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Li F, Yuan L, Shao N, Yang X, Yang S, He L, Ding J, Ding M, Yang S, Fu W, Wang C, Li X, Cai Q. Changes and significance of vascular endothelial injury markers in patients with diabetes mellitus and pulmonary thromboembolism. BMC Pulm Med 2023; 23:183. [PMID: 37231402 PMCID: PMC10212603 DOI: 10.1186/s12890-023-02486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND To investigate the changes and clinical significance of vascular endothelial injury markers in type 2 diabetes mellitus (T2DM) complicated with pulmonary embolism (PE). METHODS This prospective study enrolled patients with T2DM hospitalized in one hospital from January 2021 to June 2022. Soluble thrombomodulin (sTM) (ELISA), von Willebrand factor (vWF) (ELISA), and circulating endothelial cells (CECs) (flow cytometry) were measured. PE was diagnosed by computed tomography pulmonary angiography (CTPA). RESULTS Thirty participants were enrolled in each group. The plasma levels of sTM (151.22 ± 120.57 vs. 532.93 ± 243.82 vs. 1016.51 ± 218.00 pg/mL, P < 0.001) and vWF (9.63 ± 2.73 vs. 11.50 ± 2.17 vs. 18.02 ± 3.40 ng/mL, P < 0.001) and the percentage of CECs (0.17 ± 0.46 vs. 0.30 ± 0.08 vs. 0.56 ± 0.18%, P < 0.001) gradually increased from the control group to the T2DM group to the T2DM + PE group. sTM (OR = 1.002, 95%CI: 1.002-1.025, P = 0.022) and vWF (OR = 1.168, 95%CI: 1.168-2.916, P = 0.009) were associated with T2DM + PE. sTM > 676.68 pg/mL for the diagnosis of T2DM + PE achieved an AUC of 0.973, while vWF > 13.75 ng/mL achieved an AUC of 0.954. The combination of sTM and vWF above their cutoff points achieved an AUC of 0.993, with 100% sensitivity and 96.7% specificity. CONCLUSIONS Patients with T2DM show endothelial injury and dysfunction, which were worse in patients with T2DM and PE. High sTM and vWF levels have certain clinical predictive values for screening T2DM accompanied by PE.
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Affiliation(s)
- Fan Li
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China.
| | - Lianfang Yuan
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Na Shao
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Xiaokun Yang
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Shaohua Yang
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Linjia He
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Jie Ding
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Ming Ding
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Shengzhe Yang
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Wenwen Fu
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Congcong Wang
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Xiaochen Li
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China
| | - Qiling Cai
- Respiratory Medicine Department, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, NHC Key Laboratory of Hormones and Development / Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China.
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2
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Asante DB, Mohan GRKA, Acheampong E, Ziman M, Calapre L, Meniawy TM, Gray ES, Beasley AB. Genetic analysis of heterogeneous subsets of circulating tumour cells from high grade serous ovarian carcinoma patients. Sci Rep 2023; 13:2552. [PMID: 36781954 PMCID: PMC9925814 DOI: 10.1038/s41598-023-29416-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
Circulating tumour cells (CTCs) are heterogenous and contain genetic information from the tumour of origin. They bear specific intra- and extra-cellular protein markers aiding in their detection. However, since these markers may be shared with other rare cells in the blood, only genetic testing can confirm their malignancy. Herein, we analyse different CTC subsets using single cell whole genome DNA sequencing to validate their malignant origin. We randomly selected putative CTCs identified by immunostaining that were isolated from 4 patients with high grade serous ovarian cancer (HGSOC) and one with benign cystadenoma. We specifically targeted CTCs positive for epithelial (CK/EpCAMpos), mesenchymal (vimentinpos), and pseudoendothelial (CK/EpCAMpos plus CD31pos) markers. We isolated these cells and performed whole genome amplification (WGA) and low-pass whole-genome sequencing (LP-WGS) for analysis of copy number alterations (CNA). Of the CK/EpCAMpos cells analysed from the HGSOC patients, 2 of 3 cells showed diverse chromosomal CNAs. However, the 4 pseudoendothelial cells (CK/EpCAMpos plus CD31pos) observed in the HGSOC cases did not carry any CNA. Lastly, two of the clusters of vimentin positive cells sequenced from those found in the benign cystadenoma case had CNA. Despite the low number of cells analysed, our results underscore the importance of genetic analysis of putative CTCs to confirm their neoplastic origin. In particular, it highlights the presence of a population of CK/EpCAMpos cells that are not tumour cells in patients with HGSOC, which otherwise would be counted as CTCs.
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Affiliation(s)
- Du-Bois Asante
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, 6027, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, WA, 6027, Australia
| | | | - Emmanuel Acheampong
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, 6027, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, WA, 6027, Australia
| | - Melanie Ziman
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, WA, 6027, Australia
- School of Biomedical Science, University of Western Australia, Crawley, WA, 6009, Australia
| | - Leslie Calapre
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, WA, 6027, Australia
| | - Tarek M Meniawy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, WA, 6027, Australia
- School of Medicine, University of Western Australia, Crawley, WA, 6009, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Elin S Gray
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, 6027, Australia.
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, WA, 6027, Australia.
| | - Aaron B Beasley
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, 6027, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Perth, WA, 6027, Australia
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3
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Yang H, Miao Y, Yu Z, Wei M, Jiao X. Cell adhesion molecules and immunotherapy in advanced non-small cell lung cancer: Current process and potential application. Front Oncol 2023; 13:1107631. [PMID: 36895477 PMCID: PMC9989313 DOI: 10.3389/fonc.2023.1107631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023] Open
Abstract
Advanced non-small cell lung cancer (NSCLC) is a severe disease and still has high mortality rate after conventional treatment (e.g., surgical resection, chemotherapy, radiotherapy and targeted therapy). In NSCLC patients, cancer cells can induce immunosuppression, growth and metastasis by modulating cell adhesion molecules of both cancer cells and immune cells. Therefore, immunotherapy is increasingly concerned due to its promising anti-tumor effect and broader indication, which targets cell adhesion molecules to reverse the process. Among these therapies, immune checkpoint inhibitors (mainly anti-PD-(L)1 and anti-CTLA-4) are most successful and have been adapted as first or second line therapy in advanced NSCLC. However, drug resistance and immune-related adverse reactions restrict its further application. Further understanding of mechanism, adequate biomarkers and novel therapies are necessary to improve therapeutic effect and alleviate adverse effect.
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Affiliation(s)
- Hongjian Yang
- Innovative Institute, China Medical University, Shenyang, China
| | - Yuxi Miao
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China
| | - Zhaojin Yu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Key Laboratory of Molecular Targeted Anti-Tumor Drug Development and Evaluation, Shenyang, China
| | - Minjie Wei
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Liaoning Cancer Immune Peptide Drug Engineering Technology Research Centre, Shenyang, China
| | - Xue Jiao
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China.,Shenyang Kangwei Medical Laboratory Analysis Co. LTD, Shenyang, China
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Guo CR, Han R, Xue F, Xu L, Ren WG, Li M, Feng Z, Hu BC, Peng ZM. Expression and clinical significance of CD31, CD34, and CD105 in pulmonary ground glass nodules with different vascular manifestations on CT. Front Oncol 2022; 12:956451. [PMID: 36185269 PMCID: PMC9521677 DOI: 10.3389/fonc.2022.956451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Blood vessel passage on CT exerts a vital part in early diagnosis as well as treatment of carcinoma of the lungs. Intratumoral microvascular density (iMVD) has gradually become the focus of research on biological behavior, appearance, and evolution of malignant tumors nowadays. The aim of this paper was to verify whether there is a correlation between the iMVD and the vascular morphology of ground glass nodules (GGNs). A total of 109 patients with pulmonary GGN were classified into three groups (I,II, and III) according to the vascular morphology on CT, and their expression of CD31-, CD34-, and CD105-labeled iMVD was detected by the streptoavidin–biotin method, statistically analyzing the iMVD values of each group. The expression of CD31, CD34, and CD105 in different lung tissues was significantly different, with remarkably higher iMVD in lung cancer tissues than in adjacent normal lung tissues. In the imaging sort of types I, II, and III according to the means of vascular passage, the iMVD expression of CD31, CD34, and CD105 was significantly different between groups. These data suggest that the presence and the abnormal morphology of vessels seen within GGNs indicate the occurrence and progression of lung cancer in pathology. It offers a strong theoretical foundation for early diagnosis of carcinoma of the lungs, thus providing a more precise clinical diagnosis and prognosis of early-stage lung cancer.
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Affiliation(s)
- Chen-ran Guo
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong University, Jinan, China
| | - Rui Han
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Feng Xue
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong University, Jinan, China
| | - Lin Xu
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Wan-gang Ren
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Meng Li
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Zhen Feng
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Ben-chuang Hu
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Zhong-min Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong University, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
- *Correspondence: Zhong-min Peng,
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5
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Lu J, Zhang W, Yu K, Zhang L, Lou Y, Gu P, Nie W, Qian J, Xu J, Wang H, Zhong H, Han B. Screening anlotinib responders via blood-based proteomics in non-small cell lung cancer. FASEB J 2022; 36:e22465. [PMID: 35867072 DOI: 10.1096/fj.202101658r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/17/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022]
Abstract
Anlotinib has been demonstrated to be effective in advanced non-small cell lung cancer (NSCLC) patients. The response stratification of anlotinib remains unclear. In this study, plasma samples from 28 anlotinib-treated NSCLC patients (discovery cohort: 14 responders and 14 non-responders) were subjected to proteomic analysis, and plasma samples from 35 anlotinib-treated NSCLC patients (validation cohort) were subjected to validation analysis. Liquid chromatography-tandem mass spectrometry analysis was performed on samples with different time points, namely baseline (BL), best response (BR), and progression disease (PD). Bioinformatics analysis was performed to screen for the underlying differential proteins. Enzyme-linked immunosorbent assay was performed to detect plasma ARHGDIB, FN1, CDH1, and KNG1 levels respectively. The Kaplan-Meier survival analysis was used for biomarker-based responsive stratification. Our results indicated that differential proteins between responders and non-responders showed that proteomic technology potentially contributes to biomarker screening in plasma samples at BL. Furthermore, our results suggested that the detection of plasma ARHGDIB, FN1, CDH1, and KNG1 levels have potential predictive value for anlotinib response both in the discovery cohort and validation cohort. Collectively, this study offers novel insights into the value of plasma biomarker screening via proteomic examination and suggests that plasma ARHGDIB, FN1, CDH1, and KNG1 levels could be used as biomarkers for anlotinib stratification in NSCLC patients.
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Affiliation(s)
- Jun Lu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Thoracic Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Translational Medical Research Platform for Thoracic Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Bio-Bank, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Keke Yu
- Department of Bio-Bank, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lele Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqing Lou
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Gu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Nie
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Qian
- Department of Emergency Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Xu
- Department of Emergency Medicine, The First Hospital of Anhui Medical University, Hefei, China
| | - Huimin Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Zhong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Thoracic Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Translational Medical Research Platform for Thoracic Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Tan T, Han G, Cheng Z, Jiang J, Zhang L, Xia Z, Wang X, Xia Q. Genetic Polymorphisms in CYP2C19 Cause Changes in Plasma Levels and Adverse Reactions to Anlotinib in Chinese Patients With Lung Cancer. Front Pharmacol 2022; 13:918219. [PMID: 35814206 PMCID: PMC9257029 DOI: 10.3389/fphar.2022.918219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Anlotinib is a small molecular multi-targeting tyrosine kinase inhibitor. Growing evidence indicates that treatment efficacy, and toxicity varies considerably between individuals. Therefore, this study aimed to investigate the relationship between cytochrome P450 (CYP450) gene polymorphisms, drug concentrations, and their adverse reactions in anlotinib-treated patients with lung cancer.Methods: We enrolled 139 patients with lung cancer, treated with anlotinib. Twenty loci in the following five genes of the CYP450 family were genotyped: CYP450 family 3 subfamily A member 5 (CYP3A5), 3 subfamily A member 4 (CYP3A4), 2 subfamily C member 9 (CYP2C9), 2 subfamily C member 19 (CYP2C19), and 1 subfamily A member 2 (CYP1A2). Data on adverse reactions were collected from patients, and plasma anlotinib concentrations were measured.Results: There were significant variances in plasma trough concentration (3.95–52.88 ng/ml) and peak plasma concentration (11.53–42.8 ng/ml) following administration of 8 mg anlotinib. Additionally, there were significant differences in the plasma trough concentration (5.65–81.89 ng/ml) and peak plasma concentration (18.01–107.18 ng/ml) following administration of 12 mg anlotinib. Furthermore, for CYP2C19-rs3814637, the peak plasma concentrations of mutant allele T carriers (TT+CT) were significantly higher than those of wildtypes (CC). For CYP2C19-rs11568732, the peak plasma concentrations of the mutant allele G carriers (GT+GG) were significantly higher than those of the wild-type (TT). More importantly, the incidence rates of hypertension and hemoptysis (peripheral lung cancer) with TT+CT in rs3814637 and GT+GG in rs11568732 were significantly higher than those with CC and TT.Conclusions: The plasma trough and peak concentrations varied significantly for both 8 and 12 mg of anlotinib. Single-nucleotide polymorphisms in CYP2C19 are significantly associated with hypertension, hemoptysis, and anlotinib peak concentrations. Polymorphisms in CYP450 may explain inter-individual differences in anlotinib-related adverse reactions.
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Affiliation(s)
- Tingfei Tan
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Gongwei Han
- School of Pharmacy, Anhui Medical University, Hefei, China
| | - Ziwei Cheng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Jiemei Jiang
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Zitong Xia
- School of Pharmacy, Anhui Medical University, Hefei, China
| | - Xinmeng Wang
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Quan Xia
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Quan Xia,
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Liu Z, Qin T, Yuan X, Yang J, Shi W, Zhang X, Jia Y, Liu S, Wang J, Li K. Anlotinib Downregulates RGC32 Which Provoked by Bevacizumab. Front Oncol 2022; 12:875888. [PMID: 35664796 PMCID: PMC9158131 DOI: 10.3389/fonc.2022.875888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Bevacizumab is the representative drug in antiangiogenic therapy for lung cancer. However, it induced resistance in some neoplasm. Anlotinib, a novel multi-target tyrosine kinase inhibitor which has an inhibitory action on both angiogenesis and malignancy, is possible to reverse the resistance. Methods Transwell migration and invasion experiments of bevacizumab with or without anlotinib were conducted to verify the activated/inhibited ability of lung adenocarcinoma cells. We sequenced A549 cells with enhanced migration and invasion abilities after bevacizumab treatment, screened out the differentially expressed gene and further confirmed by western blot and q-PCR assays. We also investigated immunohistochemical staining of tumor tissue in mice and human lung adenocarcinoma. Results Bevacizumab facilitated migration and invasion of lung adenocarcinoma cells. Differentially expressed gene RGC32 was screened out. Bevacizumab upregulated the expression of RGC32, N-cadherin, and MMP2 through ERK-MAPK and PI3K-AKT pathways. Anlotinib downregulated their expression and reversed the effect of bevacizumab on A549 cells. In vivo experiments confirmed that higher-dose bevacizumab facilitated metastasis in tumor-bearing nude mice and upregulated the expression of RGC32, N-cadherin, and MMP2, whereas anlotinib abrogated its effect. Expression of both RGC32 and N-cadherin positively correlated with lymph node metastasis and stage in lung adenocarcinoma was found. Survival analysis revealed that higher expressions of RGC32 and N-cadherin were associated with poor progression-free survival and overall survival. Conclusions Bevacizumab may promote invasion and metastasis of lung adenocarcinoma cells by upregulating RGC32 through ERK-MAPK and PI3K-AKT pathways to promote epithelial-mesenchymal transition, whereas anlotinib reverses the effect. RGC32 and N-cadherin are independent prognostic factors in lung adenocarcinoma.
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Affiliation(s)
- Zhujun Liu
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Tingting Qin
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Xiaohan Yuan
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China.,Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jie Yang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China.,Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology, Beijing, China.,National Key Discipline of Pediatrics (Capital Medical University), Beijing, China.,Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China.,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wei Shi
- Research and Development Department, Jiangsu Chia-Tai Tian Qing Pharmaceutical Co., Ltd., Nanjing, China
| | - Xiaoling Zhang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Yanan Jia
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Shaochuan Liu
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Jing Wang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Kai Li
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
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8
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Chen T, Liang G, Xiang Z, He J, Xu X, Tang M. Prognostic value of prognostic nutritional index and its variations in advanced non-small-cell lung cancer patients treated with anlotinib monotherapy. J Clin Lab Anal 2022; 36:e24300. [PMID: 35179795 PMCID: PMC8993602 DOI: 10.1002/jcla.24300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Anlotinib is a third‐line or further therapy for advanced non‐small‐cell lung cancer (NSCLC). However, the lack of simple biomarkers to predict the curative effect of anlotinib creates significant unmet needs in exploring the markers. This study aimed to explore the relationship between the prognostic nutritional index (PNI) and its variations and efficacy of anlotinib. Methods Data for patients with advanced NSCLC who received anlotinib were collected at Ningbo Medical Center Lihuili Hospital. The data included the values of pretreatment PNI (pre‐PNI), posttreatment PNI (post‐PNI), and ΔPNI (post‐PNI minus the pre‐PNI). The Kaplan–Meier method was used to generate survival curves, whereas univariate and multivariate Cox regression analyses were used to analyze survival predictors. Results A high disease control rate was associated with a high pre‐PNI (p = 0.007), high post‐PNI (p = 0.000), and high ΔPNI (p = 0.006). Univariable analysis revealed that pre‐PNI ≤41.80, post‐PNI ≤42.48, and ΔPNI ≤0.20 were significant risk factors for poor survival. According to the multivariate analysis, progression‐free survival (PFS) in patients with post‐PNI ≤42.48 was significantly shorter than in patients with higher values (median PFS: 1.5 months vs. 4.0 months, p = 0.010). Conclusions Pre‐PNI, ΔPNI, and post‐PNI were found to be predictive factors for response in advanced NSCLC patients treated with anlotinib as a third‐line or further treatment. Only post‐PNI was a reliable predictor of PFS. Therefore, PNI and its variations, particularly post‐PNI, are affordable and accessible predictors of NSCLC patients treated with anlotinib in clinical work.
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Affiliation(s)
- Tian Chen
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Gaofeng Liang
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Zhenfei Xiang
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Jinxian He
- Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Xiaoyu Xu
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Mengqiu Tang
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
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9
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Zhu J, Xie Q, Zhong A, Le Y. Clinical analysis of anlotinib as first-line treatment for elderly patients with advanced lung adenocarcinoma without driver gene mutations. Anticancer Drugs 2022; 33:e584-e589. [PMID: 34387607 DOI: 10.1097/cad.0000000000001186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This retrospective study was conducted to explore the effects of anlotinib as first-line treatment for patients with advanced lung adenocarcinoma. We retrospectively reviewed medical records of 60 patients with advanced lung adenocarcinoma, admitted to the Fuzhou Pulmonary Hospital between August 2018 and December 2019. We calculated and recorded the objective remission rate (ORR), disease control rate (DCR), adverse reactions, quality of life assessment, progression-free survival (PFS) and overall survival (OS) for each group. We applied χ2, Mann-Whitney U test, Kaplan-Meier and log-rank statistical methods as appropriate to analyze the data. We found no statistically significant differences in either ORR (17.5 vs. 15%) or DCR (67.5 vs. 65.5%) between the anlotinib and pemetrexed groups (P > 0.05). The adverse reactions graded ≥3 in the anlotinib group were fatigue and diarrhea and they accounted for 5% of all the adverse reactions in the group. The patients in the anlotinib group presented better physical, role, cognitive, emotional, and social functions than those in the pemetrexed group (P < 0.05). The symptoms of fatigue, nausea and vomiting, loss of appetite and constipation in the anlotinib group were significantly less frequent than those in the pemetrexed group (P < 0.05). We found similar median PFSs (3.0 vs. 2.8 months) and median OSs (7.0 vs. 7.0 months) in both treatment groups (P > 0.05). The choice of anlotinib as first-line chemotherapy for treating elderly patients with advanced lung adenocarcinoma was effective, safe; the treatment was better than other drugs at improving the patients' quality of life.
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Affiliation(s)
- Jinxiu Zhu
- Department of Oncology, Fuzhou Pulmonary Hospital of Fujian Province, the Teaching Hospital of Fujian Medical University, Fuzhou City, China
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10
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Tang M, Song C, Zhang Y, Xu X, Wang C, Zhang Z, Chen T. Levels of pretreatment blood lipids are prognostic factors in advanced NSCLC patients treated with anlotinib. Lipids Health Dis 2021; 20:165. [PMID: 34801029 PMCID: PMC8606049 DOI: 10.1186/s12944-021-01596-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background Anlotinib, a small molecule for multi-target tyrosine kinase inhibition, is the third or further line of defense for treatment of non-small cell lung cancer (NSCLC). Findings from an ALTER0303 phase III trial revealed that this drug confers significant survival benefits in patients. Although numerous inflammatory biomarkers have been shown to play vital roles in treatment, the clinical significance of blood lipid levels before treatment has not been evaluated. Here, this research aims to explore the relationship between blood lipids and efficacy of anlotinib, with a view of generating insights to guide future development of convenient and individualized treatment therapies. Methods This study analyzed basal blood lipids levels, including triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), and high density lipoprotein (HDL), among other variables before treatment, in 137 patients with advanced NSCLC who received anlotinib as third or further-line treatment at the Ningbo Medical Center Lihuili Hospital, between July 2018 and December 2020. We determined the best cut off value for predicting treatment responses, generated survival curves using the Kaplan–Meier method, then applied univariate and multivariate Cox regression analyses to assess predictors of survival. Results The entire study population recorded median progression-free survival (PFS) and overall survival (OS) of 4 (95% CI 3.142–4.858) and 8.3 (95% CI 6.843–9.757) months, respectively. Researchers observed statistically significant differences across subgroups, between blood lipid indexes with different efficacies, except in the HDL subgroup. The low disease control rate (DCR) was associated with significantly elevated TG, TC and LDL levels (P = 0.000). Multivariate analysis demonstrated that elevated TC and LDL levels were independently associated with poor PFS or OS (P ≤ 0.003). Then, we established a prediction model, and set high TC or high LDL as the risk factor, respectively. There were significant differences in PFS (p = 0.000) and OS (p = 0.012) between 0 and ≥ 1 scores. Conclusions Prior to anlotinib therapy, TC and LDL levels, are independent prognostic indicators for patients with advanced NSCLC treated with this drug as a third or further-line treatment option. In addition, a risk score of 0 was attributed to a combination of low TC and low LDL, and these patients were exhibited excellent efficacies and survival rates.
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Affiliation(s)
- Mengqiu Tang
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Chao Song
- Department of Surgery, Yuyao Maternity and Child Health Care Hospital, Ningbo, China
| | - Yaowen Zhang
- Department of Cardiovascular Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Xiaoyu Xu
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Chen Wang
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Zhanchun Zhang
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Tian Chen
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China.
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11
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Shi J, Chen G, Wang H, Wang X, Han B, Li K, Wang Q, Zhang L, Wang Z, Cheng Y, He J, Shi Y, Chen W, Luo Y, Wu L, Wang X, Nan K, Jin F, Dong J, Li B, Liu Z. Occurrence of hypertension during third-line anlotinib is associated with progression-free survival in patients with squamous cell lung cancer (SCC): A post hoc analysis of the ALTER0303 trial. Thorac Cancer 2021; 12:2345-2351. [PMID: 34273139 PMCID: PMC8410552 DOI: 10.1111/1759-7714.14076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is a lack of targeted therapeutic options for squamous cell lung cancer (SCC). Accelerated hypertension is an issue with many targeted therapies for lung cancer. This study aimed to analyze the efficacy of anlotinib, based on progression-free survival (PFS) and overall survival (OS) in patients with SCC, stratified by hypertension and Eastern Cooperative Oncology Group (ECOG) score. METHODS This was a post hoc analysis of a multicenter, double-blind, phase III ALTER0303 randomized controlled trial. Only patients with SCC were included. The occurrence of hypertension during the study period was defined according to CTCAE 4.03. OS and PFS were the primary and secondary endpoints, respectively. The patients were stratified according to hypertension and ECOG score, respectively. RESULTS The median PFS in the patients who developed hypertension was longer than in those who did not (7.2 (95% CI: 3.5-11.0) versus 3.2 (95% CI: 1.2-5.3) months, p = 0.001; HR (95% CI), 0.4 (0.2-0.8)). In the ECOG 0 patients, the median PFS in the patients who developed hypertension versus those who did not was 5.6 vs. 1.8 months, respectively (Figure 2(d)). In the ECOG 1 patients, the median PFS in the patients who developed hypertension versus those who did not was 7.0 (95% CI: 3.0-11.0) vs. 4.8 (95% CI: 1.2-8.5) months (p = 0.043). No statistically significant differences were found in OS in the stratified analyses. CONCLUSIONS The occurrence of hypertension might be a clinical indicator predicting the efficacy of third-line anlotinib treatment in patients with SCC.
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Affiliation(s)
- Jianhua Shi
- Department of OncologyLinyi Cancer HospitalLinyiChina
| | - Guimin Chen
- Department of OncologyLinyi Cancer HospitalLinyiChina
| | - Haitao Wang
- Department of Cardiothoracic SurgeryZhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical CollegeHangzhouChina
| | - Xiuxiu Wang
- Department of OncologyLinyi Cancer HospitalLinyiChina
| | - Baohui Han
- Department of Pulmonary MedicineShanghai Chest Hospital, Shanghai Jiaotong UniversityShanghaiChina
| | - Kai Li
- Department of Thoracic OncologyTianjin Medical University Cancer HospitalTianjinChina
| | - Qiming Wang
- Department of Internal MedicineAffiliated Cancer Hospital of Zhengzhou UniversityZhengzhouChina
- Department of Internal MedicineHenan Cancer HospitalZhengzhouChina
| | - Li Zhang
- Department of Respiratory DiseasesPeking Union Medical College HospitalBeijingChina
| | - Zhehai Wang
- Department of Internal Medicine‐OncologyShandong Cancer HospitalJinanChina
| | - Ying Cheng
- Department of Thoracic OncologyJilin Cancer HospitalChangchunChina
| | - Jianxing He
- Department of Thoracic SurgeryThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Yuankai Shi
- Department of Medical OncologyCancer Hospital Chinese Academy of Medical SciencesBeijingChina
| | - Weiqiang Chen
- Department of Pulmonary MedicineLanzhou Military General HospitalLanzhouChina
| | - Yi Luo
- Department of Medical OncologyHunan Cancer HospitalChangshaChina
| | - Lin Wu
- Department of Medical OncologyHunan Cancer HospitalChangshaChina
| | - Xiuwen Wang
- Department of ChemotherapyQilu Hospital of Shandong UniversityJinanChina
| | - Kejun Nan
- Department of OncologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Faguang Jin
- Department of Respiratory DiseasesTang Du HospitalXi'anChina
| | - Jian Dong
- First Department of Medical OncologyYunnan Cancer HospitalKunmingChina
| | - Baolan Li
- Department of General MedicineCapital Medical University, Beijing Chest HospitalBeijingChina
| | - Zhian Liu
- Department of OncologyLinyi Cancer HospitalLinyiChina
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12
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Schneider MA, Linecker M, Fritsch R, Muehlematter UJ, Stocker D, Pestalozzi B, Samaras P, Jetter A, Kron P, Petrowsky H, Nicolau C, Lehn JM, Humar B, Graf R, Clavien PA, Limani P. Phase Ib dose-escalation study of the hypoxia-modifier Myo-inositol trispyrophosphate in patients with hepatopancreatobiliary tumors. Nat Commun 2021; 12:3807. [PMID: 34155211 PMCID: PMC8217170 DOI: 10.1038/s41467-021-24069-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Hypoxia is prominent in solid tumors and a recognized driver of malignancy. Thus far, targeting tumor hypoxia has remained unsuccessful. Myo-inositol trispyrophosphate (ITPP) is a re-oxygenating compound without apparent toxicity. In preclinical models, ITPP potentiates the efficacy of subsequent chemotherapy through vascular normalization. Here, we report the results of an unrandomized, open-labeled, 3 + 3 dose-escalation phase Ib study (NCT02528526) including 28 patients with advanced primary hepatopancreatobiliary malignancies and liver metastases of colorectal cancer receiving nine 8h-infusions of ITPP over three weeks across eight dose levels (1'866-14'500 mg/m2/dose), followed by standard chemotherapy. Primary objectives are assessment of the safety and tolerability and establishment of the maximum tolerated dose, while secondary objectives include assessment of pharmacokinetics, antitumor activity via radiological evaluation and assessment of circulatory tumor-specific and angiogenic markers. The maximum tolerated dose is 12,390 mg/m2, and ITPP treatment results in 32 treatment-related toxicities (mostly hypercalcemia) that require little or no intervention. 52% of patients have morphological disease stabilization under ITPP monotherapy. Following subsequent chemotherapy, 10% show partial responses while 60% have stable disease. Decreases in angiogenic markers are noted in ∼60% of patients after ITPP and tend to correlate with responses and survival after chemotherapy.
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Affiliation(s)
- Marcel A Schneider
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Surgery & Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Michael Linecker
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Surgery & Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Ralph Fritsch
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Oncology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Urs J Muehlematter
- Institute of Interventional and Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Daniel Stocker
- Institute of Interventional and Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Bernhard Pestalozzi
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Oncology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Panagiotis Samaras
- Oncology Center, Hirslanden Hospital Zurich, Witellikerstrasse 40, Zurich, Switzerland
| | - Alexander Jetter
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Philipp Kron
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Surgery & Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Henrik Petrowsky
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Surgery & Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Claude Nicolau
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, USA
| | - Jean-Marie Lehn
- Institut de Science et d'Ingénierie Supramoléculaires (ISIS), Université de Strasbourg, 8 allée Gaspard Monge, Strasbourg, France
| | - Bostjan Humar
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Surgery & Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Rolf Graf
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
- Department of Surgery & Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland.
- Department of Surgery & Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland.
| | - Perparim Limani
- Swiss Hepato-Pancreato-Biliary (HPB) and Transplantation Center, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland.
- Department of Surgery & Transplantation, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland.
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13
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Nan D, Yin X, Ma D, Jiang X, Wu B, Feng J. Posterior Reversible Encephalopathy Syndrome Associated With Anlotinib: A Case Report and Literature Review. Front Neurol 2021; 12:546481. [PMID: 34025545 PMCID: PMC8134686 DOI: 10.3389/fneur.2021.546481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/08/2021] [Indexed: 12/15/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a relatively rare clinical disease, characterized by reversible subcortical vasogenic edema. Here, we present the first reported case of PRES induced by anlotinib, a multi-target tyrosine kinase inhibitor. A 56-year-old female patient with lung adenocarcinoma and bone metastasis experienced hypertension and mental confusion when she received anti-angiogenesis treatment. PRES was diagnosed after magnetic resonance of the patient's brain revealed hyperintensities bilaterally around the cerebellum, pons, fronto-parieto-occipital areas, and corona radiate. Diffusion-weighted imaging showed hyperintensities bilaterally in the parieto-occipital cortical regions. Subsequently, the patient was diagnosed with PRES, and remission was achieved with anti-hypertensive drugs. Six cases of rare adverse effects induced by anlotinib were reviewed in the literature. Since anlotinib has been widely applied as a novel third-line treatment in patients with non-small-cell lung cancer, the association between PRES and anlotinib would benefit neurologists and oncologists in future diagnoses and treatment.
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Affiliation(s)
- Di Nan
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Xiang Yin
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Di Ma
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Xiaoyu Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Baihua Wu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Jiachun Feng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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14
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Tang X, Zheng Y, Jiao D, Chen J, Liu X, Xiong S, Chen Q. Anlotinib Inhibits Cell Proliferation, Migration and Invasion via Suppression of c-Met Pathway and Activation of ERK1/2 Pathway in H446 Cells. Anticancer Agents Med Chem 2021; 21:747-755. [PMID: 32682383 DOI: 10.2174/1871520620666200718235748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Small Cell Lung Cancer (SCLC) represents the most aggressive pulmonary neoplasm and is often diagnosed at late stage with limited survival, despite combined chemotherapies. The purpose of this study was to investigate the effect of anlotinib on SCLC and the potential molecular mechanisms. METHODS Cell viability was assessed by CCK-8 assay to determine the adequate concentration of anlotinib. Then, effects of anlotinib on cell apoptosis, cell cycle distribution, migration and invasion were analyzed by flow cytometry, PI staining, wound healing assay and transwell assay, respectively. The protein expression of c-met and ERK1/2 pathways in H446 cells were assessed by western blot analysis. RESULTS In this study, we found that anlotinib significantly reduced the cell viability of H446 cells, induced G2/M cell cycle arrest and decreased invasion and migration of H446 cells. Futhermore, we also found that anlotinib could suppress c-met signal transduction and activate the ERK1/2 pathway in H446 cells. More importantly, c-met was involved in the effects of anlotinib on migration and invasion in H446 cells. CONCLUSION Taken together, our results demonstrated that anlotinib was a potential anticancer agent that inhibited cell proliferation, migration and invasion via suppression of the c-met pathway and activation of the ERK1/2 pathway in H446 cells.
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Affiliation(s)
- Xiali Tang
- Department of Pulmonary and Critical Care Medicine, The 903rd Hospital of PLA, Hangzhou, Zhejiang, China
| | - Ying Zheng
- Department of Pulmonary and Critical Care Medicine, The 903rd Hospital of PLA, Hangzhou, Zhejiang, China
| | - Demin Jiao
- Department of Pulmonary and Critical Care Medicine, The 903rd Hospital of PLA, Hangzhou, Zhejiang, China
| | - Jun Chen
- Department of Pulmonary and Critical Care Medicine, The 903rd Hospital of PLA, Hangzhou, Zhejiang, China
| | - Xibang Liu
- School of the 1st Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shan Xiong
- Institute of Materia Medica, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan Shandong 250062, China
| | - Qingyong Chen
- Department of Pulmonary and Critical Care Medicine, The 903rd Hospital of PLA, Hangzhou, Zhejiang, China
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15
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Zhang P, Ma L, Wang X, Zhang R, Dong Y. Successful treatment of advanced ovarian cancer with anlotinib: a case report. J Int Med Res 2020; 48:300060520976824. [PMID: 33284728 PMCID: PMC7724413 DOI: 10.1177/0300060520976824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ovarian cancer remains the most lethal gynecological malignant tumor, with relapse
occurring in approximately 70% of advanced cases. Anlotinib is an oral small-molecule
multi-targeted tyrosine kinase inhibitor that can resist neoangiogenesis and inhibit tumor
growth. Previous research demonstrated clinical antitumor activity of anlotinib in various
cancers. We report the case of an elderly woman with advanced ovarian cancer who received
anlotinib after failure of multiple-line chemotherapy. A partial response was observed
after six cycles of anlotinib monotherapy, with a reduction in the size of the metastases
and significantly decreased serum CA125 levels from 1832.7 U/mL to 118.7 U/mL. She
continued to take anlotinib, with a progression-free survival time of more than 4 months.
Only mild hypertension was observed during the treatment. Anlotinib monotherapy may be a
novel therapeutic option for patients with advanced ovarian cancer.
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Affiliation(s)
- Ping Zhang
- Department of Oncology, Dezhou People's Hospital, Dezhou, P.R. China
| | - Liangliang Ma
- Department of Oncology, Dezhou People's Hospital, Dezhou, P.R. China
| | - Xiaojie Wang
- Department of Oncology, Dezhou People's Hospital, Dezhou, P.R. China
| | - Ruijie Zhang
- Department of Radiology, Dezhou People's Hospital, Dezhou, P.R. China
| | - Yuting Dong
- Department of Oncology, Dezhou People's Hospital, Dezhou, P.R. China
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16
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Hu T, An Z, Sun Y, Wang X, Du P, Li P, Chi Y, Liu L. Longitudinal Pharmacometabonomics for Predicting Malignant Tumor Patient Responses to Anlotinib Therapy: Phenotype, Efficacy, and Toxicity. Front Oncol 2020; 10:548300. [PMID: 33282726 PMCID: PMC7689013 DOI: 10.3389/fonc.2020.548300] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
Anlotinib is an oral small molecule inhibitor of multiple receptor tyrosine kinases (RTKs), which was approved by the National Medical Products Administration (NMPA) of China in 2018 for the third-line treatment of non-small cell lung cancer (NSCLC). Here, for the first time, the longitudinal pharmacometabonomics was explored for predicting malignant tumor patient responses to anlotinib, including the metabolic phenotype variation, drug efficacy, and toxicity. A total of 393 plasma samples from 16 subjects collected from a phase I additional study of anlotinib (NCT02752516) were submitted to targeted metabolomics analysis. The orthogonal partial least-squares discriminant analysis (OPLS-DA) models were constructed for the predication of anlotinib efficacy and toxicity based on the longitudinal pharmacometabonomics data. Statistical results showed that 38 metabolites, mainly involved in aminoacyl-tRNA biosynthesis, alanine, aspartate, and glutamate metabolism, and steroid hormone biosynthesis, were all significantly upregulated attributing to anlotinib treatment. The anti-tumor efficacy and occurrence of proteinuria after anlotinib administration can be predicted with 100% accuracy using the established OPLS-DA models. Glycodeoxycholic acid and glycocholic acid possessed the most excellent sensitivity and specificity in predicting the efficacy of anlotinib, with area under the receiver operating characteristic curve (AUC of ROC curve) 0.847 and 0.828, respectively. NG, NG-dimethylarginine was the most promising biomarker for the prediction of proteinuria occurrence after anlotinib administration, with AUC of ROC curve 0.814. In conclusion, this work developed efficient and convenient discriminant models that can accurately predict the efficacy and toxicity of anlotinib based on longitudinal pharmacometabonomics study.
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Affiliation(s)
- Ting Hu
- Pharmaceutical Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhuoling An
- Pharmaceutical Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yongkun Sun
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xunqiang Wang
- Research and Development Department, Chia Tai Tianqing Pharmaceutical Group Co., Nanjing, China
| | - Ping Du
- Pharmaceutical Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Pengfei Li
- Pharmaceutical Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yihebali Chi
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihong Liu
- Pharmaceutical Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Liu L, Wang X, Wu WB, Zhang M. Salvage anlotinib showed sustained efficacy in heavily pretreated EGFR wild-type lung adenocarcinoma: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e22707. [PMID: 33031343 PMCID: PMC7544372 DOI: 10.1097/md.0000000000022707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Anlotinib has been proved to be effective in advanced refractory non-small cell lung cancer. PATIENT CONCERNS A 47-year-old female non-smoker was admitted due to persistent chest tightness for a month. DIAGNOSES Epidermal growth factor receptor (EGFR) wild-type advanced primary lung adenocarcinoma without brain or bone metastasis. INTERVENTIONS The patient failed 2 lines of pemetrexed/docetaxel plus carboplatin and third-line erlotinib. Fourth-line anlotinib was administered thereafter. OUTCOMES The pulmonary lesions showed partial remission 5 months after anlotinib monotherapy. The patient demonstrated a progression-free survival of more than 7 months and an overall survival of >12 months. The adverse events including hypertension and fatigue were well-tolerated. LESSONS Salvage anlotinib might be a reasonable choice in EGFR wild-type lung adenocarcinoma after failure of chemotherapy. Further well-designed trials are warranted to verify this occasional finding.
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Affiliation(s)
- Lei Liu
- Institute of Digestive Disease, China Three Gorges University, Department of Gastroenterology of Yichang Central People's Hospital, Yichang, China
| | - Xiang Wang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Wen-Bin Wu
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, China
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Zuo R, Zhang C, Lin L, Meng Z, Wang Y, Su Y, Abudurazik M, Du Y, Chen P. Durable efficacy of anlotinib in a patient with advanced thymic squamous cell carcinoma after multiline chemotherapy and apatinib: A case report and literature review. Thorac Cancer 2020; 11:3383-3387. [PMID: 32997432 PMCID: PMC7606018 DOI: 10.1111/1759-7714.13658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
Thymic carcinoma is a rare and highly aggressive mediastinal tumor. Most patients are diagnosed at surgically unresectable stages. Current prospective and retrospective studies have indicated that platinum and anthracycline‐based chemotherapy are the first choice drugs of first‐line therapy for advanced thymic carcinoma. However, there is no optimal treatment after progression for patients who have undergone first‐line and subsequent chemotherapy. Anlotinib, a novel small molecule tyrosine kinase multitarget inhibitor, was approved by the China Food and Drug Administration as a third‐line treatment for advanced non‐small cell lung cancer (NSCLC) in May 2018. Herein we report a case of an advanced thymic squamous cell carcinoma patient harboring EGFR exon 20 insertion who had previously received multiline therapy, including chemotherapy, radiotherapy as well as antiangiogenic therapy. Also as an angiogenesis inhibitor, anotinib had controlled his mediastinal mass after failure of the apatinib treatment. To date, over 23 months of progression‐free survival (PFS) and six years of overall survival (OS) have been achieved. Compared with apatinib, the adverse reactions have been mild and tolerable and the patient's quality of life has improved. To our knowledge, this is the first report where anlotinib has been effective in controlling the progression of thymic carcinoma. In the multiline treatment of advanced thymic carcinoma, anlotinib appears to show great potential when utilized as a salvage treatment.
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Affiliation(s)
- Ran Zuo
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Cuicui Zhang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Li Lin
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhaoting Meng
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yajie Wang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yudong Su
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Mihray Abudurazik
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ye Du
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Peng Chen
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Tang J, Ramis-Cabrer D, Curull V, Mateu-Jiménez M, Almagro K, Duran X, Pijuan L, Rodríguez-Fuster A, Aguiló R, Barreiro E. Markers of Stroma in Lung Cancer: Influence of COPD. Arch Bronconeumol 2020; 57:130-137. [PMID: 33077297 DOI: 10.1016/j.arbres.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stroma, mainly composed by fibroblasts, extracellular matrix (ECM) and vessels, may play a role in tumorigenesis and cancer progression. Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for LC. We hypothesized that markers of fibroblasts, ECM and endothelial cells may differ in tumors of LC patients with/without COPD. METHODS Markers of cultured cancer-associated fibroblasts and normal fibroblasts [CAFs and NFs, respectively, vimentin and alpha-smooth muscle actin (SMA) markers, immunofluorescence in cultured lung fibroblasts], ECM, and endothelial cells (type I collagen and CD31 markers, respectively, immunohistochemistry) were identified in lung tumor and non-tumor specimens (thoracotomy for lung tumor resection) from 15 LC-COPD patients and 15 LC-only patients. RESULTS Numbers of CAFs significantly increased, while those of NFs significantly decreased in tumor samples compared to non-tumor specimens of both LC and LC-COPD patients. Endothelial cells (CD31) significantly decreased in tumor samples compared to non-tumor specimens only in LC patients. No significant differences were seen in levels of type I collagen in any samples or study groups. CONCLUSIONS Vascular endothelial marker CD31 expression was reduced in tumors of non-COPD patients, while type I collagen levels did not differ between groups. A rise in CAFs levels was detected in lung tumors of patients irrespective of airway obstruction. Low levels of CD31 may have implications in the overall survival of LC patients, especially in those without underlying airway obstruction. Identification of CD31 role as a prognostic and therapeutic biomarker in lung tumors of patients with underlying respiratory diseases warrants attention.
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Affiliation(s)
- Jun Tang
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Department of Medicine, Universitat Autònoma de Barcelona (UAB), Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Daniel Ramis-Cabrer
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Department of Medicine, Universitat Autònoma de Barcelona (UAB), Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Víctor Curull
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Department of Medicine, Universitat Autònoma de Barcelona (UAB), Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Mercé Mateu-Jiménez
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Department of Medicine, Universitat Autònoma de Barcelona (UAB), Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Klara Almagro
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Department of Medicine, Universitat Autònoma de Barcelona (UAB), Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Xavier Duran
- Scientific and Technical Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Lara Pijuan
- Pathology Department, Hospital del Mar-IMIM, Parc de Salut Mar, Barcelona, Spain
| | | | - Rafael Aguiló
- Thoracic Surgery Department, Hospital del Mar-IMIM, Parc de Salut Mar, Barcelona, Spain
| | - Esther Barreiro
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Department of Medicine, Universitat Autònoma de Barcelona (UAB), Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
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20
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Gao Y, Liu P, Shi R. Anlotinib as a molecular targeted therapy for tumors. Oncol Lett 2020; 20:1001-1014. [PMID: 32724339 PMCID: PMC7377159 DOI: 10.3892/ol.2020.11685] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Angiogenesis has an essential role in tumor growth and metastasis, and blocking this pathway has been a successfully utilized strategy in the clinical treatment of cancer. Anlotinib (AL3818) is a novel oral receptor tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor 2 and 3, fibroblast growth factor 1-4, platelet-derived growth factor receptor α and β, c-Kit and Ret. Anlotinib exerts inhibitory effects on tumor growth and angiogenesis and received its first approval as a third-line treatment for refractory advanced non-small-cell lung cancer in May 2018 and its second approval as a second-line treatment for advanced soft-tissue sarcoma in June 2019 in the People's Republic of China. Anlotinib has encouraging efficacy and a manageable and tolerable safety profile in a broad range of malignancies, including medullary thyroid cancer, renal cell cancer, gastric cancer and esophageal squamous cell carcinoma. In the present review, the preclinical and clinical trials of anlotinib were summarized with a focus on safety evaluation and adverse event management.
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Affiliation(s)
- Yi Gao
- School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
- Department of Gastroenterology, The Jiangyin Clinical College of Xuzhou Medical University, Jiangyin, Jiangsu 214400, P.R. China
- Jiangsu Provincial Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Pengfei Liu
- Department of Gastroenterology, The Jiangyin Clinical College of Xuzhou Medical University, Jiangyin, Jiangsu 214400, P.R. China
- State Key Laboratory of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, Jiangsu 215123, P.R. China
| | - Ruihua Shi
- School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
- Department of Gastroenterology, Zhongda Hospital, Affiliated Hospital of Southeast University, Nanjing, Jiangsu 210009, P.R. China
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21
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Zhang K, Ma X, Gao H, Wang H, Qin H, Yang S, Liu X. Efficacy and Safety of Anlotinib in Advanced Non-Small Cell Lung Cancer: A Real-World Study. Cancer Manag Res 2020; 12:3409-3417. [PMID: 32494205 PMCID: PMC7231784 DOI: 10.2147/cmar.s246000] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose The ALTER0303 trial showed that anlotinib, a novel antiangiogenic tyrosine kinase inhibitor, administered as third-line or further treatment prolonged progression-free survival (PFS) and overall survival (OS) in patients with advanced non-small cell lung cancer (NSCLC). This retrospective study investigated the efficacy and safety of anlotinib in real-world settings. Patients and Methods Medical records of patients with advanced NSCLC receiving anlotinib as third-line or further treatment were collected, and survival curves were derived using the Kaplan–Meier method. Univariate analysis was performed by log-rank testing. Cox regression analysis was used to evaluate the significance of factors obtained from the univariate analysis. Results Fifty-two patients with advanced NSCLC were included. The objective response rate was 16%, and the disease control rate was 80%. The median PFS was 4.5 months (95% confidence interval [CI]: 3.6–5.4), and the median OS was 9 months (95% CI: 6.5–11.5). Univariate analysis revealed that the group of patients with longer PFS and OS included Eastern Cooperative Oncology Group performance status (ECOG PS) ≤1, ≤2 distant metastases, no liver metastases, ≤3 previous treatment lines, and ≤2 previous chemotherapy lines. Cox regression analysis demonstrated that only patients with ECOG PS ≤1 or no liver metastases had longer PFS and OS. Grade 3 treatment-related adverse events were reported in 14% of the patients, but no life-threatening adverse events were reported. Conclusion Anlotinib was well tolerated and effective in patients with advanced NSCLC in real-world conditions. Patients with ECOG PS ≤1 or no liver metastases have longer PFS and OS.
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Affiliation(s)
- Kun Zhang
- Academy of Military Medical Science, Beijing 100089, People's Republic of China.,Department of Lung Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, People's Republic of China
| | - Xiya Ma
- Department of Lung Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, People's Republic of China
| | - Hongjun Gao
- Department of Lung Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, People's Republic of China
| | - Hong Wang
- Department of Lung Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, People's Republic of China
| | - Haifeng Qin
- Department of Lung Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, People's Republic of China
| | - Shaoxing Yang
- Department of Lung Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, People's Republic of China
| | - Xiaoqing Liu
- Department of Lung Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, People's Republic of China
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22
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Wang Z, Lian LJ, Dong YY, Cui X, Qian JC, Huang CK, Chen RJ, Sun W. Determination of Anlotinib, a Tyrosine Kinase Inhibitor, in Rat Plasma by UHPLC-MS/MS and Its Application to a Pharmacokinetic Study. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2019; 2019:5016757. [PMID: 31886022 PMCID: PMC6925768 DOI: 10.1155/2019/5016757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/24/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
Anlotinib is a novel inhibitor of receptor kinase tyrosine with multitargets and has a broad spectrum of inhibitory action on tumor angiogenesis and growth. A simple and rapid UHPLC-MS/MS bioanalytical method was validated for the determination of anlotinib in rat plasma, using imatinib as an internal standard. An Acquity BEH C18 column was used to separate analytes. The eluents consisted of formic acid/water (0.1 : 100, v/v) and acetonitrile with a mobile phase. A triple quadrupole mass spectrometer was operated for the quantification with multiple reaction monitoring (MRM) to determine transitions: 408.2 ⟶ 339.1 for anlotinib, and 494.3 ⟶ 394.1 for imatinib. The validated range was 0.1-50 ng/mL for anlotinib. Mean recovery rate of anlotinib in plasma was ≥99.32% and reproducible. Also, the intra- and interday precisions were both below 15%. This robust method was successfully applied to support the pharmacokinetic study of anlotinib in rats.
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Affiliation(s)
- Zhe Wang
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Le-jing Lian
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Yan-yan Dong
- Department of Ultrasonography, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiao Cui
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Jian-chang Qian
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Cheng-ke Huang
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Rui-jie Chen
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Wei Sun
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
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23
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Lu J, Zhong H, Wu J, Chu T, Zhang L, Li H, Wang Q, Li R, Zhao Y, Gu A, Wang H, Shi C, Xiong L, Zhang X, Zhang W, Lou Y, Yan B, Dong Y, Zhang Y, Li B, Zhang L, Zhao X, Li K, Han B. Circulating DNA-Based Sequencing Guided Anlotinib Therapy in Non-Small Cell Lung Cancer. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1900721. [PMID: 31592412 PMCID: PMC6774020 DOI: 10.1002/advs.201900721] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/20/2019] [Indexed: 06/04/2023]
Abstract
Anlotinib is a multitargeted antiangiogenic drug, and its clinical predictor for responsive non-small cell lung cancer (NSCLC) patients is still elusive. Here, tumor-specific target capture is used to profile the circulating DNA of ALTER0303 (evaluating NSCLC clinical antitumor efficacy through anlotinib therapy) study participants. The results indicate that patients receiving no benefit can be mainly excluded via analysis of ARID1A and BRCA2 genetic profiling. For patients with no durable benefit and durable clinical benefit patients, three predictors: germline and somatic mutation burden (G+S MB), nonsynonymous and synonymous mutation burden (N+S MB), and unfavorable mutation score of circulating DNA profiling are identified. Through integrating the advantages and disadvantages of three independent predictors, the tumor mutation index (TMI) is established as a prediction model and the patients who are very likely to benefit more from anlotinib therapy are identified. Furthermore, the IDH1 exon 4 mutation is identified as an unfavorable factor for anlotinib therapy under TMI-based stratification, and the TMI plus IDH1 exon 4 mutation status potentially predicts response to anlotinib. Collectively, this study provides a circulating DNA sequencing-based stratification method for identifying anlotinib responders via a noninvasive approach, and thus potentially improves the clinical outcome of NSCLC patients receiving third-line therapy.
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Affiliation(s)
- Jun Lu
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Hua Zhong
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Jun Wu
- School of Life ScienceEast China Normal UniversityShanghai200241China
| | - Tianqing Chu
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Lele Zhang
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Hua Li
- Bio‐ID CenterSchool of Biomedical EngineeringShanghai Jiao Tong UniversityShanghai200240China
| | - Qiming Wang
- Department of Internal MedicineHenan Province Tumor HospitalZhengzhou UniversityHenan450008China
| | - Rong Li
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Yizhuo Zhao
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Aiqin Gu
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Huimin Wang
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Chunlei Shi
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Liwen Xiong
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Xueyan Zhang
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Wei Zhang
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Yuqing Lou
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Bo Yan
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Yu Dong
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Yanwei Zhang
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
| | - Baolan Li
- General DepartmentBeijing Chest HospitalCapital Medical UniversityBeijing101149China
| | - Li Zhang
- Department of Respiratory MedicinePeking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijing100032China
| | - Xiaodong Zhao
- Shanghai Center for Systems BiomedicineShanghai Jiao Tong UniversityShanghai200240China
| | - Kai Li
- Department of Thoracic OncologyNational Clinical Research Center for CancerTianjin Medical University Cancer Institute and HospitalTianjin200030China
| | - Baohui Han
- Department of Pulmonary MedicineShanghai Chest HospitalShanghai Jiao Tong UniversityShanghai200030China
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Lu J, Shi Q, Zhang L, Wu J, Lou Y, Qian J, Zhang B, Wang S, Wang H, Zhao X, Han B. Integrated Transcriptome Analysis Reveals KLK5 and L1CAM Predict Response to Anlotinib in NSCLC at 3rd Line. Front Oncol 2019; 9:886. [PMID: 31572680 PMCID: PMC6749025 DOI: 10.3389/fonc.2019.00886] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
The oral multi-targeted tyrosine kinase inhibitor (TKI) anlotinib is effective for non-small cell lung cancer (NSCLC) in clinical trials at 3rd line. However, a fraction of patients remains non-responsive, raising the need of how to identify anlotinib-responsive patients. In the present study, we aimed to screen potential biomarkers for anlotinib-responsive stratification via integrated transcriptome analysis. Comparing with the anlotinib-sensitive lung cancer cell NCI-H1975, we found 1,315 genes were differentially expressed in anlotinib-resistant NCI-H1975 cells. Among the enriched angiogenesis-related genes, we observed high expression of KLK5 and L1CAM was mostly associated with poor clinical outcomes in NSCLC patients through Kaplan-Meier survival analysis in a TCGA cohort. Moreover, an independent validation in a cohort of ALTER0303 (NCT02388919) indicated that high serum levels of KLK5 and L1CAM were also associated with poor anlotinib response in NSCLC patients at 3rd line. Lastly, we demonstrated that knockdown of KLK5 and L1CAM increases anlotinib-induced cytotoxicity in anlotinib-resistant NCI-H1975 cells. Collectively, our study suggested serum levels of KLK5 and L1CAM potentially serve as biomarkers for anlotinib-responsive stratification in NSCLC patients at 3rd line.
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Affiliation(s)
- Jun Lu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qin Shi
- Department of Oncology, Baoshan Branch of Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lele Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Wu
- School of Life Science, East China Normal University, Shanghai, China
| | - Yuqing Lou
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Qian
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuyuan Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huimin Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaodong Zhao
- Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Zhang Y, Zou JY, Wang Z, Wang Y. Fruquintinib: a novel antivascular endothelial growth factor receptor tyrosine kinase inhibitor for the treatment of metastatic colorectal cancer. Cancer Manag Res 2019; 11:7787-7803. [PMID: 31496821 PMCID: PMC6701622 DOI: 10.2147/cmar.s215533] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/28/2019] [Indexed: 12/13/2022] Open
Abstract
Angiogenesis plays a critical role in the neoplastic growth, progression, and metastasis of colorectal cancer (CRC) in a process regulated by vascular endothelial growth factor (VEGF) family members and their receptors (VEGFR). Several small-molecule anti-VEGFR tyrosine kinase inhibitors (TKIs), such as regorafenib, famitinib, axitinib and apatinib, have been shown to be effective in treating metastatic colorectal cancer (mCRC). Fruquintinib (ELUNATE®) is a novel oral anti-VEGFR TKI, originated and developed by Hutchison MediPharma. Fruquintinib is a potent and highly selective small-molecule inhibitor of VEGFR-1, -2 and -3. In the Phase 3 FRESCO trial, fruquintinib improved both overall survival (OS) and progression-free survival (PFS) in patients with mCRC, compared with placebo. Fruquintinib also showed an acceptable safety and tolerability profile. Based on the data from this trial, fruquintinib was approved by the China Food and Drug Administration (CFDA) in 2018, for the treatment of patients with mCRC who had undergone at least two prior standard anticancer therapies. The existing clinical trials and future prospects of fruquintinib in mCRC will be discussed in this article. In addition, to better understand the role of fruquintinib in this setting, recent advances in other anti-VEGFR TKIs for mCRC treatment are also reviewed herein.
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Affiliation(s)
- Ying Zhang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Jia-Yun Zou
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Zhe Wang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Ying Wang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
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26
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Liu Z, Wang J, Meng Z, Wang X, Zhang C, Qin T, Chen J, Jiang X, Wang L, Lin L, Zhang X, Chen P, Huang C, Jiang R, Li K. CD31-labeled circulating endothelial cells as predictor in anlotinib-treated non-small-cell lung cancer: Analysis on ALTER-0303 study. Cancer Med 2018; 7:3011-3021. [PMID: 29856135 PMCID: PMC6051165 DOI: 10.1002/cam4.1584] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/08/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Our previous studies revealed that the level of activated circulating endothelial cells (aCECs) was correlated with the progression‐free survival (PFS) in antiangiogenesis therapy. Anlotinib displayed affirmatory efficacies in several clinical trials of non‐small‐cell lung cancer (NSCLC). To find a marker predicting the efficacy of anlotinib treatment, we investigated the correlations of aCECs with PFS and overall survival (OS) in patients with NSCLC treated with anlotinib and the impact of anlotinib on human umbilical vascular endothelial cells (HUVECs). The blood samples of 78 patients with NSCLC were collected. aCECs were identified by flow cytometry as CD45−/CD146+/CD31+ cells and CD45−/CD146+/CD105+ cells. The mean value of baseline aCECs counts was defined as the cutoff value, according to which patients were divided into high and low baseline groups. Statistical correlation between high baseline CD31‐labeled aCECs counts and number of metastatic lesions (>3) (χ2 = 4.905, P = .027) was analyzed. The 49 patients treated with anlotinib were stratified according to the ratio of minimal aCECs counts at any time points to baseline (aCECs min/baseline) as <1 or ≥1. Interestingly, the patients with aCECs (CD31) min/baseline <1 displayed longer PFS [HR = 0.439, 95%CI (0.211‐0.912), P = .023]. The biological effect of anlotinib on HUVECs was investigated using MTT assays. Western blot analysis was conducted to evaluate the expression levels of CD31 and CD105 under anlotinib treatment and the underlying mechanisms. In vitro experiment data demonstrated that CD31 exhibited more sensitive changes than CD105 under anlotinib treatment through PI3K‐AKT pathway. Thus, our finding provides new insights into the mechanism by which the CD31‐labeled aCECs are a more sensitive marker for predicting the efficiency of anlotinib treatment.
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Affiliation(s)
- Zhujun Liu
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Jing Wang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Zhaoting Meng
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Xinyue Wang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Cuicui Zhang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Tingting Qin
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Jinliang Chen
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Xiangli Jiang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Liuchun Wang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Li Lin
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Xiaoling Zhang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Peng Chen
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Chun Huang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Richeng Jiang
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Kai Li
- National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
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