Clinical Research Papers:
Comprehensive immunotherapy combined with intratumoral injection of zoledronate-pulsed dendritic cells, intravenous adoptive activated T lymphocyte and gemcitabine in unresectable locally advanced pancreatic carcinoma: a phase I/II trial
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Yoshiki Hirooka1, Hiroki Kawashima2, Eizaburo Ohno2, Takuya Ishikawa2, Takashi Kamigaki3,4, Shigenori Goto3, Masashi Takahara5 and Hidemi Goto2
1Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
2Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
3Seta Clinic, Tokyo, Japan
4Department of Next Generation Cell and Immune Therapy, Juntendo University School of Medicine, Tokyo, Japan
5Medinet Medical Institute, MEDINET Co. Ltd., Yokohama, Japan
Yoshiki Hirooka, email: [email protected]
Keywords: immunotherapy; zoledronate-pulsed DCs; gemcitabine; advanced pancreatic carcinoma; EUS-guided FNA
Received: October 19, 2017 Accepted: November 15, 2017 Published: December 05, 2017
Dendritic cell (DC)-based vaccines prepared using various antigen loading methods have been studied for cancer immunotherapy. The in vivo provocation of immunity by the direct injection of DCs without using tumor-specific antigens into tumors after apoptosis-inducing chemotherapy is more applicable. We previously reported that zoledronate-pulsed DCs (Zol-DCs) may induce tumor-antigen-specific CD8+ T cells by activating Vγ9γδT cells. In this report, we studied the feasibility, safety, and efficacy of a comprehensive immunotherapy involving the combined intratumoral injection of Zol-DC, gemcitabine (GEM) and αβT cells in locally advanced pancreatic carcinoma. Seven of 15 patients showed a stable disease (SD) and most of the patients showed long-term clinical responses. The FACT-BRM score was significantly higher in the patients with SD. Additionally the CD8+/Treg ratio significantly increased in SD patients after treatment. The median over-all survival and progression-free-survival of 15 patients were 12.0 months and 5.5 months, respectively. Patients with a pretreatment neutrophil/lymphocyte ratio (NLR) lower than 5.0 showed significantly longer survival. Even in an analysis limited to the patients with an NLR lower than 5.0, the patients whose CD8+/Treg ratio increased more than twofold tended to survive longer. In conclusion, the comprehensive immunotherapy using Zol-DCs, systemic αβT cells, and GEM may synergistically show a therapeutic effect on locally advanced pancreatic carcinoma. By using appropriate and precise biomarkers, such as NLR and CD8+/Treg ratio, the present comprehensive immunotherapy could be more beneficial for patients with pancreatic carcinoma.
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