Meta-Analysis
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World J Gastroenterol. Jan 28, 2014; 20(4): 1095-1106
Published online Jan 28, 2014. doi: 10.3748/wjg.v20.i4.1095
Combination of chemotherapy and immunotherapy for colon cancer in China: A meta-analysis
Zheng-Xu Wang, Jun-Xia Cao, Zhi-Ping Liu, Yu-Xin Cui, Chun-Yun Li, Duo Li, Xiao-Yan Zhang, Jin-Long Liu, Jun-Li Li
Zheng-Xu Wang, Jun-Xia Cao, Chun-Yun Li, Duo Li, Xiao-Yan Zhang, Jin-Long Liu, Jun-Li Li, Biotherapy Center, the General Hospital of Beijing Military Command, Beijing 100700, China
Zhi-Ping Liu, Department of Immunology, St Jude Children’s Research Hospital, Memphis, TN 38105, United States
Yu-Xin Cui, School of Cellular and Molecular Medicine, University of Bristol, University Walk, Bristol BS8 1TD, United Kingdom
Author contributions: Wang ZX designed the research; Cao JX and Li CY performed the research; Liu ZP and Cui YX contributed new reagents or analytic tools; Cao JX, Li CY, Li D, Zhang XY, Liu JL and Li JL analyzed data; Wang ZX, Cao JX, Liu ZP and Cui YX wrote the paper.
Supported by National Natural Science Foundation of China, No. 31171427 and No. 30971651 to Wang ZX; National Natural Science Foundation of China, No. 30700974 to Cao JX; and Postdoctoral Foundation of China, No. 20060400775 to Cao JX
Correspondence to: Zheng-Xu Wang, MD, PhD, Associate Professor, Director of Biotherapy Center, the General Hospital of Beijing Military Command, No.5 of Nan Men Cang Rd, Dongcheng District, Beijing 100700, China. zhxwang18@hotmail.com
Telephone: +86-10-66721169 Fax: +86-10-64038276
Received: September 10, 2013
Revised: October 28, 2013
Accepted: November 12, 2013
Published online: January 28, 2014
Abstract

AIM: To investigate whether autologous dendritic cell (DC)-cytokine-induced killer (CIK) cell therapy is able to improve the therapeutic efficacy of chemotherapy in colon cancer.

METHODS: We conducted a systematic review of published papers from the sources of MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the Wanfang Database, the China Science and Technology Periodical Database and China Journal Net. Published data were extracted independently by two authors using predefined database templates. The quality of the data from individual papers was also assessed. The effects of chemotherapy were compared with those of chemotherapy in combination with DC-CIK immunotherapy. The pooled analysis was performed using the data from random or fixed-effect models.

RESULTS: Seven trials matched our inclusion criteria (n = 533). The overall analysis showed significant survival benefit [one-year overall survival (OS), P < 0.0001; two-year OS, P = 0.009; three-year OS, P = 0.002] in favor of DC-CIK immunotherapy combined with chemotherapy. Disease-free survival (DFS) rate was improved after the combination of DC-CIK immunotherapy and chemotherapy (one-year DFS, P < 0.0001; two-year DFS, P = 0.002; three-year DFS, P = 0.02). An improved overall response rate (P = 0.009) was also observed in patients who received DC-CIK therapy. Furthermore, the analysis of T-lymphocyte subsets in peripheral blood indicated that the number of CD4+ T cells significantly increased in the DC-CIK plus chemotherapy group (P < 0.05).

CONCLUSION: The combination of DC-CIK immunotherapy and chemotherapy was superior in prolonging the survival time and enhancing immunological responses.

Keywords: Dendritic cells, Cytokine-induced killer cells, Meta-analysis, Colon cancer, Immunotherapy

Core tip: A growing body of knowledge on tumor immunosurveillance and loss thereof has contributed to the refinement of anti-tumor immunotherapy. The aim of our meta-analysis was to determine whether an association exists between dendritic cell (DC)-cytokine-induced killer (CIK) cell therapy combined with chemotherapy and chemotherapy alone. Our analysis demonstrates that DC-CIK therapy improved 1, 2 and 3-year overall survival, 1, 2 and 3-year disease-free survival, overall response rate and immune indices in colon cancer. In all, the combination of DC-CIK immunotherapy and chemotherapy was superior in prolonging the survival time and enhancing immunological responses, suggesting the possible application of this promising adjuvant immunotherapy in colon cancer.