Serum tumor markers in non-small cell lung cancer. A comparative analysis.

BACKGROUND: The role of serum tumor markers in non-small cell lung cancer (NSCLC) remains undefined. New proposed markers have seldom been rigorously compared with existing standards. The authors prospectively compared the performance of three new monoclonal antibodies (MoAb) (5E8, 5C7, and 1F10) with the established serum markers carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC). METHODS: The cohort consisted of 45 consecutive out-patients with newly diagnosed NSCLC: Control subjects were 38 outpatients with non-neoplastic chronic pulmonary diseases. Blood from each patient and control subject was assayed for all five tumor markers. An enzyme-linked immunosorbent assay (ELISA) was used to determine 5E8, 5C7, and 1F10 reactivity. Commercially available kits were used to measure SCC by radioimmunoassay and CEA by ELISA: Individual and combinations of tumor markers were compared in terms of sensitivity, specificity, and accuracy for NSCLC diagnosis. RESULTS: 5E8 plus 5C7 plus 1F10 significantly surpassed SCC plus CEA in terms of sensitivity (P < 0.05) and proved the most accurate marker combination. Among single markers, 5E8 was most specific, 5C7 most sensitive, and 5C7 and 1F10 each most accurate, but differences from CEA alone were not significant. Subgroup analysis by histologic type and stage demonstrated similar findings, and marker combinations yielded little additional diagnostic benefit. CONCLUSIONS: 5E8, 5C7, and 1F10 performed marginally better than did CEA and SCC in patients with newly diagnosed NSCLC: Many limitations apply in defining a clinical niche for these tumor markers in NSCLC, although 5E8, 5C7, and 1F10 previously have demonstrated a modest prognostic value. An adjunctive role in a few specific clinical contexts remains possible.

Digestive tract cell proliferation and food consumption patterns of Ha/ICR mice.

The relationship between the daily pattern of food consumption and the proliferation rate of the oesophagus, stomach, forestomach, small intestine and colon of Ha/ICR mice was examined. Proliferative activity was determined by [3H]TdR incorporation on a wet weight tissue basis, along with selective counting of labelled nuclei. Under conditions of ad libitum feeding with a 12 hr light cycle (lights on at 0600) mice eat most of their food during the dark period. A distinct circadian rhythm was observed in the oesophagus, stomach, forestomach and colon with the peak of [3H]TdR incorporation between 0400 and 0600 and the nadir between 1600 and 1800. Although a circadian fluctuation was observed in the small intestine, its amplitude was much less than in other areas. This rhythmic change in proliferation rate could be phase shifted by allowing the mice to feed only between 0800 and 1600 for 14 days. Under these conditions the peak in proliferative activity occurred between 1800 and 2000. Fasting reduced the daily level of proliferative activity in all of the digestive tract sites studied, and for all areas except the oesophagus greatly reduced or eliminated the circadian fluctuation. The forestomach and colon were the most influenced by fasting with 24 hr [3H]TdR incorporation reduced to 30-40% of the control value. Refeeding following a 48 hr fast produced a rapid increase in proliferative activity peaking at levels well above the control value at 16 hr after the onset of refeeding. The major exception to this was the small intestine which slowly returned to the control value during the first 24 hr. Partial refeeding produced a diminished refeeding response. Once the normal pattern of food consumption was re-established following refeeding the normal proliferative fluctuations were again observed.

Renal and haemopoietic proliferative defects as a delayed consequence of cis-platin, adriamycin and daunomycin treatments.

The long-term effects of Adriamycin (ADR), daunomycin (DMN) and cis-dichlorodiammine platinum (II) (DDP) on the ability of murine renal tubular epithelium and erythropoiesis to respond to an acute proliferative stress was investigated. Folic acid (FA) and acute anaemia induced by bleeding were used as acute proliferative stimuli for renal-tubule epithelium and erythropoiesis respectively. The ability of these normal cell-renewal systems to mount a regenerative proliferative response was evaluated by radioisotopic, morphological and gravimetric techniques 4 months after drug treatment. The results indicate that pretreatment with these agents produce a long-lasting reduction in the ability of these cell-renewal systems to mount regenerative proliferation. In the kidney, the ability to respond to FA was most severely compromised by ADR and DDP, whereas in the erythropoietic system all 3 agents induced a long-lasting proliferative defect.

Proliferative defects in renal and intestinal epithelium after cis-dichlorodiammine platinum (II).

The effects of cis-dichlorodiammine platinum II (DDP) on the intestinal mucosa and the kidney were studied after single and multiple treatments with intervals of 7-45 days. After a single treatment, the jejunal epithelium underwent a transient interruption of cell proliferation followed by a hyperplastic recovery and return to control proliferative rate on Day 7. Subsequent treatments led to suboptimal recovery for all treatment intervals. In contrast, DDP induced a 6-fold increase in [3H]dT incorporation in the kidney by Day 7 which remained high until Day 21, and returned to near-control values by Day 45. After a single DDP treatment, the "recovery potential" of kidneys, measured by the proliferative response to folic-acid stress, demonstrated suboptimal proliferative reserve compartments for up to 45 days. The distinction between acute and delayed sensitivity to subsequent drug treatment was more apparent in the DDP-treated kidney than in the intestinal epithelium.

Alterations in gastrointestinal steady-state kinetics associated with the growth of experimental tumours.

Changes in the growth kinetics of the intestinal epithelium were observed in mice bearing the Lewis lung carcinoma and the T1699 mammary adenocarcinoma and in rats bearing the H-4-II-E2 hepatoma. Proliferative activity in the jejunal tissue was markedly depressed with increasing tumour burden. Simultaneously, a significant reduction in total crypt cellularity occurred, followed by a reduction in villus height. While the total number of proliferative cells per crypt decreased, the relative proliferative compartment within the shrinking crypt increased. The rate of mucosal DNA synthesis remained constant during the initial cytokinetic changes, falling only after proliferative activity of the intestine was reduced to less than 50% of control levels. No general correlation could be drawn from the three tumour models studied between the level of gastrointestinal proliferation and tumour size, tumour growth rate or loss of weight by the tumour-bearing animals. However, intestinal proliferation was reduced by 50% when the tumour burden for each of the three tumours reached 6--8% of the host animal weight.

Adriamycin-induced delayed erythropoietic injury expressed following anemia stress.

The present studies were undertaken to compare anemia-induced erythropoietic responses in femoral marrows and spleens of mice pretreated with Adriamycin (ADR) or 1-beta-D-arabinofuranosylcytosine with those of untreated age-matched controls. Mice were bled 45 or 120 days after drug treatment. The erythropoietic response to bleeding was quantitated by morphological, gravimetric, and radioiron methods 48 hr after bleeding. At 120 days after ADR, prebleeding base-line cellularity parameters were, in general, similar to those found in untreated age-matched controls. The response to the anemia stress was compared in drug-treated animals and in age-matched untreated controls, and the response deficit was expressed as residual injury (RI). At 120 days, ADR-induced RI was observed to be dose dependent in both femoral marrow and spleen. ADR-induced RI in femoral marrow and spleen were similar at 45 and 120 days, with no significant recovery. Although marrow RI was noted 45 days after 200 mg 1-beta-D-arabinofuranosylcytosine per kg, there was no RI at 120 days. The results indicate that ADR can induce a long-lasting hematopoietic injury which is not obvious from measures of homeostatic cellularity, but which can be expressed after induction of an acute proliferative demand.

ICRF-159 enhancement of radiation response in combined modality therapies. I. Time/dose relationships for tumour response.

The combined effect of the chemotherapeutic agent ICRF-159 and irradiation were evaluated using the Lewis lung tumour (LL). At a daily dose of 25 mg/kg, ICOF given alone prevented the progressive growth of LL. Daily pretreatment also potentiated the effects of radiation (600 rad) on tumour growth, provided the pretreatment kinetics of the tumour permitted a response to radiation alone. Single acute doses of the drug failed to alter the growth of LL, and when combined with radiation failed to enhance the radiation effect. Fractionation of the drug (25 mg/kg; 4 doses at 3h intervals) before irradiation, however, results in immediate effects on tumour growth which are more than additive. The results suggest that a low dose of ICRF-159 for extended periods is more effective in enhancing radiotherapy than a high dose provided acutely.

ICRF-159 enhancement of radiation response in combined modality therapies. II. Differential responses of tumour and normal tissues.

The combined effect of the chemotherapeutic agent ICRF-159 and radiation on the proliferative status of tumor/normal systems has been evaluated using the Lewis lung tumour in BDF1 mice. We have previously shown that a 25 mg/kg dose of ICRF-159, given at 3h intervals X4 before irradiation, significantly enhanced tumour growth retardation relative to a single dose of 100 mg/kg before irradiation. Whilst both single and fractionated drug treatments produced a transient inhibition of cell proliferation, comparisons of the temporal recovery from the antiproliferative effect of radiation in both tumour and intestinal epithelium suggested that single acute doses of ICRF-159 fail to potentiate the radiation response of either tissue. Protracted drug administration before irradiation, however, markedly decreases the post-radiation proliferative recovery of the tumour, without significantly altering intestinal recovery. The data suggest that both drug concentration and/or exposure time determine the interactions seen with combined modes.

Influence of adriamycin and adriamycin-radiation combination on jejunal proliferation in the mouse.

The influence of adriamycin and adriamycin-radiation combinations on posttreatment proliferative activity of the mouse jejunum was examined by measuring [3H]thymidine incorporation. Single doses of 5 or 10 mg/kg produced a transient reduction in the proliferative activity, while 1 mg/kg had little effect. After 10 mg/kg, there was a rapid decrease in the number of mitotic figures, followed by a gradual decrease in the number of and rate of DNA synthesis in S-phase cells. A compensatory epithelial hyperplasia characterized by an enlarged crypt proliferative population and shortened mitotic cycle duration was observed beginning 48 hr after treatment. Multiple doses of adriamycin totalling 10 mg/kg inhibited cell production to a greater extent than the equivalent single dose. In combination with 1000 R, adriamycin (5 mg/kg) given from 96 hr before to 72 hr after irradiation reduced the amount of postirradiation proliferation.

Combined-modality oncotherapy with cyclophosphamide (NSC-26271) and radiotherapy: control of murine mastocytoma.

We investigated the effects of cyclophosphamide, alone and in combination with a 1,000-R/week radiotherapy schedule, on the growth of solid P815X2 tumors in 12-week-old male DBA/2 mice. Single-dose treatments of 150 mg cyclophosphamide/kg were given to animals bearing tumors of different ages. Such treatment of young tumors resulted in proportionately greater degrees of regression and steeper regrowth curves than did treatment of older tumors. Although slopes of regrowth curves differed greatly, time to regrowth (to pretreatment size) was the same for all age classes of tumors. Graded weekly exposures of 50-250 mg/kg for 4 weeks resulted in dose-dependent increases in incidence of complete remission, duration of remission (time to regrowth), and mean animal life-spans. The combination of radiotherapy to the tumor and 75, 150, or 225 mg cyclophosphamide/kg/week resulted in better local tumor control than occurred with radiotherapy or the drug alone. However, a dose-dependent increase in radiosensitivity of the gastrointestinal mucosa included in radiotherapy fields was observed. A 3-week course of radiotherapy plus 75 mg cyclophosphamide/kg/week (which is tolerated by the mucosa) increased animal lifespans to 165% of those of controls.