Effects of combined therapies with protein-bound polysaccharide (PSK, Krestin) and fluorinated pyrimidine derivatives on experimental liver metastases and on the immunologic capacities of the hosts.

An experimental model is introduced for the study of liver metastases using intrasplenically injected EL-4 and Lewis lung tumor cells. Fluorinated pyrimidine derivatives, 1-(2-tetrahydrofuryl)-5-fluorouracil and 5-fluorouracil, showed inhibitory effects on the frequencies of liver metastases. Immunosuppressive effects of these drugs were compared at the doses capable of showing 50% inhibition of the development of metastatic nodules. These derivatives strongly suppressed the phagocytic activity and the number of Kupffer cells of the liver and then the humoral response against sheep red blood cells, the delayed hypersensitivity against picryl chloride. On the contrary, combined administration of protein-bound polysaccharide (PSK) and 1-(2-tetrahydrofuryl)-5-fluorouracil showed no inhibitory effect on these activities.     

A case of liver metastases of sigmoid colon cancer treated effectively by oral UFT/LV

The patient was a 77-year-old woman with multiple liver metastases of sigmoid colon cancer. She underwent low anterior resection for sigmoid colon cancer. After surgery, she selected oral administration of UFT and LV for liver metastases and multiple lymph node metastases. After two courses, the liver metastases had markedly diminished. Thirty-two months later, liver metastases had disappeared on computer tomography. This therapy was continued for five years, and recurrences are no longer shown. Severe adverse effects were not observed. Oral anti-cancer drugs can serve as effective therapy for advanced colorectal cancer of old patients.     

Pharmacology and antitumour effects of intraportal pirarubicin on experimental liver metastases.

Early liver metastases have a predominant portal blood supply. Intraportal (i.port.) vein administration of cytotoxics could theoretically achieve enhanced drug concentrations in tumour cells and be effective as adjuvant therapy after resection of colorectal carcinoma. Pirarubicin (which has a higher hepatic extraction than doxorubicin) was investigated on liver metastases of the VX2 rabbit tumour, which were of less than 2 mm in diameter 7 days after cells injection into the portal vein. To evaluate antitumour activity, 24 rabbits were randomised into three groups 7 days after implantation: (a) control, (b) i.v. pirarubicin, (c) i.port. pirarubicin at doses of 2 mg kg-1 in both groups. Portal infusions led to no hematological or hepatic toxicity. Pharmacokinetic parameters showed a significantly reduced systemic exposure after i.port. administration. Fourteen days after treatment, livers and lungs were analysed. The mean number (+/- s.d.) of tumour foci was (a) 8.62 (+/- 5.4), (b) 4.62 (+/- 3.2), (c) 2.25 (+/- 1.4) (P < 0.05 a vs c). The mean tumour area was (a) 6.31 (+/- 6.1), (b) 1.31 (+/- 2.2), (c) 0.43 (+/- 0.4 cm2) (P < 0.05 a vs c) and the percentage (95% C.I.) of rabbits with lung metastasis was: (a) 87.5% (47-99%), (b) 75% (35-97%), (c) 12.5% (3-52%) (P < 0.02 b vs c). Intraportal pirarubicin seems to be well tolerated and more efficient than i.v. administration, particularly in preventing extrahepatic dissemination.     

A case of multiple liver metastases of sigmoid colon cancer responding well to UFT+Leucovorin therapy

The subject was a 75-year-old female. For the treatment of multiple liver metastases from sigmoid colon cancer, the administration of UFT(300 mg/day)and oral Leucovorin(75 mg/day)was initiated after a resection of the sigmoid colon. A decrease in the liver metastases was observed in a CT scan 4 months after the start of this administration, and the disappearance of the metastatic focus in the liver was confirmed at 10 months thereafter. The administration of UFT and oral Leucovorin was continued for 2 months. Thereafter, at 12 months after the start of this administration, was continued with only the administration of UFT(300 mg/day)for 1 year. Now, 26 months have passed since the liver metastases disappeared and no recurrence has been found, even within the abdominal cavity. The condition of the patient has been excellent. The subject of this study was an elderly person, but an excellent QOL was secured without any adverse events, and the chemotherapy regimen could be maintained for 2 years. These findings suggest that UFT and oral Leucovorin can be expected to have an excellent therapeutic effect as an oral chemotherapeutic agent.     

Effects of OK-432 on UFT activation

An experiment to gauge the effect of OK-432 on UFT activation under a combined administration of UFT and OK-432 at a therapeutic dose has been pursued clinically by determining the blood and intratumoral 5-FU concentrations after administration of UFT. UFT was administered orally to a group of AH-130-bearing rats at a dose of 12 mg/kg or 8 mg/kg. In another group that was given combined treatment with OK-432, the OK-432 was administered subcutaneously at a dose of 0.1 KE/kg together with UFT. The intratumoral 5-FU concentration at 4 hours after UFT 12 mg/kg administration showed higher values in th single UFT treated group than in the combined treated group, but at 8 hours no significant difference was found between these two groups as the concentrations were 0.133 +/- 0.027 microgram/g and 0.128 +/- 0.021 microgram/g, respectively. Further, no significant differences were noticed in the blood and intratumoral 5-FU concentrations between both groups after administration of UFT at a dose of 8 mg/kg. Clinically, the blood FT-207 and 5-FU concentrations after UFT administration showed no significant difference between the single UFT treated group and the combined OK-432 treated group, nor was there a significant difference in the intratumoral concentration. In summary, it is considered that OK-432 has little effect on UFT activation when UFT and OK-432 are administered in combination.     

Marked response to oral administration of UFT and leucovorin for liver metastases from colon cancer in an elderly patient

A83 -year-old man was admitted to our hospital for the treatment of advanced ascending colon cancer with liver metastases. He had initially undergone an ileocecal resection for ascending colon cancer. Subsequently, we started oral administration of UFT/LV(UFT 400mg/day, LV 75 mg/day, and 4 weeks of therapy followed by a week suspension of treatment). After 3 courses, his tumors responded well to treatment, and CT showed marked regression of liver metastases. After 10 courses, liver metastases had almost disappeared. Two years passed without any adverse events since UFT/LV therapy was started. These findings suggest that UFT/LV therapy is very safe and effective for elderly patients with unresectable colorectal cancer.     

Effects of total-body hyperthermia on metastases from experimental mouse tumors

To study the effects of total-body hyperthermia (TBH) on metastases from malignant tumors, Lewis lung carcinoma (LLC)-bearing C57BL/6 mice and mouse ascites hepatoma 134-bearing C3H/He mice were immersed in a heated water bath. Rectal temperature was maintained for 30 min at 40 degrees C or 42 degrees C. After treatment, the incidence of lung metastasis was analyzed in LLC-inoculated mice, and the presence or absence of metastasis in affiliated lymph nodes was determined in mouse ascites hepatoma 134-inoculated mice. A significant inhibition in primary tumor growth in LLC- and mouse ascites hepatoma 134-bearing mice treated with 42 degrees C TBH was noted. The incidence of lung metastasis was increased from the control level of 1.6 +/- 0.63 (SD) to 2.4 +/- 0.98 in the 42 degrees C TBH (P less than 0.01) groups but not in the 40 degrees C TBH group. Metastasis to affiliated lymph nodes was similar for the controls and the 40 degrees C and 42 degrees C TBH groups. The increase in lung metastasis in LLC-treated mice subjected to 42 degrees C TBH could be prevented by the combined use of anticancer drugs such as cis-diamminedichloroplatinum(II) (1.0, 3.0 mg/kg) or mitomycin C (0.3, 1.0 mg/kg). Furthermore, the combined use of 42 degrees C TBH and anticancer drugs showed the inhibition of primary tumor growth to a greater degree than did 42 degrees C TBH alone or anticancer drugs alone. Since 42 degrees C TBH may induce tumor metastasis, especially hematogenous metastasis, it seems advisable to use anticancer drugs in combination with clinical thermal applications.     

Tissue UFT distribution and histological changes following UFT administration in metastatic liver cancer cases

For the purpose of assessing the anti-tumor effect of UFT in metastatic liver cancer, blood futraful (FT), 5-fluorouracil (5-FU) and uracil levels and their distribution in tissue (cancer lesion, etc.) following oral UFT administration were examined in 10 surgically treated cases of metastatic liver cancer secondary to cancer of the large intestine and 4 cases of metastatic liver cancer secondary to stomach cancer. Liver tissue 5-FU distribution following UFT treatment was excellent. 5-FU concentration in liver cancer lesion was 0.164 +/- 0.128 micrograms/g, which was markedly higher than the minimal effective tissue concentration for 5-FU (0.050 micrograms/g). 5-FU level in normal tissue of the organ with primary cancer was significantly lower than that in the tumor-affected tissue of the same organ, while no difference in 5-FU level was noted between cancer-affected and normal tissues of the liver. Tissue 5-FU level in both primary and metastatic cancer lesions was significantly higher than the simultaneously determined blood 5-FU level. Histological findings of cancer-affected liver did not differ between different UFT dose levels, but degeneration of cancer cells was severe in some cases given high doses of UFT.     

Effects of oral administration of UFT in unresectable gastric cancer with liver metastasis

A 62-year-old male was admitted because of upper abdominal mass. Exploratory laparotomy revealed unresectable gastric cancer, liver metastases and swelling of regional lymph nodes. Histological examination showed papillotubular adenocarcinoma. After 6 months' postoperative administration of UFT at a daily dose of 600 mg, X-ray and endoscopic examination revealed remarkable improvement of the gastric cancer. Computed tomography and ultrasonography showed disappearance of the mass in the liver and a remarkable decrease in the size of paraaortic lymph nodes. The cancer marker, serum CEA also decreased from 5.2 ng/ml to 2.1 ng/ml. At present, the abdominal mass is not palpable and the patient is asymptomatic except for pigmentation and being followed up in the outpatient department. This case suggests the possibility that UFT may be effective for advanced gastric cancer with liver metastases.     

Arabinogalactan blockade of experimental metastases to liver by murine hepatoma

Blocking of organ-specific experimental metastasis was investigated in a syngeneic tumor-host system using a new tumor which primarily colonizes the liver upon intravenous injection. The study included systemic treatment with D-galactose and arabinogalactan as well as cell pretreatment with arabinogalactan and two other glycoconjugates. Treatment with arabinogalactan reduced the amount of liver metastases and prolonged the survival times of the animals in both studies. Host treatment was more effective than tumor cell pretreatment. This could be an effect of arabinogalactan blockade of potential liver receptors by covering of galactose-specific binding sites.     

A case of liver metastases from cecal cancer successfully treated with fluorouracil and folinic acid (UFT/LV)

A 76-year-old man had undergone a right hemicolectomy for cecal cancer. Oral UFT (450 mg/day) administration alone was started 2 months following the operation. From a CT scan of the abdomen performed 3 months postoperatively, he was diagnosed with liver metastasis. Because the liver metastasis had progressed, combination oral administration of UFT+LV was started (UFT 450 mg/day, LV 75 mg/day, 4 weeks of therapy followed by a 1-week treatment break). After 1 cycle, a good partial response of that lesion was achieved. The pulmonary metastasis had almost disappeared to within normal limits. In conclusion, this treatment was very safe and effective.     

Efficacy of oral UFT plus leucovorin therapy for colon cancer with ovarian and multiple liver metastases: report of two cases

Case 1: a patient was diagnosed as having ascending colon cancer with right ovarian metastasis, and underwent palliative right hemicolectomy plus oophorectomy. The tumor was a well-differentiated adenocarcinoma with right ovarian metastasis, and the disease was classified as stage IV. Oral chemotherapy with UFT plus LV was performed for about 3 years, and the patient is still being followed up with no recurrence at 5 years postoperatively. Case 2: a patient was diagnosed as having incomplete large bowel obstruction caused by ascending colon cancer, and underwent curative right hemicolectomy. The tumor was a moderately differentiated adenocarcinoma, and the disease was classified as stage II. Since multiple liver metastases developed at 3 months postoperatively, oral chemotherapy with UFT plus LV was started. Imaging studies showed the complete elimination of liver metastases after 2 months. Subsequently, liver metastasis recurred about 10 months later. The patient died of unrelated cerebral infarction at 2 years and 6 months postoperatively.     

An experimental minimally invasive perfusion technique for the treatment of liver metastases.

AIM: Isolated hepatic perfusion (IHP) is an invasive, technically difficult, non-repeatable and demanding operation. In this study we report the development of a less invasive alternative for the surgical IHP in a pig model. METHODS: Our technique was tested in 8 Yorkshire pigs (60 kg). The liver was isolated from the systemic circuit using minimally invasive techniques: an occlusion stent-graft and balloon catheters, with reversal of the blood flow through the liver during IHP. RESULTS: Tests with varying pressures applied at the PV revealed a clear relation between the suction pressure at the outflow site (PV), intrahepatic pressure and systemic leakage of 99mTc. A leakage-free IHP could be obtained in seven separate experiments. CONCLUSION: Isolated hepatic perfusion using minimally invasive techniques is feasible in pigs when the intrahepatic pressure is controlled. This technique has yet to be tested in patients.     

A case of advanced gastric cancer with multiple liver metastases in an elderly patient that responded dramatically to UFT therapy

An 88-year-old female patient suffering from Borrmann type 3 advanced gastric cancer complicated by multiple hepatic metastases underwent a total gastrectomy. A small dose of 200 mg/day of UFT was administered orally every day postoperatively. At postoperative month 6, a marked diminishment of the hepatic metastatic lesions was noted. Resection of the primary lesion with a regimen of a small oral dose of UFT was remarkably effective in this elderly gastric cancer patient with complications from multiple hepatic metastases.     

Antitumor activity of UFT against murine renal cell carcinoma: a study on the suppression tumor metastases

Experimental chemotherapy with UFT was performed against murine renal cell carcinoma (Renca) of spontaneous origin in BALB/c mice and the antitumor activity of UFT was compared with that of 5-FU. By oral administration started from the day after inoculation of Renca cells under the capsule of a kidney, the growth of tumor and formation of the spontaneous metastases to the lymph nodes, lung, spleen, and abdominal wall were inhibited significantly. The UFT or 5-FU treatment started on the 8th day after tumor inoculation also extended the survival time of the tumor-bearing mice and the anti-tumor effect of UFT was more marked than 5-FU. However, UFT treatment started on the 15th day did not prolong the survival time of Renca-bearing mice. From these results, UFT therapy seems to be beneficial for prevention of metastases after nephrectomy in the patients with renal cell carcinoma.     

The effects of vasopressin infusion on hepatic haemodynamics in an experimental model of liver metastases

Vasoactive drugs have a variety of effects upon splanchnic and hepatic haemodynamics which may alter tumour blood flow and potentiate the delivery of a chemotherapeutic drug to hepatic tumour. We have investigated the effects of vasopressin infusion on hepatic tumour blood flow in an experimental model of liver tumour. Hepatic tumour was induced by the intraportal inoculation of HSN sarcoma cells. Hepatic and splanchnic blood flow was determined using a dual reference microsphere technique before and after an intravenous infusion of vasopressin at a dose of 0.1 mU kg-1 min-1 for 10 min. There was a significant increase in systemic arterial blood pressure associated with a rise in portal venous inflow (P less than 0.01, Wilcoxen Signed rank Test) and a significant fall in hepatic arterial flow (P less than 0.05). The tumour: liver blood flow ratio was significantly increased by vasopressin infusion (P less than 0.02). Vasopressin infusion decreases hepatic arterial flow and increases tumour blood flow which may potentiate the delivery of a regionally delivered chemotherapeutic drug to hepatic tumour.     

Effects of liposome-entrapped doxorubicin on liver metastases of mouse colon carcinomas 26 and 38

The effects of doxorubicin (DOX) and DOX entrapped in standardized liposomes [mean diameter, 0.15 micron; (DOX-Lip)] on the survival of mice bearing liver metastases of mouse colon carcinoma CT38LD (C57BL/6J mice) or CT26 (BALB/c mice) were investigated. In vitro cultured CT38LD cells were more sensitive to DOX than CT26. In vivo DOX and DOX-Lip, administered iv 10 mg/kg weekly to a maximum of five injections, increased the life-spans of mice bearing CT38LD liver metastases 32% (P less than .05) and 64% (P less than .05), respectively. DOX-Lip was more effective than DOX in prolonging survival (P less than .05). Free DOX did not significantly increase the life-spans of mice bearing CT26 liver metastases (P greater than .5), whereas DOX-Lip increased the life-spans 35% (P less than .05). The results suggest that liposomal delivery of agents to the liver can enhance therapeutic activity and could be used as an arm of protocols for adjuvant therapy of liver metastases.