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Font A, Ruiz de Porras V, Valderrama BP, Ramirez JL, Nonell L, Virizuela JA, Anido U, González-del-Alba A, Lainez N, Llorente MDM, Jiménez N, Mellado B, García-Donas J, Bellmunt J. Epithelial-to-Mesenchymal Transition Mediates Resistance to Maintenance Therapy with Vinflunine in Advanced Urothelial Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13246235. [PMID: 34944855 PMCID: PMC8699401 DOI: 10.3390/cancers13246235] [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: 11/02/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Platinum-based chemotherapy is the first-line treatment for advanced urothelial cell carcinoma (aUCC). After first-line treatment, we previously showed that maintenance therapy with vinflunine improves progression-free survival. However, some patients are resistant to vinflunine and the specific mechanisms of resistance in aUCC are unclear. We analyzed the genomic landscape and the biological processes potentially related to vinflunine activity and found that epithelial-to-mesenchymal transition (EMT) plays a pivotal role as a resistance mechanism. In experiments with cell lines, curcumin reversed EMT and sensitized cells to vinflunine. We suggest that EMT mediates resistance to vinflunine and that the reversion of this process could enhance the effect of vinflunine in aUCC patients. Abstract In the phase II MAJA trial, maintenance therapy with vinflunine resulted in longer progression-free survival compared to best supportive care in advanced urothelial cell carcinoma (aUCC) patients who did not progress after first-line platinum-based chemotherapy. However, despite an initial benefit observed in some patients, unequivocal resistance appears which underlying mechanisms are presently unknown. We have performed gene expression and functional enrichment analyses to shed light on the discovery of these underlying resistance mechanisms. Differential gene expression profile of eight patients with poor outcome and nine with good outcome to vinflunine administered in the MAJA trial were analyzed. RNA was isolated from tumor tissue and gene expression was assessed by microarray. Differential expression was determined with linear models for microarray data. Gene Set Enrichment Analysis (GSEA) was used for the functional classification of the genes. In vitro functional studies were performed using UCC cell lines. Hierarchical clustering showed a differential gene expression pattern between patients with good and poor outcome to vinflunine treatment. GSEA identified epithelial-to-mesenchymal transition (EMT) as the top negatively enriched hallmark in patients with good outcome. In vitro analyses showed that the polyphenol curcumin downregulated EMT markers and sensitized UCC cells to vinflunine. We conclude that EMT mediates resistance to vinflunine and suggest that the reversion of this process could enhance the effect of vinflunine in aUCC patients.
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Affiliation(s)
- Albert Font
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Germans Trias i Pujol, Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain;
- Catalan Institute of Oncology, Badalona Applied Research Group in Oncology (B·ARGO), Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain;
| | - Vicenç Ruiz de Porras
- Catalan Institute of Oncology, Badalona Applied Research Group in Oncology (B·ARGO), Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain;
- Germans Trias i Pujol Research Institute (IGTP), Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain
| | - Begoña P. Valderrama
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
| | - Jose Luis Ramirez
- Department of Haematology, Catalan Institute of Oncology, University Hospital Germans Trias i Pujol, Ctra. Can Ruti-Camí de les Escoles s/n, 08916 Badalona, Spain;
| | - Lara Nonell
- MARGenomics, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
| | - José Antonio Virizuela
- Department of Medical Oncology, Hospital Universitario Virgen de Macarena, 41009 Seville, Spain;
| | - Urbano Anido
- Department of Medical Oncology, Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | - Aránzazu González-del-Alba
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, 28222 Madrid, Spain;
| | - Nuria Lainez
- Department of Medical Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Maria del Mar Llorente
- Department of Medical Oncology, Hospital General Universitario de Elda, 03600 Alicante, Spain;
| | - Natalia Jiménez
- Translational Genomics and Targeted Therapeutics in Solid Tumors Laboratory, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
| | - Begoña Mellado
- Department of Medical Oncology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Jesus García-Donas
- Division of Medical Oncology, HM Hospitales-Centro Integral Oncológico Hospital de Madrid Clara Campal, 28050 Madrid, Spain
- Correspondence: (J.G.D.); (J.B.)
| | - Joaquim Bellmunt
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Correspondence: (J.G.D.); (J.B.)
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Final Overall Survival Analysis of the SOGUG Phase 2 MAJA Study: Maintenance Vinflunine Versus Best Supportive Care After First-Line Chemotherapy in Advanced Urothelial Carcinoma. Clin Genitourin Cancer 2020; 18:452-460. [DOI: 10.1016/j.clgc.2020.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 01/10/2023]
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Aoun F, Rassy EE, Assi T, Albisinni S, Katan J. Advances in urothelial bladder cancer immunotherapy, dawn of a new age of treatment. Immunotherapy 2017; 9:451-460. [PMID: 28357911 DOI: 10.2217/imt-2017-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Urothelial bladder cancer displays a high number of somatic mutations that render these tumors more responsive to immunotherapy. Several immunotherapeutic agents were examined in patients with advanced stage urothelial bladder cancer and recently atezolizumab - an (PDL-1) immune checkpoint inhibitor antibody - was approved for the treatment of patients with metastatic disease progressing after platinum combination therapy. Despite the great success, there are still some unanswered questions and ongoing trials that are in progress to define the role of combination therapy and sequencing strategies. The objective of our manuscript is to summarize the most recent data on immunotherapy in advanced urothelial cancer. Current challenges and future perspectives of immunotherapy as a monotherapy or in combination strategies will also be analyzed.
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Affiliation(s)
- Fouad Aoun
- Department of Urology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon.,Department of Urology, Jules Bordet Institute, 1 Rue Héger Bordet, 1000 Brussels, Belgium
| | - Elie El Rassy
- Department of Oncology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
| | - Tarek Assi
- Department of Oncology, Gustave Roussy Institute, Paris, France
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute, 1 Rue Héger Bordet, 1000 Brussels, Belgium
| | - Joseph Katan
- Department of Oncology, Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon
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Maintenance therapy with vinflunine plus best supportive care versus best supportive care alone in patients with advanced urothelial carcinoma with a response after first-line chemotherapy (MAJA; SOGUG 2011/02): a multicentre, randomised, controlled, open-label, phase 2 trial. Lancet Oncol 2017; 18:672-681a. [DOI: 10.1016/s1470-2045(17)30242-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023]
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