Immunological responses in a patient with glioblastoma multiforme treated with sequential courses of temozolomide and immunotherapy: Case study

¹ Departments of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, and Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
² Departments of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
³ Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
⁴ Neuropathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
⁵ Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
⁶ Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
⁷ Department of Pathology, Duke University Medical Center, Durham, NC, USA
⁸ Division of Neurosurgery, Departments of Surgery and Pathology, Duke University Medical Center, Durham, NC, USA

^* To whom correspondence should be addressed. E-mail: aheimber{at}mdanderson.org.

	Abstract

Cytotoxic chemotherapy that induces lymphopenia is predicted to ablate the benefits of active antitumor immunization. Temozolomide is an effective chemotherapeutic 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 both 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