http://www.rubinmedical.com/articles/mechanisms.pdf
....Ultimately, lasting eradication of malignancy, as well as prevention of malignancy in the first place, depends solely upon competent immune function. Cytoreductive strategies, such as radio-or chemotherapy, serve their intended purpose of rapid tumor reduction but are hopeless at creating or even enabling a full endogenous immunological response. Unsurprisingly, then, such therapies diminish self-defense mechanisms leaving the host susceptible not only to infectious disease, but to recurrence and metastasis of their cancer as well.
...
When angiogenesis is inhibited, cells become deprived of necessary nutrients including oxygen. When this occurs, the cells begin to go through the process of apoptosis,14 or programmed cell death. When
cells become apoptotic, they begin to display certain markers on their cell surface.20 Phosphatidyl serine, normally located on the cytosolic aspect of the phospholipid bilayer membrane and the most immunologically important membrane-bound molecule, becomes displayed on the extracellular surface during the apoptotic event. The
phosphatidyl serine then serves as a signal to phagocytic cells to approach and then engulf the apoptotic cell.
Promiscuously, as the phagocytic cell engulfs the apoptotic cell, the TSA is engulfed as well. Once inside the phagocytic cell, the TSA becomes recognized and processed the same way it would be if free TSA (tumor-specific antigen) were taken up by the phagocyte. In this way, angiogenesis inhibition is a form of indirect immunotherapy via augmentation of the membrane characteristics of the cancer cell.
Microfractionated Chemotherapy
As mentioned at the beginning of this article,
specific activation of the immune system against an autologous tumor associated antigen is the ultimate route to preventing relapse of a malignancy. During times when a patient has a large tumor volume, this route of treatment is too slow to act. Thus, a more quickly acting metabolic-debulking strategy is necessary. In this way, as mentioned above, the tumor cells become more immunogenic. For this reason, MCT is usually potentiated with biological response modification (BRMP) with the use of immunothera-Microfractionated
chemotherapy
(MCT) represents such a modality wherein conventional cytotoxic agents are utilized at non-cytotoxic doses.
Three main purposes are served in this model; when delivered via the microfractionation method
conventional agents can be: 1) antiangiogenic; 2) pro-apoptotic; and 3) immuno-stimulatory.
Three conventional agents have recently been shown to have angiogenic
inhibitory qualities, namely docetaxel and paclitaxel (taxanes) and vinflunine, a vinca alkaloid.21-22 As above, angiogenesis inhibition will also result in a pro-apoptotic effect on the tumor cells. MCT provides a general treatment contrast to traditional dosing of the same agents in that the goal of the traditional treatment is to eradicate the tumor cells quickly while the goal of the microfractionation method is to induce a subtle but constant apoptotic effect.
In this way, as mentioned above, the tumor cells become more immunogenic. For this reason, MCT is usually potentiated with biological
response modification (BRMP) with the use of immunothera-peutic and other agents.
As the induction of a specific anti-TSA immune response is not immediate, the MCT model enables survival of the patient to the time when such a response can be elicited.23
By using the microfracitonation method the immune systems of patients are left intact thereby able to be stimulated either by immune therapy or by some other mechanism.