Immunological responses in a patient with glioblastoma multiforme treated with sequential courses of temozolomide and immunotherapy: case study.
Cytotoxic chemotherapy that induces lymphopenia is predicted to ablate the benefits of active antitumor immunization. Temozolomide is an effective chemotherapeutic agent for patients with glioblastoma multiforme, but it induces significant lymphopenia. Although there is monthly fluctuation of the white blood cell count, specifically the CD4 and CD8 counts, there was no cumulative decline in the patient described in this case report. Depriving patients of this agent, in order to treat with immunotherapy, is controversial. Despite conventional dogma, we demonstrated that chemotherapy and immunotherapy can be delivered concurrently without negating the effects of immunotherapy. In fact, the temozolomide-induced lymphopenia may prove to be synergistic with a peptide vaccine secondary to inhibition of regulatory T cells or their delayed recovery.
Heimberger
Amy B
AB
Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA. aheimber@mdanderson.org
Sun
Wei
W
Hussain
S Farzana
SF
Dey
Mahua
M
Crutcher
Lamonne
L
Aldape
Ken
K
Gilbert
Mark
M
Hassenbusch
Samuel J
SJ
Sawaya
Raymond
R
Schmittling
Bob
B
Archer
Gary E
GE
Mitchell
Duane A
DA
Bigner
Darell D
DD
Sampson
John H
JH
D018906:Antineoplastic Agents, Alkylating; D001932:Brain Neoplasms / Q000276:immunology* / Q000628:therapy*; D019496:Cancer Vaccines / Q000276:immunology / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives; D066246:ErbB Receptors / Q000276:immunology / Q000378:metabolism; D005434:Flow Cytometry; D005909:Glioblastoma / Q000276:immunology* / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy; D016176:T-Lymphocyte Subsets / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology; D000077204:Temozolomide; D022223:Vaccines, Subunit
D018906:Antineoplastic Agents, Alkylating; D019496:Cancer Vaccines; D022223:Vaccines, Subunit; D003606:Dacarbazine; D066246:ErbB Receptors; D000077204:Temozolomide