3 DISCUSSION
As far as we know, monotherapy of stage IV carcinoma with cancer vaccines, except AFTV, has had dismal outcomes. AFTV made from resected formalin-fixed and paraffin-embedded autologous tumor tissue has been effective in glioblastoma,1-4 bone-metastatic triple-negative breast cancer,5, 6upper tract urothelial carcinoma,7 advanced hepatocyte carcinoma,8, 9 malignant histiocytoma,10 peritoneal serous carcinoma recurrent after chemotherapy,11 gall bladder cancer,12 advanced colon cancer,12uterine cervical small cell carcinoma.13 Almost all of these tumors, at advanced stages, are known to be refractory to chemotherapy and immune-checkpoint inhibitors.
In the present case of advanced uterine carcinoma, early cancellation of the standard chemotherapy (carboplatin-docetaxel, only one injection) may have preserved her bone marrow in a healthy condition from where immune competent T lymphocytes were released without impairing cell proliferation and differentiation capacity. AFTV is capable of stimulating these cells to differentiate into cytotoxic T lymphocytes (CTL) in vivo.9 The basic mechanism of CTL induction in formalin-fixed paraffin-embedded tumor tissue sections has been shown in our prior publication.14
Although monotherapy with AFTV was three injections in the present case, all of the nine lung metastases of the carcinoma shrunk apparently to less than half of their original sizes (Fig. 1, series ii). Although we are not quite able to conclude that the complete responses of all of the lung metastases (Fig 1, series iii) and the paraaortic lymph node (Fig. 1, h, iii) are solely due to the monotherapy with AFTV, the course of the present case strongly implies that AFTV monotherapy followed by, if necessary, one injection of cytotoxic agents will be an attractive treatment option for patients fearing severe adverse effects of standard chemotherapy.