Kazuo Matai

Immunotherapy using fusions of autologous dendritic cells and tumor cells showed effective clinical response in a patient with advanced gastric carcinoma

Immunotherapy using tumor antigen-loaded dendritic cells is a new approach for the treatment of various types of malignant tumors. Here, we describe a patient with advanced gastric carcinoma who received immunotherapy using fused autologous dendritic cells and carcinoma cells (fusions) and showed effective clinical responses to the treatment. A 74-year-old man showed massive ascitic effusion due to peritonitis carcinomatosa after surgical operation for gastric carcinoma. A gastric carcinoma cell line was established from the patient’s tumor tissue. Dendritic cells were obtained by cultivation of the adherent cell fraction of the patient’s peripheral blood mononuclear cells (PBMCs) with granulocyte macrophage-colony stimulating factor, interleukin-4, and tumor necrosis factor-alpha. The cells were mixed with irradiated tumor cells and treated with 50% polyethyleneglycol (PEG) for the generation of fusions, as described previously. The PEG-treated cells were injected subcutaneously every 2 weeks. Low-grade fever was observed after the first and second treatments. After the third treatment, ascitic effusion and leg edema decreased markedly, without any other treatments. Serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 decreased to levels lower than those at the initiation of treatment. PBMCs collected after the fifth treatment elicited cytotoxic activity against autologous tumor cells. Although treatment was continued in the same way, recurrence of the disease was observed about 5 months after the start of the treatment. This is the first report of immunotherapy utilizing fusions of autologous dendritic cells and tumor cells resulting in effective clinical responses in advanced gastric carcinoma, without severe adverse effects.

A White Tone Sessile Type Polyp; Submucosal Invasion Sigmoid Colon Cancer - 6 mm in a Diameter

A 53-year-old woman received a total colonoscopy for a FOBT (Faecal Occult Blood Test) positive and detected a sessile type poly in the sigmoid colon. Colonoscopy exhibited a “somewhat of a white tone” and measured 6 mm sessile type poly, with no irregular pit pattern, and suspected an adenoma. Also, endoscopic mucosal resection was done. The pathological diagnosis was a well differentiated adenocarcinoma and the depth of invasion was 1,200 micron. Submucosal invasive adenocarcinoma with 6 mm, non-depressive sessile type case is very rare. Therefore, one should recommended an endoscopic mucosal resection, not observation, when the endoscopic findings was recognized a “white tone” sessile type polyp.

The Role of Absolute Noncurative Gastrectomy for Primary Gastric Cancer

One hundred patients underwent a palliative procedure for primary gastric cancer between 1975 and 1984. Palliative partial resection of the stomach was performed in 59 patients, gastrojejunostomy in 17 patients, laparotomy and closure in 21 patients, and other palliative procedures in 3 patients. In cases without a distant metastasis to the peritoneum, the mean survival time after noncurative gastrectomy was significantly longer than that after other palliative procedures (16.4 versus 10.6 months, respectively). Similarly, in the absence of metastases to both liver lobes, there was a significant difference between the two groups with regard to the mean survival time.