Heys S D, Deehan D J, Eremin O
Department of Surgery, University of Aberdeen, UK.
Eur J Surg Oncol. 1994 Dec;20(6):622-9.
Recent interest in the treatment of advanced colorectal cancer with immunotherapy has focused on the use of recombinant interleukin 2 (rIL2). These studies have shown that rIL2 used alone, in combination with lymphokine-activated killer (LAK) cells or tumour-infiltrating lymphocytes (TILs), has little anti-tumour activity, with low, short-lived clinical responses being documented. However, phase I and II studies evaluating rIL2 in combination with 5-fluorouracil (5FU) or 5FU and leucovorin (LV) have been more encouraging, with response rates of up to 46% being reported. Only one randomized, controlled study, however, has compared rIL2 combined with 5FU/LV vs 5FU/LV alone. Although there was no difference in tumour response rates between the two groups, there was a doubling in the median survival of those patients in the poor performance status group (ECOG 1). Also, studies have evaluated the effects of rIL2, given in the peri-operative period, on reversing the immunosuppression that occurs following 'curative' resection for colorectal cancer. These studies have shown an abrogation of immune suppression induced by surgery and an enhancement of host anti-tumour defence mechanisms in the peri-operative period, a time when active tumour dissemination has been shown to occur. These results may have important implications for the management of those patients with malignant disease who are undergoing major curative surgery.
近期，免疫疗法治疗晚期结直肠癌的研究重点集中在重组白细胞介素2（rIL2）的应用上。这些研究表明，单独使用rIL2、或将其与淋巴因子激活的杀伤细胞（LAK）或肿瘤浸润淋巴细胞（TIL）联合使用时，抗肿瘤活性很小，临床反应低且持续时间短。然而，评估rIL2与5-氟尿嘧啶（5FU）或5FU和亚叶酸（LV）联合使用的I期和II期研究结果更令人鼓舞，报告的缓解率高达46%。然而，只有一项随机对照研究比较了rIL2联合5FU/LV与单纯5FU/LV的疗效。尽管两组的肿瘤反应率没有差异，但在体能状态较差的患者组（东部肿瘤协作组1级）中，患者的中位生存期延长了一倍。此外，还有研究评估了围手术期给予rIL2对逆转结直肠癌“根治性”切除术后发生的免疫抑制的作用。这些研究表明，手术诱导的免疫抑制被消除，围手术期宿主抗肿瘤防御机制得到增强，而这一时期已证实会发生活跃的肿瘤播散。这些结果可能对接受大型根治性手术的恶性疾病患者的管理具有重要意义。
