, Volume 3, Issue 5, pp 362-385
Date: 18 Nov 2012

Immunology of Head and Neck Cancer

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Summary

Patients with squamous cell cancer of the head and neck region frequently have cell-mediated immune defects and anergy, which progress with disease. T lymphocytopenia and dysfunction, monocyte dysfunction, prostaglandins, antigen-antibody complexes, serum and cell suppressive factors, radiation therapy and poor nutrition with zinc deficiency all play a role. However, cell-mediated immunoreactivity to tumour is manifest in the majority of patients in blood and regional nodes, and in the tumour itself by tumour-infiltrating lymphocytes. Lymphocytes from these sources cloned in the presence of interleukin-2 ± tumour extracts show relatively specific cytotoxicity against squamous cell cancer. Humoral immunity is intact, and increased IgA levels and antibodies reactive to tumour antigens are common. Tumour-associated antigens detected in tumour and serum include carcinoembryonic antigen, tumour polypeptide antigen, squamous cell cancer antigen, tumour antigen-4 and various mucin antigens. The mucin antigens, in particular, elicit T cell cytotoxicity.

Immunotherapeutic efforts in head and neck squamous cell cancer should logically employ T cell adjuvants, contrasuppression and immunorestoration. Nonspecific stimulation with bacille Calmette-Guérin (BCG), levamisole and other agents has not been successful. Encouraging results have been observed in limited trials with indomethacin, plasmapheresis and thymic peptides. Early trials with local administration of low dosages of interferon-α, natural interleukin-2 and a natural interleukin mixture have produced partial and complete regressions with no toxicity, with intense leucocyte infiltration indicating cell-mediated immunity. On the contrary, treatment with high dosages of recombinant interferon-α and interleukin-2 has yielded few responses with considerable toxicity. Combination strategies are warranted to improve upon this initial immunotherapeutic effort.