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Muñoz-Montaño W, Muñiz-Hernández S, Avilés-Salas A, Catalán R, Lara-Mejía L, Samtani-Bassarmal S, Cardona AF, Mendoza-Desión J, Hernández-Cueto D, Maldonado A, Baay-Guzmán G, Huerta-Yepes S, Arrieta O. RRM1 and ERCC1 as biomarkers in patients with locally advanced and metastatic malignant pleural mesothelioma treated with continuous infusion of low-dose gemcitabine plus cisplatin. BMC Cancer 2021; 21:892. [PMID: 34353292 PMCID: PMC8340445 DOI: 10.1186/s12885-021-08287-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/04/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Malignant Pleural Mesothelioma (MPM) is a rare but aggressive neoplasia that usually presents at advanced stages. Even though some advances have been achieved in the management of patients with MPM, this malignancy continuous to impose a deleterious prognosis for affected patients (12-18 months as median survival, and 5-10% 5-year survival rate), accordingly, the recognition of biomarkers that allow us to select the most appropriate therapy are necessary. METHODS Immunohistochemistry semi-quantitative analysis was performed to evaluate four different biomarkers (ERCC1, RRM1, RRM2, and hENT-1) with the intent to explore if any of them was useful to predict response to treatment with continuous infusion gemcitabine plus cisplatin. Tissue biopsies from patients with locally advanced or metastatic MPM were analyzed to quantitatively asses the aforementioned biomarkers. Every included patient received treatment with low-dose gemcitabine (250 mg/m2) in a 6-h continuous infusion plus cisplatin 35 mg/m2 on days 1 and 8 every 3 weeks as first-line therapy. RESULTS From the 70 eligible patients, the mean and standard deviation (SD) for ERCC1, RRM1, RRM2 and hENT-1 were 286,178.3 (± 219, 019.8); 104,647.1 (± 65, 773.4); 4536.5 (± 5, 521.3); and 2458.7 (± 4, 983.4), respectively. Patients with high expression of RRM1 had an increased median PFS compared with those with lower expression (9.5 vs 4.8 months, p = < 0.001). Furthermore, high expression of RRM1 and ERCC1 were associated with an increased median OS compared with their lower expression counterparts; [(23.1 vs 7.2 months for RRM1 p = < 0.001) and (17.4 vs 9.8 months for ERCC1 p = 0.018)]. CONCLUSIONS ERCC1 and RRM1 are useful biomarkers that predict better survival outcomes in patients with advanced MPM treated with continuous infusion of gemcitabine plus cisplatin.
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Affiliation(s)
- Wendy Muñoz-Montaño
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, San Fernando 22 Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Sae Muñiz-Hernández
- Laboratory of Personalized Medicine, Instituto Nacional de Cancerología, San Fernando 22 Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
| | | | - Rodrigo Catalán
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, San Fernando 22 Sección XVI, Tlalpan, 14080, Mexico City, Mexico.,Laboratory of Personalized Medicine, Instituto Nacional de Cancerología, San Fernando 22 Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Luis Lara-Mejía
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, San Fernando 22 Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | | | - Andres F Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia.,Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Jorge Mendoza-Desión
- Laboratory of Personalized Medicine, Instituto Nacional de Cancerología, San Fernando 22 Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Daniel Hernández-Cueto
- Molecular Markers Laboratory, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City, Mexico
| | - Altagracia Maldonado
- Molecular Markers Laboratory, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City, Mexico
| | - Guillermina Baay-Guzmán
- Molecular Markers Laboratory, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City, Mexico
| | - Sara Huerta-Yepes
- Molecular Markers Laboratory, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City, Mexico
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, San Fernando 22 Sección XVI, Tlalpan, 14080, Mexico City, Mexico. .,Laboratory of Personalized Medicine, Instituto Nacional de Cancerología, San Fernando 22 Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
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2
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Fuso Nerini I, Roca E, Mannarino L, Grosso F, Frapolli R, D'Incalci M. Is DNA repair a potential target for effective therapies against malignant mesothelioma? Cancer Treat Rev 2020; 90:102101. [PMID: 32892058 DOI: 10.1016/j.ctrv.2020.102101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/29/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a rare malignancy mainly caused by asbestos exposure. Germinal and acquired mutations in genes of DNA repair pathways, in particular of homologous recombination repair, are frequent in MPM. Here we overview the available experimental data suggesting that an impaired DNA repair system affects MPM pathogenesis by leaving lesions through the genome unresolved. DNA repair defects represent a vulnerability of MPM, and it seems plausible to propose that leveraging these deficiencies could have therapeutic potential for patients with MPM, for whom there is an urgent need of more effective therapies.
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Affiliation(s)
- Ilaria Fuso Nerini
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Elisa Roca
- Lung Unit, Thoracic Oncology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Laura Mannarino
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Federica Grosso
- Mesothelioma Unit, SS Antonio and Biagio General Hospital, Alessandria, Italy
| | - Roberta Frapolli
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio D'Incalci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
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Rojas L, Cardona AF, Trejo-Rosales R, Zatarain-Barrón ZL, Ramírez-Tirado LA, Ruiz-Patiño A, Campos Gómez S, Corrales L, Oblitas G, Bacon L, Martín C, de Lima VCC, Freitas HC, Mas L, Vargas C, Carranza H, Otero J, Pérez MA, González L, Chirinos L, Granados ST, Rodriguez J, Báez R, Remolina Bonilla YA, Núñez Cerrillo G, Archila P, Cuello M, Karachaliou N, Rosell R, Arrieta O. Characteristics and long-term outcomes of advanced pleural mesothelioma in Latin America (MeSO-CLICaP). Thorac Cancer 2019; 10:508-518. [PMID: 30706690 PMCID: PMC6397921 DOI: 10.1111/1759-7714.12967] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/27/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is an aggressive tumor, associated with poor prognosis. There is a lack of information about the clinical and pathological features related with survival in the Latin American population. Methods The MeSO‐CLICaP registry identified 302 patients with advanced MPM diagnosed and treated between January 2008 and March 2016. The Cox model was applied to determine the variables associated with survival. A random forest tree model was built to predict the response to first‐line chemotherapy among Latin American patients. Results The median age was 61.1 years (SD 10.6 years), 191 (63.2%) were men, 65.9% were ever smokers, and 38.7% had previous exposure to asbestos. A total of 237 (78.5%) had epithelioid tumors, and 188 (62.3%) and 114 (37.7%) cases had stage III or IV MPM, respectively. A total of 49 patients (16.2%) underwent pleurectomy, 57 (18.9%) received radiotherapy, and 279 patients received first‐line platinum‐based chemotherapy. The overall response rate to first‐line chemotherapy was 40.4%, progression‐free survival to first‐line treatment was 5.7 months (95% CI 4.9–6.5), and 63 (20.8%) patients had pemetrexed maintenance. The median overall survival was 16.8 months (95% CI 13.0–20.5), and multivariate analysis found that stage (P = 0.013), and pleurodesis (P = 0.048), were independent prognostic factors for first‐line overall survival. The model to predict response to first‐line chemotherapy obtained a 0.98 area under the curve, a sensitivity of 93%, and a specificity of 95% for detecting responders and non‐responders. Conclusion This study identifies factors associated with clinical benefit from chemotherapy among advanced MPM Latin American patients, emphasizing the impact of histology and the clinical benefit of chemotherapy on outcomes.
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Affiliation(s)
- Leonardo Rojas
- Clinical Oncology Department, Organización Sanitas Internacional, University Clinic Colombia, Bogota, Colombia.,Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia
| | - Andrés F Cardona
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | | | | | | | | | - Saúl Campos Gómez
- Medical Oncology Department, State Oncology Center ISSEMyM, Toluca, Mexico
| | - Luis Corrales
- Oncology Department, San Juan de Dios Hospital, San José Costa Rica, Costa Rica
| | | | - Ludwing Bacon
- Oncology Department, Roberto Calderón Hospital, Managua, Nicaragua
| | - Claudio Martín
- Thoracic Oncology Section, Alexander Fleming Institute, Buenos Aires, Argentina
| | | | - Helano C Freitas
- Medical Oncology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Luis Mas
- Clinical Oncology Department, Naiional Institute for Neoplastic Diseases - INEN, Lima, Peru
| | - Carlos Vargas
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Hernán Carranza
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Jorge Otero
- Clinical and Traslational Oncology Group, Country Clinic, Bogota, Colombia.,Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | | | | | | | - Sara T Granados
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia
| | - July Rodriguez
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Renata Báez
- National Institute for Respiratory Diseases, Mexico City, Mexico
| | | | | | - Pilar Archila
- Foundation for Clinical and Applied Cancer Research - FICMAC, Bogota, Colombia.,Clinical Research and Biology Systems Department, El Bosque University, Bogotá, Colombia
| | - Mauricio Cuello
- Hospital de Clínicas, Republic University - UdeLAR, Montevideo, Uruguay
| | - Niki Karachaliou
- Dr. Rosell Oncology Institute (IOR), Catalan Institute of Oncology, Barcelona, Spain
| | - Rafael Rosell
- Dr. Rosell Oncology Institute (IOR), Catalan Institute of Oncology, Barcelona, Spain
| | - Oscar Arrieta
- Thoracic Oncology Unit, National Cancer Institute, Mexico City, Mexico
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Abstract
One particular approach of multimodality treatment for mesothelioma is induction therapy followed by surgery. Among its several advantages, the most important is downstaging of the tumor into a resectable stage, although morbidity and mortality might be increased. In this article we review the principles and outcome of different modalities for induction treatment of mesothelioma.
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Affiliation(s)
- Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland..
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Frischknecht L, Meerang M, Soltermann A, Stahel R, Moch H, Seifert B, Weder W, Opitz I. Importance of excision repair cross-complementation group 1 and ribonucleotide reductase M1 as prognostic biomarkers in malignant pleural mesothelioma treated with platinum-based induction chemotherapy followed by surgery. J Thorac Cardiovasc Surg 2015; 149:1539-46.e1. [PMID: 25840756 DOI: 10.1016/j.jtcvs.2015.01.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 12/11/2014] [Accepted: 01/23/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Survival and response to platinum-based induction chemotherapy are heterogeneous among patients with malignant pleural mesothelioma. The aim of the present study was to assess the prognostic role of DNA repair markers, such as excision repair cross-complementation group 1 and ribonucleotide reductase M1, in multimodally treated patients with malignant pleural mesothelioma. METHODS Tumor tissue of a malignant pleural mesothelioma cohort (n = 107) treated with platinum/gemcitabine (n = 46) or platinum/pemetrexed (n = 61) induction chemotherapy followed by extrapleural pneumonectomy was assembled on a tissue microarray. Immunohistochemical expression of excision repair cross-complementation group 1 (nuclear) and ribonucleotide reductase M1 (nuclear and cytoplasmic) was assessed for its prognostic impact (association with overall survival or freedom from recurrence). RESULTS Patients with high nuclear ribonucleotide reductase M1 expression before chemotherapy showed significantly longer freedom from recurrence (P = .03). When specifically analyzed in the subgroup of patients receiving platinum/gemcitabine followed by extrapleural pneumonectomy, high nuclear ribonucleotide reductase M1 was associated with prolonged freedom from recurrence (P = .03) and overall survival (P = .02). Low excision repair cross-complementation group 1 expression in prechemotherapy tumor tissues was associated with significantly longer freedom from recurrence (P = .04). Nuclear ribonucleotide reductase M1 and excision repair cross-complementation group 1 were independent prognosticators of freedom from recurrence in addition to pT stage in multivariate analysis. CONCLUSIONS In the present study, nuclear ribonucleotide reductase M1 and excision repair cross-complementation group 1 expression were identified as independent prognosticators for freedom from recurrence of malignant pleural mesothelioma in patients undergoing induction chemotherapy followed by extrapleural pneumonectomy.
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Affiliation(s)
- Lukas Frischknecht
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Mayura Meerang
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alex Soltermann
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Stahel
- Laboratory of Molecular Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, ISPM, University Zurich, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
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6
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Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales. Br J Cancer 2014; 111:1860-9. [PMID: 25188323 PMCID: PMC4453733 DOI: 10.1038/bjc.2014.478] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/29/2014] [Accepted: 08/07/2014] [Indexed: 12/29/2022] Open
Abstract
Background: Although the prognosis of most patients presenting with malignant pleural mesothelioma (MPM) is poor, a small proportion survives long term. We investigated factors associated with survival in a large patient series. Methods: All patients registered with the NSW Dust Diseases Board (2002–2009) were included in an analysis of prognostic factors using Kaplan–Meier and Cox regression analysis. On the basis of these analyses, we developed a risk score (Prognostic Index (PI)). Results: We identified 910 patients: 90% male; histology (epithelioid 60% biphasic 13% sarcomatoid 17%); stage (Tx-I-II 48% III-IV 52%); and calretinin expression (91%). Treatment: chemotherapy(CT) 44%, and extrapleural-pneumonectomy (EPP) 6%. Median overall survival (OS) was 10.0 months. Longer OS was associated with: age <70 (13.5 vs 8.5 months; P<0.001); female gender (12.0 vs 9.9 months; P<0.001); epithelioid subtype (13.3 vs 6.2 months; P<0.001); ECOG status 0 (27.4 vs 9.7 months; P=0.015), calretinin expression (10.9 vs 5.5 months; P<0.001); neutrophil–lymphocyte ratio (NLR) <5 (11.9 vs 7.5 months; P<0.001); platelet count <400 (11.5 vs 7.2 months; P<0.001); and normal haemoglobin (16.4 vs 8.8 months; P<0.001). On time-dependent analysis, patients receiving pemetrexed-based chemotherapy (HR=0.83; P=0.048) or EPP (HR=0.41; P<0.001) had improved survival. Age, gender, histology, calretinin and haematological factors remained significant on multivariate analysis. In all, 24% of patients survived >20 months: 16% of these receiving EPP, and 66% CT. The PI offered improved prognostic discrimination over one of the existing prognostic models (EORTC). Conclusions: We identified calretinin expression, age, gender, histological subtype, platelet count and haemoglobin level as independent prognostic factors. Patients undergoing EPP or pemetrexed-based chemotherapy demonstrated better survival, but 84% and 34% of long survivors, respectively, did not receive radical surgery or chemotherapy.
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7
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High liposomal doxorubicin tumour tissue distribution, as determined by radiopharmaceutical labelling with (99m)Tc-LD, is associated with the response and survival of patients with unresectable pleural mesothelioma treated with a combination of liposomal doxorubicin and cisplatin. Cancer Chemother Pharmacol 2014; 74:211-5. [PMID: 24817602 DOI: 10.1007/s00280-014-2477-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND There are currently no available biomarkers for advanced pleural mesothelioma that determine which patients could benefit from a specific chemotherapy regimen. METHODS Based on the results of a previously published phase II study, we associated the (99m)Technetium-labelled liposomal doxorubicin ((99m)Tc-LD) uptake value (75 % cut-off) with the response rate, progression-free survival and overall survival of patients treated with a combination of liposomal doxorubicin and cisplatin. RESULTS Patients with tumours exhibiting increased (99m)Tc-LD uptake showed better response rates, progression-free survival and overall survival than those exhibiting lower uptake 73.3 versus 15 % (p < 0.001); 6.9 versus 3.2 months (p = 0.033) and 23 versus 6.6 months (p = 0.001), respectively. CONCLUSION (99m)Tc-DL uptake in tumour tissue could define a set of patients who would benefit from this chemotherapy regimen.
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Linton A, Cheng YY, Griggs K, Kirschner MB, Gattani S, Srikaran S, Chuan-Hao Kao S, McCaughan BC, Klebe S, van Zandwijk N, Reid G. An RNAi-based screen reveals PLK1, CDK1 and NDC80 as potential therapeutic targets in malignant pleural mesothelioma. Br J Cancer 2014; 110:510-9. [PMID: 24327015 PMCID: PMC3899767 DOI: 10.1038/bjc.2013.731] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/14/2013] [Accepted: 10/25/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is an aggressive tumour originating in the thoracic mesothelium. Prognosis remains poor with 9- to 12-month median survival, and new targets for treatments are desperately needed. METHODS Utilising an RNA interference (RNAi)-based screen of 40 genes overexpressed in tumours, including genes involved in the control of cell cycle, DNA replication and repair, we investigated potential therapeutic targets for MPM. Following in vitro characterisation of the effects of target silencing on MPM cells, candidates were assessed in tumour samples from 154 patients. RESULTS Gene knockdown in MPM cell lines identified growth inhibition following knockdown of NDC80, CDK1 and PLK1. Target knockdown induced cell-cycle arrest and increased apoptosis. Using small-molecule inhibitors specific for these three proteins also led to growth inhibition of MPM cell lines, and Roscovitine (inhibitor of CDK1) sensitised cells to cisplatin. Protein expression was also measured in tumour samples, with markedly variable levels of CDK1 and PLK1 noted. PLK1 expression in over 10% of cells correlated significantly with a poor prognosis. CONCLUSION These results suggest that RNAi-based screening has utility in identifying new targets for MPM, and that inhibition of NDC80, CDK1 and PLK1 may hold promise for treatment of this disease.
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Affiliation(s)
- A Linton
- Asbestos Diseases Research Institute (ADRI), University of Sydney, Concord, NSW 2139, Australia
| | - Y Y Cheng
- Asbestos Diseases Research Institute (ADRI), University of Sydney, Concord, NSW 2139, Australia
| | - K Griggs
- Department of Anatomical Pathology, Flinders Medical Centre, Bedford, SA, Australia
| | - M B Kirschner
- Asbestos Diseases Research Institute (ADRI), University of Sydney, Concord, NSW 2139, Australia
| | - S Gattani
- Asbestos Diseases Research Institute (ADRI), University of Sydney, Concord, NSW 2139, Australia
| | - S Srikaran
- Asbestos Diseases Research Institute (ADRI), University of Sydney, Concord, NSW 2139, Australia
| | - S Chuan-Hao Kao
- Asbestos Diseases Research Institute (ADRI), University of Sydney, Concord, NSW 2139, Australia
| | - B C McCaughan
- Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute and Sydney Medical School, University of Sydney, Sydney, Australia
| | - S Klebe
- Department of Anatomical Pathology, Flinders Medical Centre, Bedford, SA, Australia
| | - N van Zandwijk
- Asbestos Diseases Research Institute (ADRI), University of Sydney, Concord, NSW 2139, Australia
| | - G Reid
- Asbestos Diseases Research Institute (ADRI), University of Sydney, Concord, NSW 2139, Australia
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