonged survival. However, because long-term tumor recurrence is 67%, the efficacy of continued postoperative immunotherapy is now evaluated. Thirty-two A J mice with 1 cm subcutaneous C1300 tumors were treated for 13 days with CY-100 mg/kg, intraperitoneally (IP), on day 2 of treatment then 25 mg/kg on day 9, RP-2500 IU IP 2 x/week, and IL2 1.6 × 10 5 U IP BID on days 4 to 9 and 11 to 13. On day 14, mice were divided into five treatment groups: (1) OP (operated-tumor resection, n = 6); (2) OP + CY (resection and postoperative CY, n = 7); (3) OP+CY+RP (resection and postoperative CY+RP, n = 7); (4) OP+CY+RP+IL2 (resection and postoperative CY+RP+IL2, n = 7); and (5) CY+RP+IL2 (continued CY+RP+IL2 with no resection, n = 5). Survival and postoperative tumor recurrence were followed for 60 days. The cure rates were group 1 33% ( 2 6 ), group 2 43% ( 3 7 ), group 3 29% ( 2 7 ), group 4 71% ( 5 7 ), and group 5 20% ( 1 5 ). After surgery, tumors that recurred did so in 8 to 22 days, with no statistical difference noted between groups. MHC class I antigenic expression of tumors resected on day 14 and recurrent tumors was determined with monoclonal antibodies and flow cytometry. In tumors resected on day 14, class I expression measured by mean fluorescence, was 374.8 ± 27.40. Recurrent tumors in all groups expressed significantly less class I antigen (230.7 ± 38.32) than the original tumors. Because class I expression is important for cell-mediated tumor lysis, the low expression in the recurrent tumors suggests that the mechanism of their recurrence and resistance to preoperative immunotherapy was through escape of host antitumor immunosurveillance. Because the best overall results, with 71% cures, were obtained with continued postoperative triple immunotherapy despite the presence of viable immunoresistant cells, the success of continuing the triple-drug regimen suggests that the mechanism of action of the regimen may not be purely immunotherapeutic but chemotherapeutic as well.
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