title: Delayed type hypersensitivity response to recall antigens does not accurately reflect immune competence in advanced stage breast cancer patients.
abstract: The development of delayed-type hypersensitivity (DTH) response to recall antigens has long been utilized as a measure of immune competence. It is assumed that because patients with advanced stage cancers exhibit multiple immune system defects they may not be responsive to immunization. We pre-selected patients with advanced HER-2/neu (HER2) overexpressing breast and ovarian cancers for enrolment into a phase I trial designed to evaluate the immunogenicity of a HER2 peptide vaccine based on the patient's immune competence as assessed by DTH skin testing to common recall antigens (Multitest CMI, Institut Merieux, Lyon, France). At the time of a positive DTH response to tetanus toxoid (tt) peripheral blood was obtained to measure T cell responses to tt. Of 53 patients evaluated, 38 (72%) were not anergic. Among the 15 (28%) who were, seven patients with advanced stage breast cancer were re-tested a median of 26 days (range 12-150 days) after receiving a tt bopster vaccination. Five of the seven had positive DTH responses when re-challenged with tt and six had peripheral blood tetanus specific T cell response with stimulation index >2.0. Thus, the majority of patients studied with advanced stage breast or ovarian cancer were able to mount a DTH response to common recall antigens. Moreover, a negative response by DTH testing to a battery of common recall antigens was not a reflection of the breast cancer patient's ability to mount a cell-mediated immune response to a vaccinated antigen, tt.
authors.affiliation: Tumor Vaccine Group, University of Washington, Seattle 98195-6527, USA. kschiff@u.washington.edu
authors.forename: Kathy
authors.initials: K
authors.lastname: Schiffman
authors.forename: Kristine
authors.initials: K
authors.lastname: Rinn
authors.forename: Mary L
authors.initials: ML
authors.lastname: Disis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000941:Antigens; D001943:Breast Neoplasms / Q000276:immunology* / Q000473:pathology; D019496:Cancer Vaccines / Q000276:immunology*; D005260:Female; D018734:Genes, erbB-2; D006801:Humans; D006968:Hypersensitivity, Delayed; D007108:Immune Tolerance; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology; D013745:Tetanus Toxoid / Q000276:immunology*; D014611:Vaccination
chemical_list: D000941:Antigens; D019496:Cancer Vaccines; D013745:Tetanus Toxoid