Metronomic cyclophosphamide treatment in metastasized breast cancer patients: immunological effects and clinical outcome

Severe immune suppression is frequent in late-stage tumor patients and promotes tumor immune evasion and subsequent tumor progression. Regulatory T cells (Treg) are major suppressors of anti-tumor immune responses. Therefore, targeting of Treg has become a key goal of anti-tumor therapy. Several pre...

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Hauptverfasser: Ge, Yingzi (VerfasserIn) , Domschke, Christoph (VerfasserIn) , Schott, Sarah (VerfasserIn) , Heil, Jörg (VerfasserIn) , Rom, Joachim (VerfasserIn) , Blumenstein, Maria (VerfasserIn) , Thum, Janina (VerfasserIn) , Sohn, Christof (VerfasserIn) , Schneeweiss, Andreas (VerfasserIn) , Beckhove, Philipp (VerfasserIn) , Schütz, Florian (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 2012
In: Cancer immunology immunotherapy
Year: 2011, Jahrgang: 61, Heft: 3, Pages: 353-362
ISSN:1432-0851
DOI:10.1007/s00262-011-1106-3
Online-Zugang:Verlag, Volltext: http://dx.doi.org/10.1007/s00262-011-1106-3
Verlag, Volltext: https://link.springer.com/article/10.1007/s00262-011-1106-3
Volltext
Verfasserangaben:Yingzi Ge, Christoph Domschke, Natalija Stoiber, Sarah Schott, Joerg Heil, Joachim Rom, Maria Blumenstein, Janina Thum, Christof Sohn, Andreas Schneeweiss, Philipp Beckhove, Florian Schuetz

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520 |a Severe immune suppression is frequent in late-stage tumor patients and promotes tumor immune evasion and subsequent tumor progression. Regulatory T cells (Treg) are major suppressors of anti-tumor immune responses. Therefore, targeting of Treg has become a key goal of anti-tumor therapy. Several preclinical and clinical observations suggest that Treg can be depleted by cyclophosphamide. Over a period of 3 months, we investigated the effect of metronomic low-dose cyclophosphamide on Treg numbers, suppressive capacity and proliferation on endogenous anti-tumor T-cell responses and on their correlation to clinical outcome in 12 patients with treatment-refractory metastasized breast cancer who received single-agent 50 mg cyclophosphamide p.o. daily. Cyclophosphamide treatment initially caused a significant reduction in circulating Treg by more than 40% (P = 0.002). However, Treg numbers completely recovered during the treatment due to increased proliferative activity and maintained their suppressive capacity. Treg depletion coincided with a strong increase in breast tumor-reactive T cells (P = 0.03) that remained at high levels during the whole period. Numbers of tumor-reactive T cells but not of Treg correlated with disease stabilization (P = 0.03) and overall survival (P = 0.027). We conclude that metronomic low-dose cyclophosphamide only transiently reduces Treg but induces stable tumor-specific T-cell responses, which correlate with improved clinical outcome in advanced-stage breast cancer patients. 
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