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Alfei S, Zuccari G. Attempts to Improve Lipophilic Drugs' Solubility and Bioavailability: A Focus on Fenretinide. Pharmaceutics 2024; 16:579. [PMID: 38794242 PMCID: PMC11125266 DOI: 10.3390/pharmaceutics16050579] [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: 03/22/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
The development of numerous drugs is often arrested at clinical testing stages, due to their unfavorable biopharmaceutical characteristics. It is the case of fenretinide (4-HPR), a second-generation retinoid, that demonstrated promising in vitro cytotoxic activity against several cancer cell lines. Unfortunately, response rates in early clinical trials with 4-HPR did not confirm the in vitro findings, mainly due to the low bioavailability of the oral capsular formulation that was initially developed. Capsular 4-HPR provided variable and insufficient drug plasma levels attributable to the high hepatic first-pass effect and poor drug water solubility. To improve 4-HPR bioavailability, several approaches have been put forward and tested in preclinical and early-phase clinical trials, demonstrating generally improved plasma levels and minimal systemic toxicities, but also modest antitumor efficacy. The challenge is thus currently still far from being met. To redirect the diminished interest of pharmaceutical companies toward 4-HPR and promote its further clinical development, this manuscript reviewed the attempts made so far by researchers to enhance 4-HPR bioavailability. A comparison of the available data was performed, and future directions were proposed.
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Affiliation(s)
- Silvana Alfei
- Department of Pharmacy, University of Genoa, Viale Cembrano 4, 16148 Genoa, Italy;
| | - Guendalina Zuccari
- Department of Pharmacy, University of Genoa, Viale Benedetto XV, 16132 Genoa, Italy
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2
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Makimoto A, Fujisaki H, Matsumoto K, Takahashi Y, Cho Y, Morikawa Y, Yuza Y, Tajiri T, Iehara T. Retinoid Therapy for Neuroblastoma: Historical Overview, Regulatory Challenges, and Prospects. Cancers (Basel) 2024; 16:544. [PMID: 38339295 PMCID: PMC10854948 DOI: 10.3390/cancers16030544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Retinoids are vitamin A derivatives and include trans-retinoic acid, isotretinoin, tamibarotene, and bexarotene, all of which are currently available for clinical use. The clinical development of retinoid therapy for neuroblastoma has a history spanning more than four decades. The most promising agent is isotretinoin, which can contribute to improving event-free survival in patients with high-risk neuroblastoma by approximately 10% when administered over six months as maintenance therapy. Although isotretinoin is regarded as an essential component in the standard clinical management of high-risk neuroblastoma, its use for this purpose in the US and EU is off-label. To promote isotretinoin use in Japan as a treatment for neuroblastoma, our clinical research team is planning to launch an investigator-initiated, registration-directed clinical trial. The present review article discusses the basic science behind retinoid therapy, pre-clinical/clinical evidence on neuroblastoma, the concept of the proposed clinical trial, and prospects for this therapy.
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Affiliation(s)
- Atsushi Makimoto
- Department of Laboratory Medicine, Tokyo Metropolitan Children’s Medical Center, Fuchu 183-8561, Japan
- Clinical Research Support Center, Tokyo Metropolitan Children’s Medical Center, Fuchu 183-8561, Japan;
- Department of Hematology/Oncology, Tokyo Metropolitan Children’s Medical Center, Fuchu 183-8561, Japan;
| | - Hiroyuki Fujisaki
- Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka 534-0021, Japan;
| | - Kimikazu Matsumoto
- Children’s Cancer Center, National Center for Child Health and Development, Tokyo 157-8535, Japan;
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan;
| | - Yuko Cho
- Department of Pediatrics, Hokkaido University Hospital, Sapporo 060-8648, Japan;
| | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children’s Medical Center, Fuchu 183-8561, Japan;
| | - Yuki Yuza
- Department of Hematology/Oncology, Tokyo Metropolitan Children’s Medical Center, Fuchu 183-8561, Japan;
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;
| | - Tomoko Iehara
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
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3
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Al-Bustany HA, Muhammad HA, Chawsheen MA, Dash PR. Fenretinide induces apoptosis and synergises the apoptosis inducing effect of gemcitabine through inhibition of key signalling molecules involved in A549 cell survival in in silico and in vitro analyses. Cell Signal 2023; 111:110885. [PMID: 37704095 DOI: 10.1016/j.cellsig.2023.110885] [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: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
Fenretinide is a synthetic retinoid compound, which induces apoptosis via generating reactive oxygen species (ROS) and modulating PI3K/Akt/mTOR signalling pathway. We hypothesise that fenretinide's mechanism of action in triggering apoptosis may involve other targets, beside mTOR signalling pathway and it may augment apoptosis inducing effects of chemotherapeutic drugs in lung cancer. Time-lapse microscopy and Western blotting were used to evaluate apoptosis and apoptotic marker cleaved-Caspase 3 in A549 cells. Relative levels of protein phosphorylation and ROS were quantified by Human Phospho-Kinase Array Kit and CellROX® Green Reagent, respectively. Docking and simulation analyses of proteins and fenretinide interactions were identified and visualised by Discovery Studio Visualizer and AutoDock Vina software. Our results showed that fenretinide induced apoptosis in a dose dependant manner and combinations of fenretinide (5 μg/mL) and gemcitabine (1, 2, 4, 8 and 16 μg/mL) synergistically enhanced apoptosis in A549 cells. Fenretinide caused significant increase of cleaved-Caspase 3, de-phosphorylated p-S473 of Akt and failed to inhibit mTORC1 downstream targets. In silico results revealed that Akt required the lowest energy (-10.2 kcal/mol) to interact with fenretinide in comparison with other proteins. In conclusion, Akt may be exploited as a good target for induction of apoptosis in A549 cells and fenretinide has great potentials to fulfil this task. The mechanism by which fenretinide boosts the apoptosis inducing effects of gemcitabine, which is likely expected to be via inhibiting mTORC2 downstream targets. However, docking investigation revealed that fenretinide lacks specificity as it may also interact with several secondary targets beside Akt.
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Affiliation(s)
- Hazem A Al-Bustany
- Department of Basic Science, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
| | - Hawzheen A Muhammad
- Department of Basic Sciences, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq
| | - Mahmoud A Chawsheen
- Department of General Sciences, Faculty of Education, Soran University, Erbil, Kurdistan Region, Iraq; Medical Research Centre, Hawler Medical University, Erbil, Kurdistan Region. Iraq.
| | - Phil R Dash
- School of Biological Sciences, University of Reading, Reading, United Kingdom
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4
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Martin AJ, Shackleford DM, Charman SA, Wagstaff KM, Porter CJH, Jans DA. Increased In Vivo Exposure of N-(4-Hydroxyphenyl) Retinamide (4-HPR) to Achieve Plasma Concentrations Effective against Dengue Virus. Pharmaceutics 2023; 15:1974. [PMID: 37514160 PMCID: PMC10384639 DOI: 10.3390/pharmaceutics15071974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
N-(4-hydroxyphenyl) retinamide (4-HPR, or fenretinide) has promising in vitro and in vivo antiviral activity against a range of flaviviruses and an established safety record, but there are challenges to its clinical use. This study evaluated the in vivo exposure profile of a 4-HPR dosage regime previously shown to be effective in a mouse model of severe dengue virus (DENV) infection, comparing it to an existing formulation for human clinical use for other indications and developed/characterised self-emulsifying lipid-based formulations of 4-HPR to enhance 4-HPR in vivo exposure. Pharmacokinetic (PK) analysis comprising single-dose oral and IV plasma concentration-time profiles was performed in mice; equilibrium solubility testing of 4-HPR in a range of lipids, surfactants and cosolvents was used to inform formulation approaches, with lead formulation candidates digested in vitro to analyse solubilisation/precipitation prior to in vivo testing. PK analysis suggested that effective plasma concentrations could be achieved with the clinical formulation, while novel lipid-based formulations achieved > 3-fold improvement. Additionally, 4-HPR exposure was found to be limited by both solubility and first-pass intestinal elimination but could be improved through inhibition of cytochrome P450 (CYP) metabolism. Simulated exposure profiles suggest that a b.i.d dosage regime is likely to maintain 4-HPR above the minimum effective plasma concentration for anti-DENV activity using the clinical formulation, with new formulations/CYP inhibition viable options to increase exposure in the future.
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Affiliation(s)
- Alexander J Martin
- Nuclear Signalling Laboratory, Department Biochem. & Mol. Biol., Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - David M Shackleford
- Centre for Drug Candidate Optimisation, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville 3052, Victoria, Australia
| | - Susan A Charman
- Centre for Drug Candidate Optimisation, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville 3052, Victoria, Australia
| | - Kylie M Wagstaff
- Nuclear Signalling Laboratory, Department Biochem. & Mol. Biol., Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - Christopher J H Porter
- Drug Delivery Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville 3052, Victoria, Australia
| | - David A Jans
- Nuclear Signalling Laboratory, Department Biochem. & Mol. Biol., Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
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Aravindan N, Natarajan M, Somasundaram DB, Aravindan S. Chemoprevention of neuroblastoma: progress and promise beyond uncertainties. JOURNAL OF CANCER METASTASIS AND TREATMENT 2023; 9:9. [PMID: 38249515 PMCID: PMC10798790 DOI: 10.20517/2394-4722.2022.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Neuroblastoma is the most common extracranial solid tumor in children and comprises one-tenth of all childhood cancer deaths. The current clinical therapy for this deadly disease is multimodal, involving an induction phase with alternating regimens of high-dose chemotherapeutic drugs and load reduction surgery; a consolidation phase with more intensive chemotherapy, radiotherapy, and stem cell transplant; and a maintenance phase with immunotherapy and immune-activating cytokine treatment. Despite such intensive treatment, children with neuroblastoma have unacceptable life quality and survival, warranting preventive measures to regulate the cellular functions that orchestrate tumor progression, therapy resistance, metastasis, and tumor relapse/recurrence. Globally, active efforts are underway to identify novel chemopreventive agents, define their mechanism(s) of action, and assess their clinical benefit. Some chemoprevention strategies (e.g., retinoids, difluoromethylornithine) have already been adopted clinically as part of maintenance phase therapy. Several agents are in the pipeline, while many others are in preclinical characterization. Here we review the classes of chemopreventive agents investigated for neuroblastoma, including cellular events targeted, mode(s) of action, and the level of development. Our review: (i) highlights the pressing need for new and improved chemopreventive strategies for progressive neuroblastoma; (ii) lists the emerging classes of chemopreventive agents for neuroblastoma; and (iii) recognizes the relevance of targeting dynamically evolving hallmark functions of tumor evolution (e.g., survival, differentiation, lineage transformation). With recent gains in the understanding of tumor evolution processes and preclinical and clinical efforts, it is our strong opinion that effective chemopreventive strategies for aggressive neuroblastoma are a near reality.
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Affiliation(s)
- Natarajan Aravindan
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Stephenson Cancer Center, Oklahoma City, OK 73104, USA
| | - Mohan Natarajan
- Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, TX 78229, USA
| | - Dinesh Babu Somasundaram
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Park JR, Villablanca JG, Hero B, Kushner BH, Wheatley K, Beiske KH, Ladenstein RL, Baruchel S, Macy ME, Moreno L, Seibel NL, Pearson AD, Matthay KK, Valteua-Couanet D. Early-phase clinical trial eligibility and response evaluation criteria for refractory, relapsed, or progressive neuroblastoma: A consensus statement from the National Cancer Institute Clinical Trials Planning Meeting. Cancer 2022; 128:3775-3783. [PMID: 36101004 PMCID: PMC9614386 DOI: 10.1002/cncr.34445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/13/2022] [Accepted: 07/18/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND International standardized criteria for eligibility, evaluable disease sites, and disease response assessment in patients with refractory, progressive, or relapsed high-risk neuroblastoma enrolled in early-phase clinical trials are lacking. METHODS A National Cancer Institute-sponsored Clinical Trials Planning Meeting was convened to develop an international consensus to refine the tumor site eligibility criteria and evaluation of disease response for early-phase clinical trials in children with high-risk neuroblastoma. RESULTS Standardized data collection of patient and disease characteristics (including specified genomic data), eligibility criteria, a definition of evaluable disease, and response evaluations for primary and metastatic sites of disease were developed. Eligibility included two distinct patient groups: progressive disease and refractory disease. The refractory disease group was subdivided into responding persistent disease and stable persistent disease to better capture the clinical heterogeneity of refractory neuroblastoma. Requirements for defining disease evaluable for a response assessment were provided; they included requirements for biopsy to confirm viable neuroblastoma and/or ganglioneuroblastoma in those patients with soft tissue or bone disease not avid for iodine-123 meta-iodobenzylguanidine. Standardized evaluations for response components and time intervals for response evaluations were established. CONCLUSIONS The use of international consensus eligibility, evaluability, and response criteria for early-phase clinical studies will facilitate the collection of comparable data across international trials and promote more rapid identification of effective treatment regimens for high-risk neuroblastoma.
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Affiliation(s)
- Julie R. Park
- Seattle Children’s Hospital and Department of Pediatrics University of Washington School of Medicine, Seattle WA, 98105
| | - Judith G. Villablanca
- Children’s Hospital Los Angeles and Department of Pediatrics, USC Keck School of Medicine, Los Angeles, CA
| | - Barbara Hero
- Children’s Hospital and University of Cologne, D 50924 Koeln, Germany
| | | | | | - Klaus H. Beiske
- Oslo University Hospital, Department of Pathology, Oslo, Norway
| | - Ruth L. Ladenstein
- Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | | | - Margaret E. Macy
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Lucas Moreno
- Division of Paediatric Haematology and Oncology, Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Nita L. Seibel
- Clinical Investigations Branch, National Cancer Institute, Bethesda, MD 20892
| | - Andrew D. Pearson
- Divisions of Cancer Therapeutics and Clinical Studies, Institute of Cancer Research and Children and Young People’s Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey UK (Retired)
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7
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Hayashi Y, Matsuda K, Tanigawa K, Tanikawa T, Maeda K, Tsuchiya K. Dihydroceramide Δ4-Desaturase 1 Is Not Involved in SARS-CoV-2 Infection. Biol Pharm Bull 2022; 45:1559-1563. [PMID: 36184516 DOI: 10.1248/bpb.b22-00503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dihydroceramide Δ4-desaturase 1 (DEGS1) enzymatic activity is inhibited with N-(4-hydroxyphenyl)-retinamide (4-HPR). We reported previously that 4-HPR suppresses severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry through a DEGS1-independent mechanism. However, it remains unclear whether DEGS1 is involved in other SARS-CoV-2 infection processes, such as virus replication and release. Here we established DEGS1 knockout (KO) in VeroE6TMPRSS2 cells. No significant difference was observed in virus production in the culture supernatant between wild-type (WT) cells and DEGS1-KO cells, although the levels of dihydroceramide (DHCer), a DEGS1 substrate, were significantly higher in DEGS1-KO cells than WT cells. Furthermore, the virus-induced cytopathic effect was also observed in DEGS1-KO cells. Importantly, the EC50 value of 4-HPR in DEGS1-KO cells was almost identical to the value reported previously in WT cells. Our results indicated the lack of involvement of DEGS1 in SARS-CoV-2 infection.
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Affiliation(s)
| | - Kouki Matsuda
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute
| | | | - Takashi Tanikawa
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University
| | - Kenji Maeda
- Division of Antiviral Therapy, Joint Research Center for Human Retrovirus Infection, Kagoshima University
| | - Kiyoto Tsuchiya
- AIDS Clinical Center, National Center for Global Health and Medicine
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8
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Potenza RL, Lodeserto P, Orienti I. Fenretinide in Cancer and Neurological Disease: A Two-Face Janus Molecule. Int J Mol Sci 2022; 23:ijms23137426. [PMID: 35806431 PMCID: PMC9266536 DOI: 10.3390/ijms23137426] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 02/05/2023] Open
Abstract
Recently, several chemotherapeutic drugs have been repositioned in neurological diseases, based on common biological backgrounds and the inverse comorbidity between cancer and neurodegenerative diseases. Fenretinide (all-trans-N-(4-hydroxyphenyl) retinamide, 4-HPR) is a synthetic derivative of all-trans-retinoic acid initially proposed in anticancer therapy for its antitumor effects combined with limited toxicity. Subsequently, fenretinide has been proposed for other diseases, for which it was not intentionally designed for, due to its ability to influence different biological pathways, providing a broad spectrum of pharmacological effects. Here, we review the most relevant preclinical and clinical findings from fenretinide and discuss its therapeutic role towards cancer and neurological diseases, highlighting the hormetic behavior of this pleiotropic molecule.
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Affiliation(s)
- Rosa Luisa Potenza
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-06-49902389
| | - Pietro Lodeserto
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, 40127 Bologna, Italy; (P.L.); (I.O.)
| | - Isabella Orienti
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, 40127 Bologna, Italy; (P.L.); (I.O.)
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9
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Neuroblastoma: Essential genetic pathways and current therapeutic options. Eur J Pharmacol 2022; 926:175030. [DOI: 10.1016/j.ejphar.2022.175030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/29/2022]
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10
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Abbas AA, Samkari AMN. High-Risk Neuroblastoma: Poor Outcomes Despite Aggressive Multimodal
Therapy. CURRENT CANCER THERAPY REVIEWS 2022. [DOI: 10.2174/1573394717666210805114226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
:
Neuroblastoma (NBL) is a highly malignant embryonal tumor that originates from the
primordial neural crest cells. NBL is the most common tumor in infants and the most common extracranial
solid tumor in children. The tumor is more commonly diagnosed in children of 1-4 years
of age. NBL is characterized by enigmatic clinical behavior that ranges from spontaneous regression
to an aggressive clinical course leading to frequent relapses and death. Based on the likelihood
of progression and relapse, the International Neuroblastoma Risk Group classification system categorized
NBL into very low risk, low risk, intermediate risk, and high risk (HR) groups. HR NBL is
defined based on the patient's age (> 18 months), disease metastasis, tumor histology, and MYCN
gene amplification. HR NBL is diagnosed in nearly 40% of patients, mainly those > 18 months of
age, and is associated with aggressive clinical behavior. Treatment strategies involve the use of intensive
chemotherapy (CTR), surgical resection, high dose CTR with hematopoietic stem cell support,
radiotherapy, biotherapy, and immunotherapy with Anti-ganglioside 2 monoclonal antibodies.
Although HR NBL is now better characterized and aggressive multimodal therapy is applied, the
outcomes of treatment are still poor, with overall survival and event-free survival of approximately
40% and 30% at 3-years, respectively. The short and long-term side effects of therapy are tremendous.
HR NBL carries a high mortality rate accounting for nearly 15% of pediatric cancer deaths.
However, most mortalities are attributed to the high frequency of disease relapse (50%) and disease
reactiveness to therapy (20%). Newer treatment strategies are therefore urgently needed. Recent
discoveries in the field of biology and molecular genetics of NBL have led to the identification
of several targets that can improve the treatment results. In this review, we discuss the different
aspects of the epidemiology, biology, clinical presentations, diagnosis, and treatment of HR
NBL, in addition to the recent developments in the management of the disease.
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Affiliation(s)
- Adil Abdelhamed Abbas
- College of Medicine King Saud bin Abdulaziz, University for Health Sciences Consultant Pediatric Hematology / Oncology
& BMT The Pediatric Hematology/Oncology Section Princess Nourah Oncology Centre King Abdulaziz Medical
City, Jeddah, Saudi Arabia
| | - Alaa Mohammed Noor Samkari
- College of Medicine King Saud bin Abdulaziz, University for Health Sciences Consultant
Anatomical Pathologist Department of Laboratory Medicine King Abdulaziz Medical City, Jeddah, Saudi Arabia
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11
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Companioni O, Mir C, Garcia-Mayea Y, LLeonart ME. Targeting Sphingolipids for Cancer Therapy. Front Oncol 2021; 11:745092. [PMID: 34737957 PMCID: PMC8560795 DOI: 10.3389/fonc.2021.745092] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022] Open
Abstract
Sphingolipids are an extensive class of lipids with different functions in the cell, ranging from proliferation to cell death. Sphingolipids are modified in multiple cancers and are responsible for tumor proliferation, progression, and metastasis. Several inhibitors or activators of sphingolipid signaling, such as fenretinide, safingol, ABC294640, ceramide nanoliposomes (CNLs), SKI-II, α-galactosylceramide, fingolimod, and sonepcizumab, have been described. The objective of this review was to analyze the results from preclinical and clinical trials of these drugs for the treatment of cancer. Sphingolipid-targeting drugs have been tested alone or in combination with chemotherapy, exhibiting antitumor activity alone and in synergism with chemotherapy in vitro and in vivo. As a consequence of treatments, the most frequent mechanism of cell death is apoptosis, followed by autophagy. Aslthough all these drugs have produced good results in preclinical studies of multiple cancers, the outcomes of clinical trials have not been similar. The most effective drugs are fenretinide and α-galactosylceramide (α-GalCer). In contrast, minor adverse effects restricted to a few subjects and hepatic toxicity have been observed in clinical trials of ABC294640 and safingol, respectively. In the case of CNLs, SKI-II, fingolimod and sonepcizumab there are some limitations and absence of enough clinical studies to demonstrate a benefit. The effectiveness or lack of a major therapeutic effect of sphingolipid modulation by some drugs as a cancer therapy and other aspects related to their mechanism of action are discussed in this review.
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Affiliation(s)
- Osmel Companioni
- Biomedical Research in Cancer Stem Cells Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Mir
- Biomedical Research in Cancer Stem Cells Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yoelsis Garcia-Mayea
- Biomedical Research in Cancer Stem Cells Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matilde E LLeonart
- Biomedical Research in Cancer Stem Cells Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Spanish Biomedical Research Network Center in Oncology, CIBERONC, Madrid, Spain
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12
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Hayashi Y, Tsuchiya K, Yamamoto M, Nemoto-Sasaki Y, Tanigawa K, Hama K, Ueda Y, Tanikawa T, Gohda J, Maeda K, Inoue JI, Yamashita A. N-(4-Hydroxyphenyl) Retinamide Suppresses SARS-CoV-2 Spike Protein-Mediated Cell-Cell Fusion by a Dihydroceramide Δ4-Desaturase 1-Independent Mechanism. J Virol 2021; 95:e0080721. [PMID: 34106748 PMCID: PMC8354230 DOI: 10.1128/jvi.00807-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023] Open
Abstract
The membrane fusion between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and host cells is essential for the initial step of infection; therefore, the host cell membrane components, including sphingolipids, influence the viral infection. We assessed several inhibitors of the enzymes pertaining to sphingolipid metabolism, against SARS-CoV-2 spike protein (S)-mediated cell-cell fusion and viral infection. N-(4-Hydroxyphenyl) retinamide (4-HPR), an inhibitor of dihydroceramide Δ4-desaturase 1 (DES1), suppressed cell-cell fusion and viral infection. The analysis of sphingolipid levels revealed that the inhibition efficiencies of cell-cell fusion and viral infection in 4-HPR-treated cells were consistent with an increased ratio of saturated sphinganine-based lipids to total sphingolipids. We investigated the relationship of DES1 with the inhibition efficiencies of cell-cell fusion. The changes in the sphingolipid profile induced by 4-HPR were mitigated by the supplementation with exogenous cell-permeative ceramide; however, the reduced cell-cell fusion could not be reversed. The efficiency of cell-cell fusion in DES1 knockout (KO) cells was at a level comparable to that in wild-type (WT) cells; however, the ratio of saturated sphinganine-based lipids to the total sphingolipids was higher in DES1 KO cells than in WT cells. 4-HPR reduced cell membrane fluidity without any significant effects on the expression or localization of angiotensin-converting enzyme 2, the SARS-CoV-2 receptor. Therefore, 4-HPR suppresses SARS-CoV-2 S-mediated membrane fusion through a DES1-independent mechanism, and this decrease in membrane fluidity induced by 4-HPR could be the major cause for the inhibition of SARS-CoV-2 infection. IMPORTANCE Sphingolipids could play an important role in SARS-CoV-2 S-mediated membrane fusion with host cells. We studied the cell-cell fusion using SARS-CoV-2 S-expressing cells and sphingolipid-manipulated target cells, with an inhibitor of the sphingolipid metabolism. 4-HPR (also known as fenretinide) is an inhibitor of DES1, and it exhibits antitumor activity and suppresses cell-cell fusion and viral infection. 4-HPR suppresses membrane fusion through a decrease in membrane fluidity, which could possibly be the cause for the inhibition of SARS-CoV-2 infection. There is accumulating clinical data on the safety of 4-HPR. Therefore, it could be a potential candidate drug against COVID-19.
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Affiliation(s)
| | - Kiyoto Tsuchiya
- AIDS Clinical Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Mizuki Yamamoto
- Research Center for Asian Infectious Diseases, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | | | | | - Kotaro Hama
- Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Yusuke Ueda
- Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Takashi Tanikawa
- Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Jin Gohda
- Research Center for Asian Infectious Diseases, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kenji Maeda
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo, Japan
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13
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Pezeshki PS, Moeinafshar A, Ghaemdoust F, Razi S, Keshavarz-Fathi M, Rezaei N. Advances in pharmacotherapy for neuroblastoma. Expert Opin Pharmacother 2021; 22:2383-2404. [PMID: 34254549 DOI: 10.1080/14656566.2021.1953470] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Neuroblastoma is the most prevalent cancer type diagnosed within the first year after birth and accounts for 15% of deaths from pediatric cancer. Despite the improvements in survival rates of patients with neuroblastoma, the incidence of the disease has increased over the last decade. Neuroblastoma tumor cells harbor a vast range of variable and heterogeneous histochemical and genetic alterations which calls for the need to administer individualized and targeted therapies to induce tumor regression in each patient. AREAS COVERED This paper provides reviews the recent clinical trials which used chemotherapeutic and/or targeted agents as either monotherapies or in combination to improve the response rate in patients with neuroblastoma, and especially high-risk neuroblastoma. It also reviews some of the prominent preclinical studies which can provide the rationale for future clinical trials. EXPERT OPINION Although some distinguished advances in pharmacotherapy have been made to improve the survival rate and reduce adverse events in patients with neuroblastoma, a more comprehensive understanding of the mechanisms of tumorigenesis, resistance to therapies or relapse, identifying biomarkers of response to each specific drug, and developing predictive preclinical models of the tumor can lead to further breakthroughs in the treatment of neuroblastoma.
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Affiliation(s)
- Parmida Sadat Pezeshki
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aysan Moeinafshar
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Ghaemdoust
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Razi
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Keshavarz-Fathi
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Stockholm, Sweden
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14
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Brack E, Bender S, Wachtel M, Pruschy M, Schäfer BW. Fenretinide Acts as Potent Radiosensitizer for Treatment of Rhabdomyosarcoma Cells. Front Oncol 2021; 11:664462. [PMID: 34211841 PMCID: PMC8239363 DOI: 10.3389/fonc.2021.664462] [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: 02/05/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Fusion-positive rhabdomyosarcoma (FP-RMS) is a highly aggressive childhood malignancy which is mainly treated by conventional chemotherapy, surgery and radiation therapy. Since radiotherapy is associated with a high burden of late side effects in pediatric patients, addition of radiosensitizers would be beneficial. Here, we thought to assess the role of fenretinide, a potential agent for FP-RMS treatment, as radiosensitizer. Survival of human FP-RMS cells was assessed after combination therapy with fenretinide and ionizing radiation (IR) by cell viability and clonogenicity assays. Indeed, this was found to significantly reduce cell viability compared to single treatments. Mechanistically, this was accompanied by enhanced production of reactive oxygen species, initiation of cell cycle arrest and induction of apoptosis. Interestingly, the combination treatment also triggered a new form of dynamin-dependent macropinocytosis, which was previously described in fenretinide-only treated cells. Our data suggest that fenretinide acts in combination with IR to induce cell death in FP-RMS cells and therefore might represent a novel radiosensitizer for the treatment of this disease.
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Affiliation(s)
- Eva Brack
- Department of Oncology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabine Bender
- Department of Radiology Biology, University Hospital Zurich, Radio-Oncology, Zurich, Switzerland
| | - Marco Wachtel
- Department of Oncology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Pruschy
- Department of Radiology Biology, University Hospital Zurich, Radio-Oncology, Zurich, Switzerland
| | - Beat W Schäfer
- Department of Oncology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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15
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Differentiating Neuroblastoma: A Systematic Review of the Retinoic Acid, Its Derivatives, and Synergistic Interactions. J Pers Med 2021; 11:jpm11030211. [PMID: 33809565 PMCID: PMC7999600 DOI: 10.3390/jpm11030211] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022] Open
Abstract
A neuroblastoma (NB) is a solid paediatric tumour arising from undifferentiated neuronal cells. Despite the recent advances in disease management and treatment, it remains one of the leading causes of childhood cancer deaths, thereby necessitating the development of new therapeutic agents and regimens. Retinoic acid (RA), a vitamin A derivative, is a promising agent that can induce differentiation in NB cells. Its isoform, 13-cis RA or isotretinoin, is used in NB therapy; however, its effectiveness is limited to treating a minimal residual disease as maintenance therapy. As such, research focuses on RA derivatives that might increase the anti-NB action or explores the potential synergy between RA and other classes of drugs, such as cellular processes mediators, epigenetic modifiers, and immune modulators. This review summarises the in vitro, in vivo, and clinical data of RA, its derivatives, and synergising compounds, thereby establishing the most promising RA derivatives and combinations of RA for further investigation.
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16
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Thomas JS, El-Khoueiry AB, Maurer BJ, Groshen S, Pinski JK, Cobos E, Gandara DR, Lenz HJ, Kang MH, Reynolds CP, Newman EM. A phase I study of intravenous fenretinide (4-HPR) for patients with malignant solid tumors. Cancer Chemother Pharmacol 2021; 87:525-532. [PMID: 33423090 DOI: 10.1007/s00280-020-04224-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fenretinide is a synthetic retinoid that can induce cytotoxicity by several mechanisms. Achieving effective systemic exposure with oral formulations has been challenging. An intravenous lipid emulsion fenretinide formulation was developed to overcome this barrier. We conducted a study to establish the maximum tolerated dose (MTD), preliminary efficacy, and pharmacokinetics of intravenous lipid emulsion fenretinide in patients with advanced solid tumors. METHODS Twenty-three patients with advanced solid tumors refractory to standard treatments received fenretinide as a continuous infusion for five consecutive days in 21-day cycles. Five different dose cohorts were evaluated between doses of 905 mg/m2 and 1414 mg/m2 per day using a 3 + 3 dose escalation design. A priming dose of 600 mg/m2 on day 1 was introduced in an attempt to address the asymptomatic serum triglyceride elevations related to the lipid emulsion. RESULTS The treatment-related adverse events occurring in ≥ 20% of patients were anemia, hypertriglyceridemia, fatigue, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) increase, thrombocytopenia, bilirubin increase, and dry skin. Five evaluable patients had stable disease as best response, and no patients had objective responses. Plasma steady-state concentrations of the active metabolite were significantly higher than with previous capsule formulations. CONCLUSION Fenretinide emulsion intravenous infusion had a manageable safety profile and achieved higher plasma steady-state concentrations of the active metabolite compared to previous capsule formulations. Single-agent activity was minimal but combinatorial approaches are under evaluation.
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Affiliation(s)
- Jacob S Thomas
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
| | - Anthony B El-Khoueiry
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Barry J Maurer
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Susan Groshen
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jacek K Pinski
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Everardo Cobos
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA.,Kern Medical Center, Bakersfield, CA, USA
| | - David R Gandara
- Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
| | - Heinz J Lenz
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Min H Kang
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - C Patrick Reynolds
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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17
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Orienti I, Farruggia G, Nguyen F, Guan P, Calonghi N, Kolla V, Chorny M, Brodeur GM. Nanomicellar Lenalidomide-Fenretinide Combination Suppresses Tumor Growth in an MYCN Amplified Neuroblastoma Tumor. Int J Nanomedicine 2020; 15:6873-6886. [PMID: 32982239 PMCID: PMC7502401 DOI: 10.2147/ijn.s262032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose In a previous study, we demonstrated that the combination of fenretinide with lenalidomide, administered by a novel nanomicellar formulation (FLM), provided a strong antitumor effect in a neuroblastoma TrkB-expressing tumor. In this study, we tested the nanomicellar combination in an MYCN amplified neuroblastoma xenograft to assess its efficacy in different tumor genotypes and evaluate the interactions of the nanomicelles with the tumor cells. Experimental Design FLM was administered to mice bearing human NLF xenografts to evaluate its efficacy in comparison with the nanomicelles containing fenretinide alone (FM). Confocal laser-scanning fluorescence microscopy images of the NLF cells treated with FLM and FM allowed us to estimate the nanomicelle ability to transport the encapsulated drugs inside the tumor cells. Flow cytometric analysis of the cells from treated tumors was performed to assess the effect of treatment on GD2 expression and NK cell infiltration. Results FLM and FM decreased the growth of NLF xenografts at comparable extents during the treatment period. Afterwards, FLM induced a progressive tumor regression without regrowth, while FM treatment was followed by regrowth within 15-20 days after the end of treatment. Both FLM and FM were able to penetrate the tumor cells transporting the encapsulated drugs. FLM transported higher amount of fenretinide inside the cells. Also, FLM treatment strongly increased GD2 expression in treated tumors and slightly decreased the NK infiltration compared to FM. Conclusion FLM treatment induced a superior antitumor response than FM in NLF xenografts, presumably due to the combined effects of fenretinide cytotoxicity and lenalidomide antiangiogenic activity. The ability of FLM to penetrate tumor cells, transporting the encapsulated drugs, substantially improved the therapeutic efficiency of this system. Moreover, the enhancement of GD2 expression in FLM treated tumors offers the possibility to further increase the antitumor effect by the use of anti-GD2 CAR-T cells and anti-GD2 antibodies in combination with FLM in multimodal therapies.
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Affiliation(s)
- Isabella Orienti
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna 40127, Italy
| | - Giovanna Farruggia
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna 40127, Italy
| | - Ferro Nguyen
- Divisions of Oncology and Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Peng Guan
- Divisions of Oncology and Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Natalia Calonghi
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna 40127, Italy
| | - Venkatadri Kolla
- Divisions of Oncology and Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Michael Chorny
- Divisions of Oncology and Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Garrett M Brodeur
- Divisions of Oncology and Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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18
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Zhang H, Xu H, Zhang R, Zhao X, Liang M, Wei F. Chemosensitization by 4-hydroxyphenyl retinamide-induced NF-κB inhibition in acute myeloid leukemia cells. Cancer Chemother Pharmacol 2020; 86:257-266. [PMID: 32696214 DOI: 10.1007/s00280-020-04115-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/14/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE Inherent and/or acquired multi-drug resistance might be the instigator of treatment failure for acute myeloid leukemia (AML). In the current study, we aimed to explored the chemosensitizing effect of 4-HPR on AML therapy. METHODS Luciferase reporter assays were used to test the effect of 4-HPR on transcriptional signaling pathways. The quantitative real-time polymerase chain reaction and immunoblots were used to confirm the role of 4-HPR in NF-κB inhibition, apoptosis, and drug resistance. MTT and flow cytometry assays were applied to test the drug response and chemosensitizing effect of 4-HPR with AML cell lines and primary AML samples. RESULTS 4-HPR suppressed tumor necrosis factor-α- and daunorubin-induced NF-κB activation in AML cell lines. The expression of anti-apoptotic gene, BCL2, was downregulated, while expressions of pro-apoptotic genes, cIAP, XIAP, and BID, were increased after 4-HPR treatment. Immunoblots showed decreased p65-NF-κB, IκBα, and MDR1, but increased cleaved poly (ADP-ribose) polymerase and BIM. A low concentration of 4-HPR chemosensitized AML cells to daunorubin treatment in vitro. CONCLUSION 4-HPR-induced NF-κB inhibition was the main driver of the chemosensitizing effect observed in AML cell lines and primary AML samples. These results highlight that 4-HPR might be a promising chemosensitizing agent in AML therapy.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B/metabolism
- Antibiotics, Antineoplastic/pharmacology
- Antineoplastic Agents/pharmacology
- Apoptosis
- Cell Proliferation
- Daunorubicin/pharmacology
- Drug Synergism
- Fenretinide/pharmacology
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- NF-kappa B/antagonists & inhibitors
- NF-kappa B/metabolism
- Tumor Cells, Cultured
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Affiliation(s)
- Hui Zhang
- Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong, China.
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
| | - Haoyu Xu
- Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong, China
| | - Ranran Zhang
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Xinying Zhao
- Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, Guangdong, China
| | - Ming Liang
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Fenggui Wei
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
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19
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Orienti I, Gentilomi GA, Farruggia G. Pulmonary Delivery of Fenretinide: A Possible Adjuvant Treatment In COVID-19. Int J Mol Sci 2020; 21:E3812. [PMID: 32471278 PMCID: PMC7312074 DOI: 10.3390/ijms21113812] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 02/08/2023] Open
Abstract
At present, there is no vaccine or effective standard treatment for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection (or coronavirus disease-19 (COVID-19)), which frequently leads to lethal pulmonary inflammatory responses. COVID-19 pathology is characterized by extreme inflammation and amplified immune response with activation of a cytokine storm. A subsequent progression to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) can take place, which is often followed by death. The causes of these strong inflammatory responses in SARS-CoV-2 infection are still unknown. As uncontrolled pulmonary inflammation is likely the main cause of death in SARS-CoV-2 infection, anti-inflammatory therapeutic interventions are particularly important. Fenretinide N-(4-hydroxyphenyl) retinamide is a bioactive molecule characterized by poly-pharmacological properties and a low toxicity profile. Fenretinide is endowed with antitumor, anti-inflammatory, antiviral, and immunomodulating properties other than efficacy in obesity/diabetic pathologies. Its anti-inflammatory and antiviral activities, in particular, could likely have utility in multimodal therapies for the treatment of ALI/ARDS in COVID-19 patients. Moreover, fenretinide administration by pulmonary delivery systems could further increase its therapeutic value by carrying high drug concentrations to the lungs and triggering a rapid onset of activity. This is particularly important in SARS-CoV-2 infection, where only a narrow time window exists for therapeutic intervention.
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Affiliation(s)
- Isabella Orienti
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Via S. Donato 19/2, 40127 Bologna, Italy;
| | - Giovanna Angela Gentilomi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
- Unit of Microbiology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Giovanna Farruggia
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Via S. Donato 19/2, 40127 Bologna, Italy;
- Biostructures and Biosystems National Institute (BBNI), 00136 Roma, Italy
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20
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Orienti I, Nguyen F, Guan P, Kolla V, Calonghi N, Farruggia G, Chorny M, Brodeur GM. A Novel Nanomicellar Combination of Fenretinide and Lenalidomide Shows Marked Antitumor Activity in a Neuroblastoma Xenograft Model. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:4305-4319. [PMID: 31908416 PMCID: PMC6930389 DOI: 10.2147/dddt.s221909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/05/2019] [Indexed: 12/18/2022]
Abstract
Purpose Currently >50% of high-risk neuroblastoma (NB) patients, despite intensive therapy and initial partial or complete response, develop recurrent NB due to the persistence of minimal residual disease (MRD) that is resistant to conventional antitumor drugs. Indeed, their low therapeutic index prevents drug-dose escalation and protracted administration schedules, as would be required for MRD treatment. Thus, more effective and less toxic therapies are urgently needed for the management of MRD. To address this aim, we evaluated a new combination of fenretinide and lenalidomide, both endowed with antitumor activity and low-toxicity profiles. New nanomicelles were prepared as carriers for this combination to maximize bioavailability and accumulation at the tumor site because of the enhanced permeability and retention (EPR) effect. Experimental design New nanomicelles containing the fenretinide–lenalidomide combination (FLnMs) were prepared by a one-step method, providing high drug encapsulation and micelle dimensions suitable for tumor accumulation. Their administration to mice bearing human NB xenografts allowed us to evaluate their efficacy in comparison with the nanomicelles containing fenretinide alone (FnMs). Results Treatment by FLnMs significantly decreased the tumor growth of NB xenografts. FLnMs were more active than FnMs despite comparable fenretinide concentrations in tumors, and lenalidomide alone did not show cytotoxic activity in vitro against NB cells. The tumor mass at the end of treatment with FLnMs was predominantly necrotic, with a decreased Ki-67 proliferation index. Conclusion FLnMs provided superior antitumor efficacy in NB xenografts compared to FnMs. The enhanced efficacy of the combination was likely due to the antiangiogenic effect of lenalidomide added to the cytotoxic effect of fenretinide. This new nanomicellar combination is characterized by a low-toxicity profile and offers a novel therapeutic option for the treatment of high-risk tumors where the persistence of MRD requires repeated administrations of therapeutic agents over long periods of time to avoid recurrent disease.
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Affiliation(s)
- Isabella Orienti
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna 40127, Italy
| | - Ferro Nguyen
- Divisions of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Peng Guan
- Divisions of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Venkatadri Kolla
- Divisions of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Natalia Calonghi
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna 40127, Italy
| | - Giovanna Farruggia
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna 40127, Italy
| | - Michael Chorny
- Divisions of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Garrett M Brodeur
- Divisions of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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21
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Nguyen TH, Koneru B, Wei SJ, Chen WH, Makena MR, Urias E, Kang MH, Reynolds CP. Fenretinide via NOXA Induction, Enhanced Activity of the BCL-2 Inhibitor Venetoclax in High BCL-2–Expressing Neuroblastoma Preclinical Models. Mol Cancer Ther 2019; 18:2270-2282. [DOI: 10.1158/1535-7163.mct-19-0385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/25/2019] [Accepted: 08/27/2019] [Indexed: 11/16/2022]
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22
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Orienti I, Salvati V, Sette G, Zucchetti M, Bongiorno-Borbone L, Peschiaroli A, Zolla L, Francescangeli F, Ferrari M, Matteo C, Bello E, Di Virgilio A, Falchi M, De Angelis ML, Baiocchi M, Melino G, De Maria R, Zeuner A, Eramo A. A novel oral micellar fenretinide formulation with enhanced bioavailability and antitumour activity against multiple tumours from cancer stem cells. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:373. [PMID: 31439019 PMCID: PMC6706930 DOI: 10.1186/s13046-019-1383-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/13/2019] [Indexed: 11/15/2022]
Abstract
Background An increasing number of anticancer agents has been proposed in recent years with the attempt to overcome treatment-resistant cancer cells and particularly cancer stem cells (CSC), the major culprits for tumour resistance and recurrence. However, a huge obstacle to treatment success is the ineffective delivery of drugs within the tumour environment due to limited solubility, short circulation time or inconsistent stability of compounds that, together with concomitant dose-limiting systemic toxicity, contribute to hamper the achievement of therapeutic drug concentrations. The synthetic retinoid Fenretinide (4-hydroxy (phenyl)retinamide; 4-HPR) formerly emerged as a promising anticancer agent based on pre-clinical and clinical studies. However, a major limitation of fenretinide is traditionally represented by its poor aqueous solubility/bioavailability due to its hydrophobic nature, that undermined the clinical success of previous clinical trials. Methods Here, we developed a novel nano-micellar fenretinide formulation called bionanofenretinide (Bio-nFeR), based on drug encapsulation in an ion-pair stabilized lipid matrix, with the aim to raise fenretinide bioavailability and antitumour efficacy. Results Bio-nFeR displayed marked antitumour activity against lung, colon and melanoma CSC both in vitro and in tumour xenografts, in absence of mice toxicity. Bio-nFeR is suitable for oral administration, reaching therapeutic concentrations within tumours and an unprecedented therapeutic activity in vivo as single agent. Conclusion Altogether, our results indicate Bio-nFeR as a novel anticancer agent with low toxicity and high activity against tumourigenic cells, potentially useful for the treatment of solid tumours of multiple origin. Electronic supplementary material The online version of this article (10.1186/s13046-019-1383-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabella Orienti
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Valentina Salvati
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy.,Istituto di Patologia Generale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Sette
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy.,Istituto di Patologia Generale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Zucchetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Angelo Peschiaroli
- National Research Council of Italy (CNR), Institute of Translational Pharmacology IFT, Rome, Italy
| | - Lello Zolla
- Department of Ecological and Biological Sciences, University of Tuscia, Viterbo, Italy
| | | | - Mariella Ferrari
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cristina Matteo
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ezia Bello
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Antonio Di Virgilio
- Service for Biotechnology and Animal Welfare, Istituto Superiore di Sanità, Rome, Italy
| | - Mario Falchi
- National AIDS Center, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Laura De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Marta Baiocchi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Gerry Melino
- Department of Experimental Medicine, TOR, University of Rome "Tor Vergata", Rome, Italy
| | - Ruggero De Maria
- Istituto di Patologia Generale, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Rome, Italy
| | - Ann Zeuner
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Adriana Eramo
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy.
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Orienti I, Francescangeli F, De Angelis ML, Fecchi K, Bongiorno-Borbone L, Signore M, Peschiaroli A, Boe A, Bruselles A, Costantino A, Eramo A, Salvati V, Sette G, Contavalli P, Zolla L, Oki T, Kitamura T, Spada M, Giuliani A, Baiocchi M, La Torre F, Melino G, Tartaglia M, De Maria R, Zeuner A. A new bioavailable fenretinide formulation with antiproliferative, antimetabolic, and cytotoxic effects on solid tumors. Cell Death Dis 2019; 10:529. [PMID: 31332161 PMCID: PMC6646369 DOI: 10.1038/s41419-019-1775-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/26/2019] [Indexed: 02/04/2023]
Abstract
Fenretinide is a synthetic retinoid characterized by anticancer activity in preclinical models and favorable toxicological profile, but also by a low bioavailability that hindered its clinical efficacy in former clinical trials. We developed a new formulation of fenretinide complexed with 2-hydroxypropyl-beta-cyclodextrin (nanofenretinide) characterized by an increased bioavailability and therapeutic efficacy. Nanofenretinide was active in cell lines derived from multiple solid tumors, in primary spheroid cultures and in xenografts of lung and colorectal cancer, where it inhibited tumor growth independently from the mutational status of tumor cells. A global profiling of pathways activated by nanofenretinide was performed by reverse-phase proteomic arrays and lipid analysis, revealing widespread repression of the mTOR pathway, activation of apoptotic, autophagic and DNA damage signals and massive production of dihydroceramide, a bioactive lipid with pleiotropic effects on several biological processes. In cells that survived nanofenretinide treatment there was a decrease of factors involved in cell cycle progression and an increase in the levels of p16 and phosphorylated p38 MAPK with consequent block in G0 and early G1. The capacity of nanofenretinide to induce cancer cell death and quiescence, together with its elevated bioavailability and broad antitumor activity indicate its potential use in cancer treatment and chemoprevention.
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Affiliation(s)
- Isabella Orienti
- Department of Pharmacy and Biotechnology, University of Bologna via San Donato 19/2, 40127, Bologna, Italy
| | - Federica Francescangeli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Maria Laura De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Katia Fecchi
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Lucilla Bongiorno-Borbone
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Michele Signore
- RPPA Unit, Proteomics, Core Facilities, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Angelo Peschiaroli
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Alessandra Boe
- Core Facilities, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Bruselles
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Angelita Costantino
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.,Department of Biomedical and Biotechnological Sciences BIOMETEC, University of Catania, via Santa Sofia 97, 95123, Catania, Italy
| | - Adriana Eramo
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Valentina Salvati
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Giovanni Sette
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Paola Contavalli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Lello Zolla
- DAFNE Department, University Tuscia, Via S. Camillo de Lellis, 01100, Viterbo, Italy
| | - Toshihiko Oki
- Division of Cellular Therapy, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, 108-8639, Japan.,Division of Stem Cell Signaling, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Toshio Kitamura
- Division of Cellular Therapy, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, 108-8639, Japan.,Division of Stem Cell Signaling, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Massimo Spada
- Center of Animal research and Welfare, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Giuliani
- Environment and Health Department, Istituto Superiore di Sanita', Rome, Italy
| | - Marta Baiocchi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Filippo La Torre
- Surgical Sciences and Emergency Department, Division of Emergency & Trauma Surgery, Emergency Department, Policlinico Umberto I/Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gerry Melino
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, Viale di San Paolo 15, 00146, Rome, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Ann Zeuner
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
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Cytotoxicity and molecular activity of fenretinide and metabolites in T-cell lymphoid malignancy, neuroblastoma, and ovarian cancer cell lines in physiological hypoxia. Anticancer Drugs 2019; 30:117-127. [DOI: 10.1097/cad.0000000000000696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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25
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Makena MR, Cho HE, Nguyen TH, Koneru B, Verlekar DU, Hindle A, Kang MH, Reynolds CP. Cytotoxic activity of difluoromethylornithine compared with fenretinide in neuroblastoma cell lines. Pediatr Blood Cancer 2018; 65:e27447. [PMID: 30251395 PMCID: PMC9621602 DOI: 10.1002/pbc.27447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/31/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Maintenance therapy with 13-cis-retinoic acid and immunotherapy (given after completion of intensive cytotoxic therapy) improves outcome for high-risk neuroblastoma patients. The synthetic retinoid fenretinide (4-HPR) achieved multiple complete responses in relapse/refractory neuroblastoma in early-phase clinical trials, has low systemic toxicity, and has been considered for maintenance therapy clinical trials. Difluoromethylornithine (DFMO, an irreversible inhibitor of ornithine decarboxylase with minimal single-agent clinical response data) is being used for maintenance therapy of neuroblastoma. We evaluated the cytotoxic activity of DFMO and fenretinide in neuroblastoma cell lines. PROCEDURE We tested 16 neuroblastoma cell lines in bone marrow-level hypoxia (5% O2 ) using the DIMSCAN cytotoxicity assay. Polyamines were measured by HPLC-mass spectrometry and apoptosis by transferase dUTP nick end labeling (TUNEL) using flow cytometry. RESULTS At clinically achievable levels (100 μM), DFMO significantly decreased (P < 0.05) polyamine putrescine and achieved modest cytotoxicity (<1 log (90% cytotoxicity). Prolonged exposures (7 days) or culture in 2% and 20% O2 did not enhance DFMO cytotoxicity. However, fenretinide (10 μM) even at a concentration lower than clinically achievable in neuroblastoma patients (20 μM) induced ≥ 1 log cell kill in 14 cell lines. The average IC90 and IC99 of fenretinide was 4.7 ± 1 μM and 9.9 ± 1.8 μM, respectively. DFMO did not induce a significant increase (P > 0.05) in apoptosis (TUNEL assay). Apoptosis by fenretinide was significantly higher (P < 0.001) compared with DFMO or controls. CONCLUSIONS DFMO as a single agent has minimal cytotoxic activity for neuroblastoma cell lines.
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Affiliation(s)
- Monish R. Makena
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Departments of Cell Biology & Biochemistry, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Hwang Eui Cho
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Departments of Cell Biology & Biochemistry, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Thinh H. Nguyen
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Pharmacology and Neuroscience, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Balakrishna Koneru
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Departments of Cell Biology & Biochemistry, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Dattesh U. Verlekar
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Departments of Cell Biology & Biochemistry, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Ashly Hindle
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Departments of Cell Biology & Biochemistry, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Min H. Kang
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Departments of Cell Biology & Biochemistry, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Pharmacology and Neuroscience, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - C. Patrick Reynolds
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Departments of Cell Biology & Biochemistry, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Pharmacology and Neuroscience, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX.,Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
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26
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Bouriez D, Giraud J, Gronnier C, Varon C. Efficiency of All-Trans Retinoic Acid on Gastric Cancer: A Narrative Literature Review. Int J Mol Sci 2018; 19:ijms19113388. [PMID: 30380687 PMCID: PMC6275086 DOI: 10.3390/ijms19113388] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer (GC) is the third leading cause of cancer-related death worldwide with a five-year survival rate of around 25%, and 4% when diagnosed at a metastatic stage. Cancer stem cells (CSC) have recently been characterized as being responsible for resistance to radio/chemotherapies and metastasis formation, opening up perspectives for new targeted therapies. Those CSCs express biomarkers such as cluster of differentiation 44 (CD44) and display high aldehyde dehydrogenase activity that converts vitamin A-derived retinal into retinoic acids. All-trans retinoic acid (ATRA), which has pro-differentiating properties, has revolutionized the prognosis of acute promyelotic leukemia by increasing its remission rate from 15% to 85%. Recent studies have started to show that ATRA also has an anti-tumoral role on solid cancers such as GC. The purpose of this review is therefore to summarize the work that evaluated the effects of ATRA in GC and to evaluate whether its anti-cancerous action involves gastric CSCs targeting. It has been demonstrated that ATRA can block the cell cycle, enhance apoptosis, and decrease gastric CSCs properties in GC cell lines, tumorspheres, and patient-derived xenograft mice models. Therefore, retinoids and new synthetic retinoids seem to be a promising step forward in targeted therapy of gastric CSC in combination with existing chemotherapies. Future studies should probably focus on these points.
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Affiliation(s)
- Damien Bouriez
- INSERM, U1053, Bordeaux Research in Translational Oncology, 33000 Bordeaux, France.
- Department of Digestive Surgery, Haut-Lévêque Hospital, 33000 Bordeaux, France.
| | - Julie Giraud
- INSERM, U1053, Bordeaux Research in Translational Oncology, 33000 Bordeaux, France.
- Department of Life and Health Sciences, University of Bordeaux, 33000 Bordeaux, France.
| | - Caroline Gronnier
- INSERM, U1053, Bordeaux Research in Translational Oncology, 33000 Bordeaux, France.
- Department of Digestive Surgery, Haut-Lévêque Hospital, 33000 Bordeaux, France.
- Department of Life and Health Sciences, University of Bordeaux, 33000 Bordeaux, France.
| | - Christine Varon
- INSERM, U1053, Bordeaux Research in Translational Oncology, 33000 Bordeaux, France.
- Department of Life and Health Sciences, University of Bordeaux, 33000 Bordeaux, France.
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27
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DeBord LC, Pathak RR, Villaneuva M, Liu HC, Harrington DA, Yu W, Lewis MT, Sikora AG. The chick chorioallantoic membrane (CAM) as a versatile patient-derived xenograft (PDX) platform for precision medicine and preclinical research. Am J Cancer Res 2018; 8:1642-1660. [PMID: 30210932 PMCID: PMC6129484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023] Open
Abstract
Patient-derived xenografts (PDX) are an increasingly valuable tool in oncology, providing biologically faithful models of many different cancer types, and potential platforms for the development of precision oncology approaches. However, PDX have primarily been established in immunodeficient rodent models, with accompanying cost and efficiency constraints that pose barriers to more widespread adoption. The chicken egg chorioallantoic membrane (CAM) is an alternative in vivo PDX model. We provide here a comprehensive review of studies that grafted primary human tissue, as opposed to cell lines, onto the CAM. Twenty publications met our criteria of having inoculated patient-derived tumor tissue onto the CAM. Successful engraftment has been reported for over a dozen tumor subtypes, supporting the appropriateness of the CAM as a PDX platform. Resemblance of xenografts to the original patient tumor, increased vascularity of the CAM following engraftment, and micrometastasis into the chick mesenchyme were frequently reported. Application of standard or experimental cancer therapies to xenografts has also been undertaken, with the discovery of both synergistic drug effects and positive associations between the assay and clinical outcome. The CAM provides opportunities for RNA and DNA based sequencing of patient tumors, and the ability to efficiently (in 5-10 days) test multiple targeted therapies on fragments derived from the same tumor. While routine use of the CAM-based PDX model would benefit from a more-complete understanding of the stromal environment of CAM xenografts and interaction with the developing avian immune system, current literature supports the model's potential as an efficient, scalable precision medicine platform.
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Affiliation(s)
- Logan C DeBord
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of MedicineHouston, TX 77030, USA
| | - Ravi R Pathak
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of MedicineHouston, TX 77030, USA
| | - Mariana Villaneuva
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of MedicineHouston, TX 77030, USA
| | - Hsuan-Chen Liu
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of MedicineHouston, TX 77030, USA
| | - Daniel A Harrington
- The University of Texas Health Science Center at Houston, School of Dentistry, Department of Diagnostic and Biomedical SciencesHouston, TX 77054, USA
| | - Wendong Yu
- Department of Pathology, Baylor College of MedicineHouston, TX 77054, USA
| | - Michael T Lewis
- Department of Molecular and Cellular Biology, Baylor College of MedicineHouston, TX 77054, USA
| | - Andrew G Sikora
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of MedicineHouston, TX 77030, USA
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28
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Villablanca JG, Ji L, Shapira-Lewinson A, Marachelian A, Shimada H, Hawkins RA, Pampaloni M, Lai H, Goodarzian F, Sposto R, Park JR, Matthay KK. Predictors of response, progression-free survival, and overall survival using NANT Response Criteria (v1.0) in relapsed and refractory high-risk neuroblastoma. Pediatr Blood Cancer 2018; 65:e26940. [PMID: 29350464 PMCID: PMC7456604 DOI: 10.1002/pbc.26940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/08/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE The New Approaches to Neuroblastoma Therapy Response Criteria (NANTRC) were developed to optimize response assessment in patients with recurrent/refractory neuroblastoma. Response predictors and associations of the NANTRC version 1.0 (NANTRCv1.0) and prognostic factors with outcome were analyzed. METHODS A retrospective analysis was performed of patients with recurrent/refractory neuroblastoma enrolled from 2000 to 2009 on 13 NANT Phase 1/2 trials. NANTRC overall response integrated CT/MRI (Response Evaluation Criteria in Solid Tumors [RECIST]), metaiodobenzylguanidine (MIBG; Curie scoring), and percent bone marrow (BM) tumor (morphology). RESULTS Fourteen (6.9%) complete response (CR) and 14 (6.9%) partial response (PR) occurred among 203 patients evaluable for response. Five-year progression-free survival (PFS) was 16 ± 3%; overall survival (OS) was 27 ± 3%. Disease sites at enrollment included MIBG-avid lesions (100% MIBG trials; 84% non-MIBG trials), measurable CT/MRI lesions (48%), and BM (49%). By multivariable analysis, Curie score of 0 (P < 0.001), lower Curie score (P = 0.003), no measurable CT/MRI lesions (P = 0.044), and treatment on peripheral blood stem cell (PBSC) supported trials (P = 0.005) were associated with achieving CR/PR. Overall response of stable disease (SD) or better was associated with better OS (P < 0.001). In multivariable analysis, MYCN amplification (P = 0.037) was associated with worse PFS; measurable CT/MRI lesions (P = 0.041) were associated with worse OS; prior progressive disease (PD; P < 0.001/P < 0.001), Curie score ≥ 1 (P < 0.001; P = 0.001), higher Curie score (P = 0.048/0.037), and treatment on non-PBSC trials (P = < 0.001/0.003) were associated with worse PFS and OS. CONCLUSIONS NANTRCv1.0 response of at least SD is associated with better OS in patients with recurrent/refractory neuroblastoma. Patient and tumor characteristics may predict response and outcome. Identifying these variables can optimize Phase 1/2 trial design to select novel agents for further testing.
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Affiliation(s)
- Judith G. Villablanca
- Department of Pediatrics, Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Lingyun Ji
- Department of Preventative Medicine Statistics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Adi Shapira-Lewinson
- Department of Pediatric Hematology- Oncology, The Ruth Rappaport Children’s Hospital, Haifa, Israel
| | - Araz Marachelian
- Department of Pediatrics, Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Hiroyuki Shimada
- Department of Pathology, Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Randall A. Hawkins
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Miguel Pampaloni
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Hollie Lai
- Department of Pediatric Radiology, Children’s Hospital Orange County, Orange, California
| | - Fariba Goodarzian
- Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Richard Sposto
- Department of Preventative Medicine Statistics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Julie R. Park
- Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Katherine K. Matthay
- Department of Pediatrics, University of California San Francisco, San Francisco, California
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29
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Neuroblastoma: clinical and biological approach to risk stratification and treatment. Cell Tissue Res 2018; 372:195-209. [PMID: 29572647 DOI: 10.1007/s00441-018-2821-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/28/2018] [Indexed: 01/15/2023]
Abstract
Neuroblastoma is the most common extra-cranial solid tumor of childhood and the most common in the first year of life. It is a unique malignancy in that infants often present with either localized or metastatic disease that can spontaneously regress without intervention while older children can succumb to the disease after months to years of arduous therapy. Given this wide range of outcomes, the International Neuroblastoma Risk Group was created to stratify patients based on presenting characteristics and tumor biology in order to guide intensity of treatment strategies. The goal has been to decrease therapy for low-risk patients to avoid long-term complications while augmenting and targeting therapies for high-risk patients to improve overall survival. The international risk stratification depends on age, stage, histology, MYCN gene amplification status, tumor cell ploidy and segmental chromosomal abnormalities. Treatment for asymptomatic low-risk patients with an estimated survival of > 98% is often observation or surgical resection alone, whereas intermediate-risk patients with an estimated survival of > 90% require moderate doses of response-adjusted chemotherapy along with resection. High-risk patients undergo multiple cycles of combination chemotherapy before surgery, followed by consolidation with myeloablative autologous hematopoietic stem cell transplantation and local radiation and finally immunotherapy with differentiation therapy as maintenance phase. With this approach, outcome for patients with neuroblastoma has improved, as the field continues to expand efforts in more targeted therapies for high-risk patients.
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30
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Jans DA, Martin AJ. Nucleocytoplasmic Trafficking of Dengue Non-structural Protein 5 as a Target for Antivirals. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1062:199-213. [DOI: 10.1007/978-981-10-8727-1_15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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31
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Wang C, Yang SNY, Smith K, Forwood JK, Jans DA. Nuclear import inhibitor N-(4-hydroxyphenyl) retinamide targets Zika virus (ZIKV) nonstructural protein 5 to inhibit ZIKV infection. Biochem Biophys Res Commun 2017; 493:1555-1559. [PMID: 28988109 DOI: 10.1016/j.bbrc.2017.10.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022]
Abstract
In the absence of approved therapeutics, Zika virus (ZIKV)'s recent prolific outbreaks in the Americas, together with impacts on unborn fetuses of infected mothers, make it a pressing human health concern worldwide. Although a key player in viral replication in the infected host cell cytoplasm, ZIKV non-structural protein 5 (NS5) appears to contribute integrally to pathogenesis by localising in the host cell nucleus, in similar fashion to NS5 from Dengue virus (DENV). We show here for the first time that ZIKV NS5 is recognized with high nanomolar affinity by the host cell importin α/β1 heterodimer, and that this interaction can be blocked by the novel DENV NS5 targeting inhibitor N-(4-hydroxyphenyl) retinamide (4-HPR). Importantly, we show that 4-HPR has potent anti-ZIKV activity at low μM concentrations. With an established safety profile for human use, 4-HPR represents an exciting possibility as an anti-ZIKV agent.
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Affiliation(s)
- Chunxiao Wang
- Nuclear Signaling Laboratory, Department of Biochemistry and Molecular Biology, Monash University, Clayton, Vic. 3800, Australia
| | - Sundy N Y Yang
- Nuclear Signaling Laboratory, Department of Biochemistry and Molecular Biology, Monash University, Clayton, Vic. 3800, Australia
| | - Kate Smith
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2650, Australia
| | - Jade K Forwood
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2650, Australia
| | - David A Jans
- Nuclear Signaling Laboratory, Department of Biochemistry and Molecular Biology, Monash University, Clayton, Vic. 3800, Australia.
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32
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Peinemann F, van Dalen EC, Enk H, Berthold F. Retinoic acid postconsolidation therapy for high-risk neuroblastoma patients treated with autologous haematopoietic stem cell transplantation. Cochrane Database Syst Rev 2017; 8:CD010685. [PMID: 28840597 PMCID: PMC6483698 DOI: 10.1002/14651858.cd010685.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neuroblastoma is a rare malignant disease and mainly affects infants and very young children. The tumours mainly develop in the adrenal medullary tissue, with an abdominal mass as the most common presentation. About 50% of patients have metastatic disease at diagnosis. The high-risk group is characterised by metastasis and other features that increase the risk of an adverse outcome. High-risk patients have a five-year event-free survival of less than 50%. Retinoic acid has been shown to inhibit growth of human neuroblastoma cells and has been considered as a potential candidate for improving the outcome of patients with high-risk neuroblastoma. This review is an update of a previously published Cochrane Review. OBJECTIVES To evaluate the efficacy and safety of additional retinoic acid as part of a postconsolidation therapy after high-dose chemotherapy (HDCT) followed by autologous haematopoietic stem cell transplantation (HSCT), compared to placebo retinoic acid or to no additional retinoic acid in people with high-risk neuroblastoma (as defined by the International Neuroblastoma Risk Group (INRG) classification system). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2016, Issue 11), MEDLINE in PubMed (1946 to 24 November 2016), and Embase in Ovid (1947 to 24 November 2016). Further searches included trial registries (on 22 December 2016), conference proceedings (on 23 March 2017) and reference lists of recent reviews and relevant studies. We did not apply limits by publication year or languages. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating additional retinoic acid after HDCT followed by HSCT for people with high-risk neuroblastoma compared to placebo retinoic acid or to no additional retinoic acid. Primary outcomes were overall survival and treatment-related mortality. Secondary outcomes were progression-free survival, event-free survival, early toxicity, late toxicity, and health-related quality of life. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS The update search did not identify any additional studies. We identified one RCT that included people with high-risk neuroblastoma who received HDCT followed by autologous HSCT (N = 98) after a first random allocation and who received retinoic acid (13-cis-retinoic acid; N = 50) or no further therapy (N = 48) after a second random allocation. These 98 participants had no progressive disease after HDCT followed by autologous HSCT. There was no clear evidence of difference between the treatment groups either in overall survival (hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.46 to 1.63; one trial; P = 0.66) or in event-free survival (HR 0.86, 95% CI 0.50 to 1.49; one trial; P = 0.59). We calculated the HR values using the complete follow-up period of the trial. The study also reported overall survival estimates at a fixed point in time. At the time point of five years, the survival estimate was reported to be 59% for the retinoic acid group and 41% for the no-further-therapy group (P value not reported). We did not identify results for treatment-related mortality, progression-free survival, early or late toxicity, or health-related quality of life. We could not rule out the possible presence of selection bias, performance bias, attrition bias, and other bias. We judged the evidence to be of low quality for overall survival and event-free survival, downgraded because of study limitations and imprecision. AUTHORS' CONCLUSIONS We identified one RCT that evaluated additional retinoic acid as part of a postconsolidation therapy after HDCT followed by autologous HSCT versus no further therapy in people with high-risk neuroblastoma. There was no clear evidence of a difference in overall survival and event-free survival between the treatment alternatives. This could be the result of low power. Information on other outcomes was not available. This trial was performed in the 1990s, since when many changes in treatment and risk classification have occurred. Based on the currently available evidence, we are therefore uncertain about the effects of retinoic acid in people with high-risk neuroblastoma. More research is needed for a definitive conclusion.
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Affiliation(s)
- Frank Peinemann
- Children's Hospital, University of ColognePediatric Oncology and HematologyKerpener Str. 62CologneGermany50937
| | - Elvira C van Dalen
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660 (room H4‐139)AmsterdamNetherlands1100 DD
| | - Heike Enk
- c/o Cochrane Childhood CancerAmsterdamNetherlands
| | - Frank Berthold
- Children's Hospital, University of ColognePediatric Oncology and HematologyKerpener Str. 62CologneGermany50937
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Park JR, Bagatell R, Cohn SL, Pearson AD, Villablanca JG, Berthold F, Burchill S, Boubaker A, McHugh K, Nuchtern JG, London WB, Seibel NL, Lindwasser OW, Maris JM, Brock P, Schleiermacher G, Ladenstein R, Matthay KK, Valteau-Couanet D. Revisions to the International Neuroblastoma Response Criteria: A Consensus Statement From the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol 2017; 35:2580-2587. [PMID: 28471719 PMCID: PMC5676955 DOI: 10.1200/jco.2016.72.0177] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose More than two decades ago, an international working group established the International Neuroblastoma Response Criteria (INRC) to assess treatment response in children with neuroblastoma. However, this system requires modification to incorporate modern imaging techniques and new methods for quantifying bone marrow disease that were not previously widely available. The National Cancer Institute sponsored a clinical trials planning meeting in 2012 to update and refine response criteria for patients with neuroblastoma. Methods Multidisciplinary investigators from 13 countries reviewed data from published trials performed through cooperative groups, consortia, and single institutions. Data from both prospective and retrospective trials were used to refine the INRC. Monthly international conference calls were held from 2011 to 2015, and consensus was reached through review by working group leadership and the National Cancer Institute Clinical Trials Planning Meeting leadership council. Results Overall response in the revised INRC will integrate tumor response in the primary tumor, soft tissue and bone metastases, and bone marrow. Primary and metastatic soft tissue sites will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST) and iodine-123 (123I) -metaiodobenzylguanidine (MIBG) scans or [18F]fluorodeoxyglucose-positron emission tomography scans if the tumor is MIBG nonavid. 123I-MIBG scans, or [18F]fluorodeoxyglucose-positron emission tomography scans for MIBG-nonavid disease, replace technetium-99m diphosphonate bone scintigraphy for osteomedullary metastasis assessment. Bone marrow will be assessed by histology or immunohistochemistry and cytology or immunocytology. Bone marrow with ≤ 5% tumor involvement will be classified as minimal disease. Urinary catecholamine levels will not be included in response assessment. Overall response will be defined as complete response, partial response, minor response, stable disease, or progressive disease. Conclusion These revised criteria will provide a uniform assessment of disease response, improve the interpretability of clinical trial results, and facilitate collaborative trial designs.
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Affiliation(s)
- Julie R. Park
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Rochelle Bagatell
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Susan L. Cohn
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Andrew D. Pearson
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Judith G. Villablanca
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Frank Berthold
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Susan Burchill
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Ariane Boubaker
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Kieran McHugh
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Jed G. Nuchtern
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Wendy B. London
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Nita L. Seibel
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - O. Wolf Lindwasser
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - John M. Maris
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Penelope Brock
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Gudrun Schleiermacher
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Ruth Ladenstein
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Katherine K. Matthay
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
| | - Dominique Valteau-Couanet
- Julie R. Park, Seattle Children’s Hospital and University of Washington School of Medicine, Seattle, WA; Rochelle Bagatell and John M. Maris, Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; Susan L. Cohn, University of Chicago, Chicago, IL; Andrew D. Pearson, Institute of Cancer Research and Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, Surrey; Susan Burchill, Leeds Institute of Cancer and Pathology, St James University Hospital, Leeds; Kieran McHugh and Penelope Brock, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom; Judith G. Villablanca, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles; Katherine K. Matthay, University of California San Francisco School of Medicine, San Francisco, CA; Frank Berthold, Children’s Hospital and University of Cologne, Köln, Germany; Ariane Boubaker, Institute of Radiology, Clinique de La Source, Lausanne, Switzerland; Jed G. Nuchtern, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX; Wendy B. London, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA; Nita L. Seibel and O. Wolf Lindwasser, National Cancer Institute, Bethesda, MD; Gudrun Schleiermacher, Institut Curie, Paris; Dominique Valteau-Couanet, Gustave Roussy, Villejuif, France; and Ruth Ladenstein, Children’s Cancer Research Institute, St Anna Children’s Hospital, Vienna, Austria
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Cooper JP, Reynolds CP, Cho H, Kang MH. Clinical development of fenretinide as an antineoplastic drug: Pharmacology perspectives. Exp Biol Med (Maywood) 2017; 242:1178-1184. [PMID: 28429653 PMCID: PMC5478002 DOI: 10.1177/1535370217706952] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fenretinide (4-HPR) is a synthetic retinoid that has cytotoxic activity against cancer cells. Despite substantial in vitro cytotoxicity, response rates in early clinical trials with 4-HPR have been less than anticipated, likely due to the low bioavailability of the initial oral capsule formulation. Several clinical studies have shown that the oral capsule formulation at maximum tolerated dose (MTD) achieved <10 µmol/L concentrations in patients. To improve bioavailability of 4-HPR, new oral powder (LYM-X-SORB®, LXS) and intravenous lipid emulsion (ILE) formulations are being tested in early-phase clinical trials. ILE 4-HPR administered as five-day continuous infusion achieved over 50 µmol/L at MTD with minimal systemic toxicities; multiple complete and partial responses were observed in peripheral T cell lymphomas. The LXS oral powder 4-HPR formulation increased plasma levels approximately two-fold at MTD in children without dose-limiting toxicities and demonstrated multiple complete responses in recurrent neuroblastoma. The clinical activity observed with new 4-HPR formulations is attributed to increased bioavailability. Phase I and II clinical trials of both LXS 4-HPR and ILE 4-HPR are in progress as a single agent or in combination with other drugs. Impact statement One of the critical components in drug development is understanding pharmacology (especially pharmacokinetics) of the drugs being developed. Often the pharmacokinetic properties, such as poor solubility leading to poor bioavailability, of the drug can limit further development of the drug. The development of numerous drugs has often halted at clinical testing stages, and several of them were due to the pharmacological properties of the agents, resulting in increased drug development cost. The current review provides an example of how improved clinical activity can be achieved by changing the formulations of a drug with poor bioavailability. Thus, it emphasizes the importance of understanding pharmacologic characteristics of the drug in drug development.
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Affiliation(s)
- Jason P Cooper
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Cell Biology & Biochemistry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Divisions of Hematology and Medical Oncology, Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA 98109, USA
| | - C Patrick Reynolds
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Cell Biology & Biochemistry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Pharmacology & Neuroscience, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Pediatrics, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Hwangeui Cho
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Cell Biology & Biochemistry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Min H Kang
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Cell Biology & Biochemistry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Pharmacology & Neuroscience, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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Lopez-Barcons L, Maurer BJ, Kang MH, Reynolds CP. P450 inhibitor ketoconazole increased the intratumor drug levels and antitumor activity of fenretinide in human neuroblastoma xenograft models. Int J Cancer 2017; 141:405-413. [PMID: 28340497 DOI: 10.1002/ijc.30706] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/22/2017] [Accepted: 03/13/2017] [Indexed: 01/02/2023]
Abstract
We previously reported that concurrent ketoconazole, an oral anti-fungal agent and P450 enzyme inhibitor, increased plasma levels of the cytotoxic retinoid, fenretinide (4-HPR) in mice. We have now determined the effects of concurrent ketoconazole on 4-HPR cytotoxic dose-response in four neuroblastoma (NB) cell lines in vitro and on 4-HPR activity against two cell line-derived, subcutaneous NB xenografts (CDX) and three patient-derived NB xenografts (PDX). Cytotoxicity in vitro was assessed by DIMSCAN assay. Xenografted animals were treated with 4-HPR/LXS (240 mg/kg/day) + ketoconazole (38 mg/kg/day) in divided oral doses in cycles of five continuous days a week. In one model, intratumoral levels of 4-HPR and metabolites were assessed by HPLC assay, and in two models intratumoral apoptosis was assessed by TUNEL assay, on Day 5 of the first cycle. Antitumor activity was assessed by Kaplan-Meier event-free survival (EFS). The in vitro cytotoxicity of 4-HPR was not affected by ketoconazole (p ≥ 0.06). Ketoconazole increased intratumoral levels of 4-HPR (p = 0.02), of the active 4-oxo-4-HPR metabolite (p = 0.04), and intratumoral apoptosis (p ≤ 0.0006), compared to 4-HPR/LXS-alone. Concurrent ketoconazole increased EFS in both CDX models compared to 4-HPR/LXS-alone (p ≤ 0.008). 4-HPR + ketoconazole also increased EFS in PDX models compared to controls (p ≤ 0.03). Thus, concurrent ketoconazole decreased 4-HPR metabolism with resultant increases of plasma and intratumoral drug levels and antitumor effects in neuroblastoma murine xenografts. These results support the clinical testing of concurrent ketoconazole and oral fenretinide in neuroblastoma.
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Affiliation(s)
- Lluis Lopez-Barcons
- Cancer Center and Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, 79430
| | - Barry J Maurer
- Cancer Center and Departments of Cell Biology and Biochemistry, Pediatrics and Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, 79430
| | - Min H Kang
- Cancer Center and Departments of Cell Biology and Biochemistry, Internal Medicine, and Pharmacology/Neuroscience, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, 79430
| | - C Patrick Reynolds
- Cancer Center and Departments of Cell Biology and Biochemistry, Pediatrics and Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, 79430
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Mohrbacher AM, Yang AS, Groshen S, Kummar S, Gutierrez ME, Kang MH, Tsao-Wei D, Reynolds CP, Newman EM, Maurer BJ. Phase I Study of Fenretinide Delivered Intravenously in Patients with Relapsed or Refractory Hematologic Malignancies: A California Cancer Consortium Trial. Clin Cancer Res 2017; 23:4550-4555. [PMID: 28420721 DOI: 10.1158/1078-0432.ccr-17-0234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 01/26/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022]
Abstract
Purpose: A phase I study was conducted to determine the MTD, dose-limiting toxicities (DLT), and pharmacokinetics of fenretinide delivered as an intravenous emulsion in relapsed/refractory hematologic malignancies.Experimental Design: Fenretinide (80-1,810 mg/m2/day) was administered by continuous infusion on days 1 to 5, in 21-day cycles, using an accelerated titration design.Results: Twenty-nine patients, treated with a median of three prior regimens (range, 1-7), were enrolled and received the test drug. Ninety-seven courses were completed. An MTD was reached at 1,280 mg/m2/day for 5 days. Course 1 DLTs included 6 patients with hypertriglyceridemia, 4 of whom were asymptomatic; 2 patients experienced DLT thrombocytopenia (asymptomatic). Of 11 patients with response-evaluable peripheral T-cell lymphomas, two had complete responses [CR, progression-free survival (PFS) 68+ months; unconfirmed CR, PFS 14+ months], two had unconfirmed partial responses (unconfirmed PR, PFS 5 months; unconfirmed PR, PFS 6 months), and five had stable disease (2-12 cycles). One patient with mature B-cell lymphoma had an unconfirmed PR sustained for two cycles. Steady-state plasma levels were approximately 10 mcg/mL (mid-20s μmol/L) at 640 mg/m2/day, approximately 14 mcg/mL (mid-30s μmol/L) at 905 mg/m2/day, and approximately 22 mcg/mL (mid-50s μmol/L) at 1,280 mg/m2/day.Conclusions: Intravenous fenretinide obtained significantly higher plasma levels than a previous capsule formulation, had acceptable toxicities, and evidenced antitumor activity in peripheral T-cell lymphomas. A recommended phase II dosing is 600 mg/m2 on day 1, followed by 1,200 mg/m2 on days 2 to 5, every 21 days. A registration-enabling phase II study in relapsed/refractory PTCL (ClinicalTrials.gov identifier: NCT02495415) is ongoing. Clin Cancer Res; 23(16); 4550-5. ©2017 AACR.
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Affiliation(s)
- Ann M Mohrbacher
- Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Allen S Yang
- Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan Groshen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shivaani Kummar
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Martin E Gutierrez
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey
| | - Min H Kang
- Cancer Center and Departments of Cell Biology and Biochemistry and Pharmacy, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Denice Tsao-Wei
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - C Patrick Reynolds
- Cancer Center and Departments of Cell Biology and Biochemistry, Pediatrics, and Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Edward M Newman
- Department of Cancer Biology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Barry J Maurer
- Cancer Center and Departments of Cell Biology and Biochemistry, Pediatrics, and Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
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Applebaum MA, Desai AV, Glade Bender JL, Cohn SL. Emerging and investigational therapies for neuroblastoma. Expert Opin Orphan Drugs 2017; 5:355-368. [PMID: 29062613 PMCID: PMC5649635 DOI: 10.1080/21678707.2017.1304212] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Treatment for children with clinically aggressive, high-risk neuroblastoma remains challenging. Less than 50% of patients with high-risk neuroblastoma will survive long-term with current therapies, and survivors are at risk for serious treatment-related late toxicities. Here, we review new and evolving treatments that may ultimately improve outcome for children with high-risk neuroblastoma with decreased potential for late adverse events. AREAS COVERED New strategies for treating high-risk neuroblastoma are reviewed including: radiotherapy, targeted cytotoxics, biologics, immunotherapy, and molecularly targeted agents. Recently completed and ongoing neuroblastoma clinical trials testing these novel treatments are highlighted. In addition, we discuss ongoing clinical trials designed to evaluate precision medicine approaches that target actionable somatic mutations and oncogenic cellular pathways. EXPERT OPINION Advances in genomic medicine and molecular biology have led to the development of early phase studies testing biologically rational therapies targeting aberrantly activated cellular pathways. Because many of these drugs have a wider therapeutic index than standard chemotherapeutic agents, these treatments may be more effective and less toxic than current strategies. However, to effectively integrate these targeted strategies, robust predictive biomarkers must be developed that will identify patients who will benefit from these approaches and rapidly match treatments to patients at diagnosis.
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Affiliation(s)
- Mark A. Applebaum
- Department of Pediatrics, University of Chicago, Chicago, Illinois, 60637, United States of America
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, 60637, United States of America
| | - Ami V. Desai
- Department of Pediatrics, University of Chicago, Chicago, Illinois, 60637, United States of America
| | - Julia L. Glade Bender
- Department of Pediatrics, Columbia University Medical Center, New York, New York, 10032
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York, 10032
| | - Susan L. Cohn
- Department of Pediatrics, University of Chicago, Chicago, Illinois, 60637, United States of America
- Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, Illinois, 60637, United States of America
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Dorris K, Liu C, Li D, Hummel TR, Wang X, Perentesis J, Kim MO, Fouladi M. A comparison of safety and efficacy of cytotoxic versus molecularly targeted drugs in pediatric phase I solid tumor oncology trials. Pediatr Blood Cancer 2017; 64. [PMID: 27654490 DOI: 10.1002/pbc.26258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/19/2016] [Accepted: 08/10/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prior reviews of phase I pediatric oncology trials involving primarily cytotoxic agents have reported objective response rates (ORRs) and toxic death rates of 7.9-9.6% and 0.5%, respectively. These data may not reflect safety and efficacy in phase I trials of molecularly targeted (targeted) drugs. METHODS A systematic review of pediatric phase I solid tumor trials published in 1990-2013 was performed. The published reports were evaluated for patient characteristics, toxicity information, and response numbers. RESULTS A total of 143 phase I pediatric clinical trials enrolling 3,896 children involving 53 targeted and 48 cytotoxic drugs were identified. A meta-analysis demonstrated that the ORR is 2.1-fold higher with cytotoxic drugs (0.066 vs. 0.031 per subject; P = 0.007). By contrast, the pooled estimate of the stable disease rate (SDR) is similar for cytotoxic and targeted drugs (0.2 vs. 0.23 per subject; P = 0.27). The pooled estimate of the dose-limiting toxicity rate is 1.8-fold larger with cytotoxic drugs (0.24 vs. 0.13 per subject; P = 0.0003). The hematologic grade 3-4 (G3/4) toxicity rate is 3.6-fold larger with cytotoxic drugs (0.43 vs. 0.12 per treatment course; P = 0.0001); however, the nonhematologic G3/4 toxicities and toxic deaths occur at similar rates for cytotoxic and targeted drugs. CONCLUSIONS In phase I pediatric solid tumor trials, ORRs were significantly higher for cytotoxic versus targeted agents. SDRs were similar in targeted and cytotoxic drug trials. Patients treated with cytotoxic agents were more likely to experience hematologic G3/4 toxicities than those patients receiving targeted drugs.
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Affiliation(s)
- Kathleen Dorris
- Section of Pediatric Hematology, Oncology, Bone Marrow Transplantation, Children's Hospital Colorado, Aurora, Colorado
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dandan Li
- Consumer Credit Risk Management, Fifth Third Bank, Cincinnati, Ohio
| | - Trent R Hummel
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Xia Wang
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio
| | - John Perentesis
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mi-Ok Kim
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Maryam Fouladi
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Berlanga P, Cañete A, Castel V. Advances in emerging drugs for the treatment of neuroblastoma. Expert Opin Emerg Drugs 2017; 22:63-75. [PMID: 28253830 DOI: 10.1080/14728214.2017.1294159] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Neuroblastoma is the most common solid extracranial tumor of childhood. Outcome for children with high-risk neuroblastoma remains suboptimal. More than half of children diagnosed with high-risk neuroblastoma either do not respond to conventional therapies or relapse after treatment with dismal prognosis. Areas covered: This paper presents a short review of the state of the art in the current treatment of high-risk neuroblastoma. An updated review of new targeted therapies in this group of patients is also presented. Expert opinion: In order to improve prognosis for high-risk patients there is an urgent need to better understand spatial and temporal heterogeneity and obtain new predictive preclinical models in neuroblastoma. Combination strategies with conventional chemotherapy and/or other targeted therapies may overcome current ALK inhibitors resistance. Improvement of international and transatlantic cooperation to speed clinical trials accrual is needed.
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Affiliation(s)
- Pablo Berlanga
- a Unidad de Oncologia Pediatrica, Hospital Universitario La Fe , Valencia , Spain
| | - Adela Cañete
- a Unidad de Oncologia Pediatrica, Hospital Universitario La Fe , Valencia , Spain
| | - Victoria Castel
- a Unidad de Oncologia Pediatrica, Hospital Universitario La Fe , Valencia , Spain.,b Instituto de Investigación Sanitaria La Fe , Valencia , Spain
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Boppana NB, Kraveka JM, Rahmaniyan M, Li LI, Bielawska A, Bielawski J, Pierce JS, Delor JS, Zhang K, Korbelik M, Separovic D. Fumonisin B1 Inhibits Endoplasmic Reticulum Stress Associated-apoptosis After FoscanPDT Combined with C6-Pyridinium Ceramide or Fenretinide. Anticancer Res 2017; 37:455-463. [PMID: 28179290 DOI: 10.21873/anticanres.11337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Combining an anticancer agent fenretinide (HPR) or C6-pyridinium ceramide (LCL29) with Foscan-mediated photodynamic therapy (FoscanPDT) is expected to augment anticancer benefits of each substance. We showed that treatment with FoscanPDT+HPR enhanced accumulation of C16-dihydroceramide, and that fumonisin B1 (FB), an inhibitor of ceramide synthase, counteracted caspase-3 activation and colony-forming ability of head and neck squamous cell carcinoma (HNSCC) cells. Because cancer cells appear to be more susceptible to increased levels of the endoplasmic reticulum (ER) stress than normal cells, herein we tested the hypothesis that FoscanPDT combined with HPR or LCL29 induces FB-sensitive ER stress-associated apoptosis that affects cell survival. MATERIALS AND METHODS Using an HNSCC cell line, we determined: cell survival by clonogenic assay, caspase-3 activity by spectrofluorometry, the expression of the ER markers BiP and CHOP by quantitative real-time polymerase chain reaction and western immunoblotting, and sphingolipid levels by mass spectrometry. RESULTS Similar to HPR+FoscanPDT, LCL29+FoscanPDT induced enhanced loss of clonogenicity and caspase-3 activation, that were both inhibited by FB. Our additional pharmacological evidence showed that the enhanced loss of clonogenicity after the combined treatments was singlet oxygen-, ER stress- and apoptosis-dependent. The combined treatments induced enhanced, FB-sensitive, up-regulation of BiP and CHOP, as well as enhanced accumulation of sphingolipids. CONCLUSION Our data suggest that enhanced clonogenic cell killing after the combined treatments is dependent on oxidative- and ER-stress, apoptosis, and FB-sensitive sphingolipid production, and should help develop more effective mechanism-based therapeutic strategies.
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Affiliation(s)
- Nithin B Boppana
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, U.S.A
| | - Jacqueline M Kraveka
- Department of Pediatrics Division of Hematology-Oncology, Charles Darby Children's Research Institute, and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, U.S.A
| | - Mehrdad Rahmaniyan
- Department of Pediatrics Division of Hematology-Oncology, Charles Darby Children's Research Institute, and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, U.S.A
| | - L I Li
- Department of Pediatrics Division of Hematology-Oncology, Charles Darby Children's Research Institute, and Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, U.S.A
| | - Alicja Bielawska
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC, U.S.A
| | - Jacek Bielawski
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC, U.S.A
| | - Jason S Pierce
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC, U.S.A
| | - Jeremy S Delor
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, U.S.A
| | - Kezhong Zhang
- Center for Molecular Medicine and Genetics and Department of Immunology and Microbiology, Wayne State University School of Medicine, Wayne State University, Detroit, MI, U.S.A
| | | | - Duska Separovic
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, U.S.A. .,Karmanos Cancer Institute, Wayne State University, Detroit, MI, U.S.A
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Cowan AJ, Stevenson PA, Gooley TA, Frayo SL, Oliveira GR, Smith SD, Green DJ, Roden JE, Pagel JM, Wood BL, Press OW, Gopal AK. Results of a phase I-II study of fenretinide and rituximab for patients with indolent B-cell lymphoma and mantle cell lymphoma. Br J Haematol 2017; 176:583-590. [PMID: 28055107 DOI: 10.1111/bjh.14451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022]
Abstract
Fenretinide, a synthetic retinoid, induces apoptotic cell death in B-cell non-Hodgkin lymphoma (B-NHL) and acts synergistically with rituximab in preclinical models. We report results from a phase I-II study of fenretinide with rituximab for B-NHLs. Eligible diagnoses included indolent B-NHL or mantle cell lymphoma. The phase I design de-escalated from fenretinide at 900 mg/m2 PO BID for days 1-5 of a 7-day cycle. The phase II portion added 375 mg/m2 IV rituximab weekly on weeks 5-9 then every 3 months. Fenretinide was continued until progression or intolerance. Thirty-two patients were treated: 7 in phase I, and 25 in phase II of the trial. No dose-limiting toxicities were observed. The phase II component utilized fenretinide 900 mg/m2 twice daily with rituximab. The most common treatment-related adverse events of grade 3 or higher were rash (n = 3) and neutropenia (n = 3). Responses were seen in 6 (24%) patients on the phase II study, with a median duration of response of 47 months (95% confidence interval, 2-56). The combination of fenretinide and rituximab was well tolerated, yielded a modest overall response rate, but with prolonged remission durations. Further study should focus on identifying the responsive subset of B-NHL.
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Affiliation(s)
- Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Phillip A Stevenson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ted A Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shani L Frayo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - George R Oliveira
- Department of Radiology, Harvard Medical School, MGH Hospital, Boston, MA, USA
| | - Stephen D Smith
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer E Roden
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Brent L Wood
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Hematopathology, Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Oliver W Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
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42
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Wang XQ, Li ZN, Wang QM, Jin HY, Gao Z, Jin ZH. Lipid nano-bubble combined with ultrasound for anti-keloids therapy. J Liposome Res 2016; 28:5-13. [PMID: 27733083 DOI: 10.1080/08982104.2016.1239633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Keloids were characterized by excessive growth of fibrous tissues, and shared several pathological characteristics with cancer. They did put physical and emotional stress on patients in that keloids could badly change appearance of patients. N-(4-hydroxyphenyl) retinamide (4HPR) showed cytotoxic activity on a wide variety of invasive-growth cells. Our work was aim to prepare N-(4-hydroxyphenyl) retinamide-loaded lipid microbubbles (4HPR-LM) combined with ultrasound for anti-keloid therapy. 4HPR-loaded liposomes (4HPR-L) were first prepared by film evaporation method, and then 4HPR-LM were manufactured by mixing 4HPR-L and perfluoropentane (PFP) with ultrasonic cavitation method. The mean particle size and entrapment efficiency 4HPR-LM were 113 nm and 95%, respectively. The anti-keloids activity of 4HPR-LM was assessed with BALB/c nude mice bearing subcutaneous xenograft keloids model. 4HPR-LM, combined with ultrasound, could significantly induce apoptosis of keloid fibroblasts in vitro and inhibited growth of keloids in vivo. Thus, 4HPR-LM could be considered as a promising agent for anti-keloids therapy.
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Affiliation(s)
- Xiao Qing Wang
- a State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.,b Yanbian University Hospital , Yanji , China , and.,c Jining No.1 People's Hospital , Jining , China
| | - Zhou-Na Li
- a State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.,b Yanbian University Hospital , Yanji , China , and
| | - Qi-Ming Wang
- a State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Hong-Yan Jin
- b Yanbian University Hospital , Yanji , China , and
| | - Zhonggao Gao
- a State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Zhe-Hu Jin
- b Yanbian University Hospital , Yanji , China , and
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Abstract
Neuroblastoma is the most common extracranial solid tumour occurring in childhood and has a diverse clinical presentation and course depending on the tumour biology. Unique features of these neuroendocrine tumours are the early age of onset, the high frequency of metastatic disease at diagnosis and the tendency for spontaneous regression of tumours in infancy. The most malignant tumours have amplification of the MYCN oncogene (encoding a transcription factor), which is usually associated with poor survival, even in localized disease. Although transgenic mouse models have shown that MYCN overexpression can be a tumour-initiating factor, many other cooperating genes and tumour suppressor genes are still under investigation and might also have a role in tumour development. Segmental chromosome alterations are frequent in neuroblastoma and are associated with worse outcome. The rare familial neuroblastomas are usually associated with germline mutations in ALK, which is mutated in 10-15% of primary tumours, and provides a potential therapeutic target. Risk-stratified therapy has facilitated the reduction of therapy for children with low-risk and intermediate-risk disease. Advances in therapy for patients with high-risk disease include intensive induction chemotherapy and myeloablative chemotherapy, followed by the treatment of minimal residual disease using differentiation therapy and immunotherapy; these have improved 5-year overall survival to 50%. Currently, new approaches targeting the noradrenaline transporter, genetic pathways and the tumour microenvironment hold promise for further improvements in survival and long-term quality of life.
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44
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Steineck A, MacKenzie JD, Twist CJ. Premature physeal closure following 13-cis-retinoic acid and prolonged fenretinide administration in neuroblastoma. Pediatr Blood Cancer 2016; 63:2050-3. [PMID: 27399265 DOI: 10.1002/pbc.26124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/05/2016] [Accepted: 06/08/2016] [Indexed: 11/11/2022]
Abstract
Retinoid therapy has contributed to improved outcomes in neuroblastoma. Clinical trials of fenretinide report favorable toxicity and disease stabilization in patients with high risk (HR) neuroblastoma. Skeletal effects have been described with other retinoids, but not with fenretinide to date. Two patients with HR, metastatic, refractory neuroblastoma received protracted courses of oral fenretinide for more than 5 years' duration. Both developed premature long bone physeal closure, causing limb length discrepancies; their neuroblastoma remains in remission. The radiographic and clinical findings reported suggest these skeletal abnormalities may be a consequence of treatment with 13-cis-retinoic acid (13cisRA) followed by prolonged oral fenretinide exposure.
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Affiliation(s)
- Angela Steineck
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
| | - John D MacKenzie
- Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Clare J Twist
- Department of Pediatrics, Division of Hematology/Oncology, Stanford University School of Medicine, Stanford, California
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45
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Yan W, Du J, Du Y, Pu H, Liu S, He J, Zhang J, Hou J. Fenretinide targets the side population in myeloma cell line NCI-H929 and potentiates the efficacy of antimyeloma with bortezomib and dexamethasone regimen. Leuk Res 2016; 51:32-40. [PMID: 27821288 DOI: 10.1016/j.leukres.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 09/01/2016] [Accepted: 10/19/2016] [Indexed: 01/02/2023]
Abstract
Side population (SP) cells, a subset of enriched tumor initiating cells, have been demonstrated to have stem cell-like properties in multiple myeloma (MM) by us as well as other previous studies. A lack of agents targeting tumor initiating cells, however, represents a challenge in the treatment of MM. Previously, fenretinide, a well-tolerated vitamin A derivative, has been shown to exert effect on leukemic stem cells, but its actions against myeloma stem-like cells are still unknown. In this study, the effects of fenretinide on myeloma stem-like cells characteristic was comprehensively examined in SP and non-SP (MP) cells of NCI-H929 cell sorted by flow cytometry-based on Hoechst 33342 stain. We find that fenretinide is capable of eradicating MM SP and MP cells, but not normal bone marrow mononuclear cells (BMMCs) at physiologically achievable concentrations. Fenretinide alone exerted a selective cytotoxic effect on MM SP cells, as well as in combination with bortezomib and dexamethasone. In particular, SP cells were highly sensitive to fenretinide, and in combination with bortezomib and dexamethasone in colony formation and apoptosis assays. Accordingly, the apparent fenretinide-induced-apoptosis was linked to the rapid generation of reactive oxygen species (ROS). Therefore, we propose that fenretinide is a potent agent that targets tumor initiating cells and may be a promising therapeutic agent in MM treatment.
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Affiliation(s)
- Wenqing Yan
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Juan Du
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Yanzhi Du
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai Jiao Tong University School of Medicine (SJTU-SM), Shanghai, China
| | - Honglei Pu
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Shuyan Liu
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Jie He
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Ji Zhang
- Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences (SIBS), Chinese Academy of Sciences (CAS), Shanghai Jiao Tong University School of Medicine (SJTU-SM), Shanghai, China
| | - Jian Hou
- Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
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46
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Cho HE, Min HK. Analysis of fenretinide and its metabolites in human plasma by liquid chromatography-tandem mass spectrometry and its application to clinical pharmacokinetics. J Pharm Biomed Anal 2016; 132:117-124. [PMID: 27701038 DOI: 10.1016/j.jpba.2016.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
A simple and accurate high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for the determination of N-(4-hydroxyphenyl)retinamide (fenretinide, 4-HPR) and its metabolites, 4-oxo-N-(4-hydroxyphenyl)retinamide (4-oxo-4-HPR) and N-(4-methoxyphenyl)retinamide (4-MPR), in human plasma. Plasma samples were prepared using protein precipitation with ethanol. Chromatographic separation of the three analytes and N-(4-ethoxyphenyl)retinamide (4-EPR), an internal standard, was achieved on a Zorbax SB-C18 column (3.5μm, 50×2.1mm) using gradient elution with the mobile phase of 0.1% formic acid in water and acetonitrile (pH* 2.4) at a flow rate of 0.5mL/min. Electrospray ionization (ESI) mass spectrometry was operated in the positive ion mode with multiple reaction monitoring (MRM). The calibration curves obtained were linear over the concentration range of 0.2-50ng/mL with a lower limit of quantification of 0.2ng/mL. The relative standard deviation of intra-day and inter-day precision was below 7.64%, and the accuracy ranged from 94.92 to 105.43%. The extraction recoveries were found to be higher than 90.39% and no matrix effect was observed. The analytes were stable for the durations of the stability studies. The validated method was successfully applied to the analyses of the pharmacokinetic study for patients treated with 4-HPR in a clinical trial.
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Affiliation(s)
- Hwang Eui Cho
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Cell Biology and Biochemistry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - H Kang Min
- Cancer Center, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Cell Biology and Biochemistry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Pharmacology and Neuroscience, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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47
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Chen NE, Maldonado NV, Khankaldyyan V, Shimada H, Song MM, Maurer BJ, Reynolds CP. Reactive Oxygen Species Mediates the Synergistic Activity of Fenretinide Combined with the Microtubule Inhibitor ABT-751 against Multidrug-Resistant Recurrent Neuroblastoma Xenografts. Mol Cancer Ther 2016; 15:2653-2664. [PMID: 27530131 DOI: 10.1158/1535-7163.mct-16-0156] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022]
Abstract
ABT-751 is a colchicine-binding site microtubule inhibitor. Fenretinide (4-HPR) is a synthetic retinoid. Both agents have shown activity against neuroblastoma in laboratory models and clinical trials. We investigated the antitumor activity of 4-HPR + the microtubule-targeting agents ABT-751, vincristine, paclitaxel, vinorelbine, or colchicine in laboratory models of recurrent neuroblastoma. Drug cytotoxicity was assessed in vitro by a fluorescence-based assay (DIMSCAN) and in subcutaneous xenografts in nu/nu mice. Reactive oxygen species levels (ROS), apoptosis, and mitochondrial depolarization were measured by flow cytometry; cytochrome c release and proapoptotic proteins were measured by immunoblotting. 4-HPR + ABT-751 showed modest additive or synergistic cytotoxicity, mitochondrial membrane depolarization, cytochrome c release, and caspase activation compared with single agents in vitro; synergism was inhibited by antioxidants (ascorbic acid, α-tocopherol). 4-HPR + ABT-751 was highly active against four xenograft models, achieving multiple maintained complete responses. The median event-free survival (days) for xenografts from 4 patients combined was control = 28, 4-HPR = 49, ABT-751 = 77, and 4-HPR + ABT-751 > 150 (P < 0.001). Apoptosis (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, TUNEL) was significantly higher in 4-HPR + ABT-751-treated tumors than with single agents (P < 0.01) and was inhibited by ascorbic acid and α-tocopherol (P < 0.01), indicating that ROS from 4-HPR enhanced the activity of ABT-751. 4-HPR also enhanced the activity against neuroblastoma xenografts of vincristine or paclitaxel, but the latter combinations were less active than 4-HPR + ABT-751. Our data support clinical evaluation of 4-HPR combined with ABT-751 in recurrent and refractory neuroblastoma. Mol Cancer Ther; 15(11); 2653-64. ©2016 AACR.
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Affiliation(s)
- Nancy E Chen
- Department of Systems, Biology, and Disease, University of Southern California School of Medicine, Los Angeles, California
| | - N Vanessa Maldonado
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Vazgen Khankaldyyan
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Hiroyuki Shimada
- Department of Pathology, Children's Hospital Los Angeles, Los Angeles, California
| | - Michael M Song
- Cancer Center and Department of Cell Biology and Biochemistry, Pediatrics and Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Barry J Maurer
- Cancer Center and Department of Cell Biology and Biochemistry, Pediatrics and Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - C Patrick Reynolds
- Cancer Center and Department of Cell Biology and Biochemistry, Pediatrics and Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas.
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48
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Bassani B, Bartolini D, Pagani A, Principi E, Zollo M, Noonan DM, Albini A, Bruno A. Fenretinide (4-HPR) Targets Caspase-9, ERK 1/2 and the Wnt3a/β-Catenin Pathway in Medulloblastoma Cells and Medulloblastoma Cell Spheroids. PLoS One 2016; 11:e0154111. [PMID: 27367907 PMCID: PMC4930187 DOI: 10.1371/journal.pone.0154111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/08/2016] [Indexed: 12/11/2022] Open
Abstract
Medulloblastoma (MB), a neuroectodermal tumor arising in the cerebellum, represents the most frequent childhood brain malignancy. Current treatments for MB combine radiation and chemotherapy and are often associated with relevant side effects; novel therapeutic strategies are urgently needed. N-(4-Hydroxyphenyl) retinamide (4-HPR, fenretinide), a synthetic analogue of all-trans retinoic acid, has emerged as a promising and well-tolerated cancer chemopreventive and chemotherapeutic agent for various neoplasms, from breast cancer to neuroblastoma. Here we investigated the effects of 4-HPR on MB cell lines and identified the mechanism of action for a potential use in therapy of MB. Flow cytometry analysis was performed to evaluate 4-HPR induction of apoptosis and oxygen reactive species (ROS) production, as well as cell cycle effects. Functional analysis to determine 4-HPR ability to interfere with MB cell migration and invasion were performed. Western Blot analysis were used to investigate the crucial molecules involved in selected signaling pathways associated with apoptosis (caspase-9 and PARP-1), cell survival (ERK 1/2) and tumor progression (Wnt3a and β-catenin). We show that 4-HPR induces caspase 9-dependent cell death in DAOY and ONS-76 cells, associated with increased ROS generation, suggesting that free radical intermediates might be directly involved. We observed 4-HPR induction of cell cycle arrest in G1/S phase, inactivated β-catenin, and inhibition of MB cell migration and invasion. We also evaluated the ability of 4-HPR to target MB cancer-stem/cancer-initiating cells, using an MB spheroids model, followed by flow cytometry and quantitative real-time PCR. 4-HPR treatment reduced DAOY and ONS-76 spheroid formation, in term of number and size. Decreased expression of the surface markers CD133+ and ABCG2+ as well as Oct-4 and Sox-2 gene expression were observed on BTICs treated with 4-HPR further reducing BITIC invasive activities. Finally, we analyzed 4-HPR ability to inhibit MB tumor cell growth in vivo in nude mice. Taken together, our data suggest that 4-HPR targets both parental and MB tumor stem/initiating cell-like populations. Since 4-HPR exerts low toxicity, it could represent a valid compound in the treatment of human MB.
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Affiliation(s)
- Barbara Bassani
- Scientific and Technological Pole, IRCCS MultiMedica, Milano, Italy
| | | | - Arianna Pagani
- Scientific and Technological Pole, IRCCS MultiMedica, Milano, Italy
| | - Elisa Principi
- Scientific and Technological Pole, IRCCS MultiMedica, Milano, Italy
| | - Massimo Zollo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
- Ceinge Biotecnologie Avanzate, Naples, Italy
| | - Douglas M. Noonan
- Scientific and Technological Pole, IRCCS MultiMedica, Milano, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Adriana Albini
- Scientific and Technological Pole, IRCCS MultiMedica, Milano, Italy
- * E-mail:
| | - Antonino Bruno
- Scientific and Technological Pole, IRCCS MultiMedica, Milano, Italy
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49
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Enhanced apoptotic cancer cell killing after Foscan photodynamic therapy combined with fenretinide via de novo sphingolipid biosynthesis pathway. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2016; 159:191-5. [PMID: 27085050 DOI: 10.1016/j.jphotobiol.2016.02.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/27/2016] [Accepted: 02/29/2016] [Indexed: 12/11/2022]
Abstract
We and others have shown that stresses, including photodynamic therapy (PDT), can disrupt the de novo sphingolipid biosynthesis pathway, leading to changes in the levels of sphingolipids, and subsequently, modulation of cell death. The de novo sphingolipid biosynthesis pathway includes a ceramide synthase-dependent reaction, giving rise to dihydroceramide, which is then converted in a desaturase-dependent reaction to ceramide. In this study we tested the hypothesis that combining Foscan-mediated PDT with desaturase inhibitor fenretinide (HPR) enhances cancer cell killing. We discovered that by subjecting SCC19 cells, a human head and neck squamous cell carcinoma cell line, to PDT+HPR resulted in enhanced accumulation of C16-dihydroceramide, not ceramide. Concomitantly, mitochondrial depolarization was enhanced by the combined treatment. Enhanced activation of caspase-3 after PDT+HPR was inhibited by FB. Enhanced clonogenic cell death after the combination was sensitive to FB, as well as Bcl2- and caspase inhibitors. Treatment of mouse SCCVII squamous cell carcinoma tumors with PDT+HPR resulted in improved long-term tumor cures. Overall, our data showed that combining PDT with HPR enhanced apoptotic cancer cell killing and antitumor efficacy of PDT. The data suggest the involvement of the de novo sphingolipid biosynthesis pathway in enhanced apoptotic cell killing after PDT+HPR, and identify the combination as a novel more effective anticancer treatment than either treatment alone.
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50
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Pavone ME, Malpani SS, Dyson M, Kim JJ, Bulun SE. Fenretinide: A Potential Treatment for Endometriosis. Reprod Sci 2016; 23:1139-47. [PMID: 26919975 DOI: 10.1177/1933719116632920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Fenretinide is a synthetic retinoid analogue that promotes apoptosis but has decreased toxicity when compared to other retinoids. We have previously shown that retinoic acid (RA) production in endometriotic tissue is decreased, resulting in reduced estrogen metabolism and apoptotic resistance. We hypothesize fenretinide may induce apoptosis in endometriotic cells and tissues, thereby reducing disease burden. MATERIALS AND METHODS Primary endometriotic stromal cells were collected, isolated, cultured, and treated with fenretinide in doses from 0 to 20 µmol/L. Cell count, viability, and immunoblots were performed to examine apoptosis. Quantitative reverse transcription-polymerase chain reaction from endometriotic cells treated with fenretinide was used to examine expression of genes involved in RA signaling including stimulated by RA 6 (STRA6), cellular RA binding protein 2 (CRABP2), and fatty acid binding protein 5 (FABP5). Endometriotic tissue was xenografted subcutaneously into the flanks of mice which were treated with fenretinide for 2 weeks, after which the mice were killed and lesion volumes calculated. Statistical analysis was performed using t test and analysis of variance. RESULTS Treatment with fenretinide significantly decreased total cell count (doses 5-20 µL) and viability (doses 10-20 µmol/L). Fenretinide increased protein levels of the apoptotic marker poly (ADP ribose) polymerase (starting at 10 µmol/L) and decreased proliferation marker proliferating cell nuclear antigen (10 µmol/L, starting at 8-day treatment). Examination of genes involved in retinoid uptake and action showed that treatment induced STRA6 expression while expression of CRABP2 and FABP5 remained unchanged. Fenretinide also significantly decreased the endometriotic lesion xenograft volume. CONCLUSIONS Fenretinide increases STRA6 expression thereby potentially reversing the pathological loss of retinoid availability. Treatment with this compound induces apoptosis. In vivo treatments decrease lesion volume. Targeting the RA signaling pathway may be a promising novel treatment for women with endometriosis.
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Affiliation(s)
- Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Saurabh S Malpani
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew Dyson
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Julie Kim
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Serdar E Bulun
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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