Malignant pleural effusions and ascites are distressing complications in solid cancer patients with considerable management problems. Intracavitrary immunotherapy has been studied recently in a variety of solid tumors that otherwise might be
incurable.
Using the intraperitoneal administration of a cytokine, such as the interferons and the interleukins, some complete regressions of tumors have been documented. But those trials were applied for malignant lesions that are isolated to the
peritoneal
cavity, such as residual ovarian cancer. To evaluate the clinical implications of intracavitary interferon-alpha-2b(IFN-a2b) instillation with or without systemic chemotherapy in various solid tumors, thirteen patients (five with gastric, four
with
hepatic, two with bronchial, one with ovarian, and one with pancreatic tumor) with carcinomatous pleural effusions or ascites were treated with intracavitary instillation of IFN-a2b 6MU or 10MU on day 1, 8, 15, repeated every 28 days. Two
patients
who
had recurrent ascites after initial response, were retreated by same method and total 15 cases were evaluable. Ten patients were treated with intracavitary IFN-a2b and systemic chemotherapy (six-with oral UFT and leucovorin, two with Etoposide,
Ifosfomide, and Cisplatin, one with Cyclophsphamide, Adriamycin, and Cisplatin, one with Etoposide, Leucovorin, and Cisplatin). Nine cases (60%) showed clinical evidence of therapeutic benefit by disappearance of malignant ascites or pleural
effusion.
The response ranged from 8 to 44+weeks with a median of 12+ weeks. Especially responders treated with intracavitary IFN-α2b and systemic chemotherapy showed longer duration of response. Fever (8/15)and abdominal pain (4/15) were the most common
side
effects. Patients who treated with IFN-α2b instillation only did not show any significant side effects and leukopenia and mucositis which developed after combined therapy with chemotherapy were not seem to be related with IFN-a2b instillation.
These
results suggest a role of intracavitary IFN-a2b instillation for control of malignant ascites and pleural effusion in advanced solid tumor. Also minor side effects of intracavitary IFN-a2b instillation suggest that this treatment can be combined
safely
with systemic chemotherapy.
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