3 DISCUSSION
As far as we know, monotherapy of stage IV carcinoma with cancer
vaccines, except AFTV, has had dismal outcomes. AFTV made from resected
formalin-fixed and paraffin-embedded autologous tumor tissue has been
effective in glioblastoma,1-4 bone-metastatic
triple-negative breast cancer,5, 6upper tract urothelial
carcinoma,7 advanced hepatocyte
carcinoma,8, 9 malignant
histiocytoma,10 peritoneal serous carcinoma recurrent
after chemotherapy,11 gall bladder
cancer,12 advanced colon cancer,12uterine cervical small cell carcinoma.13 Almost all of
these tumors, at advanced stages, are known to be refractory to
chemotherapy and immune-checkpoint inhibitors.
In the present case of advanced uterine carcinoma, early cancellation of
the standard chemotherapy (carboplatin-docetaxel, only one injection)
may have preserved her bone marrow in a healthy condition from where
immune competent T lymphocytes were released without
impairing cell
proliferation and differentiation capacity.
AFTV is capable of stimulating these cells to differentiate into
cytotoxic T lymphocytes (CTL) in vivo.9 The basic
mechanism of CTL induction in formalin-fixed paraffin-embedded tumor
tissue sections has been shown in our prior
publication.14
Although monotherapy with AFTV was three injections in the present case,
all of the nine lung metastases of the carcinoma shrunk apparently to
less than half of their original sizes (Fig. 1, series ii). Although we
are not quite able to conclude that the complete responses of all of the
lung metastases (Fig 1, series iii) and the paraaortic lymph node (Fig.
1, h, iii) are solely due to the monotherapy with AFTV, the course of
the present case strongly implies that AFTV monotherapy followed by, if
necessary, one injection of cytotoxic agents will be an attractive
treatment option for patients fearing severe adverse effects of standard
chemotherapy.