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Kim DH, Lee S, Kang HG, Park HW, Lee HW, Kim D, Yoem DH, Ahn JH, Ha E, You WK, Lee SH, Kim SJ, Chun KH. Synergistic antitumor activity of a DLL4/VEGF bispecific therapeutic antibody in combination with irinotecan in gastric cancer. BMB Rep 2020. [PMID: 32580836 PMCID: PMC7607148 DOI: 10.5483/bmbrep.2020.53.10.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Notch signaling has been identified as a critical pathway in gastric cancer (GC) progression and metastasis, and inhibition of Delta-like ligand 4 (DLL4), a Notch ligand, is suggested as a potent therapeutic approach for GC. Expression of both DLL4 and vascular endothelial growth factor receptor 2 (VEGFR2) was similar in the malignant tissues of GC patients. We focused on vascular endothelial growth factor (VEGF), a known angiogenesis regulator and activator of DLL4. Here, we used ABL001, a DLL4/VEGF bispecific therapeutic antibody, and investigated its therapeutic effect in GC. Treatment with human DLL4 therapeutic antibody (anti-hDLL4) or ABL001 slightly reduced GC cell growth in monolayer culture; however, they significantly inhibited cell growth in 3D-culture, suggesting a reduction in the cancer stem cell population. Treatment with anti-hDLL4 or ABL001 also decreased GC cell migration and invasion. Moreover, the combined treatment of irinotecan with anti-hDLL4 or ABL001 showed synergistic antitumor activity. Both combination treatments further reduced cell growth in 3D-culture as well as cell invasion. Interestingly, the combination treatment of ABL001 with irinotecan synergistically reduced the GC burden in both xenograft and orthotopic mouse models. Collectively, DLL4 inhibition significantly decreased cell motility and stem-like phenotype and the combination treatment of DLL4/VEGF bispecific therapeutic antibody with irinotecan synergistically reduced the GC burden in mouse models. Our data suggest that ABL001 potentially represents a potent agent in GC therapy. Further biochemical and pre-clinical studies are needed for its application in the clinic.
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Affiliation(s)
- Da-Hyun Kim
- Department of Biochemistry & Molecular Biology, Yonsei University College of Medicine, Goyang 10408, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Goyang 10408, Korea
| | - Seul Lee
- Department of Biochemistry & Molecular Biology, Yonsei University College of Medicine, Goyang 10408, Korea
| | - Hyeok Gu Kang
- Department of Biochemistry & Molecular Biology, Yonsei University College of Medicine, Goyang 10408, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Goyang 10408, Korea
| | - Hyun-Woo Park
- Department of Biochemistry, College of Life Science, Yonsei University, Seoul 03722, Korea
| | - Han-Woong Lee
- Department of Biochemistry, College of Life Science, Yonsei University, Seoul 03722, Korea
| | - Dongin Kim
- R&D center, ABL Bio Inc., Seongnam 13488, Korea
| | | | | | - Eunsin Ha
- R&D center, ABL Bio Inc., Seongnam 13488, Korea
- National OncoVenture, National Cancer Center, Goyang 10408, Korea
| | | | | | - Seok-Jun Kim
- Department of Biomedical Science, College of Natural Science, Chosun University, Goyang 10408, Korea
- Brain Korea 21 Plus Research Team for Bioactive Control Technology, College of Natural Sciences, Chosun University, Gwangju 61452, Korea
- Corresponding authors. Seok-Jun Kim, Tel: +82-62-230-6664; Fax: +82-62-234-4326; E-mail: ; Kyung-Hee Chun, Tel: +82-2-2228-1699; Fax: +82-2-312-5041; E-mail:
| | - Kyung-Hee Chun
- Department of Biochemistry & Molecular Biology, Yonsei University College of Medicine, Goyang 10408, Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Goyang 10408, Korea
- Corresponding authors. Seok-Jun Kim, Tel: +82-62-230-6664; Fax: +82-62-234-4326; E-mail: ; Kyung-Hee Chun, Tel: +82-2-2228-1699; Fax: +82-2-312-5041; E-mail:
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Li Q, Chen J, Zhao X, Yin X, Mei K, Zhou C, Cai X. A Pilot Study of Irinotecan Combined with 5-Fluorouracil and Leucovorin for the Treatment of Chinese Patients with Locally Advanced and Metastatic Gastric Cancer. TUMORI JOURNAL 2018; 95:432-7. [DOI: 10.1177/030089160909500404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aims and background The FOLFIRI regimen was evaluated for its anti-tumor activity and toxicity in Chinese patients with locally advanced and metastatic gastric cancer. Methods and study design Treatment consisted of irinotecan, 180 mg/m2 (90-min infusion), leucovorin, 200 mg/m2 (2-h infusion), followed by 5-fluorouracil, 400 mg/m2 (bolus), and then 5-fluorouracil, 600 mg/m2 (22-h continuous infusion) on days 1 and 2, every 14 days. Results Twenty-six patients, of whom 17 were pretreated, were included in the study. Partial response was observed in 9 patients (37.5%). The overall disease control rate was 83.3%. Median progression-free and overall survival was 6.8 and 11.2 months, respectively. Grade 3–4 neutropenia was observed in 6 patients (23.1%) and grade 2–3 diarrhea in 5 (19.2%). No treatment-related deaths occurred. Conclusions The results demonstrate that the FOLFIRI regimen is an active regimen with acceptable toxicity for Chinese patients with advanced and metastatic gastric cancer that merits further investigation in comparative trials.
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Affiliation(s)
- Qiu Li
- Department of Abdominal Cancer, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University
| | - Jing Chen
- Oncology Department, Sichuan Cancer Hospital, Sichuan The People's Republic of China
| | - Xin Zhao
- Oncology Department, Sichuan Cancer Hospital, Sichuan The People's Republic of China
| | - Xude Yin
- Oncology Department, Sichuan Cancer Hospital, Sichuan The People's Republic of China
| | - Kai Mei
- Oncology Department, Sichuan Cancer Hospital, Sichuan The People's Republic of China
| | - Chengya Zhou
- Oncology Department, Sichuan Cancer Hospital, Sichuan The People's Republic of China
| | - Xiaohong Cai
- Oncology Department, Sichuan Cancer Hospital, Sichuan The People's Republic of China
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Chen YL, Chueh FS, Yang JS, Hsueh SC, Lu CC, Chiang JH, Lee CS, Lu HF, Chung JG. Antitumor effects with apoptotic death in human promyelocytic leukemia HL-60 cells and suppression of leukemia xenograft tumor growth by irinotecan HCl. ENVIRONMENTAL TOXICOLOGY 2015; 30:803-815. [PMID: 24474168 DOI: 10.1002/tox.21959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 01/09/2014] [Indexed: 06/03/2023]
Abstract
Irinotecan HCl (CPT-11) is an anticancer prodrug, but there is no available information addressing CPT-11-inhibited leukemia cells in in vitro and in vivo studies. Therefore, we investigated the cytotoxic effects of CPT-11 in promyelocytic leukemia HL-60 cells and in vivo and tumor growth in a leukemia xenograft model. Effects of CPT-11 on HL-60 cells were determined using flow cytometry, immunofluorescence staining, comet assay, real-time PCR, and Western blotting. CPT-11 demonstrated a dose- and time-dependent inhibition of cell growth, induction of apoptosis, and cell-cycle arrest at G0/G1 phase in HL-60 cells. CPT-11 promoted the release of AIF from mitochondria and its translocation to the nucleus. Bid, Bax, Apaf-1, caspase-9, AIF, Endo G, caspase-12, ATF-6b, Grp78, CDK2, Chk2, and cyclin D were all significantly upregulated and Bcl-2 was down-regulated by CPT-11 in HL-60 cells. Induction of cell-cycle arrest by CPT-11 was associated with changes in expression of key cell-cycle regulators such as CDK2, Chk2, and cyclin D in HL-60 cells. To test whether CPT-11 could augment antitumor activity in vivo, athymic BALB/c(nu/nu) nude mice were inoculated with HL-60 cells, followed by treatment with either CPT-11. The treatments significantly inhibited tumor growth and reduced tumor weight and volume in the HL-60 xenograft mice. The present study demonstrates the schedule-dependent antileukemia effect of CPT-11 using both in vitro and in vivo models. CPT-11 could potentially be a promising agent for the treatment of promyelocytic leukemia and requires further investigation.
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MESH Headings
- Animals
- Antineoplastic Agents, Phytogenic/therapeutic use
- Antineoplastic Agents, Phytogenic/toxicity
- Apoptosis/drug effects
- Apoptosis Regulatory Proteins/metabolism
- Camptothecin/analogs & derivatives
- Camptothecin/therapeutic use
- Camptothecin/toxicity
- Caspase 3/metabolism
- Cell Cycle Proteins/metabolism
- DNA Damage/drug effects
- Disease Models, Animal
- Endoplasmic Reticulum Chaperone BiP
- G1 Phase Cell Cycle Checkpoints/drug effects
- HL-60 Cells
- Humans
- Irinotecan
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/metabolism
- Leukemia, Promyelocytic, Acute/pathology
- Male
- Membrane Potential, Mitochondrial/drug effects
- Mice
- Mice, Inbred BALB C
- Mice, Nude
- Microscopy, Confocal
- Transplantation, Heterologous
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Affiliation(s)
- Yung-Liang Chen
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University, Hsinchu 300, Taiwan
| | - Fu-Shin Chueh
- School of Pharmacy, China Medical University, Taichung 404, Taiwan
| | - Jai-Sing Yang
- Department of Pharmacology, China Medical University, Taichung 404, Taiwan
| | - Shu-Ching Hsueh
- Department of Clinical Pathology, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Chi-Cheng Lu
- Department of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
| | - Jo-Hua Chiang
- Department of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
| | - Ching-Sung Lee
- Department of Restaurant, Hotel and Institutional Management, Fu-Jen Catholic University, New Taipei 242, Taiwan
| | - Hsu-Feng Lu
- Department of Clinical Pathology, Cheng Hsin General Hospital, Taipei 112, Taiwan
- Department of Restaurant, Hotel and Institutional Management, Fu-Jen Catholic University, New Taipei 242, Taiwan
| | - Jing-Gung Chung
- Department of Biological Science and Technology, China Medical University, Taichung 404, Taiwan
- Department of Biotechnology, Asia University, Taichung 413, Taiwan
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Lin J, Li Y, Wu H, Yang X, Li Y, Ye S, Hou Z, Lin C. Tumor-targeted co-delivery of mitomycin C and 10-hydroxycamptothecin via micellar nanocarriers for enhanced anticancer efficacy. RSC Adv 2015. [DOI: 10.1039/c4ra14602f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Polymer–lipid hybrid micelles co-delivered hydrophilic mitomycin C and hydrophobic 10-hydroxycamptothecin showed improved cellular uptake and cytotoxicity in vitro and enhanced tumor accumulation and antitumor activity in vivo.
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Affiliation(s)
- Jinyan Lin
- Department of Biomaterials
- Research Center of Biomedical Engineering
- Institute of Soft Matter and Biomimetics
- College of Materials
- Xiamen University
| | - Yang Li
- Department of Biomaterials
- Research Center of Biomedical Engineering
- Institute of Soft Matter and Biomimetics
- College of Materials
- Xiamen University
| | - Hongjie Wu
- Department of Pharmacy
- School of Pharmaceutical Sciences
- Xiamen University
- Xiamen 361002
- China
| | - Xiangrui Yang
- Department of Biomaterials
- Research Center of Biomedical Engineering
- Institute of Soft Matter and Biomimetics
- College of Materials
- Xiamen University
| | - Yanxiu Li
- Department of Biomaterials
- Research Center of Biomedical Engineering
- Institute of Soft Matter and Biomimetics
- College of Materials
- Xiamen University
| | - Shefang Ye
- Department of Biomaterials
- Research Center of Biomedical Engineering
- Institute of Soft Matter and Biomimetics
- College of Materials
- Xiamen University
| | - Zhenqing Hou
- Department of Biomaterials
- Research Center of Biomedical Engineering
- Institute of Soft Matter and Biomimetics
- College of Materials
- Xiamen University
| | - Changjian Lin
- Department of Chemistry
- College of Chemistry and Chemical Engineering
- Xiamen University
- Xiamen 361005
- China
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Vitale FV, Malaponte E, Calì S, Antonelli G, Panebianco V, Blandino R, Ferraù F. Is there still a role for mitomycin-based combination chemotherapy in treating patients with nonsmall cell lung cancer? A single institution experience. J Oncol Pharm Pract 2012; 19:202-7. [DOI: 10.1177/1078155212458133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Mitomycin and irinotecan are widely used in the treatment of colorectal cancer, furthermore both of these drugs are active agents against nonsmall cell lung cancer and their combination has shown synergism in preclinical studies. The aim of the study was to evaluate the efficacy and safety of mitomycin- and irinotecan-based chemotherapy combination in patients with advanced nonsmall cell lung cancer progressing after previous antineoplastic therapies. Methods: Thirty-one consecutive patients suffering from nonsmall cell lung cancer, who underwent mitomycin- plus irinotecan-based chemotherapy as salvage treatment after failure of at least two previous systemic treatments, were retrospectively identified in our database. Between September 2003 and March 2011, 31 patients with histologically proven stage IIIB or IV nonsmall cell lung cancer, received mitomycin 5 mg/m2 on day 1 followed by irinotecan 150 mg/m2 on day 2. Cycles were repeated at 2-week interval. Results: A total of 164 cycles of treatment were given with a median of five per patient (range 1–10). The objective responses included partial response in 6 patients (19.3%), stable disease in 4 (13%), and progressive disease in 21 (67.7%). Median time to disease progression was 4 months, and median survival was 9+ months. Twelve patients (38%) reached 1-year survival. Grade 3–4 toxicities occurred in seven patients (22.5%), mainly myelosuppression (neutropenia, anemia, and thrombocytopenia), mucositis, and diarrhea. No treatment-related death was recorded. Conclusion: The mitomycin- and irinotecan-based combination chemotherapy seems to be tolerated and active in this subset of heavily pretreated patients with advanced nonsmall cell lung cancer. However, evaluation or recruitment of a larger number of patients would be needed to provide more adequate data on safety and activity of the described combination.
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Affiliation(s)
| | | | - Stefania Calì
- Division of Medical Oncology, San Vincenzo Hospital, Italy
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Irinotecan plus mitomycin C as second-line chemotherapy for advanced gastric cancer resistant to fluoropyrimidine and Cisplatin: a retrospective study. Gastroenterol Res Pract 2012; 2012:640401. [PMID: 22474446 PMCID: PMC3296209 DOI: 10.1155/2012/640401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 11/22/2011] [Accepted: 12/02/2011] [Indexed: 01/29/2023] Open
Abstract
Background. S-1 plus cisplatin has been established to be standard first-line chemotherapy for advanced gastric cancer in Japan. The optimal second-line treatment refractory to S-1 plus cisplatin remains unclear. Methods. We retrospectively studied the efficacy, toxicity, and survival of irinotecan plus mitomycin C in patients with advanced gastric cancer refractory to a fluoropyrimidine plus cisplatin. Results. Twenty-four patients were studied. Prior chemotherapy was S-1 plus cisplatin in 15 patients, S-1 plus cisplatin and docetaxel in 8, and 5-fluorouracil plus cisplatin with radiotherapy in 1. The overall response rate was 17.4%. The median overall survival was 8.6 months, and the median progression-free survival was 3.6 months. Grade 3 or 4 toxicities included leukopenia (33%), neutropenia (50%), anemia (33%), thrombocytopenia (4%), anorexia (13%), diarrhea (4%), and febrile neutropenia (13%). Conclusion. A combination of irinotecan and mitomycin C is potentially effective in patients with advanced gastric cancer refractory to a fluoropyrimidine plus cisplatin.
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Tanaka T, Bai T, Toujima S, Utsunomiya T, Matsuoka T, Kobayashi A, Yamamoto M, Sasaki N, Tanizaki Y, Utsunomiya H, Tanaka J, Yukawa K. Demethylation restores SN38 sensitivity in cells with acquired resistance to SN38 derived from human cervical squamous cancer cells. Oncol Rep 2012; 27:1292-8. [PMID: 22246465 PMCID: PMC3583479 DOI: 10.3892/or.2012.1628] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 12/30/2011] [Indexed: 12/20/2022] Open
Abstract
Using seven monoclonal SN38-resistant subclones established from ME180 human cervical squamous cell carcinoma cells, we examined the demethylation effects of 5-aza-2′-deoxycytidine (5-aza-CdR) on the SN38-sensitivity of the cells as well as the expression of death-associated protein kinase (DAPK) in the SN38-resistant cells. The DAPK expression levels were evaluated among parent ME180 cells, SN38-resistant ME180 cells and cisplatin-resistant ME180 cells by methylation-specific DAPK-PCR, quantitative RT-PCR and western blot analysis. The SN38-resistant cells co-treated with SN38 and 5-aza-CdR strongly exhibited enhanced SN38-sensitivities resembling those found in the parent cells. In the SN38-resistant subclones, no relationships were found between the restored SN38 sensitivity and hypermethylation of the DAPK promoter, DAPK mRNA expression, DAPK protein expression and induction of DAPK protein after 5-aza-CdR treatment, unlike the strong suppression of 5-aza-CdR-induced DAPK protein expression in the cisplatin-resistant subclones. These findings indicate that reversibly methylated molecules, but not DAPK, may regulate SN38 resistance, and that demethylating agents can be strong sensitizing anticancer chemotherapeutic drugs for SN38-resistant cancers.
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Affiliation(s)
- Tetsuji Tanaka
- Santamaria Hospital, 13-15 Shinjo-cho, Ibaraki, Osaka 567-0884, Japan
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Hamaguchi T, Shirao K, Ohtsu A, Hyodo I, Arai Y, Takiuchi H, Fujii H, Yoshida M, Saito H, Denda T, Koizumi W, Iwase H, Boku N. A phase II study of biweekly mitomycin C and irinotecan combination therapy in patients with fluoropyrimidine-resistant advanced gastric cancer: a report from the Gastrointestinal Oncology Group of the Japan Clinical Oncology Group (JCOG0109-DI Trial). Gastric Cancer 2011; 14:226-33. [PMID: 21503598 DOI: 10.1007/s10120-011-0030-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/24/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preclinical studies have shown that mitomycin C (MMC) acts synergistically with irinotecan (CPT-11). In this phase II study, we evaluated the efficacy and toxicity of MMC/CPT-11 therapy as second-line chemotherapy for patients with fluoropyrimidine-resistant advanced gastric cancer. METHODS Eligible patients had evidence of tumor progression despite prior treatment with fluoropyrimidine-based regimens or had relapsed within 6 months after completion of therapy with adjuvant fluoropyrimidines. Treatment consisted of MMC (5 mg/m(2)) and CPT-11 (150 mg/m(2)) administered i.v. every 2 weeks. The primary endpoint was the response rate (RR). Our hypothesis was that this combination therapy was efficacious when the lower boundary of the 95% confidence interval (CI) of the RR exceeded 20% of the threshold RR. RESULTS Between April 2002 and July 2003, 45 eligible patients were registered and analyzed. Among the 45 patients, 40 (89%) had previously received chemotherapy for metastasis and 24 (53%) had a performance status (PS) of 0. Thirteen partial responses were obtained among the 45 patients, resulting in an overall RR of 29% (95% CI, 16-42%). The median time to progression was 4.1 months, and the median survival time was 10 months, with a 1-year survival rate of 36%. Grade 4 neutropenia was observed in 29% of the patients, whereas febrile neutropenia occurred in 9%. The incidence rates of grade 3 nausea and diarrhea were 13 and 2%, respectively. CONCLUSIONS Although this study did not achieve the per-protocol definition of activity, the progression-free survival and overall survival appeared to be promising, with acceptable tolerability. Thus, MMC/CPT-11 therapy as second-line chemotherapy for fluoropyrimidine-resistant advanced gastric cancer presents a potential treatment option in patients with a good PS.
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Affiliation(s)
- Tetsuya Hamaguchi
- Division of Gastrointestinal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Sencan O, Buyukcelik A, Yalcin B, Boruban MC, Akbulut H, Demirkazik A, Senler FC, Onur H, Icli F. The symptomatic benefit (the clinical benefit response) from the second-line chemotherapy in patients with advanced gastric adenocarcinoma. Eur J Cancer Care (Engl) 2008; 17:26-32. [PMID: 18181888 DOI: 10.1111/j.1365-2354.2007.00798.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There are few reports on use of symptomatic benefits as an alternative or adjunctive for the assessment of objective response in chemotherapy of the advanced cancer. This study is performed to assess the symptomatic benefits (the clinical benefit response), in addition to the efficacy and toxicity of cisplatin plus infusional 5-fluorouracil (5-FU) combination as second-line therapy in patients with advanced gastric cancer. Fifty-eight advanced gastric cancer patients with previous chemotherapy were enrolled into the study. Cisplatin 20 mg/m(2) was given for 5 days, and 5-FU was given 1000 mg/m(2) as 20 h continuous infusion for 5 days, repeated every 28 days. The overall objective response rate was 11.3%, and overall tumour control rate was 33.9%. The clinical benefit response, in terms of weight gain, reduction in analgesic consumption and the improvement in performance status observed in 12 patients [six patients with partial response (PR) and six patients with stable disease (SD)] (22.6%), while the rates of the clinical benefit response in patients with PR and with SD were 100% and 50% respectively. Cisplatin plus infusional 5-FU combination seems to improve disease-related symptoms (clinical benefit response) of patients with advanced gastric cancer, even in patients without objective response.
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Affiliation(s)
- O Sencan
- Department of Medical Oncology, Ankara University School of Medicine, Dikimevi, Ankara, Turkey
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Hofheinz RD, Beyer U, Al-Batran SE, Hartmann JT. Mitomycin C in the treatment of gastrointestinal tumours: recent data and perspectives. ACTA ACUST UNITED AC 2008; 31:271-81. [PMID: 18497518 DOI: 10.1159/000122590] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mitomycin C (MMC) is among the most effective anticancer drugs used for the treatment of a broad variety of tumours. This review summarises results of MMC-based chemotherapy in gastrointestinal tumours with special focus on current treatment options in gastric, pancreatic, biliary tract, colorectal, and anal cancer. In addition, these new developments are critically discussed with special attention to their potential clinical relevance.
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Affiliation(s)
- Ralf-Dieter Hofheinz
- Onkologisches Zentrum, III. Medizinische Klinik, Medizinische Fakultat Mannheim, Universitat Heidelberg, Germany.
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11
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Farhat FS. A general review of the role of irinotecan (CPT11) in the treatment of gastric cancer. Med Oncol 2007; 24:137-46. [PMID: 17848736 DOI: 10.1007/bf02698032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 11/30/1999] [Accepted: 11/17/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND The prognosis of gastric tumor is generally poor because most tumors are diagnosed at an advanced stage. Chemotherapy has a proven palliative role in advanced gastric cancer and several combination regimens were explored in the last 10 yr. Nevertheless, none of them showed a convincing improvement resulting in an enhancement of response rate and overall survival without discrimination of the quality of life. Irinotecan (CPT11) has been evaluated in multiple trials alone or in combined therapy with promising results and good tolerance. Thus, a review of the importance and impact of CPT11 in this indication is detailed. METHODS This article reviews the evidence for the use of CPT11 in the treatment of gastric cancer based on a computerized MEDLINE search of literature published until August 2006 leading to a total of 91 publications. RESULTS CPT11 was frequently used and showed a good response rate varying from 14% to 23% as single agent and 45% to 70% in combination with a median time to progression of 3 mo in single agent and 4-6 mo in combination, and median overall survival of approx 7 mo in single agent and up to 10.58 mo in combination. CONCLUSION The overall response of irinotecan-based chemotherapy in advanced gastric cancer was shown to be as effective as other combined chemotherapy. The hematological and digestive toxicity were tolerable and mild, especially in weekly regimen. Thus, irinotecan-based chemotherapy should be considered as one of the preferred choices in front line chemotherapy in advanced gastric cancer.
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Affiliation(s)
- Fadi Sami Farhat
- Division of Hematology-Oncology, Hammoud Hospital University Medical Center, Ghassan Hammoud Street, Sidon, 652, Lebanon.
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Yamazaki K, Boku N, Shibamoto K, Yasui H, Fukutomi A, Yoshino T, Hironaka S, Onozawa Y, Otake Y, Hasuike N, Matsubayashi H, Inui T, Yamaguchi Y, Ono H. The role of the outpatient clinic in chemotherapy for patients with unresectable or recurrent gastric cancer. Jpn J Clin Oncol 2007; 37:96-101. [PMID: 17272316 DOI: 10.1093/jjco/hyl145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recently, outpatient chemotherapy centers have become popular in Japan. To clarify the actual conditions of outpatient clinics, we surveyed entire clinical courses of chemotherapy in patients with unresectable or recurrent gastric cancer. METHODS From the medical records of 64 patients with unresectable or recurrent gastric cancer with no prior chemotherapy, we obtained data on overall survival, non-hospitalized survival, the number of and reasons for attendance at the outpatient clinic and hospitalization, and medical conditions at discharge. RESULTS The median follow-up time was 520 days, the median survival time was 353 days, and the median non-hospitalized survival time was 282 days. Patients attended the outpatient clinic 1917 times in total; 145 (8%) of these were unplanned visits for accidental disease, disease progression, or toxicity. Patients were hospitalized 291 times in total: 110 (38%) of hospitalizations were unplanned or emergencies because of disease progression or toxicity. Patients were discharged 290 times in total; in 56 of these discharges (19%) unresolved medical problems remained, such as toxicity, total parenteral nutrition, or symptoms related to cancer. Three patients (5%) died from treatment-related leucopenia and thrombocytopenia. CONCLUSIONS Patients with unresectable and recurrent gastric cancer were treated at outpatient clinics for periods up to 80% longer than the entire clinical course of chemotherapy. However, there were some unplanned or emergency hospitalizations and some patients still experienced medical problems at discharge. The role of the outpatient clinic is very important to chemotherapy for patients with unresectable or recurrent gastric cancer.
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Affiliation(s)
- Kentaro Yamazaki
- Division of Gastrointestinal Oncology and Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan.
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Giuliani F, Molica S, Maiello E, Battaglia C, Gebbia V, Di Bisceglie M, Vinciarelli G, Gebbia N, Colucci G. Irinotecan (CPT-11) and Mitomycin-C (MMC) as Second-Line Therapy in Advanced Gastric Cancer. Am J Clin Oncol 2005; 28:581-5. [PMID: 16317268 DOI: 10.1097/01.coc.0000190398.52142.7f] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the activity and toxicity of a combination regimen of CPT-11 and mitomycin-c as second-line chemotherapy for pretreated patients with advanced, metastatic, or both, gastric adenocarcinoma. MATERIALS AND METHODS Patients with pretreated metastatic disease or early relapsed after adjuvant chemotherapy were enrolled. Entry criteria included histologic/cytologic diagnosis of gastric adenocarcinoma, age 18 to 75 years, performance status > or =70 (Karnofsky scale), bi-dimensionally measurable disease. Patients received CPT-11 and mitomycin-c at the dosage of 150 mg/m2 on days 1 and 15, and 8 mg/m2 on day 1, respectively, every 4 weeks. The disease evaluation was done every 3 cycles. RESULTS Among the 38 patients we observed, 1 (3%) complete response and 11 (29%) partial responses for an overall response rate of 32% according to an intent-to-treat analysis. The median duration of response was 6.5 months. The median time to progression was 4 months with a median overall survival 8 months. All patients were evaluable for toxicity and the only grade 3-4 observed toxicities were leukopenia (8%), neutropenia (21%), and anemia (5%). CONCLUSIONS The combination of CPT-11 and mitomycin-c is an active and well tolerated second-line treatment in pretreated gastric cancer patients. Further studies are needed to test its role in first-line treatment.
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Dobrzyńska MM. The effects in mice of combined treatments to X-rays and antineoplastic drugs in the Comet assay. Toxicology 2005; 207:331-8. [PMID: 15596263 DOI: 10.1016/j.tox.2004.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Revised: 10/18/2004] [Accepted: 10/18/2004] [Indexed: 10/26/2022]
Abstract
The Comet assay is a rapid, easy and reproducible method to detect genotoxic activity of chemical and physical agents in vitro and in vivo. In the present study the effects of exposure to irradiation or chemicals: cyclophosphamide (CP) and mitomycin C (MMC) or combined exposure to low doses of both agents (0.25 Gy+3.15 mg/kgbw CP and 0.25 Gy+0.25 mg/kgbw MMC) were examined for the induction of DNA damage in the Comet assay measured simultaneously in somatic (bone marrow lymphocytes) and haploid germ cells. The male mice were treated in vivo and sacrificed at 24 h after exposure. The percentage contents of DNA in the "comet tail" increased with increasing doses of X-rays and chemicals. After combined exposure to X-rays and CP and to X-rays and MMC weak increases of DNA damage in bone marrow lymphocytes and in germ cells were observed by comparison with the results obtained for each agent acting alone. There were slightly different responses in bone marrow lymphocytes and in germ cells, but effects were observed over a similar dose range.
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Affiliation(s)
- Małgorzata M Dobrzyńska
- National Institute of Hygiene, Department of Radiation Protection and Radiobiology, 24 Chocimska Street, 00-791 Warsaw, Poland.
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Reni M, Panucci MG, Passoni P, Bonetto E, Nicoletti R, Ronzoni M, Zerbi A, Staudacher C, Di Carlo V, Villa E. Salvage chemotherapy with mitomycin, docetaxel, and irinotecan (MDI regimen) in metastatic pancreatic adenocarcinoma: a phase I and II trial. Cancer Invest 2004; 22:688-96. [PMID: 15581049 DOI: 10.1081/cnv-200032929] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study evaluates the maximum tolerated dose (MTD) and activity of mitomycin, docetaxel, and irinotecan (MDI) regimen on metastatic pancreatic adenocarcinoma, previously treated with gemcitabine-containing chemotherapy. PATIENTS AND METHODS Patients with less than 76 years, Karnofsky performance status > or = 60, and adequate bone marrow, kidney, and liver function were eligible for this trial. Treatment consisted of mitomycin 6 mg/m2 day 1, docetaxel and irinotecan on days 2 and 8 with escalating doses, every 4 weeks. Dose levels were level 1:30 and 70 mg/m2; level 2:30 and 100 mg/m2; level 3:30 and 85 mg/m2; and level 4:35 and 85 mg/m2. Dose-limiting toxicity (DLT) was defined as grade 4 neutropenia > 7 days, febrile neutropenia, grade 4 thrombocytopenia, nausea and vomiting, or diarrhea, grade > or = 3 nonhematological toxicity, or failure to recover to grade < or = 1 toxicity by day 43, occurring during the first cycle of chemotherapy. RESULTS Between September 2001 and October 2002, 15 eligible patients, three of whom had been previously treated with two lines of chemotherapy, received 33 cycles of MDI. Toxicity consisted of grade 3 to 4 neutropenia in 23% of cycles, fatigue, diarrhea, and vomiting in 10% of cycles, and one toxic death. DLT was observed in 2 of 6 level 2 patients (one toxic death and one grade 3 fatigue), and 2 of 3 level 4 patients (one neutropenic fever and one grade 3 fatigue). Thirteen patients were assessable for response. No objective response was observed among patients treated with MTD or higher doses. Three patients had stable disease; all other patients had progressive disease. The median time to tumor progression and median survival was 1.7 and 6.1 months, respectively. CONCLUSION The MTD was mitomycin 6 mg/m2 day one, and docetaxel 30 and irinotecan 85 mg/m2 days 2 and 8. This regimen is inactive in metastatic pancreatic cancer.
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Affiliation(s)
- Michele Reni
- Department of Radiochemotherapy, San Raffaele H. Scientific Institute, Milan, Italy.
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Umesaki N, Fujii T, Nishimura R, Tanaka T, Nishida M, Fushiki H, Takizawa K, Yamamoto K, Hasegawa K, Izumi R. Phase II study of irinotecan combined with mitomycin-C for advanced or recurrent squamous cell carcinoma of the uterine cervix: the JGOG study. Gynecol Oncol 2004; 95:127-32. [PMID: 15385121 DOI: 10.1016/j.ygyno.2004.06.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2003] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The efficacy and toxicity of combined therapy with irinotecan (CPT-11) plus mitomycin-C (MMC) were evaluated in patients with advanced or recurrent squamous cell carcinoma (SCC) of the uterine cervix. METHODS CPT-11 (100 mg/m(2)) was administered on days 1, 8, and 15 by intravenous (iv) infusion over 90 min, while MMC (10 mg/m(2) iv) was given on day 1. This regimen was repeated every 28 days and at least two courses were given. RESULTS Among 51 eligible patients (median age: 52 years; range: 25-72 years), 2 showed complete response (CR) and 24 showed PR, for an overall response rate (ORR) of 51.0% (95% confidence interval: 36.6-65.3%). In patients without prior chemotherapy, the ORR was 54.8% (38.7-70.2%). Twenty-five patients (Ib2:3, IIb:17, and IIIb:5) received this regimen as neoadjuvant chemotherapy and their ORR was 76% (54.9-90.6%). Twenty-two patients were able to undergo radical surgery after NAC. The major toxicity was neutropenia, which was grade 3-4 in 59% of the patients. Grade 3-4 thrombocytopenia and anemia were also seen in 26% of the patients each. The most common nonhematologic toxicity was diarrhea (grade 3-4 in 12%). CONCLUSION CPT-11 combined with MMC can be effective against advanced or recurrent SCC of the uterine cervix.
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Affiliation(s)
- Naohiko Umesaki
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama 641-0012, Japan.
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Hirao K, Hirasaki S, Tsuzuki T, Kajiwara T, Hyodo I. Unresectable alpha fetoprotein-producing gastric cancer successfully treated with irinotecan and mitomycin C after S-1 failure. Intern Med 2004; 43:106-10. [PMID: 15005251 DOI: 10.2169/internalmedicine.43.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Diagnostic imaging of a 70-year-old woman revealed widespread lymph node swelling and pyloric stenosis due to alpha fetoprotein-producing gastric cancer. Second line chemotherapy of irinotecan and mitomycin C was administered after S-1 failure. After 6 courses of 2nd line chemotherapy, pyloric stenosis was improved, and lymph node swelling disappeared. This patient has been alive without disease for more than 3 years since 2nd line chemotherapy began and for more than 4 years since her first admittance to our hospital. Second line chemotherapy may have contributed to the favorable clinical outcome in this patient.
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Affiliation(s)
- Ken Hirao
- Department of Internal Medicine, National Shikoku Cancer Center, 13 Horino-uchi, Matsuyama 790-0007
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Affiliation(s)
- P Schöffski
- Department of Haematology and Oncology, Hannover Medical School, Hannover, Germany
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Soepenberg O, Sparreboom A, Verweij J. Clinical studies of camptothecin and derivatives. THE ALKALOIDS. CHEMISTRY AND BIOLOGY 2003; 60:1-50. [PMID: 14593855 DOI: 10.1016/s0099-9598(03)60001-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Otto Soepenberg
- Department of Medical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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