Anti-Cancer Drugs. 17(8):949-959, SEPTEMBER 2006
DOI: 10.1097/01.cad.0000224450.54447.b3
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PMID: 16940805
Issn Print: 0959-4973
Publication Date: September 2006
Early destruction of tumor vasculature in tumor necrosis factor-α-based isolated limb perfusion is responsible for tumor response
Saske Hoving;Ann Seynhaeve;Sandra van Tiel;Gisela aan de Wiel-Ambagtsheer;Ernst de Bruijn;Alexander Eggermont;Timo ten Hagen;
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aDepartment of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The NetherlandsbDepartment of Experimental Oncology, University of Leuven, Leuven, Belgium
Abstract
Addition of high-dose tumor necrosis factor-α to melphalan-based isolated limb perfusion enhances anti-tumor effects impressively. Unfortunately, the mechanism of action of tumor necrosis factor-α is still not fully understood. Here, we investigated the effects of tumor necrosis factor-α on the tumor microenvironment and on secondary immunological events during and shortly after isolated limb perfusion in soft-tissue sarcoma-bearing rats. Already during isolated limb perfusion, softening of the tumor was observed. Co-administration of tumor necrosis factor-α in the isolated limb perfusion with melphalan induced a six-fold enhanced drug accumulation of melphalan in the tumor compared with isolated limb perfusion with melphalan alone. In addition, directly after perfusion with tumor necrosis factor-α plus melphalan, over a time-frame of 30 min, vascular destruction, erythrocyte extravasation and hemorrhage was detected. Interstitial fluid pressure and pH in the tumor, however, were not altered by tumor necrosis factor-α and no clear immune effects, cellular infiltration or cytokine expression were observed. Taken together, these results indicate that tumor necrosis factor-α induces rapid damage to the tumor vascular endothelial lining resulting in augmented drug accumulation. As other important parameters were not changed (e.g. interstitial fluid pressure and pH), we speculate that the tumor vascular changes, and concurrent hemorrhage and drug accumulation are the key explanations for the observed synergistic anti-tumor response.
