Use of CDK1 and CDK2 activity to predict renal cell cancer recurrence

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Background: We established original methods enabling simultaneous analysis of protein expressions and kinase activities of the CDK (cyclin-dependent kinase) molecules in lysate of tumor tissue in a clinical setting (C2P technology, Ishihara et al: Biochim Biophys Acta. 1741; 226-233, 2005). The clinical utility of the technology was first evaluated in breast cancer, and combination analysis of CDK1 and CDK2 activity was shown to be a significant prognostic indicator for relapse (Kim et al. Ann Oncol. 19;68-72,2009). The objective of our study is to evaluate the efficacy of CDK1 and CDK2 activity as a prognostic marker in human renal cell carcinoma (RCC).

Methods: Surgical specimens were obtained from 115 patients with RCC without metastasis. These patients were selected randomly for this study. Protein expression and kinase activity of CDKs and cyclins were analyzed using a newly developed assay system. The system to measure the CDK specific activity (SA) is named C2Ps (Sysmex, Kobe, Japan). We then examined the specific activities of CDK1 and CDK2 and calculated CDK2/CDK1 ratio in RCC. Also, risk score (RS) was examined as described in previous study (JGH van Nes et al: Br J Cancer. 100; 494-500, 2009). Cut off value was calculated by ROC analysis.

Results: 115 cases were tested, though 32 cases were excluded of low sample quality (30 cases) and of assay failure (2 cases). 83 cases were analyzed. They included 63 male and 20 female patients, ranging in age from 19 to 83 years. At a median follow up of 33 months (1-109M), tumor with low CDK2/CDK1 ratio showed significantly better 5-year progression-free survival (PFS) than those with high CDK2/CDK1 ratio (91.2% vs. 51.6%, p=0.0016). Also, RS enabled the classification of RCCs into high-risk and low-risk groups, patients with tumors classified as low RS showed better PFS than patients with tumors with high RS (88.9% vs. 63.9%, p=0.0488).

Conclusions: CDK1 specific activity of tumors and the CDK2 specific activity are both associated with recurrence and prognosis. Analysis of cyclin-dependent kinase activity in the clinical setting could be a powerful approach for predicting cancer recurrence and prognosis in RCC after surgery and has potential for use as a routine laboratory test.

No significant financial relationships to disclose.

Abstract 4644: Significance of serum tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) levels of renal cell carcinoma patients as prognostic and monitoring biomarker

TRAIL and its receptors have been reported to play a significant role as cytotoxic and apoptotic mechanisms in cytotoxic T-lymphocytes and natural killer cells. TRAIL has been reported to induce apoptosis preferentially in various types of cancer cells, including renal cell carcinoma (RCC) cells. These findings suggest that TRAIL and its receptors might be useful biomarkers for RCC. In this study, we examined serum TRAIL levels of RCC patients and normal individuals and evaluated its utility as biomarker. Peripheral blood samples were obtained from 85 patients (60 men and 25 women, median age; 63 years [36-85]) with RCC before surgery. All the patients underwent radical or partial nephrectomy. The histological grade and TNM status distribution was as follows: Grade 1, n =1; Grade 2, n = 63 and Grade 3, n = 21; T1, n =56; T2, n = 8; T3, n =18 and T4, n = 3; N1-2, n = 7; and M1, n = 13. Blood samples were also collected from 52 healthy controls. The serum TRAIL levels were measured by a sandwich enzyme-linked immunosorbent assay (ELISA). The serum TRAIL levels in patients with RCC was lower than those of normal control individuals (79±8pg/ml vs 118±16 pg/ml, P =0.038). The serum TRAIL levels in RCC patients with lymph node metastasis (N1-2), distant metastasis (M1), microscopic venous invasion, and stage III-IV were significantly lower compared to those in RCC patients without lymph node metastasis (N0), without distant metastasis (M0), without microscopic venous invasion, and with stage I-II, respectively (P =0.051, P =0.045, P = 0.02, and P = 0.048). The serum TRAIL levels before and after surgery from the same patients (n = 17) was 61±15 pg/ml and 110±29 pg/ml, respectively, with significant difference (P = 0.015). The serum TRAIL levels after the surgery in these patients elevated to be similar to those detected in healthy controls (n = 52). The cause-specific survival rate of the RCC patients with high serum TRAIL was shown to be significantly higher than that of those with low serum TRAIL in the 5-year follow-up (P < 0.0385). The cytotoxicity of recombinant TRAIL and lymphocytes against human RCC cell line ACHN and primary culture RCC cell was measured by Crystal violet assay in the absence and presence of neutralizing anti-TRAIL antibody. TRAIL was estimated to contribute to about 20% of the lymphocyte-mediated cytotoxicity against ACHN and primary culture RCC cell. To our knowledge, the current study is the first to demonstrate the serum TRAIL levels of RCC patients in comparison with those of normal controls, in correlation with clinicopathological factors, and in association with postoperative prognosis. In conclusion, it is suggested that serum TRAIL levels in RCC patients might be utilized not only as diagnostic and prognostic biomarker but also as a possible biomarker for monitoring postoperative progression.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4644.

Prostate cancer risk in relation to insulin-like growth factor (IGF)-I and IGF-binding protein-3: A nested case-control study in large scale cohort study in Japan

High levels of insulin-like growth factor (IGF)-I are reported to be associated with an increased risk of prostate cancer. On the other hand, the insulin-like growth factor binding protein-3 (IGFBP-3) may decrease the risk. We therefore investigated the influence of serum IGF-I and IGFBP-3 on prostate cancer risk in a case-control study nested within a large-scale cohort in Japan (the Japan Collaborative Cohort Study). Information on lifestyle and sera of the subjects were collected in 1988-90. Serum IGF-I, IGF-II and IGFBP-3 were measured in sera stored at -80 degrees C by immuno-radiometric assay. In 13,508 male subjects of the cohort who donated sera, 40 cases and 120 controls (1:3 matched with age and survey area) were identified. Ages of the cases ranged from 59 to 79 years, with a mean of 69.8. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the highest and middle tertiles compared with the lowest in controls using a conditional logistic model. Non-adjusted ORs for the highest tertiles were 0.99 (95% CI, 0.34-2.91) for IGF-I (trend-P = 0.60), 1.91 (95% CI, 0.68-5.38) for IGFBP-3 (trend-P = 0.23), 1.73 (95% CI, 0.69-3.47) for IGF-II (trend-P = 0.23), and 0.67 (95% CI, 0.26-1.76) for the IGF-I/IGBP-3 ratio (trend-P = 0.83). Serum levels of IGF-I, IGF-II, IGFBP-3, or IGF-I/IGFBP-3 ratio were thus not thought to be associated with risk of prostate cancer.

[Radio-frequency ablation (RFA) for post-chemotherapeutic metastatic germ cell tumors as minimally invasive salvage therapy]

Radio-frequency ablation (RFA) has been successfully applied for local control of metastatic tumor. The aim of this study was to assess the effectiveness and safety of RFA to post-chemotherapeutic metastatic germ cell tumors (GCTs). As combined modality therapy, RFA was performed to 42 tumors in 19 patients of GCTs at our institution between November 2000 and December 2008. RFA was performed for 10 liver metastatic tumors (in 6 cases), 32 lung metastatic tumors (in 13 cases), and median age was 36 years old (range 20-53) and the median tumor size was 12 mm (range 2-40). We used Cool-tip RF system (straight electrode needle of the internal cooling type, Radionics, Palm Coast, USA) for RFA with ultrasound or CT fluorosent guidance under intravenous or local anesthesia. The therapeutic effect was assessed by the contrast-enhanced CT or MRI. When contrast enhancement was remained in the tumor, the treatment was repeated. The 28 evaluable lesions followed were with median 25 months in the term of the surveillance, and 9 tumors were treated by an additional session of RFA repeatedly. complete response (CR) was achieved in 12 out of 12 tumors (100%) with tumor maker normalization. On the other hand, 12 out of 16 tumors (75%) without marker normalization showed CR. All of the 24 tumors with tumor diameter of 30 mm or less achieved CR, and the tumor greater than 30 mm achieved no CR. Major complications included pneumothorax (n=9) and hemato-thoraxes (n=2), but no complications in surrounding organs. The chest drainage tube was required in 4 cases (36%). RFA might be an alternative therapeutic option of combined modality therapy as salvage therapy for post-chemotherapeutic metastatic germ cell tumors.

Radiofrequency ablation for renal tumors: our experience

OBJECTIVES

To report our results of percutaneous radiofrequency ablation (RFA) for renal tumors and to assess predictors of therapeutic efficacy.

METHODS

Forty patients (median age 73 years) with renal tumors were treated with RFA under local or epidural anesthesia. All of them had high surgical risk or refused radical surgery. Tumors were punctured percutaneously using the Radionics Cool-tip RF System under computed tomography or ultrasonographic guidance. Median tumor diameter was 24 mm. After RFA, contrast-enhanced computed tomography or magnetic resonance imaging was performed within 1 month. Complete response (CR) was defined as no enhancement inside the tumor. Factors related to the outcome and to renal function were assessed.

RESULTS

Median follow up was 16 months. CR was observed in 34 cases (85.0%). A significant difference in CR rate was observed between tumors < or =30 mm and those >30 mm. Outcomes tended to be better for tumors in the mid to lower kidney, and those away from the renal hilum. Recurrence was observed in one case (2.9%), but a CR was obtained again by additional RFA. Out of a total of 77 RFA procedures, complications occurred in only three cases (3.9%), and conservative treatment was possible in all cases. Serum creatinine levels 3 months after RFA did not differ from those before RFA.

CONCLUSIONS

Percutaneous RFA is a safe and effective treatment for small renal tumors in patients with high surgical risk or who refuse radical surgery.

Salvage chemotherapy with irinotecan and nedaplatin for cisplatin refractory germ cell tumors

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Background: Only 20 - 30 % of patients with cisplatin (CDDP) refractory germ cell tumor (GCT) will remain continuously disease-free with salvage chemotherapy. The present study investigated the combination chemotherapy with irinotecan (Ir) and nedaplatin (CDGP), the second generation derivative of CDDP developed in Japan, as salvage chemotherapy for CDDP-refractory GCT. Methods: Between June 1998 and December 2007, 39 CDDP refractory GCT patients treated with irinotecan and CDGP (IrN therapy) were assessed retrospectively. IrN therapy consisted of Ir: 100–150 mg/m2 on day 1, 15 or 200–300 mg/m2 on day 2, CDGP: 100 mg/m2 on day 1 every four weeks with oral administration of Chinese-herb ‘Hange-shashinto’ and sodium bicarbonate for diarrhea. After tumor marker normalization, residual masses were resected and chemotherapy was continued in the case of without marker normalization. Results: The median age was 31 years old (range; 17–48). The median number of cycles of prior chemotherapy was 6 (range; 2–30). The median number of cycles of IrN therapy was 3 (range: 1–9). The response rate was 30.8% ( CR: 0%, PRm−: 15.4%, PRm+: 15.4% ) and the outcome was no evidence of disease (NED) 46.2%, alive with disease (AWD) 25.6% and dead 28.2%, respectively. Twenty-five patients with IrN therapy as 2nd (17 cases) and 3rd (8 cases) line salvage therapy showed that the response rate was 48% (CR: 0%, PRm−: 16.0%, PRm+: 16.0, NCm−: 16.0%) and the outcome was as follows; NED 64%, AWD 16% and dead 20%, respectively. On the other hand, 14 pts who had the treatment as fourth-line or more showed less response rate (PR: 28.5%) and worse outcome (NED 14.2%). Major adverse events more than grade 3 were neutropenia and thrombocytopenia. These adverse events were manageable. Grade 4 diarrhea which was major adverse event of CPT-11 was observed in only one case and there was no treatment related death. Conclusions: This study demonstrates that combination chemotherapy with CPT-11 and CDGP showed significant anticancer activity for patients with CDDP-refractory GCT without severe adverse events. These findings suggest that salvage IrN therapy may be one of the options as second- or third-line therapy.

No significant financial relationships to disclose.

Significance of the expression of thymidylate synthase in prostate cancer

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Background: Thymidylate synthase ( TS ) is an important enzyme in de novo DNA synthesis pathway. 5-Fluorouracil ( 5-FU ), an anticancer chemotherapeutic agent used clinically against a variety of cancers including prostate cancer, inhibits DNA synthesis by binding TS. In the present study, we examined TS expression in prostate cancer and investigated its prognostic significance. Methods: Fifty-two prostate cancer tissue specimens were obtained from patients who underwent radical prostatectomy for prostate cancer without neoadjuvant hormonal therapy. Forty-eight prostate cancer tissue specimens were also obtained from patients who underwent radical prostatectomy for prostate cancer with neoadjuvant hormonal therapy. We examined prostate cancer tissue and normal prostate tissue for TS expression by immunohistochemistry. Results: TS was expressed at higher levels in prostate cancer without neoadjuvant hormonal therapy, compared with normal prostate.TS expression in stage T3 prostate cancer was higher than that in stage T2 prostate cancer. In addition, the level of TS expression in Gleason score 7 or greater prostate cancer was higher than that in Gleason score less than 7 prostate cancer. Patients with prostate cancer with negative TS expression without neoadjuvant hormonal therapy had a longer postoperative recurrence-free rate than those with positive expression in the 5 year follow-up. In addition, patients with Gleason score less than 7 prostate cancer with negative TS expression had a much longer postoperative recurrence-free rate than those with positive expression in the 5-year follow-up. TS expression was significantly decreased in prostate cancer patients who received neoadjuvant hormonal therapy, especially stage T2 prostate cancer patients. Conclusions: The current study has demonstrated for the first time that TS expression may be a prognostic parameterr for prostate cancer patients undergoing radical prostatectomy.

No significant financial relationships to disclose.

[Squamous cell carcinoma of the renal pelvis with elevation of G-CSF in the serum: a case report]

A 67-year-old man was admitted with left renal pelvic tumor. He had a leukocytosis of 26,500/mm3 (neutrophils: 81.7%) in the peripheral blood, but with no obvious focus of infection. Moreover, the serum granulocyte-colony stimulating factor (G-CSF) and squamous cell carcinoma antigen (SCC) were elevated. Abdominal enhanced computed tomography (CT) and left retrograde pyelography showed left renal pelvic cancer T4N0M0. He received neoadjuvant chemotherapy (M-VAC: cisplatin + methotrexate + vinblastin + doxorubicin, TN: paclitaxel + nedaplatin). After neoadjuvant chemotherapy, left nephroureterectomy was performed because of normalization of the serum SCC and G-CSF. Histological examination revealed squamous cell carcinoma of the renal pelvis. He is alive with no evidence of disease for 4 years.