乳癌疫苗會誘發長期免疫


  Oct. 24, 2003--根據10月22日美國外科醫師協會第89屆臨床會議的一項報告顯示,乳癌疫苗能誘發長期免疫,在12到14高危險病患中,這種疫苗把三分之一乳癌女性會出現的HER2/neu蛋白的縮氨酸E75作為目標,誘發長久的免疫反應。
  
  在華盛頓D.C. Walter Reed陸軍醫療中心的美國外科醫師協會會員,資深作者Craig Shriver博士表示,在我們的研究中,大多數但並非全部病患對於這項治療都有良好的反應。
  
  這項研究紀錄39位於外科、放射療法、或是化學療法後沒有疾病證據,但因為一開始為淋巴節陽性,所以有復發的高危險性之乳癌病患。
  
  在34位有資格接受治療的病患中,14位有細胞表面表現E75縮氨酸的腫瘤,這些病患每位接受一劑100、500μg、或1,000μg的E75及一般免疫刺激藥劑-顆粒細胞巨噬細胞族群刺激的預防接種六次。剩下的20位病患則視為控制組。
  
  免疫力提高的證據在於接種後病患體表血液中的CD8+ T -淋巴球細胞和E75-specific interferon-gamma secreting cells增加,有二位病患產生Grade II 毒性。
  
  在14位注射疫苗的病患中,有12位產生長久性的縮氨酸免疫反應,在平均追蹤期18個月之內,這12位女性並沒有復發,在五年內,淋巴結陽性的女性預期復發的比例為30%到40%。
  
  有注射疫苗但是沒有長久性反應的婦女有復發,但是這些病患的發生期中位數為10個月,都比控制組及罹患可比較的疾病的女性較晚發生,在控制組之中,20位中的其中三位女性在中位數為六個月時癌症復發。
  
  Shriver醫師表示,依據這些首次研究淋巴結陽性的高危險病患所得令人振奮的結果,我們目前的疫苗試驗包含淋巴結陰性的女性,我們試著增加更多符合資格的女性及使非高危險的患者經由注射疫苗而得到陽性的反應。

Breast Cancer Vaccine Can Indu

By Laurie Barclay, MD
Medscape Medical News

Oct. 24, 2003 — A breast cancer vaccine can induce long-term immunity, according to a presentation on Oct. 22 at the 89th Clinical Congress of the American College of Surgeons. This vaccine, targeting peptide E75 of the HER2/neu protein, which is present in one third of women with breast cancer, induced durable immune response in 12 of 14 high-risk patients.

"In our study, most, but not all, patients responded well to this treatment," senior author Craig Shriver, MD, FACS, director of the Clinical Breast Care Project at Walter Reed Army Medical Center in Washington, D.C., told Medscape.

This study enrolled 39 breast cancer patients without evidence of disease after surgery, radiotherapy, or chemotherapy, but who were at high risk for recurrence because they initially had positive lymph nodes. Of 34 who were eligible for treatment, 14 had tumors that expressed the E75 peptide on cell surfaces. These patients each received six vaccinations with E75 and granulocyte-macrophage colony stimulation as a general immunostimulant, at doses of 100 µg, 500 µg, or 1,000 µg. The remaining 20 patients served as controls.

Evidence of enhanced immunity in the vaccinated patients included increased numbers of CD8+ T-lymphocyte cells and E75-specific interferon-gamma secreting cells in the peripheral blood. Grade II toxicity occurred in two patients.

Of the 14 patients who were vaccinated, 12 generated a durable immune response to the peptide. These 12 women have had no recurrences during an average follow-up of 18 months. At five years, the expected rate of recurrence in node-positive women is 30% to 40%.

Both women who were vaccinated but did not have a durable response had recurrences, but these occurred at a median of 10 months, later than in women in the control group and in women with comparable disease. In the control group, three of 20 women had a recurrence of cancer at a median of six months.

"Based on these encouraging results from our first study in high-risk patients with positive nodes, we are now involved in a vaccination trial in node-negative women," Dr. Shriver said. "We're trying to increase eligibility for more women and to get a positive response to vaccination in patients who are not as high risk."

The Clinical Breast Care Project supported this study. The authors report no financial disclosures.

J Am Coll Surg. 2003;197:s81-s82.

Reviewed by Gary D. Vogin, MD

    
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