Adoptive Immunotherapy
DESCRIPTION
The spontaneous regression of certain cancers, such as renal cell cancer or melanoma, support the idea that an individual’s immune system is sometimes capable of delaying tumor progression, and on rare occasions, can eliminate the tumor all together. These observations have led to research interest in a variety of immunologic therapies designed to stimulate an individual’s own immune system, which can be categorized as follows: 1) active non-specific immunotherapy, i.e. the use of interleukin-2, 2) active specific immunotherapy, e.g. immunization with a variety of therapeutic vaccines, 3) passive non-specific immunotherapy, i.e. transfer of lymphokine-activated killer cells, and 4) passive specific immunotherapy, i.e. transfer of specific immune cells such as cytotoxic T-lymphocytes or lymphocytes producing specific antibodies. Adoptive immunotherapy (i.e., biologic therapy, biotherapy) is a general term describing the transfer of immunocompetent cells.
POLICY
Adoptive immunotherapy, using either tumor infiltrating lymphocytes, lymphokine-activated killer (LAK) cells, activated in vitro by recombinant or natural IL 2 or other lymphokines, or antigen loaded dendritic cells for advanced renal cell carcinoma, melanoma, or other malignancies, is considered investigational.
Autolymphocyte therapy (ALT) using peripheral T cells stimulated in vitro by AKT3 monoclonal antibody in conjunction with IL 2 is considered investigational.
Adoptive immunotherapy for the treatment of other conditions/diseases is considered investigational.
IMPORTANT REMINDER
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ADDITIONAL INFORMATION
Since the lack of any well-designed randomized controlled trials and studies in peer review journals, no conclusions can be drawn about whether adoptive immunotherapy has an effect on health outcomes.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2008). Adoptive Immunotherapy (8.01.01) Retrieved March 9, 2010 from BlueWeb. (31 articles and/or guidelines reviewed)
Dossett, M. L., Teague, R. M., Schmitt, T. M., Tan, X., Cooper, L., Pinzon, C, et al. (2009). Adoptive immunotherapy of disseminated leukemia with TCR-transduced, CD8+ T cells expressing a known endogenous TCR. Molecular Therapy, 17 (4), 742-749. (Level 4 Evidence - Independent study)
Fry, T. J., & Lankester, A. C. (2010). Cancer immunotherapy: Will expanding knowledge lead to success in pediatric oncology? Hematology/Oncology Clinics of North America, 24 (1), 109-127.
Gattinoni, L., Powell, Jr., D. J., Rosenberg, S. A., & Restifo, N. P. (2006). Adoptive immunotherapy for cancer: Building on success. Nature Reviews. Immunology, 6 (5), 383-393.
National Institute for Health and Clinical Excellence (NICE). (2008, October). Adoptive cellular immunotherapy for cytomegalovirus viraemia. Retrieved March 10, 2010 from http://guidance.nice.org.uk/index.jsp?action=byID&o=12727.
Ohira, M., Ishivama, K., Tanaka, Y., Doskali, M., Igarashi, Y., Tashiro, H., et al. (2009). Adoptive immunotherapy with liver allograft-derived lymphocytes induces anti-HCV activity after liver transplantation in humans and humanized mice. The Journal of Clinical Investigation, 119 (11), 3226-3235. (Level 4 Evidence - Independent study)
Riddell, S. R. (2007). Engineering antitumor immunity by T-cell adoptive immunotherapy. Hematology/the Education Program of the American Society of Hematology, 250-256.
Tan, D., & Horning, S. (2008). Follicular Lymphoma: Clinical features and treatment. Hematology/Oncology Clinics of North America, 22 (5), 863-882.
ORIGINAL EFFECTIVE DATE: 10/11/2008
MOST RECENT REVIEW DATE: 4/8/2010
ID_BT
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