Ann Thorac Surg 1996;61:1617
© 1996 The Society of Thoracic Surgeons
Discussion
Discussion
See also page 1609.
DR DANIEL L. MILLER (Louisville, KY): This was an excellent presentation and a great deal of work. First of all, could you explain the selection criteria for the 20 patients who received TNF? Also, have you considered first doing a cytoreductive operation to remove as many of the metastases as possible before giving TNF? If you have, what were the results?
DR PASS: As you know, we do a lot of metastasectomies at the National Cancer Institute, and our criteria have been very liberal, despite trying to define prognostic factors. But these patients clearly were out of the bell curve, meaning that they averaged more than five metastases before we operated on them. So we essentially defined this as a group of patients in whom we believed we were not going to have any efficacy at multiple resections without taking a lot of lung also.
The second question, about doing an operation and then giving TNF afterward for large lesions, begs two answers. Number one, we do not know whether the larger lesions are going to be more responsive than the smaller lesions, because this may indeed be a vascular phenomenon, whereby larger lesions have more vessels and may actually have a greater chance of response. Number two, I do not think you should do a study like this until you have defined what the response rate is with the different agents. I would like to see response rates and have a good cocktail before we start thinking of using this in an adjuvant setting.
DR MARK J. KRASNA (Baltimore, MD): I have one quick question, Dr Pass. Regarding the use of hyperthermia and TNF combined with interferon, would you comment on the relative contribution of the hyperthermia? Obviously, you have not compared hyperthermia alone, but there are many reports both in pleural lavage and in pulmonary lavage using hyperthermic perfusion alone and with an additional agent.
DR PASS: These hyperthermic levels are really moderate. I do not think that we are seeing only a hyperthermic effect here, although that begs another study.
Interferon-
gives extremely low response rates in these patients. Certainly I do not think, in many studies that are done in patients using either interferon-
interferon-, that you get significant response rates. Those response rates are in the 7% to 9% range.
Related Article
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Isolated Lung Perfusion With Tumor Necrosis Factor for Pulmonary Metastases
- Harvey I. Pass, Daphne J. Y. Mew, Karen C. Kranda, Barbara K. Temeck, Jessica S. Donington, and Steven A. Rosenberg
Ann. Thorac. Surg. 1996 61: 1609-1617.
[Abstract]
[Full Text]
