Treatment of Oligometastases After Successful Immunotherapy

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Local destruction of individual metastases by any of a number of effective modalities fails as a treatment for most patients with disseminated cancer because of the presence of either undetected micrometastases or simply too many lesions. The availability of a systemic therapy that could reduce the number of metastases to a manageable few would dramatically increase the utility of surgical metastasectomy or other locally ablative measures. Interleukin-2–based immunotherapy can serve exactly this function in some patients with renal cancer or melanoma. We review the effectiveness of surgery in treating limited relapses or residual disease in patients who have responded to systemic immunotherapy. These data indicate that a surprising percentage of such patients can enjoy durable disease-free survival after surgical removal of their oligometastases, and, for a significant minority, it appears to be curative.

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Summary

The failure of resection as a therapeutic modality for metastatic disease is because of a multiplicity of undetected metastases or an excessive number of bulk metastases with no effective means to sterilize enough to make resection reasonable. A systemic adjunct that debulks by incompletely reducing all tumors, large or small, does not contribute to the success of metastasectomy. In contrast to this, a key feature of immunotherapy is the durability of regression when a lesion is rendered

References (19)

  • S.A. Rosenberg et al.

    Identification of the genes encoding cancer antigensImplications for cancer immunotherapy

    Adv Cancer Res

    (1996)
  • S.A. Rosenberg et al.

    Observations on the systemic administration of autologous lymphokine-activated killer cells and recombinant interleukin-2 to patients with metastatic cancer

    N Engl J Med

    (1985)
  • S.A. Rosenberg et al.

    Treatment of 283 consecutive patients with metastatic melanoma or renal cell cancer using high-dose bolus interleukin 2

    JAMA

    (1994)
  • S.A. Rosenberg et al.

    Durability of complete responses in patients with metastatic cancer treated with high-dose interleukin-2

    Ann Surg

    (1998)
  • P. Robbins et al.

    Tumor antigens recognized by cytotoxic lymphocytes

  • K. Hanada et al.

    Identification of fibroblast growth factor-5 as an overexpressed antigen in multiple human adenocarcinomas

    Cancer Res

    (2001)
  • W.W. Overwijk et al.

    Tumor regression and autoimmunity after reversal of a functionally tolerant state of self-reactive CD8+ T cells

    J Exp Med

    (2003)
  • A. Moretta et al.

    Receptors for HLA class-I molecules in human natural killer cells

    Annu Rev Immunol

    (1996)
  • J.J. Mule et al.

    Adoptive immunotherapy of established pulmonary metastases with LAK cells and recombinant interleukin-2

    Science

    (1984)
There are more references available in the full text version of this article.

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