Use of PET is widespread and increasing in the United States, mainly for oncologic applications. In November 2006, the National Comprehensive Cancer Network (NCCN) gathered a panel of experts to review the literature and develop clinical recommendations for using PET scans in lymphoma and non-small cell lung, breast, and colorectal cancers. However, because its use is not restricted to these diseases, and evidence is accumulating for its application in other types of cancers, NCCN convened a second meeting in December 2008 to expand on the initial report. A multidisciplinary panel met to discuss the current data on PET application for various tumor types, including genitourinary, gynecologic, pancreatic, hepatobiliary, thyroid, brain, small cell lung, gastric, and esophageal cancers, and sarcoma and myeloma. This report summarizes the proceedings of this meeting, including discussions of the background of PET, the role of PET in oncology, principles of PET use, emerging applications, and possible future developments.

NCCN task force: clinical utility of PET in a variety of tumor types.

To evaluate the efficacy of cytokine-induced killer (CIK) cell therapy in the treatment of hepatocellular carcinoma. Randomized phase II and III trials on CIK cell-based therapy were identified by electronic searches using a combination of "hepatocellular carcinoma" and "cytokine-induced killer cells". The analysis showed significant survival benefit (one-year survival, p < 0.001; two-year survival, p < 0.001; median overall survival, p < 0.001) in favor of CIK-based therapy. Comparison of CIK group versus non-CIK group resulted in a significantly prolonged progression-free survival (PFS) (p < 0.01). A favored disease control rate (DCR) and overall response rate (ORR) were also observed in patients receiving CIK cell therapy (p < 0.01). Meanwhile, patients in the CIK group showed better quality of life (QoL), diminished HBV-DNA content and AFP level (p < 0.01). Comparing T-lymphocyte subsets in peripheral blood, the analysis showed the ratio of CD3+, CD4+, CD4+CD8+ and CD3+CD4+ T cells significantly increased in the CIK group, compared with the non-CIK group (p < 0.01). CIK cell therapy demonstrated a significant superiority in prolonging the median overall survival, PFS, DCR, ORR and QoL of HCC patients. These results support further larger scale randomized controlled trials for HCC patients with or without the combination of other therapeutic methods.

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Cytokine-induced killer (CIK) cell therapy for patients with hepatocellular carcinoma: efficacy and safety.

Cytokine-induced killer cells in the treatment of patients with solid carcinomas: a systematic review and pooled analysis

Background and objective Cytokine-induced killer (CIK) cells have high anti-tumor activity for hepatocellular carcinoma (HCC). Whether CIK cell therapy can eradicate residual cancer cells and prevent or postpone tumor relapse after transcatheter arterial chemoembolization (TACE) should be testified. This study was to evaluate the efficacy of CIK cell therapy combined with TACE on HCC. Methods A total of 146 consecutive patients with unresectable HCC were divided into combination group (72 patients treated with CIK cell therapy combined with TACE) and TACE group (74 patients treated only with TACE). The progression-free survival (PFS) and overall survival (OS) were analyzed. Results The 6-month, 1-year, and 2-year PFS rates were 72.2%, 40.4%, 25.3% in combination group, and 34.8%, 7.7%, 2.6% in TACE group. The median time to progression was 11 months [95% confidence interval (CI), 8-14 months] in combination group and 5 months (95% CI, 4-7 months) in TACE group. The estimated 6-month, 1-year, and 2-year OS rates were 90.3%, 71.9%, 62.4% in combination group, and 74.6%, 42.8%, 18.8% in TACE group. The median OS was 31 months (95% CI, 27-35 months) in combination group and 10 months (95% CI, 7-13 months) in TACE group. The times of TACE, ECOG performance status, and CIK cell therapy were independent prognostic factors for PFS and OS. Conclusion Adjuvant immunotherapy with CIK cells could greatly improve the efficacy of TACE on HCC, and plays an important role in prolonging the PFS and OS of HCC patients after TACE.

Efficacy of transcatheter arterial chemoembolization combined with cytokine-induced killer cell therapy on hepatocellular carcinoma: a comparative study.

Introduction : Despite development and introduction of new and innovative drugs, a large number of malignant diseases are associated with unfavourable prognosis. In recent years, considerable progress in cancer treatment has been obtained by the application of cytokine-induced killer (CIK) cells. Areas covered : This review provides an overview and summary of recent advances in adoptive immunotherapy strategies in cancer treatment using CIK cells. A selective literature search has been performed. Expert opinion : The application of CIK cells as adoptive immunotherapy plays an important role in cancer treatment. Combining CIK cells with other conventional and established therapy options represents an innovative approach and will hopefully provide new insight for the future.

New adoptive immunotherapy strategies for solid tumours with CIK cells

OBJECTIVE To ed evaluate the clinical effects of autologous cytokine-induced killer cell (CIK) fusion to lower recurrence of primary hepatocellular carcinoma (HCC) and the anti-hepatitis B virus (HBV) effect after transcatheter arterial chemoembolization (TACE) sequentially combined with radiofrequency ablation (RFA) METHODS Sixty-four HCC patients underwent TACE sequentially combined with RFA without residual tumor or extrahepatic metastasis were randomly divided into 2 groups: study group (n = 33), receiving autologous CIK fusion of the dose of (11 - 15) x 10(10) via the peripheral vein or hepatic artery, firstly once every 3 - 4 weeks for 4 times, and then once every 4 weeks for 4 times; and control group (n = 31) All patients were followed up for 1 year RESULTS In the study group, 29 patients (29/33) were recurrence-free during the 1 year follow-up, 3 had recurrence in the liver 5, 6, and 7 months later respectively, and 1 patient had lymphoadenopathy in the hepatic portal 9 months later In the control group, 23 patients (6801%) were recurrence-free, 7 had recurrence in the liver within 1 year, and 1 had lung metastasis 11 months later In the study group, the number of the patients with the HBV DNA content < 1 x 10(3) before treatment was 19, and increased to 29 after the treatment; 2 of the 19 patients who were HBsAg positive before the treatment became HBsAg negative after the treatment, and number of the patients with the HBV DNA content of 10(3) - 10(4) was 3 before the treatment, and became 13 after the treatment among which 1 patient had his HBV DNA content dropping from 16 x 10(7) to 16 x 10(4) In the control group, only 1 patient showed his HBV DNA content dropping from 11 x 10(5) to below 10(3) CONCLUSION Capable of reducing recurrence, prolonging the recurrence-free span, and attacking HBV, autologous CIK fusion after TACE sequentially combined with RFA is an effective novel therapeutic strategy for HCC

[Cytokine-induced killer cell fusion to lower recurrence of hepatocellular carcinoma after transcatheter arterial chemoembolization sequentially combined with radiofrequency ablation: a randomized trial].

BACKGROUND & OBJECTIVE Judging tumor residue of hepatocellular carcinoma (HCC) after treatment of transcatheter arterial chemo-embolization (TACE) combined with radiofrequency ablation (RFA) by computed tomography (CT) scan is difficult; while 18-fluorodeoxyglucose-positron emission tomography/CT ((18)FDG-PET/CT) has some advantages in this aspect. This study was designed to compare the results of (18)FDG-PET/CT and CT scan in judging tumor residue of HCC after treatment of TACE combined with RFA, and to guide following treatment according to the result of (18)FDG-PET/CT. METHODS Thirteen HCC patients with 18 lesions, 0.8-16.0 cm in diameter, were treated in Cancer Center of Sun Yat-sen University from Nov. 2002 to Jun. 2003. Of the 13 patients, 12 were naive patients with 15 lesions; 1 was relapsed with 3 lesions 1 year after hepatectomy. The results of CT and (18)FDG-PET/CT of the 13 patients 2-3 weeks after treatment of TACE combined with RFA were compared. If tumor residue was dictated, a further RFA treatment would be applied within 2-3 weeks. RESULTS Of the 13 HCC patients that received 1 course of TACE combined with RFA, 11 had tumor residues which were conformed by fine needle biopsy and digital substraction angiography (DSA). CT only detected 5 positive cases; however, (18)FDG-PET/CT detected 10 positive cases. Positive rate of CT was 45.4%, and that of (18)FDG-PET/CT was 90.9%. According to the results of (18)FDG-PET/CT of the 11 patients, after the second course of RFA, 10 patients had no tumor residue; 1 patient survived with uncontrolled lesion 6 weeks after treatment. CONCLUSION (18)FDG-PET/CT is better than CT in judging tumor residue of HCC after treatment of TACE combined with RFA or surgery, and in guiding further treatment of HCC.

[Evaluating efficacy of transcatheter arterial chemo-embolization combined with radiofrequency ablation on patients with hepatocellular carcinoma by 18FDG-PET/CT].

Yi Xin Zeng

Papers

[Cytokine-induced killer cell fusion to lower recurrence of hepatocellular carcinoma after transcatheter arterial chemoembolization sequentially combined with radiofrequency ablation: a randomized trial].

[Evaluating efficacy of transcatheter arterial chemo-embolization combined with radiofrequency ablation on patients with hepatocellular carcinoma by 18FDG-PET/CT].