The combination of chemotherapy and immunotherapy has already improved the prognosis of patients with a variety of disseminated solid tumors. Immunotherapy has rarely added significantly to an increase in remission rates induced with chemotherapy; in general, immunotherapy has resulted in a prolongation of chemotherapy induced remissions and survival. Combined approaches of chemoimmunotherapy have also begun to be applied successfully for patients with minimal residual disease who are potentially curable after surgery or radiotherapy. None of the immunotherapeutic agents described in this report has been cleared for general patient usage. All are under investigational new drug status, and can be used only with the collaboration of an authorized research investigator. Despite the positive leads that have been presented, it is our feeling that the regimens described are still primarily experimental. Studies with all immunomodulating agents will require careful immunological monitoring until a careful understanding of their biological and immunological effects is clear. Depending on the route of administration of these immunomodulating agents, dose, schedule, as well as the immunocompetence of the patient, an increase, no change, or even a decrease in immunity can be observed. Therefore, it is our strong feeling that patients on combined regimens of chemoimmunotherapy must undergo careful immunological monitoring. Patients should be treated in collaboration with investigators capable of monitoring the immune response of the cancer patient. These studies can then be carried out in conjunction with the physician in practice. The physician in the community therefore becomes a research collaborator in the management of cancer patients and in the procurement of new and important data for the future. Although the bulk of evidence favors the concept that the balance can be tilted in favor of the patient by manipulation of the immune response, extreme caution must be taken in modifying this response. As we dissect more carefully the host tumor relationship, great progress in the eventual control of cancer by immunological manipulation seems a realistic and an exciting challenge for the coming decade. Note: Several recently reported trials have further confirmed the efficacy of immunotherapy or chemoimmunotherapy in prolonging survival of patients with solid tumors. At the recent New York Academy of Sciences Meeting on Immunotherapy, Yamamura and co workers demonstrated that cell wall skeleton of BCG plus chemotherapy prolonged survival in lung cancer patients, when compared to survival in patients treated with chemotherapy alone. Similarly, Stewart and co workers demonstrated benefit in lung cancer patients treated with purified tumor antigen of Hollingshead plus Freund's adjuvant. In other studies McNeally and co workers recently reported that intrapleural BCG given after surgery prolonged disease free interval and survival in patients with lung cancer. Rojas and co workers reported increased disease free interval and survival in patients with Stage III breast cancer.
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