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Lack of protection against bacterial infections in patients with advanced cancer treated by biologic response
S Maoleekoonpairoj1, A Mittelman, S Savona
1Division of Neoplastic Diseases, New York Medical College, Valhalla 10595.
Abstract:
A survey of patients with advanced cancer treated by biologic response modifiers (BRMs), including (i) recombinant interleukin-2 and lymphokine-activated killer cells, (ii) recombinant interleukin-2 and alpha interferon, and (iii) tumor necrosis factor, was done. A total of 52 patients were reviewed. A total of 73 courses of BRMs were administered. Prior to the initiation of therapy, all patients were infection free and not receiving antibiotics. Twelve patients developed bacteremia during treatment with these BRMs. Five of these 12 patients had catheter-related bacteremia. Six patients had bacteremic infections without an obvious source, and one patient had a urinary tract infection with bacteremia. Staphylococcus epidermidis accounted for six of the isolates. Other organisms were Staphylococcus aureus, group B streptococci, viridans group streptococci, and gram-negative bacilli. This was an unexpectedly high incidence of bacterial infections in patients treated with BRMs. These BRMs have been previously shown to be efficacious against infections (by bacteria and other intracellular organisms) in experimental animals. In this study BRMs did not influence host defense mechanisms or offer protection against bacterial infections.
Insights
Biologic response modifiers (BRMs) unexpectedly increased bacterial infections in advanced cancer patients. These treatments did not enhance host defense mechanisms against bacteremia in this patient cohort.
Area of Science:
- Oncology
- Immunology
- Infectious Diseases
Background:
- Biologic response modifiers (BRMs) are used in advanced cancer therapy.
- BRMs have demonstrated efficacy against intracellular infections in animal models.
- The impact of BRMs on bacterial infection risk in cancer patients requires further investigation.
Purpose of the Study:
- To assess the incidence of bacterial infections in advanced cancer patients treated with BRMs.
- To determine if BRMs influence host defense mechanisms against bacterial infections.
Main Methods:
- A survey of 52 advanced cancer patients receiving BRM therapy was conducted.
- Patients received combinations of recombinant interleukin-2, lymphokine-activated killer cells, alpha interferon, or tumor necrosis factor.
- Infection status and causative organisms were monitored throughout BRM treatment courses.
Main Results:
- Twelve out of 52 patients developed bacteremia during BRM therapy.
- Catheter-related bacteremia occurred in 5 patients; 6 had infections without a clear source.
- Staphylococcus epidermidis was the most common pathogen, followed by S. aureus, streptococci, and gram-negative bacilli.
Conclusions:
- BRM therapy was associated with a high incidence of bacterial infections in this patient group.
- Contrary to animal studies, BRMs did not appear to enhance host defense against bacterial infections in humans.
- Further research is needed to understand and mitigate infection risks associated with BRM use in cancer patients.