Sequential Autologous CIK/NK Cells Combined with Chemotherapy to Induce Long-Term Tumor Control in Advanced Rectal Cancer: A Case Report

Abstract

Objective: Colorectal carcinoma (CRC) is the third most common malignancy. In addition to comprehensive cancer treatments, such as surgery, chemotherapy, and radiotherapy, the adoptive immune cell therapy (ACT) has played an increasingly important role in recent years, and the adaptive transfusion of autologous NK cells and CIK cells is a brand-new approach to cellular therapy for solid tumors.

Case presentation: A 57-year-old man underwent a radical resection of microsatellite stable (MSS) rectal cancer with synchronous liver metastases. After surgery of the primary lesion surgery, he was treated with autologous CIK/NK cells combined with XELOX translational therapy. Each cycle can obtain over 10 × 10⁹ CIK cells or over 6 × 10⁹ NK cells combined chemotherapy of XELOX every 3 weeks. After 2 cycles of therapy, he achieved partial response (PR). He immediately underwent a hepatic metastasis resection. After surgery, the patient continued to receive autologous CIK/NK cells in combined with 4 cycles of XELOX. To date, he has achieved and maintained no evidence of disease (NED) for over 40 months.

Conclusion: This is a case of successful treatment of rectal cancer with liver metastasis using ACT in conjunction with first-line chemotherapy. The advantage of this treatment plan is that it has few side effects and achieves long-term control of tumor recurrence by improving the patient's immune function. However, its responsiveness and benefit rate still need further investigation.

Keywords: advanced rectal cancer; autologous CIK cells; autologous NK cells; chemotherapy.

Figure 1

Histological and immunohistochemical staining results. Hematoxylin and eosin (HE) staining of the rectal lesions (A and B). HE staining of the 2nd segment of the left hepatic lobe lesions (C and D). HE staining of the 6th segment of the right hepatic lobe lesions (E and F). (A, C and E) magnification, ×40; (B, D and F) magnification, ×100.

Figure 2

Upper abdominal imaging examination. Liver metastases before combination therapy (A). After 2 cycles of treatment, the liver metastases significantly reduced in size (B). Imaging after 6 cycles of combined treatment and resection of liver metastases (C). Follow up imaging after 2 years of treatment (D). Red arrows indicate liver metastases.

Figure 3

Schematic diagram on schedules of CIK/NK cell treatments (A) and immunophenotypes monitoring (B).

Figure 4

Blood tumor markers examination. All markers were maintained at a low lever before and after treatments, showing no difference in the level of CEA (A), CA199 (B), CA242 (C), CA50 (D) and CA724 (E). In these graphs, checking point “Bas” means baseline, while checking points “C1” - “C6” indicate after the first time to the sixth ACT.

Figure 5

Changes in immunophenotyping and cytokines during treatment. There are total lymphocytes (A), CD3⁺ T cells (B), CD4⁺ T cells (C), CD8⁺ T cells (D), NK cells (E), NKT cell (F), Tregs (G), CD3⁺PD-1⁺ cells (H), CD8⁺CD28⁺ (I), Th1 cytokine (J), and Th2 cytokine (K). In these graphs, checking point “Bas” means Baseline, while checking points “C1” - “C6” indicate after the first time to the sixth ACT.