Loren J. Humphrey

High mortality after abdominal operation in patients with large-volume malignant ascites

Advanced intra‐abdominal cancers are frequently associated with malignant ascites. The aim of this study was to document the frequency and clinical course of patients found to have large‐volume (≥3 L) malignant ascites when undergoing a major abdominal operation. Between October 1, 1987 and September 1, 1992, 385 patients with malignant ascites were admitted to hospitals associated with a university medical center. Seventeen with large volume ascites underwent exploration for palliation of bowel obstruction or debulking of tumor. Operative mortality was 41% and mortality correlated with the presence of a nonovarian primary and advanced age. We conclude that patients with large volume nonovarian malignant ascites have a high mortality rate following a major abdominal operation. New approaches such as neoadjuvant or intraperitoneal chemotherapy or possibly peritoneovenous shunt placement at the time of the abdominal operation, are needed to improve the dismal results in this subgroup of patients.

Further observations on Fc receptors in human malignant tissue and normal lymphoid tissue

Twenty human malignant solid tumors of various histologic types were tested for the presence of Fc receptor using cryostat sections or single cell suspensions of fresh tissue. Sheep erythrocytes sensitized by various amounts of rabbit IgG antibodies served as indicator cells (EA). All tumors possessed Fc receptor, but to varying degrees; eight reacted more strongly than normal spleen without any relation to histologic type. The tumors which gave the strongest reactions in sections also formed the highest percent of EA rosettes in suspensions, thus indicating surface localization of receptors. The reactions with spleen sections localized to the B cell and monocytic areas; the latter also showed high avidity in reactions with uncomplexed IgG. Rabbit antisera to tumors, spleen, and peripheral lymphocytes (polyvalent ALS) inhibited the reactions, while a T‐cell‐specific ALS did not. Absorptions of the antisera with lymphocytes or tissue sediments of spleen and tumors removed the inhibiting activity, but sediments of muscle and kidney only reduced the titers. Again, results with spleen sections paralleled those obtained with tumor sections. Apparently, the tumor Fc receptor is very similar to the Fc receptors present in normal lymphoreticular tissues.

Serum antibody in patients with mammary disease

Antibody to a breast cancer antigen was detected by immunodiffusion or complement fixation in at least one serum sample in 46% of 84 patients with a diagnosis of carcinoma, 34% of 96 patients with fibrocystic disease, and 25% of 44 patients with fibroadenoma. A single serum sample obtained from screenees of the Detection Center for Breast Diseases was tested by immunodiffusion only, and antibody was found in 3 of 206 screenees (1.5%). Eleven of 13 patients with breast cancer metastatic to lymph nodes and no detectable serum antibody either had recurrence or were dead within 12 months of mastectomy. Fifteen of 18 patients with breast cancer metastatic to lymph nodes and with detectable serum antibody were alive and free of disease for up to 24 months. Data to date indicate that serum antibody in the patient with breast disease cannot be used at this time as an “early detection test.” As a seroprognostic factor in patients with breast cancer metastatic to lymph nodes, the finding of antibody has great promise.

Primary Culture Inhibition Test

Sera from patients in our immunotherapy program are evaluated by testing in the primary culture inhibition test (PCI), which we describe here as a sensitive indicator of antitumor activity in these se

Studies of receptors on normal and malignant tissue from man

Receptor studies on normal and malignant human tissues were carried out. Erythrocyte receptor studies failed to show differences between malignant and normal tissues; both apparently have a receptor for rat erythrocytes, a hemolysin for monkey erythrocytes, and an agglutinin for rabbit erythrocytes.

COMPARISON OF ALLOGENEIC TUMOR VACCINE WITH LEUKOCYTE TRANSFER AND TRANSFER FACTOR TREATMENT OF HUMAN CANCER

Adoptive immunotherapy hinges on the concept that tumor progression is permitted by the host when specific immune factors are missing or reduced and that these factors can be transferred to the tumor-bearing host from other individuals in whom the immune factors are present. Two systems of adoptive immunotherapy have been developed. In the first, naturally occurring specific antitumor immune responsiveness is sought after in siblings or other relatives of the host, and immune factors are usually transferred by employing extracts of leukocytes similar or identical to transfer factor (LTF), as first described by Lawrence.l Studies reported by Fudenberg et ~ l . , ~ in patients with osteogenic sarcoma and melanoma, and by LoBuglio et al., in a patient with alveolar soft-parts sarcoma, are representative of this system. The second system involves active stimulation of paired patients with each others tumors, followed by an exchange of leukocytes, which hopefully contain immunologic activity or information capable of restoring the missing factors. Nadler and Moore reported several patients who demonstrated tumor regression with this system. Krementz and Samuels 5 later confirmed this observation. Humphrey et aL6 demonstrated that the same clinical response could be obtained by immunization with cell-free tumor homogenates rather than whole tumor cells and later reported 7 improved results with a concentrated tumor homogenate extract as the immunizing agent In this study, patients with melanoma and other malignant neoplasms were randomized to treatment with allogeneic cell products plus exchange of white blood cells or with irradiated whole tumor cells plus exchange of LTF. Preliminary observations indicate that LTF produced measurable adoptive effects and may transmit antitumor activity better than whole leukocytes.

Chemotherapy for Recurrent Carcinoma of the Breast

This report describes the indications for our method of using chemotherapy for the patient with cancer of the breast. Adjuvant chemotherapy at the time of curative resection is still experimental. The