Its possible application in the management of large-bowel cancer

The rapidly emerging therapeutic modality of cancer immunotherapy has been applied to a carefully selected group of patients with carcinoma of the large bowel. Patient selection was based on the extent of disease at the time of definitive surgery, and the strict provision that all discernible disease was removed. Thus, 20 consecutive patients who had mesenteric lymph node involvement were subsequently allocated to receive either BCG alone or the combination of 5-FU plus BCG as adjuvant treatment to surgery. After 10 months of patient accrual, all patients were clinically free of disease. Therapy was well tolerated without significant morbidity. Although general immunocompetence of these patients has improved on treatment, it is still too early to say whether immunotherapy will be clinically beneficial. Serial determination of plasma levels of CEA was useful in ruling out suspected recurrent disease. In contrast, preoperative plasma levels of CEA in patients with Dukes' C classification were elevated in only 40%. This indicates that its value in establishing the primary diagnosis is still doubtful.