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Title   OK - 432 의 흉강내 주입에 의한 악성 흉막액의 치료 ( Intrapleural Instillation of OK - 432 for malignant Pleural Effusion )
Publicationinfo   1992 Jan; 024(01): 47-56.
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Abstract   Malignant pleural effusion is a distressing complication in cancer patients with considerable management problems. A sclerosing agent, either antibiotic, antineoplastic, or radioactive can be delivered intrapleurally to produce mesothelial fibrosis and obliterate small blood vessels, rather than produce specific antineoplastic activity. As previously described, the biological response modifier OK-432, a streptococcal preparation, has been to have clinical activities in malignant pleuro-peritoneal effusions. To evaluate the clinical efficacy, 10KE of OK-432 dissolved in 50ml of normal saline was in- stilled in 16 patients with malignant pleural effusion via the chest tube drain. If necessary, instillations were repeated at one-week interval, one to three times. Peripheral blood 1ymphocytes of these patients were evaluated sequentially for their natural killer(NK) and antibody- dependent cellular cytotoxic(ADCC) activities before and after OK-432 instillation. The age of patients ranged from 21 to 74 years with a median of 56 years, and the male to fe- male ratio was 10: 6. Ten patients had the lung primaries, and the other six primaries included stomach, uterine cervix, rectum, liposarcoma of the chest wall, thymic carcinoma, and melano- ma respectively. Cytologic examinations of the pleural fluid for malignant cells were positive in 5 patients. Eleven patients (68.8%) showed an objective response and the duration ranged from 4+to 24 weeks with a median of 6+ weeks. Especially all 5 patients with positive pleural fluid cytology showed the response. Chest pain (13/25), and fever and/or chills (11/25) were the most common side effects. Other untoward effects included transient aggrevation of dyspnea(4/25), vomiting (4/25), anorexia (3/25), and general weakness (2/25). No patient showed the hypersensitivity re- action or reduction of blood cell counts. Mean NK activity was markedly low in patients with malignant pleural effusion compare to that of 18 healthy volunteers (24.5+-9.6% vs 47.6+6.4%) (p<0.01), but no difference in ADCC activity (50.9+14.5% vs 56.9+5.2%). The NK activity was enhanced after instillation of OK-432 (24.5+-9.6% on day 0, 32.1 +- l7.3% on day 1 through 3, and 42.4+26.0% on day 7) but their ADCC activities were the same. In a seperate experiment, pleurae from the healthy rabbits were examined before and after intrapieural injection of OK-432. Varying dose of intrapleural OK-43Z (l. OKE-10KE)did not cause any histologic change on the pleurae from the rabbits which were sacrificed on day 7. No drug associated mortality was observed in the rabbits. OK-432 was effective to control the malignant pleural effusion especially in patients with positive pleural fluid cytology and shnwina augmentation of the NK activity in the peripheral blood. The side effects of the OK-432 was manageable. OK-432 did not rnake any histologic change on the pleurae of the heaithy rabbits.
저 자   임호영(Ho Yeong Lim),김주항(Joo Hang Kim),박영환(Young Hwan Prk),정현철(Hyun Cheol Chung),최정주(Joung Ju Choi),최숭구(Seoung Goo Choi),김호근(Ho Geun Kim),최진혁(Jin Hyuk Choi),유내춘(Nae Chun Yoo),고은희(Eun Hee Koh),장준(Joon Chang),노재경(Jae Kyung Roh),김성규(Sung Kyu Kim),이원영(Won Young