title: Injection of recombinant tumor necrosis factor directly into liver metastases: an experimental and clinical approach.
abstract: Systemic treatment with tumor necrosis factor (TNF) is associated with side-effects, limiting its clinical use in the treatment of malignancies. To investigate the feasibility of other routes of administration experimental and clinical studies were started to establish the toxicity and antitumor activity of TNF after intratumoral (i.t.) injection. In a rat model for colon adenocarcinoma, tumor fragments, implanted subcutaneously or under the hepatic capsule, were treated with TNF injected i.v. or i.t. A dosage of 40 micrograms/kg was lethal when given i.v., but not i.t. Injection of TNF (40 micrograms/kg) directly into the tumor resulted in inhibition of tumor growth in the subcutaneous as well as subhepatic tumor model. A phase I study was started in patients with advanced malignancies to determine the toxicity of TNF injected into liver metastases. Injection of TNF into liver metastases was accomplished by ultrasonography. A 50 microgram-dose escalating schedule (3 patients/dosage) was chosen, starting at a dose of 100 micrograms TNF/injection. Up to now, 12 patients have been treated, the highest dosage of TNF injected being 250 micrograms. Chills, fever, nausea and vomiting were the main side-effects. No significant changes were found in circulatory, hematologic, renal and liver parameters. In summary, i.t. administration of TNF is associated with antitumor efficacy in experimental models and well-tolerated in man. The antitumor efficacy of TNF i.t. in man awaits evaluation in a phase II study.
authors.affiliation: Department of Surgery, Erasmus University, Rotterdam, The Netherlands.
authors.forename: J N
authors.initials: JN
authors.lastname: IJzermans
authors.forename: M
authors.initials: M
authors.lastname: Scheringa
authors.forename: G P
authors.initials: GP
authors.lastname: van der Schelling
authors.forename: R A
authors.initials: RA
authors.lastname: Geerling
authors.forename: R L
authors.initials: RL
authors.lastname: Marquet
authors.forename: J
authors.initials: J
authors.lastname: Jeekel
mesh_terms: D019813:1,2-Dimethylhydrazine; D000230:Adenocarcinoma / Q000139:chemically induced / Q000556:secondary; D000328:Adult; D000368:Aged; D000818:Animals; D002273:Carcinogens; D003093:Colitis, Ulcerative / Q000139:chemically induced; D003110:Colonic Neoplasms / Q000139:chemically induced; D004127:Dimethylhydrazines; D004341:Drug Evaluation; D004354:Drug Screening Assays, Antitumor; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D051381:Rats; D011919:Rats, Inbred Strains; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D002273:Carcinogens; D004127:Dimethylhydrazines; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D019813:1,2-Dimethylhydrazine