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Case Studies/Case Illustration |
Departments of Neurosurgery (A.B.H., W.S., S.F.H., L.C., S.J.H., R.S.), Neuropathology (K.A.), and Neuro-Oncology (M.G.), The University of Texas M. D. Anderson Cancer Center, Houston, TX; Department of Neurosurgery, Baylor College of Medicine, Houston, TX (A.B.H., M.D., S.J.H., R.S.); and Division of Neurosurgery, Departments of Surgery (B.S., G.E.A., D.A.M., J.H.S.) and Pathology (D.D.B., J.H.S.), Duke University Medical Center, Durham, NC; USA
Address correspondence to Amy B. Heimberger, Unit 442, Department of Neurosurgery, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA (aheimber{at}mdanderson.org).
Cytotoxic chemotherapy that induces lymphopenia is predicted to ablate the benefits of active antitumor immunization. Temozolomide is an effective chemotherapeutic agent for patients with glioblastoma multiforme, but it induces significant lymphopenia. Although there is monthly fluctuation of the white blood cell count, specifically the CD4 and CD8 counts, there was no cumulative decline in the patient described in this case report. Depriving patients of this agent, in order to treat with immunotherapy, is controversial. Despite conventional dogma, we demonstrated that chemotherapy and immunotherapy can be delivered concurrently without negating the effects of immunotherapy. In fact, the temozolomide-induced lymphopenia may prove to be synergistic with a peptide vaccine secondary to inhibition of regulatory T cells or their delayed recovery.
Key Words: active immunotherapy • antibody • antigen • CNS neoplasms • cytotoxic T lymphocyte • epidermal growth factor receptor • glioma
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