1
|
Lai CP, Chen YS, Ying TH, Kao CY, Chiou HL, Kao SH, Hsieh YH. Melatonin acts synergistically with pazopanib against renal cell carcinoma cells through p38 mitogen-activated protein kinase-mediated mitochondrial and autophagic apoptosis. Kidney Res Clin Pract 2023; 42:487-500. [PMID: 37165617 PMCID: PMC10407642 DOI: 10.23876/j.krcp.22.114] [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: 06/03/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Mounting evidence indicates that melatonin has possible activity against different tumors. Pazopanib is an anticancer drug used to treat renal cell carcinoma (RCC). This study tested the anticancer activity of melatonin combined with pazopanib on RCC cells and explored the underlying mechanistic pathways of its action. METHODS The 786-O and A-498 human RCC cell lines were used as cell models. Cell viability and tumorigenesis were detected with the MTT and colony formation assays, respectively. Apoptosis and autophagy were assessed using TUNEL, annexin V/propidium iodide, and acridine orange staining with flow cytometry. The expression of cellular signaling proteins was investigated with western blotting. The in vivo growth of tumors derived from RCC cells was evaluated using a xenograft mouse model. RESULTS Together, melatonin and pazopanib reduced cell viability and colony formation and promoted the apoptosis of RCC cells. Furthermore, the combination of melatonin and pazopanib triggered more mitochondrial, caspase-mediated, and LC3-II-mediated autophagic apoptosis than melatonin or pazopanib alone. The combination also induced higher activation of the p38 mitogen-activated protein kinase (p38MAPK) in the promotion of autophagy and apoptosis by RCC cells than melatonin or pazopanib alone. Finally, tumor xenograft experiments confirmed that melatonin and pazopanib cooperatively inhibited RCC growth in vivo and predicted a possible interaction between melatonin/pazopanib and LC3-II. CONCLUSION The combination of melatonin and pazopanib inhibits the growth of RCC cells by inducing p38MAPK-mediated mitochondrial and autophagic apoptosis. Therefore, melatonin might be a potential adjuvant that could act synergistically with pazopanib for RCC treatment.
Collapse
Affiliation(s)
- Chien-Pin Lai
- Division of Nephrology, Department of Medicine, Chung-Kang Branch, Cheng Ching General Hospital, Taichung City, Taiwan
| | - Yong-Syuan Chen
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - Tsung-Ho Ying
- Department of Obstetrics and Gynecology, College of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Cheng-Yen Kao
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Ling Chiou
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Shao-Hsuan Kao
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Yi-Hsien Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung City, Taiwan
| |
Collapse
|
2
|
Pinto Á, Reig O, Iglesias C, Gallardo E, García-Del Muro X, Alonso T, Anguera G, Suárez C, Muñoz-Langa J, Villalobos-León L, Rodríguez-Sánchez Á, Lainez N, Martínez-Ortega E, Campayo M, Velastegui A, Rodriguez-Vida A, Villa-Guzmán JC, Méndez-Vidal MJ, Rubio G, García I, Capdevila L, Lambea J, Vázquez S, Fernández O, Hernando-Polo S, Cerezo S, Santander C, García-Marrero R, Zambrana F, González-Del Alba A, Lazaro-Quintela M, Castellano D, Chirivella I, Anido U, Viana A, García A, Sotelo M, Arévalo MG, García-Donas J, Hernández C, Bolós MV, Llinares J, Climent MA. Clinical Factors Associated With Long-Term Benefit in Patients With Metastatic Renal Cell Carcinoma Treated With Axitinib: Real-World AXILONG Study. Clin Genitourin Cancer 2021; 20:25-34. [PMID: 34789409 DOI: 10.1016/j.clgc.2021.09.006] [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: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Axitinib monotherapy obtained approval in pre-treated mRCC patients and recently in combination with pembrolizumab or avelumab in the first-line setting. However, patient profiles that may obtain increased benefit from this drug and its combinations still need to be identified. PATIENTS AND METHODS Retrospective multicentre analysis describing clinical characteristics associated with axitinib long-responder (LR) population by comparing two extreme-response sub-groups (progression-free survival [PFS] ≥9 months vs. disease progression/refractory patients [RP]). A multivariate logistic-regression model was used to analyse clinical factors. Efficacy and safety were also analysed. RESULTS In total, 157 patients who received axitinib in second or subsequent line were evaluated (91 LR and 66 RP). Older age at start of axitinib and haemoglobin levels > LLN were independent predictive factors for LR in multivariate analyses. In LR patients, median (m) PFS was 18.1 months, median overall survival was 36.0 months and objective response rate (ORR) was 45.5%. In 59 LR patients receiving axitinib in second-line, mPFS was 18.7 months, mOS was 44.8 months and ORR was 43.9%. mOS was significantly longer in second line compared to subsequent lines (44.8 vs. 26.5 months; P = .009). In LR vs. RP, mPFS with sunitinib in first-line was correlated with mPFS with axitinib in second-line (27.2 vs. 10.9 months P < .001). The safety profile was manageable and consistent with known data. CONCLUSIONS This study confirms the long-term benefits of axitinib in a selected population, helping clinicians to select the best sequential approach and patients who could obtain a greater benefit from axitinib.
Collapse
Affiliation(s)
- Álvaro Pinto
- Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Oscar Reig
- Medical Oncology Department, Hospital Clinic i Provincial, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Clara Iglesias
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida Roma, s/n, 33011 Oviedo, Spain
| | - Enrique Gallardo
- Medical Oncology Department, Hospital Universitario Parc Taulí de Sabadell, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain
| | - Xavier García-Del Muro
- Medical Oncology Department, Institut Català d'Oncologia Hospitalet, IDIBELL Institute of Researh, University of Barcelona, 1, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Alonso
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, 28034 Madrid, Spain
| | - Georgia Anguera
- Medical Oncology Department, Nou Hospital De La Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Cristina Suárez
- Medical Oncology Department, Hospital Universitario Vall de Hebrón, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - José Muñoz-Langa
- Medical Oncology Department, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Laura Villalobos-León
- Medical Oncology Department, Hospital Universitario Príncipe de Asturias, Carretera de Alcalá, s/n, 28805 Meco, Madrid, Spain
| | - Ángel Rodríguez-Sánchez
- Medical Oncology Department, Hospital Universitario de León, Calle Altos de Nava, s/n, 24071 León, Spain
| | - Nuria Lainez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Calle de Irunlarrea, 3, 31008 Pamplona, Spain
| | - Esther Martínez-Ortega
- Medical Oncology Department , Complejo Hospitalario de Jaén, Avenida del Ejército Español, 10, 23007 Jaén, Spain
| | - Marc Campayo
- Medical Oncology Department, Hospital Universitario MútuaTerrassa, Plaza del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Alejandro Velastegui
- Medical Oncology Department, Hospital Universitario Rey Juan Carlos, Calle Gladiolo, s/n, 28933 Móstoles, Madrid, Spain
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, Passeig Marítim 25-29, 08001, Barcelona, Spain
| | - José C Villa-Guzmán
- Medical Oncology Department, Hospital General Universitario de Ciudad Real General, Calle Obispo Rafael Torija, s/n, 13005 Ciudad Real, Spain
| | - Maria J Méndez-Vidal
- Medical Oncology Department, Hospital Universitario Reina Sofía, Avenida Menendez Pidal, 14004, Córdoba, Spain
| | - Gustavo Rubio
- Medical Oncology Department, Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos, 2, 28040, Madrid, Spain
| | - Iciar García
- Medical Oncology Department, Hospital Virgen de la Salud, Av. de Barber, 30, 45004 Toledo, Spain
| | - Laia Capdevila
- Medical Oncology Department, Hospital San Pablo y Santa Tecla, Rambla Vella, 14, 43003 Tarragona, Spain
| | - Julio Lambea
- Medical Oncology Department, Hospital Clínico Universitario Lozano Blesa, Avda, Calle de San Juan Bosco, 15, 50009 Zaragoza, Spain
| | - Sergio Vázquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Rúa Dr. Ulises Romero, 1, 27003 Lugo, Spain
| | - Ovidio Fernández
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Susana Hernando-Polo
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | - Sara Cerezo
- Medical Oncology Department, Hospital General La Mancha Centro, Av. Constitución, 3, 13600 Alcázar de San Juan, Ciudad Real, Spain
| | - Carmen Santander
- Medical Oncology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Rosa García-Marrero
- Medical Oncology Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Francisco Zambrana
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - Aranzazu González-Del Alba
- Medical Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Martin Lazaro-Quintela
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, 36213 Vigo, Spain
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Isabel Chirivella
- Medical Oncology Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - Urbano Anido
- Medical Oncology Department, Hospital Clínico Universitario de Santiago de Compostela, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - Antonio Viana
- Medical Oncology Department, Hospital Nuestra Señora del Prado, Carretera de Madrid Km. 114, 45600 Talavera de la Reina, Toledo, Spain
| | - Arancha García
- TFS Trial Form Support S.L., Passeig de Gràcia, 11, 08007 Barcelona, Spain
| | - Miguel Sotelo
- Medical Oncology Department, Hospital Universitario Infanta Cristina, Av. 9 de Junio, 2, 28981 Parla, Madrid, Spain
| | - María Garrido Arévalo
- Medical Oncology Department, Hospital Universitario Severo Ochoa, Av. de Orellana, s/n, 28911 Leganés, Madrid, Spain
| | - Jesús García-Donas
- Medical Oncology Department, Hospital Universitario Clara Campal, Calle de Oña, 10, 28050 Madrid, Spain
| | - Carolina Hernández
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Ctra. Gral. del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain
| | | | - Julia Llinares
- Pfizer S.L.U. Avenida de Europa, 20, 28108, Madrid, Spain
| | - Miguel A Climent
- Medical Oncology Department, Instituto Valenciano De Oncología, Carrer del Professor Beltrán Báguena, 8, 46009 Valencia, Spain
| |
Collapse
|
3
|
Wang B, Song JW, Chen HQ. First-Line Pazopanib Treatment in Metastatic Renal Cell Carcinoma: Real-World Data From a Single Chinese Center. Front Pharmacol 2020; 11:517672. [PMID: 33192500 PMCID: PMC7658599 DOI: 10.3389/fphar.2020.517672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
The response to pazopanib in patients with metastatic renal cell carcinoma (mRCC) has been found to differ in Western and Eastern populations. Here, we analyzed the efficacy and side effects of pazopanib as first-line therapy in 31 consecutive patients with mRCC who were treated at a single Chinese center. Thirty-one consecutive patients with mRCC (20 males and 11 females, median age 59 years) were treated with pazopanib between October 2017 and July 2019. All patients had received a pathological diagnosis of RCC by prior radical nephrectomy or biopsy. All cases were treated with pazopanib (800 mg/day orally) as first-line therapy. Administration was continued until disease progression or unacceptable toxicities occurred. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and safety were evaluated. Twenty-nine patients were eligible for final analysis. At the median follow-up of 12.7 months, 34.5% (10/29) patients achieved a partial response (PR), 41.4% (12/29) patients had stable disease (SD), seven (24.1%) patients had disease progression (PD), and one patient had died. The ORR and DCR were 34.5% and 75.9%, respectively, and the median PFS was 10.1 months (95% confidence interval, 4.1–17.7 months). OS could not be determined. The most common side effects were fatigue (11 cases, 37.9%), hand-foot syndrome (10 cases, 34.5%), change of hair color (10 cases, 34.5%), elevated alanine transaminase (ALT)/aspartate transaminase (AST) (10 cases, 34.5%), hypertension (seven cases, 24.1%), neutropenia (three cases, 10.3%), anemia (three cases, 10.3%), thrombocytopenia (two cases, 6.9%), and diarrhea (one cases, 3.4%). Major (grade 3 or higher) adverse events included hand-foot syndrome (two cases, 6.9%) and thrombocytopenia (one case, 3.4%). Most adverse events were ameliorated by dose reduction or treatment interruption. Remissions occurred in almost all patients with local recurrence or pulmonary metastases, whereas PD occurred in patients with bone, liver or brain metastases. Our real-world data suggest that pazopanib is definitely efficacious as first-line therapy for mRCC, with well-tolerated side effects. Different metastatic lesions may have different sensitivity to pazopanib. An additional, large sample, multicenter, prospective study is needed to confirm our results.
Collapse
Affiliation(s)
- Bin Wang
- Department of Urology, Shanxi Cancer Hospital, Taiyuan, China
| | - Ji-Wen Song
- Department of Urology, Shanxi Cancer Hospital, Taiyuan, China
| | - Hui-Qing Chen
- Department of Urology, Shanxi Cancer Hospital, Taiyuan, China
| |
Collapse
|
4
|
Tsironis G, Liontos M, Kyriazoglou A, Koutsoukos K, Tsiara A, Kaparelou M, Zakopoulou R, Cohen A, Skafida E, Fontara S, Zagouri F, Bamias A, Dimopoulos MA. Axitinib as a third or further line of treatment in renal cancer: a single institution experience. BMC Urol 2020; 20:60. [PMID: 32487200 PMCID: PMC7265645 DOI: 10.1186/s12894-020-00618-1] [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: 01/12/2020] [Accepted: 04/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney cancer is a lethal neoplasm that affects several thousands of people every year. Renal cell carcinoma (RCC) is the most common histologic type. Recent developments in the therapeutic approach include antiangiogenic targeted approaches and Immunotherapy. Thus, the therapeutic algorithm of RCC patients and the survival outcomes have changed dramatically. METHODS Herein we present a retrospective study of the patients treated in our Department with an antiangiogenic agent -Axitinib, a tyrosine kinase inhibitor- as a third or further line treatment. Statistical analysis was performed with SPSS, including the available clinicopathological data of the patients included. RESULTS Axitinib was found to be active in patients who received this treatment beyond second line. The toxicity profile of this regimen did not reveal any unknown adverse events. CONCLUSIONS Our real world data reflect that axitinib is a safe and effective option, even beyond the second line.
Collapse
Affiliation(s)
- G Tsironis
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M Liontos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Kyriazoglou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece.
| | - K Koutsoukos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Tsiara
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M Kaparelou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - R Zakopoulou
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Cohen
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - E Skafida
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - S Fontara
- 1st Department of Radiology, Aretaieio University hospital, Athens, Greece
| | - F Zagouri
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - A Bamias
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - M A Dimopoulos
- Oncology Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| |
Collapse
|
5
|
Xu Y, Zhang Y, Wang X, Kang J, Liu X. Prognostic value of performance status in metastatic renal cell carcinoma patients receiving tyrosine kinase inhibitors: a systematic review and meta-analysis. BMC Cancer 2019; 19:168. [PMID: 30795756 PMCID: PMC6385458 DOI: 10.1186/s12885-019-5375-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 02/18/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The association between performance status (PS) and the prognosis of metastatic renal cell carcinoma (mRCC) patients receiving tyrosine kinase inhibitors (TKIs) remains controversial. The aim of this study is to evaluate the prognostic value of PS in mRCC patients treated with TKIs. METHODS Electronic databases were searched to identify the studies that had assessed the association between pretreatment PS and prognosis in mRCC patients receiving TKIs. Hazard ratios (HRs) and 95% confidence interval (CI) for overall survival (OS) and progression-free survival (PFS) from eligible studies were used to calculate combined HRs. The heterogeneity across the included studies was assessed by Cochrane's Q test and I2 statistic. The Begg's funnel plot and Egger's linear regression teats were used to evaluate the potential publication bias. The meta-analysis was performed with RevMan 5.3 and Stata SE12.0 according to the PRISMA guidelines. RESULTS A total of 6780 patients from 19 studies were included in this meta-analysis. The results showed that a poor PS was an effective prognostic factor of both OS (pooled HR: 2.08, 95% CI: 1.78-2.45) and PFS (pooled HR: 1.51, 95% CI: 1.20-1.91). Subgroup analysis revealed that poor PS significantly associated with poor OS and PFS in studies using Karnofsky PS scale (OS, pooled HR: 2.20, 95% CI: 1.65-2.94; PFS, pooled HR: 1.74, 95% CI: 1.19-2.56), conducted in Asia (OS, pooled HR: 2.25, 95% CI: 1.71-2.95; PFS, pooled HR: 1.73, 95% CI: 1.14-2.64) and Newcastle-Ottawa Scale score of 8 (OS, pooled HR: 2.61, 95% CI: 1.92-3.55; PFS, pooled HR: 2.43, 95% CI: 1.36-4.33). CONCLUSIONS This study suggests that a poor PS is significantly associated with poor prognosis in mRCC patients receiving TKIs.
Collapse
Affiliation(s)
- Yawei Xu
- Department of Urology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Yuanyuan Zhang
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xianhao Wang
- Department of Urology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Jiaqi Kang
- Department of Urology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, China.
| |
Collapse
|