Two hundred patients with metastatic
breast cancer who were treated with
combination chemotherapy and nonspecific
immunotherapy with BCG or MER were skin tested prior to, and at regular intervals during the administration of
chemotherapy with a battery of six
antigens (
Dermatophytin,
Varidase, candida,
mumps,
PPD, and KLH). Delayed-type
hypersensitivity responses to this battery of
antigens were analyzed to assess whether they correlated with ability to respond to
chemotherapy, length of survival, and a number of other host and
tumor characteristics of known prognostic significance. Responsiveness to individual recall
antigens or the number of positive skin test responses did not correlate with overall or complete response rates. The correlation did exist with KLH, a primary
antigen. A positive response to two or more
antigens correlated with a longer survival. Inability to mount a skin test response to any
antigen correlated with poor survival.
PPD conversions during serial BCG administration did not correlate with a better prognosis. Serial skin testing with a battery of
antigens did not correlate with prognosis. Skin test responsiveness to the
antigens used in this study did not correlate with the other pretreatment factors of prognostic importance such as
tumor burden, absolute lymphocyte count, performance status, prior
radiation therapy, menopausal status, and age. Therefore, responsiveness to skin testing with these
antigens appears to be an independent prognostic variable and should be incorporated in the planning and analysis of systemic treatment programs in metastatic
breast cancer.