title: An overview on the use of TNF-alpha: our experience with regional administration and developments towards new opportunities for systemic application.
abstract: Tumor necrosis factor-alpha is a multifunctional cytokine and its potential as antitumor agent has been extensively investigated for the treatment of cancer: Initial enthusiasm was tempered when systemic treatment with TNF-alpha was found to cause severe toxic side effects in phase I/II studies. Other applications were sought and a revival of the drug was its application in combination with the cytotoxic drug melphalan in isolated limb perfusion (ILP). Here we discuss the pre-clinical and clinical studies which led to the success in treatment of patients with irresectable extremity soft tissue sarcoma and multiple melanoma in-transit metastases confined to the limb. This achievement may herald the development of new applications of TNF-alpha in isolated organ perfusion settings. An extension of its use may be found in the application of less toxic TNF-mutants or encapsulated in sterically stabilized liposomes. The review concludes with the possible application of low dose TNF-alpha, which can be given systemically, to enhance the anti-tumor potency of formulated drugs (such a liposomal doxorubicin) by increasing solid tumor targeting.
authors.affiliation: Department of Surgical Oncology, University Hospital Rotterdam, Dijkzigt/Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: van Der Veen
authors.forename: T L
authors.initials: TL
authors.lastname: ten Hagen
authors.forename: J H
authors.initials: JH
authors.lastname: de Wilt
authors.forename: M G
authors.initials: MG
authors.lastname: van Ijken
authors.forename: A M
authors.initials: AM
authors.lastname: Eggermont
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D010478:Chemotherapy, Cancer, Regional Perfusion; D002986:Clinical Trials as Topic; D006801:Humans; D008081:Liposomes; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology
chemical_list: D000970:Antineoplastic Agents; D008081:Liposomes; D014409:Tumor Necrosis Factor-alpha