Abstract
Context
Gastric type I carcinoid is a rare neoplasm, deriving from enterochromaffin-like cells (ECL), mainly affecting women with autoimmune gastritis. The approach to treatment, either endoscopic, medical or surgical, is not well defined, particularly in multifocal tumours or carcinoids with rapid growth/frequent recurrence.
Objective
To determine whether an anti-G17 vaccination might interfere on the natural history of gastric type I carcinoid.
Setting
Padua teaching Hospital, outpatient clinic.
Design and patients
Three patients with type I gastric carcinoid in autoimmune gastritis were administered, after informed consent and ethic committee approval, with a vaccine against gastrin 17 (G17), a synthetic peptide that stimulates specific and high-affinity anti-G17 antibodies, and followed up endoscopically and clinically for a mean of 36 months.
Main outcome measures
Gastric histology and specifically carcinoid growth/recurrence and trend in time in gastrin, G17, pepsinogens, chromogranin A and clinical parameters.
Results
Following vaccination, carcinoid regression was observed in 2/3 patients and, in one of the patients, even the disappearance of ECL hyperplasia, with a reduced ECL cells stimulation, confirmed by a significant reduction in chromogranin A levels. Regression was observed in the two patients that showed a more clear local response to the vaccine. Increased autoantibody titre was observed, but no appearance of new autoimmune diseases.
Conclusions
Anti-G17 vaccination induced regression of type I gastric carcinoid and could be considered for the treatment of this tumour, when endoscopic removal is not indicated.
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Notes
Aphton is no longer responsible for the development of the vaccine.
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No author declares potential conflicts of interest. I (FF) had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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Tieppo, C., Betterle, C., Basso, D. et al. Gastric type I carcinoid: a pilot study with human G17DT immunogen vaccination. Cancer Immunol Immunother 60, 1057–1060 (2011). https://doi.org/10.1007/s00262-011-1031-5
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DOI: https://doi.org/10.1007/s00262-011-1031-5