1
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Kamai T, Murakami S, Arai K, Nishihara D, Uematsu T, Ishida K, Kijima T. Increased expression of Nrf2 and elevated glucose uptake in pheochromocytoma and paraganglioma with SDHB gene mutation. BMC Cancer 2022; 22:289. [PMID: 35300626 PMCID: PMC8931959 DOI: 10.1186/s12885-022-09415-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background Pheochromocytomas (PCC) and paragangliomas (PGL) are catecholamine-producing neuroendocrine tumors. According to the World Health Organization Classification 2017, all PCC/PGL are considered to have malignant potential. There is growing evidence that PCC/PGL represent a metabolic disease that leads to aerobic glycolysis. Cellular energy metabolism involves both transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2) and succinate dehydrogenase (SDH) subtypes, but the association of these substances with PCC/PGL is largely unknown. Methods We investigated SDHB gene mutation and protein expressions for SDHB and Nrf2 in surgical specimens from 29 PCC/PGL. We also assessed preoperative maximum standard glucose uptake (SUVmax) on [18F]fluorodeoxy-glucose positron emission tomography and mRNA levels for Nrf2. Results Among 5 PCC/PGL with a PASS Score ≥ 4 or with a moderately to poorly differentiated type in the GAPP Score, 4 were metastatic and found to be SDHB mutants with homogeneous deletion of SDHB protein. SDHB mutants showed a higher expression of Nrf2 protein and a higher preoperative SUVmax than non-SDHB mutants with a PASS < 4 or a well-differentiated GAPP type. Furthermore, protein expression of Nrf2 was positively associated with preoperative SUVmax. The Nrf2 mRNA level positively correlated with malignant phenotype, higher expression for Nrf2 protein and SDHB gene mutant, but negatively correlated with expression for SDHB protein. There was also a positive correlation between Nrf2 mRNA level and SUVmax. Conclusion These results suggest that activation of Nrf2 and elevated metabolism play roles in PCC/PGL with malignant potential that have SDHB gene mutation and SDHB deficiency.
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Affiliation(s)
- Takao Kamai
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan.
| | - Satoshi Murakami
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan
| | - Kyoko Arai
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan
| | - Daisaku Nishihara
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan
| | - Toshitaka Uematsu
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Toshiki Kijima
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan
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2
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Besson FL, Fernandez B, Faure S, Mercier O, Seferian A, Mignard X, Mussot S, le Pechoux C, Caramella C, Botticella A, Levy A, Parent F, Bulifon S, Montani D, Mitilian D, Fadel E, Planchard D, Besse B, Ghigna-Bellinzoni MR, Comtat C, Lebon V, Durand E. 18F-FDG PET and DCE kinetic modeling and their correlations in primary NSCLC: first voxel-wise correlative analysis of human simultaneous [18F]FDG PET-MRI data. EJNMMI Res 2020; 10:88. [PMID: 32734484 PMCID: PMC7392998 DOI: 10.1186/s13550-020-00671-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To decipher the correlations between PET and DCE kinetic parameters in non-small-cell lung cancer (NSCLC), by using voxel-wise analysis of dynamic simultaneous [18F]FDG PET-MRI. MATERIAL AND METHODS Fourteen treatment-naïve patients with biopsy-proven NSCLC prospectively underwent a 1-h dynamic [18F]FDG thoracic PET-MRI scan including DCE. The PET and DCE data were normalized to their corresponding T1-weighted MR morphological space, and tumors were masked semi-automatically. Voxel-wise parametric maps of PET and DCE kinetic parameters were computed by fitting the dynamic PET and DCE tumor data to the Sokoloff and Extended Tofts models respectively, by using in-house developed procedures. Curve-fitting errors were assessed by computing the relative root mean square error (rRMSE) of the estimated PET and DCE signals at the voxel level. For each tumor, Spearman correlation coefficients (rs) between all the pairs of PET and DCE kinetic parameters were estimated on a voxel-wise basis, along with their respective bootstrapped 95% confidence intervals (n = 1000 iterations). RESULTS Curve-fitting metrics provided fit errors under 20% for almost 90% of the PET voxels (median rRMSE = 10.3, interquartile ranges IQR = 8.1; 14.3), whereas 73.3% of the DCE voxels showed fit errors under 45% (median rRMSE = 31.8%, IQR = 22.4; 46.6). The PET-PET, DCE-DCE, and PET-DCE voxel-wise correlations varied according to individual tumor behaviors. Beyond this wide variability, the PET-PET and DCE-DCE correlations were mainly high (absolute rs values > 0.7), whereas the PET-DCE correlations were mainly low to moderate (absolute rs values < 0.7). Half the tumors showed a hypometabolism with low perfused/vascularized profile, a hallmark of hypoxia, and tumor aggressiveness. CONCLUSION A dynamic "one-stop shop" procedure applied to NSCLC is technically feasible in clinical practice. PET and DCE kinetic parameters assessed simultaneously are not highly correlated in NSCLC, and these correlations showed a wide variability among tumors and patients. These results tend to suggest that PET and DCE kinetic parameters might provide complementary information. In the future, this might make PET-MRI a unique tool to characterize the individual tumor biological behavior in NSCLC.
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Affiliation(s)
- Florent L Besson
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMAPs, 91401, Orsay, France.
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270, Le Kremlin-Bicêtre, France.
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | | | - Sylvain Faure
- Laboratoire de Mathématiques d'Orsay, CNRS, Université Paris-Saclay, 91405, Orsay, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Andrei Seferian
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR_S999, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Xavier Mignard
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
| | - Sacha Mussot
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Cecile le Pechoux
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Caroline Caramella
- Department of Radiology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Angela Botticella
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Florence Parent
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR_S999, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Sophie Bulifon
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR_S999, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - David Montani
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR_S999, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Delphine Mitilian
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - David Planchard
- Department of Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Benjamin Besse
- Department of Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | | | - Claude Comtat
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMAPs, 91401, Orsay, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Vincent Lebon
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMAPs, 91401, Orsay, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuel Durand
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMAPs, 91401, Orsay, France
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270, Le Kremlin-Bicêtre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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3
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Azevedo MPF, Monteiro RM, Castelani C, Bim FL, Bim LL, Macedo AP, Oliveira VDC, Watanabe E. Biosafety of Non-Return Valves for Infusion Systems in Radiology. Sci Rep 2020; 10:9574. [PMID: 32533091 PMCID: PMC7293231 DOI: 10.1038/s41598-020-66491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 05/13/2020] [Indexed: 11/09/2022] Open
Abstract
Cross-infection in contrast injectors is still a subject under discussion with little understanding. This study evaluated the biosafety of non-return valves (NRVs). Initially, the maximum pressure during backflow of intact and disrupted flexible diaphragms (FDs) from NRVs, as well as the functionality of connectors with NRVs were verified. The performance of air columns interposed by water in connectors with NRVs was analyzed, and the diffusion distance of crystal violet through connectors with NRVs was measured. The efficacy of NRVs as a barrier to bacterial contamination from backflow was evaluated. Finally, a clinical study of bacteriological contamination from syringes was conducted. There were differences among the maximum tolerated pressure by intact and disrupted FDs. Disrupted FDs showed no failures in the functionality of connectors with NRVs based on the lack of air bubbles released. Air columns could move through connectors with NRVs with intact and disrupted FDs. The longest diffusion distance of crystal violet was 6 cm of connector length, and NRVs showed efficacy as a barrier to bacterial contamination. In the clinical study, there was no bacterial growth in any of the evaluated samples. In conclusion, biosafety depends on the functionality of NRVs as well as proper practical clinical performance.
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Affiliation(s)
- Marcela Padilha Facetto Azevedo
- Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rachel Maciel Monteiro
- Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carla Castelani
- University of Valley of the Sinos River (Unisinos), São Leopoldo, in the Metropolitan Area of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Lazarini Bim
- Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucas Lazarini Bim
- Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Paula Macedo
- Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Viviane de Cássia Oliveira
- Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Evandro Watanabe
- Department of Fundamental Nursing, College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. .,Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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The beginning of the end for conventional RECIST - novel therapies require novel imaging approaches. Nat Rev Clin Oncol 2019; 16:442-458. [PMID: 30718844 DOI: 10.1038/s41571-019-0169-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Owing to improvements in our understanding of the biological principles of tumour initiation and progression, a wide variety of novel targeted therapies have been developed. Developments in biomedical imaging, however, have not kept pace with these improvements and are still mainly designed to determine lesion size alone, which is reflected in the Response Evaluation Criteria in Solid Tumors (RECIST). Imaging approaches currently used for the evaluation of treatment responses in patients with solid tumours, therefore, often fail to detect successful responses to novel targeted agents and might even falsely suggest disease progression, a scenario known as pseudoprogression. The ability to differentiate between responders and nonresponders early in the course of treatment is essential to allowing the early adjustment of treatment regimens. Various imaging approaches targeting a single dedicated tumour feature, as described in the hallmarks of cancer, have been successful in preclinical investigations, and some have been evaluated in pilot clinical trials. However, these approaches have largely not been implemented in clinical practice. In this Review, we describe current biomedical imaging approaches used to monitor responses to treatment in patients receiving novel targeted therapies, including a summary of the most promising future approaches and how these might improve clinical practice.
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5
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Abstract
Kidney cancer, or renal cell carcinoma (RCC), is a disease of increasing incidence that commonly is seen in the general practice of nephrology. Despite this state of affairs, this fascinating and highly morbid disease frequently is under-represented, or even absent, from the curriculum of nephrologists in training and generally is underemphasized in national nephrology meetings, both scientific as well as clinical. Although classic concepts in cancer research in general had led to the concept that cancer is a disease resulting from mutations in the control of growth-regulating pathways, reinforced by the discovery of oncogenes, more contemporary research, particularly in kidney cancer, has uncovered changes in metabolic pathways mediated by those same genes that control tumor energetics and biosynthesis. This adaptation of classic biochemical pathways to the tumor's advantage has been labeled metabolic reprogramming. For example, in the case of kidney cancer there exists a near-universal presence of von Hippel-Lindau tumor suppressor (pVHL) inactivation in the most common form, clear cell RCC (ccRCC), leading to activation of hypoxia-relevant and other metabolic pathways. Studies of this and other pathways in clear cell RCC (ccRCC) have been particularly revealing, leading to the concept that ccRCC can itself be considered a metabolic disease. For this reason, the relatively new method of metabolomics has become a useful technique in the study of ccRCC to tease out those pathways that have been reprogrammed by the tumor to its maximum survival advantage. Furthermore, identification of the nodes of such pathways can lead to novel areas for drug intervention in a disease for which such targets are seriously lacking. Further research and dissemination of these concepts, likely using omics techniques, will lead to clinical trials of therapeutics specifically targeted to tumor metabolism, rather than those generally toxic to all proliferating cells. Such novel agents are highly likely to be more effective than existing drugs and to have far fewer adverse effects. This review provides a general overview of the technique of metabolomics and then discusses how it and other omics techniques have been used to further our understanding of the basic biology of kidney cancer as well as to identify new therapeutic approaches.
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Affiliation(s)
- Robert H Weiss
- Division of Nephrology, University of California, Davis, CA and Medical Service, VA Northern California Health Care System, Sacramento, CA.
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6
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Beloueche-Babari M, Wantuch S, Casals Galobart T, Koniordou M, Parkes HG, Arunan V, Chung YL, Eykyn TR, Smith PD, Leach MO. MCT1 Inhibitor AZD3965 Increases Mitochondrial Metabolism, Facilitating Combination Therapy and Noninvasive Magnetic Resonance Spectroscopy. Cancer Res 2017; 77:5913-5924. [PMID: 28923861 PMCID: PMC5669455 DOI: 10.1158/0008-5472.can-16-2686] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 06/01/2017] [Accepted: 09/06/2017] [Indexed: 12/31/2022]
Abstract
Monocarboxylate transporters (MCT) modulate tumor cell metabolism and offer promising therapeutic targets for cancer treatment. Understanding the impact of MCT blockade on tumor cell metabolism may help develop combination strategies or identify pharmacodynamic biomarkers to support the clinical development of MCT inhibitors now in clinical trials. In this study, we assessed the impact of the MCT1 inhibitor AZD3965 on cancer cell metabolism in vitro and in vivo Exposing human lymphoma and colon carcinoma cells to AZD3965 increased MCT4-dependent accumulation of intracellular lactate, inhibiting monocarboxylate influx and efflux. AZD3965 also increased the levels of TCA cycle-related metabolites and 13C-glucose mitochondrial metabolism, enhancing oxidative pyruvate dehydrogenase and anaplerotic pyruvate carboxylase fluxes. Increased mitochondrial metabolism was necessary to maintain cell survival under drug stress. These effects were counteracted by coadministration of the mitochondrial complex I inhibitor metformin and the mitochondrial pyruvate carrier inhibitor UK5099. Improved bioenergetics were confirmed in vivo after dosing with AZD3965 in mouse xenograft models of human lymphoma. Our results reveal new metabolic consequences of MCT1 inhibition that might be exploited for therapeutic and pharmacodynamic purposes. Cancer Res; 77(21); 5913-24. ©2017 AACR.
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Affiliation(s)
- Mounia Beloueche-Babari
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Slawomir Wantuch
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Teresa Casals Galobart
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Markella Koniordou
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Harold G Parkes
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Vaitha Arunan
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Yuen-Li Chung
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Thomas R Eykyn
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Paul D Smith
- AstraZeneca, Cancer Biosciences, Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Wettersten HI, Aboud OA, Lara PN, Weiss RH. Metabolic reprogramming in clear cell renal cell carcinoma. Nat Rev Nephrol 2017; 13:410-419. [PMID: 28480903 DOI: 10.1038/nrneph.2017.59] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Research in many cancers has uncovered changes in metabolic pathways that control tumour energetics and biosynthesis, so-called metabolic reprogramming. Studies in clear cell renal cell carcinoma (ccRCC) have been particularly revealing, leading to the concept that ccRCC is a metabolic disease. ccRCC is generally accompanied by reprogramming of glucose and fatty acid metabolism and of the tricarboxylic acid cycle. Metabolism of tryptophan, arginine and glutamine is also reprogrammed in many ccRCCs, and these changes provide opportunities for new therapeutic strategies, biomarkers and imaging modalities. In particular, metabolic reprogramming facilitates the identification of novel and repurposed drugs that could potentially be used to treat ccRCC, which when metastatic has currently limited long-term treatment options. Further research and dissemination of these concepts to nephrologists and oncologists will lead to clinical trials of therapeutics specifically targeted to tumour metabolism, rather than generally toxic to all proliferating cells. Such novel agents are highly likely to be more effective and to have far fewer adverse effects than existing drugs.
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Affiliation(s)
- Hiromi I Wettersten
- University of California, San Diego, Sanford Consortium for Regenerative Medicine, Room 4810, 2880 Torrey Pines Scenic Drive, La Jolla, California 92037-0695, USA
| | - Omran Abu Aboud
- Division of Nephrology, University of California Davis, Genome and Biomedical Sciences Facility, Room 6311, 451 Health Sciences Drive, Davis, California 95616, USA
| | - Primo N Lara
- University of California Davis Comprehensive Cancer Center, 4501 X Street, Suite 3003, Sacramento, California 95817, USA
| | - Robert H Weiss
- Division of Nephrology, University of California Davis, Genome and Biomedical Sciences Facility, Room 6311, 451 Health Sciences Drive, Davis, California 95616, USA
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8
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Baker LCJ, Boult JKR, Thomas M, Koehler A, Nayak T, Tessier J, Ooi CH, Birzele F, Belousov A, Zajac M, Horn C, LeFave C, Robinson SP. Acute tumour response to a bispecific Ang-2-VEGF-A antibody: insights from multiparametric MRI and gene expression profiling. Br J Cancer 2016; 115:691-702. [PMID: 27529514 PMCID: PMC5023775 DOI: 10.1038/bjc.2016.236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/03/2016] [Accepted: 07/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To assess antivascular effects, and evaluate clinically translatable magnetic resonance imaging (MRI) biomarkers of tumour response in vivo, following treatment with vanucizumab, a bispecific human antibody against angiopoietin-2 (Ang-2) and vascular endothelial growth factor-A (VEGF-A). METHODS Colo205 colon cancer xenografts were imaged before and 5 days after treatment with a single 10 mg kg(-1) dose of either vanucizumab, bevacizumab (anti-human VEGF-A), LC06 (anti-murine/human Ang-2) or omalizumab (anti-human IgE control). Volumetric response was assessed using T2-weighted MRI, and diffusion-weighted, dynamic contrast-enhanced (DCE) and susceptibility contrast MRI used to quantify tumour water diffusivity (apparent diffusion coefficient (ADC), × 10(6) mm(2) s(-1)), vascular perfusion/permeability (K(trans), min(-1)) and fractional blood volume (fBV, %) respectively. Pathological correlates were sought, and preliminary gene expression profiling performed. RESULTS Treatment with vanucizumab, bevacizumab or LC06 induced a significant (P<0.01) cytolentic response compared with control. There was no significant change in tumour ADC in any treatment group. Uptake of Gd-DTPA was restricted to the tumour periphery in all post-treatment groups. A significant reduction in tumour K(trans) (P<0.05) and fBV (P<0.01) was determined 5 days after treatment with vanucizumab only. This was associated with a significant (P<0.05) reduction in Hoechst 33342 uptake compared with control. Gene expression profiling identified 20 human genes exclusively regulated by vanucizumab, 6 of which are known to be involved in vasculogenesis and angiogenesis. CONCLUSIONS Vanucizumab is a promising antitumour and antiangiogenic treatment, whose antivascular activity can be monitored using DCE and susceptibility contrast MRI. Differential gene expression in vanucizumab-treated tumours is regulated by the combined effect of Ang-2 and VEGF-A inhibition.
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MESH Headings
- Adenocarcinoma/blood supply
- Adenocarcinoma/diagnostic imaging
- Adenocarcinoma/drug therapy
- Adenocarcinoma/pathology
- Angiogenesis Inhibitors/immunology
- Angiogenesis Inhibitors/therapeutic use
- Angiopoietin-2/antagonists & inhibitors
- Angiopoietin-2/immunology
- Animals
- Antibodies, Bispecific/therapeutic use
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Bevacizumab/therapeutic use
- Cell Line, Tumor
- Colonic Neoplasms/blood supply
- Colonic Neoplasms/diagnostic imaging
- Colonic Neoplasms/drug therapy
- Colonic Neoplasms/pathology
- DNA Replication/drug effects
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Immunoglobulin E/immunology
- Magnetic Resonance Imaging/methods
- Mice
- Molecular Targeted Therapy
- Neovascularization, Pathologic/diagnostic imaging
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/pathology
- Omalizumab/therapeutic use
- Tumor Burden
- Vascular Endothelial Growth Factor A/antagonists & inhibitors
- Vascular Endothelial Growth Factor A/immunology
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Lauren CJ Baker
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK
| | - Jessica KR Boult
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK
| | - Markus Thomas
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center, Penzberg DE-82377, Germany
| | - Astrid Koehler
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center, Penzberg DE-82377, Germany
| | - Tapan Nayak
- Roche pRED, Roche Innovation Center, Basel CH-4070, Switzerland
| | - Jean Tessier
- Roche pRED, Roche Innovation Center, Basel CH-4070, Switzerland
| | - Chia-Huey Ooi
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center, Penzberg DE-82377, Germany
| | - Fabian Birzele
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center, Penzberg DE-82377, Germany
| | - Anton Belousov
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center, Penzberg DE-82377, Germany
| | | | - Carsten Horn
- Roche pRED, Roche Innovation Center, Basel CH-4070, Switzerland
| | - Clare LeFave
- Roche pRED, Roche Innovation Center, New York, NY 10016, USA
| | - Simon P Robinson
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK
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9
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Grünwald V, Lin X, Kalanovic D, Simantov R. Early Tumour Shrinkage: A Tool for the Detection of Early Clinical Activity in Metastatic Renal Cell Carcinoma. Eur Urol 2016; 70:1006-1015. [PMID: 27238653 DOI: 10.1016/j.eururo.2016.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/08/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The predictive role of objective remission remains undefined for targeted agents in metastatic renal cell carcinoma (mRCC); however, early tumour shrinkage (eTS) was shown to be predictive and/or prognostic for overall survival (OS) and progression-free survival (PFS) in mRCC in several small studies. OBJECTIVE To evaluate the degree of eTS following systemic therapy that may predict survival in mRCC. DESIGN, SETTING, AND PARTICIPANTS Data from 4334 patients with mRCC in phase 2 and 3 clinical trials between 2003 and 2013 were pooled for analyses. Early tumour shrinkage was assessed based on percentage change in sum of the longest diameters of target lesions at first postbaseline scan. Patients were categorised by a more or equal versus less optimal threshold of eTS, assessed using receiver operating characteristic (ROC) analysis. OS and PFS in patients with eTS were summarised using the Kaplan-Meier method. INTERVENTION Axitinib, bevacizumab, interferon α, sorafenib, sunitinib, or temsirolimus. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We measured optimal thresholds of eTS and eTS as a predictor of OS or PFS. RESULTS AND LIMITATIONS Optimal threshold of eTS for the prediction of OS and PFS was determined to be approximately 10%. In Cox proportional hazards models, compared with patients without eTS, those with eTS had significantly longer OS (hazard ratio [HR]: 0.615; p<0.0001; median: 28.5 vs 16.0 mo) and PFS (HR: 0.628; p<0.0001; median: 10.5 vs 5.3 mo). The major limitation was the retrospective nature of our analysis, including different lines and types of therapy, although subset analyses detected a similar predictive pattern for eTS across all lines and types of therapy. CONCLUSIONS Early tumour shrinkage ≥10% at first postbaseline assessment could serve as a putative early end point in patients with mRCC. A prospective evaluation of eTS in clinical trials is warranted. PATIENT SUMMARY Early tumour shrinkage may be used to identify patients with metastatic renal cell carcinoma who would benefit from treatment with antitumour agents. TRIAL REGISTRATION The clinical trials are registered on ClinicalTrials.gov (NCT00267748, NCT00338884, NCT00835978, NCT00065468, NCT00083889, NCT00631371, NCT00920816, NCT00077974, NCT00137423, NCT00054886, NCT00678392, and NCT00474786).
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Affiliation(s)
| | - Xun Lin
- Pfizer Oncology, La Jolla, CA, USA
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10
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Liu Y, deSouza NM, Shankar LK, Kauczor HU, Trattnig S, Collette S, Chiti A. A risk management approach for imaging biomarker-driven clinical trials in oncology. Lancet Oncol 2015; 16:e622-8. [PMID: 26678215 DOI: 10.1016/s1470-2045(15)00164-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 11/30/2022]
Abstract
Imaging has steadily evolved in clinical cancer research as a result of improved conventional imaging methods and the innovation of new functional and molecular imaging techniques. Despite this evolution, the design and data quality derived from imaging within clinical trials are not ideal and gaps exist with paucity of optimised methods, constraints of trial operational support, and scarce resources. Difficulties associated with integrating imaging biomarkers into trials have been neglected compared with inclusion of tissue and blood biomarkers, largely because of inherent challenges in the complexity of imaging technologies, safety issues related to new imaging contrast media, standardisation of image acquisition across multivendor platforms, and various postprocessing options available with advanced software. Ignorance of these pitfalls directly affects the quality of the imaging read-out, leading to trial failure, particularly when imaging is a primary endpoint. Therefore, we propose a practical risk-based framework and recommendations for trials driven by imaging biomarkers, which allow identification of risks at trial initiation to better allocate resources and prioritise key tasks.
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Affiliation(s)
- Yan Liu
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium.
| | - Nandita M deSouza
- Cancer Research UK Cancer Imaging Centre, MRI Unit, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Lalitha K Shankar
- Clinical Trial Branch, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Siegfried Trattnig
- The Center of Excellence for High Field MR, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Sandra Collette
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Arturo Chiti
- Humanitas University and Nuclear Medicine Department, Humanitas Research Hospital, Milan, Italy
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11
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Abstract
X-rays are commonly used as a means to image the inside of objects opaque to visible light, as their short wavelength allows penetration through matter and the formation of high spatial resolution images. This physical effect has found particular importance in medicine where x-ray based imaging is routinely used as a diagnostic tool. Increasingly, however, imaging modalities that provide functional as well as morphological information are required. In this study the potential to use x-ray phase based imaging as a functional modality through the use of microbubbles that can be targeted to specific biological processes is explored. We show that the concentration of a microbubble suspension can be monitored quantitatively whilst in flow using x-ray phase contrast imaging. This could provide the basis for a dynamic imaging technique that combines the tissue penetration, spatial resolution, and high contrast of x-ray phase based imaging with the functional information offered by targeted imaging modalities.
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12
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Ken S, Deviers A, Filleron T, Catalaa I, Lotterie JA, Khalifa J, Lubrano V, Berry I, Péran P, Celsis P, Moyal ECJ, Laprie A. Voxel-based evidence of perfusion normalization in glioblastoma patients included in a phase I-II trial of radiotherapy/tipifarnib combination. J Neurooncol 2015; 124:465-73. [PMID: 26189058 DOI: 10.1007/s11060-015-1860-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/14/2015] [Indexed: 01/24/2023]
Abstract
We previously showed that the farnesyl transferase inihibitor, Tipifarnib induced vascularization normalization, oxygenation and radiosensitization in a pre-clinical glioblastoma (GBM) model. The aim of this study was to assess by dynamic-susceptibility-contrast MRI (DSC-MRI) the effect of radiotherapy (RT) and Tipifarnib combination on tumor perfusion in GBM patients. Eighteen patients with newly diagnosed GBM, enrolled in a phase I-II clinical trial associating RT with Tipifarnib, underwent anatomical MR imaging and DSC-MRI before (M0) and two months after treatment (M2). Anatomic volumes of interest (VOIs) were delineated according to contrast-enhanced and hyper-intense signal areas on T1-Gd and T2 images, respectively. Perfusion variations between M0 and M2 were assessed with median relative cerebral blood volume (rCBV) inside these VOIs. Another voxel by voxel analysis of CBV values classified 405,117 tumor voxels into High_, Normal_ and Low_CBVTUMOR according to the distribution of CBV in the contralateral normal tissue. These three categories of CBVTUMOR voxels were color-coded over anatomical MRI. Variations of median rCBV were significantly different for two groups of patients (P < 0.013): rCBV decreased when initial rCBV was ≥ 1.0 (Group_rCBV_M0 > 1) and rCBV increased when initial rCBV was < 1.0 (Group_rCBV_M0 < 1). Mapping of color-coded voxels provided additional spatial and quantitative information about tumor perfusion: Group_rCBV_M0 > 1 presented a significant decrease of High_CBVTUMOR volume (P = 0.015) simultaneously with a significant increase of Normal_CBVTUMOR volume (P = 0.009) after treatment. Group_rCBV_M0 < 1 presented a decrease of Low_CBVTUMOR volume with an increase of Normal_ and High_CBV TUMOR volume after treatment. Pre and post-treatment CBV measurements with DSC-MRI characterized tumor perfusion evolution in GBM patients treated with RT combined to Tipifarnib; showing variations in favour of tumor perfusion normalization in agreement with our pre-clinical results of vascular normalization.
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Affiliation(s)
- Soléakhéna Ken
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopôle, 1, avenue Irene Joliot-Curie, 31059, Toulouse, France. .,Department of Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopôle, 1, avenue Irene Joliot-Curie, 31059, Toulouse, France. .,INSERM UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, CHU Purpan - Pavillon Baudot, 31024, Toulouse, France.
| | - Alexandra Deviers
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopôle, 1, avenue Irene Joliot-Curie, 31059, Toulouse, France.,INSERM UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, CHU Purpan - Pavillon Baudot, 31024, Toulouse, France.,Université Paul Sabatier, Toulouse III, 118, route de Narbonne, 31062, Toulouse, France
| | - Thomas Filleron
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopôle, Bureau des Essais Cliniques, 1, avenue Irene Joliot-Curie, 31059, Toulouse, France
| | - Isabelle Catalaa
- Centre Hospitalier Universitaire de Purpan, 31059, Toulouse, France
| | - Jean-Albert Lotterie
- INSERM UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, CHU Purpan - Pavillon Baudot, 31024, Toulouse, France.,Centre Hospitalier Universitaire de Rangueil, 31059, Toulouse, France
| | - Jonathan Khalifa
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopôle, 1, avenue Irene Joliot-Curie, 31059, Toulouse, France
| | - Vincent Lubrano
- INSERM UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, CHU Purpan - Pavillon Baudot, 31024, Toulouse, France.,Centre Hospitalier Universitaire de Rangueil, 31059, Toulouse, France
| | - Isabelle Berry
- INSERM UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, CHU Purpan - Pavillon Baudot, 31024, Toulouse, France.,Centre Hospitalier Universitaire de Rangueil, 31059, Toulouse, France
| | - Patrice Péran
- INSERM UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, CHU Purpan - Pavillon Baudot, 31024, Toulouse, France
| | - Pierre Celsis
- INSERM UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, CHU Purpan - Pavillon Baudot, 31024, Toulouse, France
| | - Elizabeth Cohen-Jonathan Moyal
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopôle, 1, avenue Irene Joliot-Curie, 31059, Toulouse, France.,Université Paul Sabatier, Toulouse III, 118, route de Narbonne, 31062, Toulouse, France.,INSERM, UMR 1037, CRCT, 1, avenue Irene Joliot-Curie, 31000, Toulouse, France
| | - Anne Laprie
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopôle, 1, avenue Irene Joliot-Curie, 31059, Toulouse, France.,INSERM UMR 825 Imagerie Cérébrale et Handicaps Neurologiques, CHU Purpan - Pavillon Baudot, 31024, Toulouse, France.,Université Paul Sabatier, Toulouse III, 118, route de Narbonne, 31062, Toulouse, France
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Mizuno T, Kamai T, Abe H, Sakamoto S, Kitajima K, Nishihara D, Yuki H, Kambara T, Betsunoh H, Yashi M, Fukabori Y, Kaji Y, Yoshida KI. Clinically significant association between the maximum standardized uptake value on 18F-FDG PET and expression of phosphorylated Akt and S6 kinase for prediction of the biological characteristics of renal cell cancer. BMC Cancer 2015; 15:1097. [PMID: 25784113 PMCID: PMC4357069 DOI: 10.1186/s12885-015-1097-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/20/2015] [Indexed: 01/03/2023] Open
Abstract
Background The relationship between the clinicopathological features and molecular changes associated with standardized uptake value (SUV) determined by Positron emission tomography (PET) with [18F] fluorodeoxyglucose (18F-FDG PET) in human renal cell carcinoma (RCC) has not been elucidated. On the other hand, overactivation of the phosphatidylinositol 3’kinase (PI3K), serine/threonine kinase Akt, and mammalian target of rapamycin (mTOR) pathway has been detected in a variety of human cancers, including RCC. So far, little is known about the relationship between the SUV and these proteins in human RCC. Thus, it is important to study the relevance of SUV with clinicopathological features in human RCCs from a molecular point of view. Methods Seventy-seven consecutive patients with RCC who underwent nephrectomy and pretreatment determination of the maximum SUV (SUVmax) by 18F-FDG PET were analyzed. We investigated the relationship between the SUVmax, phosphorylated-Akt (Ser-473) (pAkt(Ser-473)), phosphorylated-Akt (Thr-308) (pAkt(Thr-308), and phosphorylated-S6 ribosomal protein (Ser-235/236) (pS6) protein levels in the primary tumor and various clinicopathological features. Results The average SUVmax of the primary tumor was 6.9 (1.5 to 40.3). A higher SUVmax was correlated with higher expression of pAkt(Ser-473), pAkt (Thr-308), and pS6 protein in the primary tumor. A higher SUVmax and increased expression of pAkt (Ser-473), pAkt (Thr-308), and pS6 of the primary tumor was associated with less tumor differentiation, a higher pT stage, regional lymph node involvement, microscopic vascular invasion, and distant metastasis, as well as with early relapse following radical nephrectomy in patients who had localized or locally advanced RCC without distant metastasis (cTanyNanyM0) and with shorter overall survival in all patients. Conclusions A higher SUVmax on 18F-FDG PET is associated with elevated tumor levels of pAkt and pS6 protein and with aggressive behavior and metastatic potential of RCC, as well as with early relapse following radical nephrectomy and shorter overall survival. These findings suggest that SUVmax may be useful for predicting the biological characteristics of RCC.
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Affiliation(s)
- Tomoya Mizuno
- Department of Urology, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan,
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14
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Dynamic Contrast-Enhanced Magnetic Resonance Imaging Measurements in Renal Cell Carcinoma. Invest Radiol 2015; 50:57-66. [DOI: 10.1097/rli.0000000000000096] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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15
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Cebulla J, Huuse EM, Pettersen K, van der Veen A, Kim E, Andersen S, Prestvik WS, Bofin AM, Pathak AP, Bjørkøy G, Bathen TF, Moestue SA. MRI reveals the in vivo cellular and vascular response to BEZ235 in ovarian cancer xenografts with different PI3-kinase pathway activity. Br J Cancer 2014; 112:504-13. [PMID: 25535727 PMCID: PMC4453650 DOI: 10.1038/bjc.2014.628] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/28/2014] [Accepted: 11/28/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The phosphoinositide-3 kinase (PI3K) pathway is an attractive therapeutic target. However, difficulty in predicting therapeutic response limits the clinical implementation of PI3K inhibitors. This study evaluates the utility of clinically relevant magnetic resonance imaging (MRI) biomarkers for noninvasively assessing the in vivo response to the dual PI3K/mTOR inhibitor BEZ235 in two ovarian cancer models with differential PI3K pathway activity. METHODS The PI3K signalling activity of TOV-21G and TOV-112D human ovarian cancer cells was investigated in vitro. Cellular and vascular response of the xenografts to BEZ235 treatment (65 mg kg(-1), 3 days) was assessed in vivo using diffusion-weighted (DW) and dynamic contrast-enhanced (DCE)-MRI. Micro-computed tomography was performed to investigate changes in vascular morphology. RESULTS The TOV-21G cells showed higher PI3K signalling activity than TOV-112D cells in vitro and in vivo. Treated TOV-21G xenografts decreased in volume and DW-MRI revealed an increased water diffusivity that was not found in TOV-112D xenografts. Treatment-induced improvement in vascular functionality was detected with DCE-MRI in both models. Changes in vascular morphology were not found. CONCLUSIONS Our results suggest that DW- and DCE-MRI can detect cellular and vascular response to PI3K/mTOR inhibition in vivo. However, only DW-MRI could discriminate between a strong and weak response to BEZ235.
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Affiliation(s)
- J Cebulla
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - E M Huuse
- 1] Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway [2] Department of Medical Imaging, St Olavs University Hospital, Trondheim 7006, Norway
| | - K Pettersen
- 1] Center of Molecular Inflammation Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim 7491, Norway [2] Department of Technology, University College of Sør-Trøndelag, Trondheim 7006, Norway [3] Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim 7006, Norway
| | - A van der Veen
- Center of Molecular Inflammation Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - E Kim
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - S Andersen
- 1] Center of Molecular Inflammation Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim 7491, Norway [2] Department of Technology, University College of Sør-Trøndelag, Trondheim 7006, Norway
| | - W S Prestvik
- Department of Technology, University College of Sør-Trøndelag, Trondheim 7006, Norway
| | - A M Bofin
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim 7006, Norway
| | - A P Pathak
- Russell H Morgan Department of Radiology and Radiological Science and Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - G Bjørkøy
- 1] Center of Molecular Inflammation Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim 7491, Norway [2] Department of Technology, University College of Sør-Trøndelag, Trondheim 7006, Norway
| | - T F Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway
| | - S A Moestue
- 1] Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim 7491, Norway [2] Department of Medical Imaging, St Olavs University Hospital, Trondheim 7006, Norway
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16
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Zöllner FG, Kalayciyan R, Chacón-Caldera J, Zimmer F, Schad LR. Pre-clinical functional Magnetic Resonance Imaging part I: The kidney. Z Med Phys 2014; 24:286-306. [DOI: 10.1016/j.zemedi.2014.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 01/10/2023]
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17
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Yap TA, Yan L, Patnaik A, Tunariu N, Biondo A, Fearen I, Papadopoulos KP, Olmos D, Baird R, Delgado L, Tetteh E, Beckman RA, Lupinacci L, Riisnaes R, Decordova S, Heaton SP, Swales K, deSouza NM, Leach MO, Garrett MD, Sullivan DM, de Bono JS, Tolcher AW. Interrogating two schedules of the AKT inhibitor MK-2206 in patients with advanced solid tumors incorporating novel pharmacodynamic and functional imaging biomarkers. Clin Cancer Res 2014; 20:5672-85. [PMID: 25239610 PMCID: PMC4233149 DOI: 10.1158/1078-0432.ccr-14-0868] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Multiple cancers harbor genetic aberrations that impact AKT signaling. MK-2206 is a potent pan-AKT inhibitor with a maximum tolerated dose (MTD) previously established at 60 mg on alternate days (QOD). Due to a long half-life (60-80 hours), a weekly (QW) MK-2206 schedule was pursued to compare intermittent QW and continuous QOD dosing. EXPERIMENTAL DESIGN Patients with advanced cancers were enrolled in a QW dose-escalation phase I study to investigate the safety and pharmacokinetic-pharmacodynamic profiles of tumor and platelet-rich plasma (PRP). The QOD MTD of MK-2206 was also assessed in patients with ovarian and castration-resistant prostate cancers and patients with advanced cancers undergoing multiparametric functional magnetic resonance imaging (MRI) studies, including dynamic contrast-enhanced MRI, diffusion-weighted imaging, magnetic resonance spectroscopy, and intrinsic susceptibility-weighted MRI. RESULTS A total of 71 patients were enrolled; 38 patients had 60 mg MK-2206 QOD, whereas 33 received MK-2206 at 90, 135, 150, 200, 250, and 300 mg QW. The QW MK-2206 MTD was established at 200 mg following dose-limiting rash at 250 and 300 mg. QW dosing appeared to be similarly tolerated to QOD, with toxicities including rash, gastrointestinal symptoms, fatigue, and hyperglycemia. Significant AKT pathway blockade was observed with both continuous QOD and intermittent QW dosing of MK-2206 in serially obtained tumor and PRP specimens. The functional imaging studies demonstrated that complex multiparametric MRI protocols may be effectively implemented in a phase I trial. CONCLUSIONS Treatment with MK-2206 safely results in significant AKT pathway blockade in QOD and QW schedules. The intermittent dose of 200 mg QW is currently used in phase II MK-2206 monotherapy and combination studies (NCT00670488).
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Affiliation(s)
- Timothy A Yap
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom. Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | - Li Yan
- Merck & Co., Inc., Whitehouse Station, New Jersey
| | - Amita Patnaik
- South Texas Accelerated Research Therapeutics, San Antonio, Texas
| | - Nina Tunariu
- CR-UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - Andrea Biondo
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom. Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | - Ivy Fearen
- Merck & Co., Inc., Whitehouse Station, New Jersey
| | | | - David Olmos
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom. Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | - Richard Baird
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom. Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | | | | | | | | | - Ruth Riisnaes
- Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | - Shaun Decordova
- Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | - Simon P Heaton
- Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | - Karen Swales
- Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | - Nandita M deSouza
- CR-UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - Martin O Leach
- CR-UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - Michelle D Garrett
- Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom
| | | | - Johann S de Bono
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom. Division of Clinical Studies, The Institute of Cancer Research, Surrey, United Kingdom.
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Translation in solid cancer: are size-based response criteria an anachronism? Clin Transl Oncol 2014; 17:1-10. [PMID: 25073600 DOI: 10.1007/s12094-014-1207-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/09/2014] [Indexed: 12/19/2022]
Abstract
The purpose of translation is the development of effective medicinal products based on validated science. A parallel objective is to obtain marketing authorization for the translated product. Unfortunately, in solid cancer, these two objectives are not mutually consistent as evidenced by the contrast between major advances in science and the continuing dismal record of pharmaceutical productivity. If the problem is unrelated to science, then the process of translation may require a closer examination, namely, the criteria for regulatory approval. This realization is important because, in this context, the objective of translation is regulatory approval, and science does not passively translate into useful medicinal products. Today, in solid cancer, response criteria related to tumor size are less useful than during the earlier cytotoxic drugs era; advanced imaging and biomarkers now allow for tracking of the natural history of the disease in the laboratory and the clinic. Also, it is difficult to infer clinical benefit from tumor shrinkage since it is rarely sustained. Accordingly, size-based response criteria may represent an anachronism relative to translation in solid cancer and it may be appropriate to align preclinical and clinical effort and shift the focus to local invasion and metastasis. The shift from a cancer cell-centric model to a stroma centric model offers novel opportunities not only to interupt the natural history of the disease, but also to rethink the relevance of outdated criteria of clinical response. Current evidence favors the opinion that, in solid cancer, a different, broader, and contextual approach may lead to interventions that could delay local invasion and metastasis. All elements supporting this shift, especially advanced imaging, are in place.
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Domblides C, Gross-Goupil M, Quivy A, Ravaud A. Emerging antiangiogenics for renal cancer. Expert Opin Emerg Drugs 2014; 18:495-511. [PMID: 24274612 DOI: 10.1517/14728214.2013.858697] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Antiangiogenic therapy is considered to be the backbone of treatment strategy in metastatic renal cell carcinoma (mRCC). New, more focused, targeted drugs are emerging, while other targeted drugs oriented toward resistance or alternative mechanisms are under development. AREAS COVERED Antiangiogenic agents include two types of agents: the monoclonal antibody, targeting vascular endothelial growth factor (VEGF), bevacizumab and the tyrosine kinase inhibitors (TKIs). Data regarding efficacy and safety of these agents are reported. Differences between the first generation of TKIs, sunitinib, sorafenib, and the new generation, pazopanib, axitinib and tivozanib are also detailed. Most of these agents have been approved in the treatment of kidney cancer in specific settings of the disease. EXPERT OPINION The class of antiangiogenic drugs for treatment of mRCC is already relatively full. After 'me-too' drugs, more targeted drugs against VEGFR have been developed but have to demonstrate a benefit in first-line treatment. Another option for the development is to combine a known drug with an antiangiogenic inhibition profile and at least one additional target involved in resistance to an antiangiogenic or in an alternative pathway. The cost of approach with targeted drugs, including antiangiogenics, has led to a tremendous increase in the cost of care in mRCC.
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Affiliation(s)
- Charlotte Domblides
- Bordeaux University Hospital, Hôpital Saint-André, Department of Medical Oncology , Bordeaux , France
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20
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Impact of perfusion map analysis on early survival prediction accuracy in glioma patients. Transl Oncol 2013; 6:766-74. [PMID: 24466380 DOI: 10.1593/tlo.13670] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 10/21/2013] [Accepted: 10/28/2013] [Indexed: 01/22/2023] Open
Abstract
Studies investigating dynamic susceptibility contrast magnetic resonance imaging-determined relative cerebral blood volume (rCBV) maps as a metric of treatment response assessment have generated conflicting results. We evaluated the potential of various analytical techniques to predict survival of patients with glioma treated with chemoradiation. rCBV maps were acquired in patients with high-grade gliomas at 0, 1, and 3 weeks into chemoradiation therapy. Various analytical techniques were applied to the same cohort of serial rCBV data for early assessment of survival. Three different methodologies were investigated: 1) percentage change of whole tumor statistics (i.e., mean, median, and percentiles), 2) physiological segmentation (low rCBV, medium rCBV, or high rCBV), and 3) a voxel-based approach, parametric response mapping (PRM). All analyses were performed using the same tumor contours, which were determined using contrast-enhanced T1-weighted and fluid attenuated inversion recovery images. The predictive potential of each response metric was assessed at 1-year and overall survival. PRM was the only analytical approach found to generate a response metric significantly predictive of patient 1-year survival. Time of acquisition and contour volume were not found to alter the sensitivity of the PRM approach for predicting overall survival. We have demonstrated the importance of the analytical approach in early response assessment using serial rCBV maps. The PRM analysis shows promise as a unified early and robust imaging biomarker of treatment response in patients diagnosed with high-grade gliomas.
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Karroum O, Mignion L, Kengen J, Karmani L, Levêque P, Danhier P, Magat J, Bol A, Labar D, Grégoire V, Bouzin C, Feron O, Gallez B, Jordan BF. Multimodal imaging of tumor response to sorafenib combined with radiation therapy: comparison between diffusion-weighted MRI, choline spectroscopy and 18F-FLT PET imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2013; 8:274-80. [PMID: 23606431 DOI: 10.1002/cmmi.1525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 11/08/2012] [Accepted: 11/29/2012] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to determine the value of different imaging modalities, that is, magnetic resonance imaging/spectroscopy (MRI/MRS) and positron emission tomography (PET), to assess early tumor response to sorafenib with or without radiotherapy. Diffusion-weighted (DW)-MRI, choline (1)H MRS at 11.7 T, and (18)F-FLT PET imaging were used to image fibrosarcoma (FSaII) tumor-bearing mice over time. The imaging markers were compared with apoptosis cell death and cell proliferation measurements assessed by histology. Anti-proliferative effects of sorafenib were evidenced by (1)H MRS and (18)F-FLT PET after 2 days of treatment with sorafenib, with no additional effect of the combination with radiation therapy, results that are in agreement with Ki67 staining. Apparent diffusion coefficient calculated using DW-MRI was not modified after 2 days of treatment with sorafenib, but showed significant increase 24 h after 2 days of sorafenib treatment combined with consecutive irradiation. The three imaging markers were able to show early tumor response as soon as 24 h after treatment initiation, with choline MRS and (18)F-FLT being sensitive to sorafenib in monotherapy as well as in combined therapy with irradiation, whereas DW-MRI was only sensitive to the combination of sorafenib with radiotherapy.
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Affiliation(s)
- Oussama Karroum
- Biomedical Magnetic Resonance Group, Louvain Drug Research Institute, Université Catholique de Louvain, Belgium, Avenue Mounier 73, B-1200 Brussels, Belgium
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Beloueche-Babari M, Jamin Y, Arunan V, Walker-Samuel S, Revill M, Smith PD, Halliday J, Waterton JC, Barjat H, Workman P, Leach MO, Robinson SP. Acute tumour response to the MEK1/2 inhibitor selumetinib (AZD6244, ARRY-142886) evaluated by non-invasive diffusion-weighted MRI. Br J Cancer 2013; 109:1562-9. [PMID: 23942066 PMCID: PMC3776979 DOI: 10.1038/bjc.2013.456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Non-invasive imaging biomarkers underpin the development of molecularly targeted anti-cancer drugs. This study evaluates tumour apparent diffusion coefficient (ADC), measured by diffusion-weighted magnetic resonance imaging (DW-MRI), as a biomarker of response to the MEK1/2 inhibitor selumetinib (AZD6244, ARRY-142886) in human tumour xenografts. METHODS Nude mice bearing human BRAF(V600D) WM266.4 melanoma or BRAF(V600E) Colo205 colon carcinoma xenografts were treated for 4 days with vehicle or selumetinib. DW-MRI was performed before and 2 h after the last dose and excised tumours analysed for levels of phospho-ERK1/2, cleaved caspase 3 (CC3) and necrosis. RESULTS Selumetinib treatment induced tumour stasis and reduced ERK1/2 phosphorylation in both WM266.4 and Colo205 tumour xenografts. Relative to day 0, mean tumour ADC was unchanged in the control groups but was significantly increased by up to 1.6-fold in selumetinib-treated WM266.4 and Colo205 tumours. Histological analysis revealed a significant increase in necrosis in selumetinib-treated WM266.4 and Colo205 xenografts and CC3 staining in selumetinib-treated Colo205 tumours relative to controls. CONCLUSION Changes in ADC following treatment with the MEK1/2 inhibitor selumetinib in responsive human tumour xenografts were concomitant with induction of tumour cell death. ADC may provide a useful non-invasive pharmacodynamic biomarker for early clinical assessment of response to selumetinib and other MEK-ERK1/2 signalling-targeted therapies.
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Affiliation(s)
- M Beloueche-Babari
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
| | - Y Jamin
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
| | - V Arunan
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
| | - S Walker-Samuel
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
| | - M Revill
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - P D Smith
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - J Halliday
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - J C Waterton
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - H Barjat
- AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
| | - P Workman
- Cancer Research UK Cancer Therapeutics Unit, Division of Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK
| | - M O Leach
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
| | - S P Robinson
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK
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Donnem T, Hu J, Ferguson M, Adighibe O, Snell C, Harris AL, Gatter KC, Pezzella F. Vessel co-option in primary human tumors and metastases: an obstacle to effective anti-angiogenic treatment? Cancer Med 2013; 2:427-36. [PMID: 24156015 PMCID: PMC3799277 DOI: 10.1002/cam4.105] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/03/2013] [Accepted: 06/03/2013] [Indexed: 12/19/2022] Open
Abstract
Angiogenesis has been regarded as essential for tumor growth and progression. Studies of many human tumors, however, suggest that their microcirculation may be provided by nonsprouting vessels and that a variety of tumors can grow and metastasize without angiogenesis. Vessel co-option, where tumor cells migrate along the preexisting vessels of the host organ, is regarded as an alternative tumor blood supply. Vessel co-option may occur in many malignancies, but so far mostly reported in highly vascularized tissues such as brain, lung, and liver. In primary and metastatic lung cancer and liver metastasis from different primary origins, as much as 10–30% of the tumors are reported to use this alternative blood supply. In addition, vessel co-option is introduced as a potential explanation of antiangiogenic drug resistance, although the impact of vessel co-option in this clinical setting is still to be further explored. In this review we discuss tumor vessel co-option with specific examples of vessel co-option in primary and secondary tumors and a consideration of the clinical implications of this alternative tumor blood supply. Both primary and metastatic tumors use preexisting host tissue vessels as their blood supply. Tumors may grow to a clinically detectable size without angiogenesis and makes them less likely to respond to drugs designed to target the abnormal vasculature produced by angiogenesis, but further studies to explore the biological and clinical implication of these co-opted vessels is needed.
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Affiliation(s)
- Tom Donnem
- Department of Oncology, University Hospital of North Norway Tromso, Norway ; Institute of Clinical Medicine, University of Tromso Tromso, Norway
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Schraml C, Schwenzer NF, Claussen CD, Martirosian P. Examination of Tissue Perfusion by Arterial Spin Labeling (ASL). CURRENT RADIOLOGY REPORTS 2013. [DOI: 10.1007/s40134-013-0009-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paulmurugan R, Oronsky B, Brouse CF, Reid T, Knox S, Scicinski J. Real time dynamic imaging and current targeted therapies in the war on cancer: a new paradigm. Theranostics 2013; 3:437-47. [PMID: 23781290 PMCID: PMC3677414 DOI: 10.7150/thno.5658] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/28/2013] [Indexed: 12/13/2022] Open
Abstract
In biology, as every science student is made to learn, ontology recapitulates phylogeny. In medicine, however, oncology recapitulates polemology, the science of warfare: The medical establishment is transitioning from highly toxic poisons that kill rapidly dividing normal and malignant cells with little specificity to tailored therapies that target the tumors with the lethality of the therapeutic warhead. From the advent of the information age with the incorporation of high-tech intelligence, reconnaissance, and surveillance has resulted in "data fusion" where a wide range of information collected in near real-time can be used to redesign most of the treatment strategies currently used in the clinic. The medical community has begun to transition from the 'black box' of tumor therapy based solely on the clinical response to the 'glass box' of dynamic imaging designed to bring transparency to the clinical battlefield during treatment, thereby informing the therapeutic decision to 'retreat or repeat'. The tumor microenvironment is dynamic, constantly changing in response to therapeutic intervention, and therefore the therapeutic assessment must map to this variable and ever-changing landscape with dynamic and non-static imaging capabilities. The path to personalized medicine will require incorporation and integration of dynamic imaging at the bedside into clinical practice for real-time, interactive assessment of response to targeted therapies. The application of advanced real time imaging techniques along with current molecularly targeted anticancer therapies which alter cellular homeostasis and microenvironment can enhance therapeutic interventions in cancer patients and further improve the current status in clinical management of patients with advanced cancers.
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The role of functional imaging in the era of targeted therapy of renal cell carcinoma. World J Urol 2013; 32:47-58. [PMID: 23588813 DOI: 10.1007/s00345-013-1074-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/01/2013] [Indexed: 12/23/2022] Open
Abstract
Antiangiogenic therapies interacting with tumor-specific pathways have been established for targeted therapy of renal cell carcinoma (RCC). However, evaluation of tumor response based on morphologic tumor diameter measurements has limitations, as tumor shrinkage may lag behind pathophysiological response. Functional imaging techniques such as dynamic contrast-enhanced (DCE) ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI), unenhanced diffusion-weighted MRI (DW-MRI), and also metabolic imaging with positron emission tomography (PET) have the ability to assess physiological parameters and to predict and monitor therapy response. Assessment of changes in vascularity, cellularity, oxygenation, and glucose uptake with functional imaging during targeted therapy may correlate with progression-free survival and can predict tumor response or progression. In this review, we explore the potential of functional imaging techniques for assessing the effects of targeted therapy of RCC and as well review the reproducibility and limitations.
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Yap TA, Omlin A, de Bono JS. Development of therapeutic combinations targeting major cancer signaling pathways. J Clin Oncol 2013; 31:1592-605. [PMID: 23509311 DOI: 10.1200/jco.2011.37.6418] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Signaling networks play key homeostatic processes in living organisms but are commonly hijacked in oncogenesis. Prominent examples include genetically altered receptor tyrosine kinases and dysregulated intracellular signaling molecules. The discovery and development of targeted therapies against such oncogenic proteins has imparted clinical benefit. Nevertheless, concerns remain about the limited single-agent efficacy and narrow therapeutic indices of many of these antitumor agents. Moreover, it is apparent that oncogenic proteins comprise complex signaling networks that interact through crosstalk and feedback loops, which modify therapeutic vulnerability. These complexities mandate the study of drug combinations, which will also become necessary to reverse tumor drug resistance. Here, we outline the challenges associated with rational drug codevelopment strategies, with a focus on the importance of analytically validated biomarkers for patient selection and pharmacokinetic-pharmacodynamic (PK-PD) studies. Overall, the most informative clinical studies of novel combinations will have the following characteristics: robust scientific hypotheses leading to their selection; supportive preclinical data from contextually appropriate preclinical model systems; sufficient preclinical PK data to inform on the risk of drug-drug interactions; and detailed PD studies to determine the biologically active dose range for each agent. Toward this end, several novel clinical trial designs may be envisioned to accelerate successful drug combination development while minimizing the risk of late drug combination attrition. Although considerable challenges remain, these efforts may enable important steps to be taken toward more durable therapeutic control of many cancers.
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Affiliation(s)
- Timothy A Yap
- Royal Marsden National Health Service Foundation Trust and The Institute of Cancer Research, Sutton, Surrey, United Kingdom
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Mansi L, Ciarmiello A, Cuccurullo V. PET/MRI and the revolution of the third eye. Eur J Nucl Med Mol Imaging 2012; 39:1519-24. [DOI: 10.1007/s00259-012-2185-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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