Abstract
Patients with metastatic renal cell carcinoma (RCC) undergoing cytokine or targeted therapies may show a remarkable decline in quality of life (QoL). We wanted to evaluate QoL in patients with metastatic RCC undergoing therapeutic vaccination with dendritic cells (DCs). In a cross-sectional analysis, QoL was therefore assessed in RCC patients participating in three consecutive clinical trials of DC vaccination. Before the first and after the third vaccination with DCs, patients completed a QoL questionnaire (EORTC QLQ-C30, version 3). Data were transformed into scale scores and analysed using SPSS 12.0 software. Mean values of the resulting scores obtained before and after DC vaccination were compared using students t test and Wilcoxon rank-sum test. P < 0.05 was considered statistically significant. The questionnaire was completed by 55 of 71 patients (compliance rate, 77.5%) who had a median age of 58.7 years (from 30 to 75 years). No significant reductions in functioning scales including physical, emotional and social criteria as well as symptom scores, which assess typical symptoms of tumour therapies, were observed indicating that QoL remained high during DC vaccination. Significant correlations were found between overall survival and functional as well as symptom scores. Our data indicate that DC vaccination, which is a personalised treatment modality, maintains QoL and thus represents an attractive nontoxic treatment option for patients with metastatic RCC. It will be important to identify the most effective conditions of DC vaccination including combinations with other therapeutics to maximise clinical efficacy while still preserving QoL.
Similar content being viewed by others
References
Ravaud A, Wallerand H, Culine S, Bernhard JC, Fergelot P, Bensalah K, Patard JJ (2008) Update on the medical treatment of metastatic renal cell carcinoma. Eur Urol 54:315–325
Di Lorenzo G, Porta C, Bellmunt J, Sternberg C, Kirkali Z, Staehler M, Joniau S, Montorsi F, Buonerba C (2011) Toxicities of targeted therapy and their management in kidney cancer. Eur Urol 59:526–540
Hutson TE, Figlin RA, Kuhn JG, Motzer RJ (2008) Targeted therapies for metastatic renal cell carcinoma: an overview of toxicity and dosing strategies. Oncologist 13:1084–1096
Asemissen AM, Brossart P (2009) Vaccination strategies in patients with renal cell carcinoma. Cancer Immunol Immunother 58:1169–1174
Van Poppel H, Joniau S, Van Gool SW (2009) Vaccine therapy in patients with renal cell carcinoma. Eur Urol 55:1333–1342
Steinman RM (2007) Lasker basic medical research award. Dendritic cells: versatile controllers of the immune system. Nat Med 13:1155–1159
Tacken PJ, de Vries IJ, Torensma R, Figdor CG (2007) Dendritic-cell immunotherapy: from ex vivo loading to in vivo targeting. Nat Rev Immunol 7:790–802
Schuler G, Schuler-Thurner B, Steinman RM (2003) The use of dendritic cells in cancer immunotherapy. Curr Opin Immunol 15:138–147
Berntsen A, Geertsen PF, Svane IM (2006) Therapeutic dendritic cell vaccination of patients with renal cell carcinoma. Eur Urol 50:34–43
Holtl L, Rieser C, Papesh C, Ramoner R, Bartsch G, Thurnher M (1998) CD83+ blood dendritic cells as a vaccine for immunotherapy of metastatic renal-cell cancer. Lancet 352:1358
Holtl L, Rieser C, Papesh C, Ramoner R, Herold M, Klocker H, Radmayr C, Stenzl A, Bartsch G, Thurnher M (1999) Cellular and humoral immune responses in patients with metastatic renal cell carcinoma after vaccination with antigen pulsed dendritic cells. J Urol 161:777–782
Holtl L, Zelle-Rieser C, Gander H, Papesh C, Ramoner R, Bartsch G, Rogatsch H, Barsoum AL, Coggin JH Jr, Thurnher M (2002) Immunotherapy of metastatic renal cell carcinoma with tumor lysate-pulsed autologous dendritic cells. Clin Cancer Res 8:3369–3376
Holtl L, Ramoner R, Zelle-Rieser C, Gander H, Putz T, Papesh C, Nussbaumer W, Falkensammer C, Bartsch G, Thurnher M (2005) Allogeneic dendritic cell vaccination against metastatic renal cell carcinoma with or without cyclophosphamide. Cancer Immunol Immunother 54:663–670
Draube A, Klein-Gonzalez N, Mattheus S, Brillant C, Hellmich M, Engert A, von Bergwelt-Baildon M (2011) Dendritic cell based tumor vaccination in prostate and renal cell cancer: a systematic review and meta-analysis. PLoS One 6:e18801
Cha E, Fong L (2011) Immunotherapy for prostate cancer: biology and therapeutic approaches. J Clin Oncol 29:3677–3685
Rieser C, Bock G, Klocker H, Bartsch G, Thurnher M (1997) Prostaglandin E2 and tumor necrosis factor alpha cooperate to activate human dendritic cells: synergistic activation of interleukin 12 production. J Exp Med 186:1603–1608
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376
Rieser C, Ramoner R, Holtl L, Rogatsch H, Papesh C, Stenzl A, Bartsch G, Thurnher M (1999) Mature dendritic cells induce T-helper type-1-dominant immune responses in patients with metastatic renal cell carcinoma. Urol Int 63:151–159
Leonhartsberger N, Ramoner R, Putz T, Gander H, Rahm A, Falkensammer C, Bartsch G, Thurnher M (2007) Antigen-independent immune responses after dendritic cell vaccination. Cancer Immunol Immunother 56:897–903
Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S (1998) Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ = C30 (+3). J Clin Oncol 16:1188–1196
Burgdorf SK, Fischer A, Myschetzky PS, Munksgaard SB, Zocca MB, Claesson MH, Rosenberg J (2008) Clinical responses in patients with advanced colorectal cancer to a dendritic cell based vaccine. Oncol Rep 20:1305–1311
Ardon H, Van Gool S, Lopes IS, Maes W, Sciot R, Wilms G, Demaerel P, Bijttebier P, Claes L, Goffin J, Van Calenbergh F, De Vleeschouwer S (2010) Integration of autologous dendritic cell-based immunotherapy in the primary treatment for patients with newly diagnosed glioblastoma multiforme: a pilot study. J Neurooncol 99:261–272
Negrier S, Escudier B, Lasset C, Douillard JY, Savary J, Chevreau C, Ravaud A, Mercatello A, Peny J, Mousseau M, Philip T, Tursz T (1998) Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Francais d’Immunotherapie. N Engl J Med 338:1272–1278
Fyfe G, Fisher RI, Rosenberg SA, Sznol M, Parkinson DR, Louie AC (1995) Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. J Clin Oncol 13:688–696
Atzpodien J, Kuchler T, Wandert T, Reitz M (2003) Rapid deterioration in quality of life during interleukin-2- and alpha-interferon-based home therapy of renal cell carcinoma is associated with a good outcome. Br J Cancer 89:50–54
Heinzer H, Mir TS, Huland E, Huland H (1999) Subjective and objective prospective, long-term analysis of quality of life during inhaled interleukin-2 immunotherapy. J Clin Oncol 17:3612–3620
Cella D (2009) Quality of life in patients with metastatic renal cell carcinoma: the importance of patient-reported outcomes. Cancer Treat Rev 35:733–737
Cella D, Pickard AS, Duh MS, Guerin A, Mishagina N, Antras L, Neary MP, McCann L, Hodge R, Sternberg CN (2011) Health-related quality of life in patients with advanced renal cell carcinoma receiving pazopanib or placebo in a randomised phase III trial. Eur J Cancer [Epub ahead of print]
Bukowski R, Cella D, Gondek K, Escudier B (2007) Effects of sorafenib on symptoms and quality of life: results from a large randomized placebo-controlled study in renal cancer. Am J Clin Oncol 30:220–227
Miyake H, Kurahashi T, Yamanaka K, Kondo Y, Takenaka A, Inoue TA, Fujisawa M (2010) Impact of sorafenib on health-related quality of life in Japanese patients with metastatic renal cell carcinoma: a prospective evaluation. BJU Int 106:1643–1647
Cella D (2011) Beyond traditional outcomes: improving quality of life in patients with renal cell carcinoma. Oncologist 16(Suppl 2):23–31
Trinh L, Plotnikoff RC, Rhodes RE, North S, Courneya KS (2011) Associations between physical activity and quality of life in a population-based sample of kidney cancer survivors. Cancer Epidemiol Biomarkers Prev 20:859–868
Oosterwijk E, Rathmell WK, Junker K, Brannon AR, Pouliot F, Finley DS, Mulders PF, Kirkali Z, Uemura H, Belldegrun A (2011) Basic research in kidney cancer. Eur Urol 60:622–633
Hipp MM, Hilf N, Walter S, Werth D, Brauer KM, Radsak MP, Weinschenk T, Singh-Jasuja H, Brossart P (2008) Sorafenib, but not sunitinib, affects function of dendritic cells and induction of primary immune responses. Blood 111:5610–5620
Acknowledgments
This work was supported by the COMET Center ONCOTYROL, which is funded by the Austrian Federal Ministries BMVIT/BMWFJ (via FFG) and the Tiroler Zukunftsstiftung/Standortagentur Tirol (SAT). We further appreciate the participation of the TILAK hospital holding company, who serves as a partner in the Oncotyrol research programme. Oncotyrol approved the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Leonhartsberger, N., Ramoner, R., Falkensammer, C. et al. Quality of life during dendritic cell vaccination against metastatic renal cell carcinoma. Cancer Immunol Immunother 61, 1407–1413 (2012). https://doi.org/10.1007/s00262-012-1207-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00262-012-1207-7