K. Havemann

Staging and prognostic factors in small cell lung cancer: a consensus report

‘Division of Oncology, Department of Medicine, University Hospital, Zitrich (Switzerland); 2Department of Surgery, Mt. Sinai Hospital, Toronto (Canada); 3Divi 4Department of Internal Medicine, Birpebjerg Hospital, Copenhagen (Denmark); ‘NCI-Navy Medical Oncology Branch, Bethesda, MD (U.S.A.); 6Department OfRadiothcrapy, Medical Academy, Gdansk (Poland); ‘lnstiiut for Cancer Research, Vienna (A@&); ‘Section ofHematologylOncology, Department of Medicine, Dartmouth-HitchcockMedical Center, Hanover.NH (U.S.A.); ‘Department OfMedicine, Central Sygehusel. Hillerod {Denrrmk); and ‘ODepartment of Radiotherapy, Inrtitut Jules Bordet. Brwsels (Belgium)

Dendritic cells derived from peripheral monocytes express endothelial markers and in the presence of angiogenic growth factors differentiate into endothelial-like cells.

CD14-positive monocytes obtained from human peripheral blood were cultured with GM-CSF and IL-4. During the early culture phase immature dendritic cells (DCs) developed which not only expressed CD1a, HLA-DR and CD86, but also expressed the endothelial cell markers von Willebrand factor (vWF), VE-cadherin and VEGF receptors Flt-1 and Flt-4. Further maturation of DCs was achieved by prolonged cultivation with TNFalpha. These cells showed typical DC morphology and like professional antigen-presenting cells (APCs) expressed CD83 and high levels of HLA-DR and CD86. However, if immature DCs were grown with VEGF, bFGF and IGF-1 on fibronectin/vitronectin-coated culture dishes, a marked change in morphology into caudated or oval cells occurred. In the presence of these angiogenic growth factors the cultured cells developed into endothelial-like cells (ELCs), characterized by increased expression of vWF, KDR and Flt-4 and a disappearance of CD1a and CD83. Addition of IL-4 and Oncostatin M also increased VE-cadherin expression, and the loosely adherent cells formed clusters, cobblestones and network-like structures. vWF- expressing ELCs mainly originated from CD1a-positive cells, and VEGF was responsible for the decrease in the expression of the DC markers CD1a and CD83. In mixed leukocyte cultures, mature DCs were more potent APCs than ELCs. Moreover, Ac-LDL uptake, and the formation of tubular structures on a plasma matrix was restricted to ELCs. These results suggest that in the presence of specific cytokines immature DCs have the potential to differentiate along different lineages, i.e. into a cell type resembling ELCs.

Physiology and Pathophysiology of Neutral Proteinases of Human Granulocytes

The occurence of proteolytic enzymes in polymorphonuclear granulocytes was first demonstrated in 1888 by the famous clinician and biochemist Friedrich von Muller1 who showed that a glycerine extract of fresh pus digests fibrin or coagulated protein at a neutral or weakly alkaline pH. Later on at the end of the last and the beginning of this century further characterization of the enzymes including their serum antiproteases was achieved by German and American scientists2,3,4. However, the neutral proteases then became largely forgotten as the result of the attention paid to the acid-cathepsins of the rabbit leukocyte, a convenient but somewhat misleading cell.

Steroid-hormone receptors in cell lines and tumor biopsies of human lung cancer

Female gender is a significant independent favorable prognostic factor in lung cancer. To study the possible role of sex hormones in lung cancer, the expression of sex‐steroid receptors and the glucocorticoid receptor was investigated in 29 lung‐cancer cell lines stemming from small‐cell lung cancer (SCLC) and non‐small‐cell lung cancer (NSCLC) by means of immunocytochemistry, ligand‐binding assays and RNA expression via polymerase chain reaction. In at least 2 methods of investigation, NSCLC cell lines showed a low expression of estrogen receptor in 6, progesterone receptor in 13 and androgen receptor in 12 out of 17 cases examined; sex‐steroid‐receptor expression was virtually absent in SCLC cell lines. The glucocorticoid receptor was expressed in all 29 cell lines studied. Additionally, 52 tumor samples from primary lung cancer were investigated for their receptor expression by means of immunohistochemistry. Among patients with primary lung‐cancer sex‐steroid‐receptor expression in tumor biopsies was detected most frequently in female patients (in 69% of 16 cases, vs. 42% of 36 tumors from men) and in patients with adenocarcinoma. Further research will focus on these subgroups. Immunohistology is a feasible method of studying steroid‐receptor expression in lung cancer.

Effect of elastase-like and chymotrypsin-like neutral proteases from human granulocytes on isolated clotting factors.

Abstract Elastase-like and chymotrypsin-like proteolytic enzymes isolated from human granulocytes were investigated for their influence on several purified clotting factors. The elastase-like proteases induce a rapid destruction of fibrinogen, factor VIII, XII and XIII activity whereas a moderate effect on factor V activity is observed. The chymotrypsin-like enzymes show a rapid inactivation of factor VIII, moderate effect on factor VII and XII and only weak activity against fibrinogen and factor XIII. Both groups of enzymes are ineffective against prothrombin whereas incubation with factor V leads to a transitory activation. The possible role of these enzymes in physiological and pathological hemostasis is discussed.

Analysis of prognostic factors in 766 patients with small cell lung cancer (SCLC): the role of sex as a predictor for survival.

The data of 766 patients participating in three German multicentre trials were analysed with regard to the relationship between baseline characteristics and prognosis in small cell lung cancer (SCLC). The central aim of this analysis has been to evaluate the role of gender as an independent prognostic factor in SCLC. The minimum follow-up period for the 652 male and 114 female patients was 36 months. Female patients were shown to have a higher complete remission rate (35% vs 25%), a superior median survival (ms) (12.1 months (mo) vs 9.8 mo), and a favourable 2-year survival rate (2ys) (19% vs 8%) to male ones. Various other prognostic factors have been proved to be significant, such as extent of disease, clinical performance status, and history of smoking, whereas weight loss prior to chemotherapy and age have been less important factors. We have been able to ascertain that womens responses were better than those of male patients independent of any other relevant prognostic variable. Furthermore, results were found to be even more advantageous for female patients with additional favourable prognostic parameters, i.e. for patients with limited disease (ms 15.2 mo vs 12.0 mo; 2ys 29% vs 9%) or with good performance status (ms 13.4 mo vs 10.4 mo; 2ys 24% vs 7%). A most remarkable observation was made in that the favourable prognostic effect of the female gender was restricted to patients aged less than 60 years (ms 13.3 mo vs 10.1 mo; 2ys 26% vs 5%), whereas for older women no advantages over mens results were established (ms 9.3 ml vs 9.1 mo; 2ys 8% vs 7%). A proportion of 32% of female patients with limited disease aged less than 60 years achieved a 3-year survival rate. We conclude (a) that sex constitutes a major prognostic factor in SCLC and is especially useful as a predictor for long-term survival, and (b) that the favourable prognostic value of the female sex is restricted to younger patients.

Severe lymphocytopenia and interstitial pneumonia in patients treated with paclitaxel and simultaneous radiotherapy for non-small-cell lung cancer.

PURPOSE In a phase II trial with paclitaxel and simultaneous radiotherapy in non-small-cell lung cancer (NSCLC) patients, an unexpected high incidence of interstitial pneumonias was observed. The type of immunodeficiency associated with this treatment approach is characterized. PATIENTS AND METHODS Fifteen patients with inoperable stage IIIA/B NSCLC were treated with paclitaxel as a 3-hour infusion on day 1 in weeks 1 to 3 and 6 to 8 at dose levels between 50 mg/m2 and 86 mg/m2 and with simultaneous radiotherapy in daily doses of 2 Gy, 5 days per week, in weeks 1 to 3 and 6 to 8 up to a total dose of 56 Gy. Hematologic parameters and lymphocyte subsets were monitored. RESULTS Fourteen patients are assessable for response. The overall response rate was 78%, with four major responses, six partial remissions, and four minor responses. The major toxic effect observed was a moderate to severe protracted lymphocytopenia (380 +/- 310/microL) in all patients. Seven patients developed moderate to severe interstitial pneumonia; one had an additional herpes zoster infection, while an eighth patient had a cytomegalovirus infection. During treatment, all lymphocyte subsets were reduced, as follows (n = 9, mean +/- SD): CD4+ T cells (100 +/- 90/microL), CD8+ T cells (130 +/- 160/microL), natural killer (NK) cells (70 +/- 80/microL), and B cells (20 +/- 10/microL). Thus, the most pronounced toxicity was seen in CD4+ T and B cells. There was no recovery of lymphocyte subsets during a 3-month follow-up period. CONCLUSION Paclitaxel with simultaneous radiation induces lymphocytopenia and promotes opportunistic infections. Long-term antibiotic and antimycotic prophylaxis is recommended. Whether the lymphocytopenia is an additive effect of paclitaxel and radiation or whether it can be induced by low-dose weekly paclitaxel alone remains to be determined.

Ectopic hormones in lung cancer patients at diagnosis and during therapy

In roughly 110 patients with lung cancer of various histologic types, the levels of hormones adrenocorticotropin (ACTH), calcitonin, parathormone, beta‐choriogonadotropin (HCG), human placental lactogen (HPL), growth hormone (HGH), and prolactin were determined by radioimmunoassay. The ACTH level was elevated in 30% of patients with oat cell carcinoma and in 26% of patients with large cell carcinoma. Calcitonin levels were increased in 48% of patients with oat cell carcinoma. Elevated levels of HCG were found in 33% of patients with oat cell carcinoma, in 26% of patients with large cell carcinoma, and in 19% of patients with squamous cell carcinoma. Parathormone was increased in 32% of patients with squamous cell carcinoma, in 27% of patients with oat cell carcinoma, and in a few patients with large cell carcinoma. Prolactin, HCG and HPL were present only in single cases. Elevated levels of at least one hormone were found in 65.2% of all patients, and in 78% of the patients with oat cell carcinoma. Serial determinations of ACTH and calcitonin showed that these hormones are useful for monitoring therapy in lung patients. There was no relation between hormone levels and the clinical stage of disease.

Growth-inhibitory effects of vitamin D analogues and retinoids on human pancreatic cancer cells.

Retinoids and vitamin D are important factors that regulate cellular growth and differentiation. An additive growth-inhibitory effect of retinoids and vitamin D analogues has been demonstrated for human myeloma, leukaemic and breast cancer cells. We set out to study the effects of the vitamin D analogue EB1089 and the retinoids all-trans- and 9-cis-retinoic acid on the human pancreatic adenocarcinoma cell lines Capan 1 and Capan 2 and the undifferentiated pancreatic carcinoma cell line Hs766T. The cell lines investigated expressed vitamin D receptor, retinoic acid receptor (RAR)-alpha and gamma as determined by polymerase chain reaction after reverse transcription. RAR-beta was expressed only in Hs766T cells. Addition of all-trans-retinoic acid increased the amount of RAR-alpha mRNA in the three cell lines and induced RAR-beta mRNA in Capan 1 and Capan 2 cells. All-trans-retinoic acid at a concentration of 10 nM inhibited the growth of Capan 1 and Capan 2 cells by 40% relative to controls. 9-cis-Retinoic acid was less effective. Neither all-trans-retinoic acid nor 9-cis-retinoic acid affected the growth of Hs766T cells. EB1089, if added alone to the cells, did not significantly inhibit growth. However, the combination of 1 nM EB1089 with 10 nM all-trans-retinoic acid exerted a growth-inhibitory effect of 90% in Capan 1 cells and of 70% in Capan 2 cells. Our data suggest that vitamin D analogues together with retinoids inhibit the growth of human pancreatic cancer cells. However, in vivo studies are necessary to examine the potential use of retinoids and vitamin D analogues on pancreatic cancer.

Expression of insulin-like growth factor receptors I and II in normal human lung and in lung cancer

Insulin-like growth factors are potent mitogenic factors in human lung cancer in vitro, acting via specific receptors. Using monoclonal antibodies we demonstrate the expression of insulin-like growth factor receptor I in bronchial epithelial cells of normal lung and in primary lung cancer (22/24 cases), being most prominent in squamous cell carcinoma. Electron microscopy on lung cancer cell lines reveals a distinct reaction pattern on the plasma membrane. Immunoreaction with a specific antibody directed against the insulin-like growth factor receptor II suggests a weak expression in primary lung cancer. Our findings underline the significance of the autocrine pathway of insulin-like growth factors in lung cancer.