Complete remission of rare adenocarcinoma of the oropharynx with APCEDEN” (dendritic cell-based vaccine)

PET-CT scan

PET-CT scan

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Summary

APCEDEN ® is an autologous monocyte‐derived dendritic cell‐based immunotherapy. A 58‐year‐old man with adenocarcinoma of oropharynx shows complete remission after receiving APCEDEN ® in conjunction with Geftinib validated by reduction in size, whereas Gefitinib alone lead to disease progression. As this is a rare form of cancer, and no standard treatment modalities are in practice, the DC therapy that can be administered along with Gefitinib medication is carried out in the present case.

Patients characteristics

A 58-year-old gentleman experienced swelling in the left submandibular region for 6 months and was diagnosed with adenocarcinoma of the oropharynx in 2010 but did not receive any adjuvant treatment. MRI scan of the neck revealed a mass of 4.4 x 4.2 x 5.8 cm in transverse, anteroposterior, and superoinferior dimensions that extends laterally into the left parapharyngeal space. The left level II lymph node was enlarged measuring 3.4 x 3.6 cm. Tumor was a large lobulated enhancing mass lesion involving the base of the tongue and faucial tonsil on the left side extending in the left vallecula, oropharynx, pre-epiglottic space, parapharyngeal space, and retromolar trigonal space on the left side with extension across the midline. Superiorly, it extended up to the left fossa of rosenmuller. CT scan of neck disclosed a large locally infiltrative oropharyngeal neoplastic mass on the left jugulodigastric lymph node involving tongue base/tonsil/lateral oropharyngeal wall with likely extension to oral tongue/floor of the mouth/ nasopharynx.

Methodology

Vaccine preparation
The process begins with isolating PBMCs from the patient by apheresis and isolating monocytes by plastic adherence. Further differentiation to DCs is carried out by culturing the monocytes in media supplemented with IL-4 and GM-CSF for 5 days. On the sixth day, DCs are co- incubated with the tumor lysate prepared from the tissue biopsy sample of the patient followed by the maturation stimuli. Mature DCs harvested on the 8th day undergo a quality check for the phenotypic markers.

Treatment

Chemotherapy
The received Inj. Cisplatin (100 mg/m2) for first three rounds of chemotherapy followed by Inj. paclitaxel (175 mg/m2) and carboplatin (AUC5) for the fourth cycle. Combination of paclitaxel (175 mg/m2), cisplatin (25 mg/m2) and fluorouracil (750 mg/m2) was administered for the last two sessions of chemotherapy.
Radiotherapy
The patient also received concurrent radiation therapy of total 6600 cGy in 33 fractions during the first session of chemotherapy. There was an initial tumor regression (3.4 x 2.6 cm) followed by a stable disease upon Gefitinib treatment.
DC vaccine
Due to no further reduction in the tumor size even after continuous dose of Gefitinib for 3 years, treatment using DC vaccine (APCEDEN) was initiated on 2014 (4 years from initial diagnosis). Six doses of DC vaccine were administered between May 2014 and August 2014 with parallel Gefitinib medication. Sixdoses (4–5 million mature DCs in each dose) in a time frame of 14 weeks are given to the patient via intravenous route.

Results

• PET scans in October 2015 highlighted a dramatic decrease in the tumor size, 2.1 x 1.6 cm versus 3.1 x 2.7 cm as observed in March 2015.
• Decrease in tumor size (3.0 x 2.5 cm) after 1 month of receiving last dose of APCEDEN” followed by slight increase in tumor mass (3.1 x 2.7 cm) before final regression (2.1 x 1.6 cm) after 14 months. • The patients with baseline neutrophil lymphocyte ratio (NLR) < 5 had a significantly improved progression-free survival (PFS) and overall survival (OS) compared with those with NLR ≥ 5. • Associations of low NLR with improved survival are confirmed in various validation cohorts of patients. In agreement with the published reports, the patients displayed a decreasing NLR < 5 supports these results showing complete remission of adenocarcinoma of the oropharynx.

Conclusion

APCEDEN ® is an autologous monocyte‐derived dendritic cell‐based immunotherapy. A 58‐year‐old man with adenocarcinoma of oropharynx shows complete remission after receiving APCEDEN ® in conjunction with Geftinib validated by reduction in size, whereas Gefitinib alone lead to disease progression.

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Scientific article publishing date 7/7/2017

Immucura identifier BSC21_262EN

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