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Choi SH, Chen YW, Panian J, Yuen K, McKay RR. Emerging innovative treatment strategies for advanced clear cell renal cell carcinoma. Oncologist 2024:oyae276. [PMID: 39401004 DOI: 10.1093/oncolo/oyae276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 09/10/2024] [Indexed: 10/15/2024] Open
Abstract
Dramatic advances in biological discoveries, since the 1990s, have continued to reshape the treatment paradigm of metastatic renal cell carcinoma (RCC). Von Hippel Lindau (VHL) gene alterations are associated with pro-angiogenic activity and are central to the pathogenesis of clear cell RCC (ccRCC), the most predominant histologic subtype of RCC. Antiangiogenic strategies revolving around this VHL/HIF/VEGF axis have been shown to improve survival in metastatic ccRCC. The discovery of immune checkpoints and agents that target their inhibition introduced a new treatment paradigm for patients with RCC. While initially approved as monotherapy, studies investigating immune checkpoint inhibitor combinations have led to their approval as the new standard of care, providing durable responses and unprecedented improvements in clinical outcome. Despite these advances, the projected 14 390 deaths in 2024 from RCC underscore the need to continue efforts in expanding and optimizing treatment options for patients with metastatic RCC. This article reviews key findings that have transformed the way we understand and treat metastatic RCC, in addition to highlighting novel treatment strategies that are currently under development.
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Affiliation(s)
- Sharon H Choi
- Division of Hematology Oncology, University of California San Diego, San Diego, CA, United States
| | - Yu-Wei Chen
- Division of Hematology Oncology, University of California San Diego, San Diego, CA, United States
| | - Justine Panian
- Division of Hematology Oncology, University of California San Diego, San Diego, CA, United States
| | - Kit Yuen
- Department of Urology, University of California San Diego, San Diego, CA, United States
| | - Rana R McKay
- Division of Hematology Oncology, University of California San Diego, San Diego, CA, United States
- Department of Urology, University of California San Diego, San Diego, CA, United States
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Maksimovic S, Boscolo NC, La Posta L, Barrios S, Moussa MJ, Gentile E, Pesquera PI, Li W, Chen J, Gomez JA, Basi A, Burks JK, Alvarez-Breckenridge C, Gao J, Campbell MT, Dondossola E. Antiangiogenic Tyrosine Kinase Inhibitors have Differential Efficacy in Clear Cell Renal Cell Carcinoma in Bone. CANCER RESEARCH COMMUNICATIONS 2024; 4:2621-2637. [PMID: 39248577 PMCID: PMC11459607 DOI: 10.1158/2767-9764.crc-24-0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/24/2024] [Accepted: 09/04/2024] [Indexed: 09/10/2024]
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most prevalent kidney neoplasm; bone metastasis (BM) develops in 35% to 40% of metastatic patients and results in substantial morbidity and mortality, as well as medical costs. A key feature of ccRCC is the loss of function of the von Hippel-Lindau protein, which enhances angiogenesis via vascular endothelial growth factor release. Consequently, antiangiogenic tyrosine kinase inhibitors (TKI) emerged as a treatment for ccRCC. However, limited data about their efficacy in BM is available, and no systematic comparisons have been performed. We developed mouse models of bone and lung ccRCC tumors and compared their anticancer efficacy, impact on mouse survival, and mechanisms of action, including effects on tumor cells and both immune and nonimmune (blood vessels and osteoclasts) bone stromal components. This approach elucidates the efficacy of TKIs in ccRCC bone tumors to support rational interrogation and development of therapies. SIGNIFICANCE TKIs showed different efficacy in synchronous bone and lung metastases and did not eradicate tumors as single agents but induced extensive reprogramming of the BM microenvironment. This resulted in a significant decrease in neoangiogenic blood vessels, bone remodeling, and immune cell infiltration (including CD8 T cells) with altered spatial distribution.
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Affiliation(s)
- Stefan Maksimovic
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Nina C. Boscolo
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Ludovica La Posta
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Sergio Barrios
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Department of Bioengineering, Rice University, Houston, Texas.
| | - Mohammad Jad Moussa
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Emanuela Gentile
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Pedro I. Pesquera
- Division of Surgery, Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Wenjiao Li
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Jianfeng Chen
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Javier A. Gomez
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Akshay Basi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Jared K. Burks
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | | | - Jianjun Gao
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Matthew T. Campbell
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Eleonora Dondossola
- Department of Genitourinary Medical Oncology, David H. Koch Center for Applied Research of Genitourinary Cancers, The University of Texas MD Anderson Cancer Center, Houston, Texas.
- Division of Cancer Medicine, Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Gao WN, Chen LG, Bao LR, He N, Hu TL, Lai C, Xu RF, Wang XF, Wang JY, Zhao JR, Meng Y. ERBB2 is a potential diagnostic and prognostic biomarker in renal clear cell carcinoma. Sci Rep 2024; 14:22775. [PMID: 39353993 PMCID: PMC11445465 DOI: 10.1038/s41598-024-73574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/18/2024] [Indexed: 10/03/2024] Open
Abstract
Renal clear cell carcinoma (ccRCC) is a common parenchymal tumor of the kidney, and the discovery of biomarkers for early and effective diagnosis of ccRCC can improve the early diagnosis of patients and thus improve long-term survival. Erb-b2 receptor tyrosine kinase 2 (ERBB2) mediates the processes of cell proliferation, differentiation, and apoptosis inhibition. The purpose of this study was to investigate the diagnostic and prognostic role of ERBB2 in ccRCC. We analyzed the expression levels of ERBB2 in various cancers from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. RNA-seq data were analyzed using R packages to identify differentially expressed genes between the high and low ERBB2 expression groups in the TCGA-KIRC dataset. Spearman correlation analysis was performed to determine the correlation between ERBB2 expression and immune cell infiltration, immune checkpoint expression, and PTEN expression. DNA methylation changes and genetic alterations in ERBB2 were assessed using the MethSurv and cBioPortal databases. Logistic regression analysis was performed to determine the correlation between ERBB2 expression and the clinicopathological characteristics of ccRCC patients. The diagnostic and prognostic value of ERBB2 was assessed using Kaplan‒Meier (K‒M) survival curves, diagnostic ROC curves, time-dependent ROC curves, nomogram models, and Cox regression models. The expression level of ERBB2 is lower in tumor tissues of ccRCC patients than in the corresponding control tissues. Differentially expressed genes associated with ERBB2 were significantly enriched in the pathways "BMP2WNT4FOXO1 pathway in primary endometrial stromal cell differentiation" and "AMAN pathway". In ccRCC tissues, ERBB2 expression levels were associated with immune cell infiltration, immune checkpoints, and PTEN. The DNA methylation status of 10 CpG islands in the ERBB2 gene was associated with the prognosis of ccRCC. ERBB2 expression levels in ccRCC tissues were associated with race, sex, T stage, M stage, histological grade, and pathological stage. Cox regression analysis showed that ERBB2 was a potential independent predictor of overall survival (OS), disease-specific survival (DSS), and progression-free interval (PFI) in ccRCC patients. ROC curve analysis showed that the expression level of ERBB2 could accurately distinguish between ccRCC tissue and adjacent normal renal tissue. Our study showed that ERBB2 expression in ccRCC tissues can be of clinical importance as a potential diagnostic and prognostic biomarker.
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MESH Headings
- Humans
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/metabolism
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/mortality
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Receptor, ErbB-2/metabolism
- Receptor, ErbB-2/genetics
- Kidney Neoplasms/genetics
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/pathology
- Kidney Neoplasms/metabolism
- Kidney Neoplasms/mortality
- Prognosis
- Female
- Male
- Gene Expression Regulation, Neoplastic
- DNA Methylation
- Middle Aged
- Kaplan-Meier Estimate
- Aged
- ROC Curve
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Affiliation(s)
- Wu-Niri Gao
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, People's Republic of China
| | - Li-Gang Chen
- Department of Urology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, People's Republic of China
| | - Lu-Ri Bao
- Department of Pathology, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, People's Republic of China
| | - Ning He
- Hemodialysis Room, The No. 2 Hospital of Hohhot, Hohhot, People's Republic of China
| | - Ta-la Hu
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, People's Republic of China
| | - Can Lai
- Department of Gastrointestinal Surgery, Inner Mongolia Campus of Peking University Cancer Hospital (The Affiliated Cancer Hospital of Inner Mongolia Medical University), Hohhot, People's Republic of China
| | - Rui-Feng Xu
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, People's Republic of China
| | - Xi-Feng Wang
- Hemodialysis Room, The No. 2 Hospital of Hohhot, Hohhot, People's Republic of China
| | - Jing-Yuan Wang
- Department of Pathology, School of Basic Medicine, Inner Mongolia Medical University, Hohhot, People's Republic of China
| | - Jian-Rong Zhao
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, People's Republic of China
| | - Yan Meng
- Department of Nephrology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, Inner Mongolia, People's Republic of China.
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Chan JA, Geyer S, Zemla T, Knopp MV, Behr S, Pulsipher S, Ou FS, Dueck AC, Acoba J, Shergill A, Wolin EM, Halfdanarson TR, Konda B, Trikalinos NA, Tawfik B, Raj N, Shaheen S, Vijayvergia N, Dasari A, Strosberg JR, Kohn EC, Kulke MH, O'Reilly EM, Meyerhardt JA. Phase 3 Trial of Cabozantinib to Treat Advanced Neuroendocrine Tumors. N Engl J Med 2024. [PMID: 39282913 DOI: 10.1056/nejmoa2403991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
BACKGROUND Treatment options for patients with advanced neuroendocrine tumors are limited. The efficacy of cabozantinib in the treatment of previously treated, progressive extrapancreatic or pancreatic neuroendocrine tumors is unclear. METHODS We enrolled two independent cohorts of patients - those with extrapancreatic neuroendocrine tumors and those with pancreatic neuroendocrine tumors - who had received peptide receptor radionuclide therapy or targeted therapy or both. Patients were randomly assigned in a 2:1 ratio to receive cabozantinib at a dose of 60 mg daily or placebo. The primary end point was progression-free survival as assessed by blinded independent central review. Key secondary end points included objective response, overall survival, and safety. RESULTS In the cohort of 203 patients with extrapancreatic neuroendocrine tumors, the median progression-free survival with cabozantinib was 8.4 months, as compared with 3.9 months with placebo (stratified hazard ratio for progression or death, 0.38; 95% confidence interval [CI], 0.25 to 0.59; P<0.001). In the cohort of 95 patients with pancreatic neuroendocrine tumors, the median progression-free survival with cabozantinib was 13.8 months, as compared with 4.4 months with placebo (stratified hazard ratio, 0.23; 95% CI, 0.12 to 0.42; P<0.001). The incidence of confirmed objective response with cabozantinib was 5% and 19% among patients with extrapancreatic and pancreatic neuroendocrine tumors, respectively, as compared with 0% with placebo. Grade 3 or higher adverse events were noted in 62 to 65% of the patients treated with cabozantinib, as compared with 23 to 27% of the patients who received placebo. Common treatment-related adverse events of grade 3 or higher included hypertension, fatigue, diarrhea, and thromboembolic events. CONCLUSIONS Cabozantinib, as compared with placebo, significantly improved progression-free survival in patients with previously treated, progressive advanced extrapancreatic or pancreatic neuroendocrine tumors. Adverse events were consistent with the known safety profile of cabozantinib. (Funded by the National Cancer Institute and others; CABINET ClinicalTrials.gov number, NCT03375320.).
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Affiliation(s)
- Jennifer A Chan
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Susan Geyer
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Tyler Zemla
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Michael V Knopp
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Spencer Behr
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Sydney Pulsipher
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Fang-Shu Ou
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Amylou C Dueck
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Jared Acoba
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Ardaman Shergill
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Edward M Wolin
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Thorvardur R Halfdanarson
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Bhavana Konda
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Nikolaos A Trikalinos
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Bernard Tawfik
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Nitya Raj
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Shagufta Shaheen
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Namrata Vijayvergia
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Arvind Dasari
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Jonathan R Strosberg
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Elise C Kohn
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Matthew H Kulke
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Eileen M O'Reilly
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
| | - Jeffrey A Meyerhardt
- From Dana-Farber Cancer Institute (J.A.C., J.A.M.), Boston Medical Center (M.H.K.), and Boston University (M.H.K.) - all in Boston; the Alliance Statistics and Data Management Center, Mayo Clinic (S.G., T.Z., S.P., F.-S.O.), and Mayo Clinic Comprehensive Cancer Center (T.R.H.) - both in Rochester, MN; Wright Center of Innovation and the Imaging and Radiation Oncology Core, University of Cincinnati, Cincinnati (M.V.K.), and the Ohio State University Comprehensive Cancer Center, Columbus (B.K.) - both in Ohio; the University of California, San Francisco, San Francisco (S.B.), and Stanford Cancer Center, Stanford (S.S.) - both in California; Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ (A.C.D.); the University of Hawaii Cancer Center, Honolulu (J.A.); the Alliance Protocol Operations Office, University of Chicago, Chicago (A.S.); Mount Sinai Medical Center (E.M.W.) and Memorial Sloan Kettering Cancer Center (N.R., E.M.O.) - both in New York; Washington University School of Medicine and Siteman Cancer Center, St. Louis (N.A.T.); the University of New Mexico Comprehensive Cancer Center, Albuquerque (B.T.); Fox Chase Cancer Center, Philadelphia (N.V.); M.D. Anderson Cancer Center, Houston (A.D.); Moffitt Cancer Center, Tampa, FL (J.R.S.); and the National Cancer Institute, Bethesda, MD (E.C.K.)
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5
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Lenhart J, Lunter DJ. Dosage by design - 3D printing individualized cabozantinib tablets with immediate release. Eur J Pharm Biopharm 2024:114501. [PMID: 39278333 DOI: 10.1016/j.ejpb.2024.114501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/27/2024] [Accepted: 09/11/2024] [Indexed: 09/18/2024]
Abstract
Production of patient-specific dosage forms is important to improve patient adherence and effectiveness while reducing the prevalence and severity of adverse effects. Due to its possibility of rapid prototyping 3D printing can be used to produce individual dosages while utilizing techniques such as hot melt extrusion to increase the bioavailability of poorly soluble drugs. In this work, Parteck MXP and Kollicoat IR were used as water-soluble polymer bases for formulation development for 3D printing of various dosages incorporating cabozantinib while enabling immediate release. The effect of tablet design and the excipients sorbitol, croscarmellose sodium, and sodium starch glycolate was investigated for this goal. A way to calculate the size of tablets for predetermined dosages is proposed to enable the printing of individual strengths from one formulation. Rheological data were collected to deepen the understanding of the role of melt viscosity in 3D printing and hot melt extrusion processes. The production of immediate-release cabozantinib tablets containing every therapeutically relevant dosage in a single unit produced by two-step 3D printing was realized.
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Affiliation(s)
- Jonas Lenhart
- Department of Pharmaceutical Technology, Eberhard Karls University, 72076 Tuebingen, Germany
| | - Dominique J Lunter
- Department of Pharmaceutical Technology, Eberhard Karls University, 72076 Tuebingen, Germany.
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6
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Pant S, Cho BC, Kyriakopoulos CE, Spira A, Tannir N, Werner TL, Yan X, Neuteboom S, Chao R, Goel S. Targeting multiple receptor tyrosine kinases with sitravatinib: A Phase 1b study in advanced renal cell carcinoma and castrate-resistant prostate cancer. Invest New Drugs 2024:10.1007/s10637-024-01465-9. [PMID: 39168901 DOI: 10.1007/s10637-024-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
Sitravatinib (MGCD516) is an oral inhibitor of several closely related oncogenic tyrosine kinase receptors that include VEGFR-2 (vascular endothelial growth factor receptor-2), AXL, and MET (mesenchymal-epithelial transition). The safety and antitumor activity of sitravatinib are reported in patients from two histologic cohorts (anti-angiogenesis-refractory clear cell renal cell carcinoma [RCC] and castrate-resistant prostate cancer [CRPC] with bone metastases) who participated in a Phase 1/1b study. The patients were enrolled using a 3-stage design that was based on observed objective responses. Objective response rate (ORR) was the primary endpoint. Duration of response, progression-free survival (PFS), overall survival (OS), and safety were also assessed. Overall, 48 patients (RCC n = 38, CRPC n = 10) received ≥ 1 dose of sitravatinib. Both cohorts were heavily pretreated (median number of prior systemic therapies: RCC cohort 3, CRPC cohort 6). In the RCC cohort, ORR was 25.9%, P = 0.015 (null hypothesis [ORR ≤ 10%] was rejected). Responses were durable (median duration 13.2 months). Median PFS was 9.5 months and median OS was 30.0 months. No objective responses were seen in the CRPC cohort; median PFS and OS were 5.8 months and 10.1 months, respectively. Across both cohorts, diarrhea (72.9%), fatigue (54.2%), and hypertension (52.1%) were the most frequent all-cause treatment-emergent adverse events (TEAEs). Diarrhea and vomiting (both, 6.3%) were the most frequent serious TEAEs considered related to study treatment. Sitravatinib demonstrated an acceptable safety profile and promising clinical activity in patients with clear cell RCC refractory to prior angiogenesis inhibitor therapy. Strong indicators for clinical activity were not seen in patients with CRPC and bone metastases. Clinical trial registration:ClinicalTrials.gov NCT02219711.
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Affiliation(s)
- Shubham Pant
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Nizar Tannir
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa L Werner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Sanjay Goel
- Montefiore Medical Center, Bronx, NY, USA.
- Rutgers Cancer Institute, New Brunswick, NJ, USA.
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7
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Liu T, Yue X, Chen X, Yan R, Wu C, Li Y, Bu X, Han H, Liu RY. Nilotinib in combination with sunitinib renders MCL-1 for degradation and activates autophagy that overcomes sunitinib resistance in renal cell carcinoma. Cell Oncol (Dordr) 2024; 47:1277-1294. [PMID: 38393513 DOI: 10.1007/s13402-024-00927-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE Sunitinib is a recommended drug for metastatic renal cell carcinoma (RCC). However, the therapeutic potential of sunitinib is impaired by toxicity and resistance. Therefore, we seek to explore a combinatorial strategy to improve sunitinib efficacy of low-toxicity dose for better clinical application. METHODS We screen synergistic reagents of sunitinib from a compound library containing 1374 FDA-approved drugs by in vitro cell viability evaluation. The synergistically antiproliferative and proapoptotic effects were demonstrated on in vitro and in vivo models. The molecular mechanism was investigated by phosphoproteomics, co-immunoprecipitation, immunofluorescence and western-blot assays, etc. RESULTS: From the four-step screening, nilotinib stood out as a potential synergistic killer combined with sunitinib. Subsequent functional evaluation demonstrated that nilotinib and sunitinib synergistically inhibit RCC cell proliferation and promote apoptosis in vitro and in vivo. Mechanistically, nilotinib activates E3-ligase HUWE1 and in combination with sunitinib renders MCL-1 for degradation via proteasome pathway, resulting in the release of Beclin-1 from MCL-1/Beclin-1 complex. Subsequently, Beclin-1 induces complete autophagy flux to promote antitumor effect. CONCLUSION Our findings revealed that a novel mechanism that nilotinib in combination with sunitinib overcomes sunitinib resistance in RCC. Therefore, this novel rational combination regimen provides a promising therapeutic avenue for metastatic RCC and rationale for evaluating this combination clinically.
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Affiliation(s)
- Tingyu Liu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xin Yue
- Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Xue Chen
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Ru Yan
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Chong Wu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yunzhi Li
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
| | - Xianzhang Bu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
| | - Hui Han
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Ran-Yi Liu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
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8
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Poliaková Turan M, Riedo R, Medo M, Pozzato C, Friese-Hamim M, Koch JP, Coggins SA, Li Q, Kim B, Albers J, Aebersold DM, Zamboni N, Zimmer Y, Medová M. E2F1-Associated Purine Synthesis Pathway Is a Major Component of the MET-DNA Damage Response Network. CANCER RESEARCH COMMUNICATIONS 2024; 4:1863-1880. [PMID: 38957115 PMCID: PMC11288008 DOI: 10.1158/2767-9764.crc-23-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 05/03/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
Various lines of investigation support a signaling interphase shared by receptor tyrosine kinases and the DNA damage response. However, the underlying network nodes and their contribution to the maintenance of DNA integrity remain unknown. We explored MET-related metabolic pathways in which interruption compromises proper resolution of DNA damage. Discovery metabolomics combined with transcriptomics identified changes in pathways relevant to DNA repair following MET inhibition (METi). METi by tepotinib was associated with the formation of γH2AX foci and with significant alterations in major metabolic circuits such as glycolysis, gluconeogenesis, and purine, pyrimidine, amino acid, and lipid metabolism. 5'-Phosphoribosyl-N-formylglycinamide, a de novo purine synthesis pathway metabolite, was consistently decreased in in vitro and in vivo MET-dependent models, and METi-related depletion of dNTPs was observed. METi instigated the downregulation of critical purine synthesis enzymes including phosphoribosylglycinamide formyltransferase, which catalyzes 5'-phosphoribosyl-N-formylglycinamide synthesis. Genes encoding these enzymes are regulated through E2F1, whose levels decrease upon METi in MET-driven cells and xenografts. Transient E2F1 overexpression prevented dNTP depletion and the concomitant METi-associated DNA damage in MET-driven cells. We conclude that DNA damage following METi results from dNTP reduction via downregulation of E2F1 and a consequent decline of de novo purine synthesis. SIGNIFICANCE Maintenance of genome stability prevents disease and affiliates with growth factor receptor tyrosine kinases. We identified de novo purine synthesis as a pathway in which key enzymatic players are regulated through MET receptor and whose depletion via MET targeting explains MET inhibition-associated formation of DNA double-strand breaks. The mechanistic importance of MET inhibition-dependent E2F1 downregulation for interference with DNA integrity has translational implications for MET-targeting-based treatment of malignancies.
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Affiliation(s)
- Michaela Poliaková Turan
- Department of Radiation Oncology, Inselspital Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research, Radiation Oncology, University of Bern, Bern, Switzerland.
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
| | - Rahel Riedo
- Department of Radiation Oncology, Inselspital Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research, Radiation Oncology, University of Bern, Bern, Switzerland.
| | - Matúš Medo
- Department of Radiation Oncology, Inselspital Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research, Radiation Oncology, University of Bern, Bern, Switzerland.
| | - Chiara Pozzato
- Department of Radiation Oncology, Inselspital Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research, Radiation Oncology, University of Bern, Bern, Switzerland.
| | - Manja Friese-Hamim
- Corporate Animal Using Vendor and Vivarium Governance (SQ-AV), Corporate Sustainability, Quality, Trade Compliance (SQ), Animal Affairs (SQ-A), The Healthcare Business of Merck KGaA, Darmstadt, Germany.
| | - Jonas P. Koch
- Department of Radiation Oncology, Inselspital Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research, Radiation Oncology, University of Bern, Bern, Switzerland.
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
| | - Si’Ana A. Coggins
- Center for Drug Discovery, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Qun Li
- Center for Drug Discovery, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Baek Kim
- Center for Drug Discovery, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
- College of Pharmacy, Kyung-Hee University, Seoul, South Korea.
| | - Joachim Albers
- Research Unit Oncology, The Healthcare Business of Merck KGaA, Darmstadt, Germany.
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research, Radiation Oncology, University of Bern, Bern, Switzerland.
| | - Nicola Zamboni
- Institute of Molecular Systems Biology, ETH Zürich, Zürich, Switzerland.
- PHRT Swiss Multi-Omics Center, Zurich, Switzerland.
| | - Yitzhak Zimmer
- Department of Radiation Oncology, Inselspital Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research, Radiation Oncology, University of Bern, Bern, Switzerland.
| | - Michaela Medová
- Department of Radiation Oncology, Inselspital Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research, Radiation Oncology, University of Bern, Bern, Switzerland.
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9
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AlBarakat MM, Ahmed YB, Alshwayyat S, Ellaithy A, Y. Al-Shammari Y, Soliman Y, Rezq H, Abdelazeem B, Kunadi A. The efficacy and safety of cabozantinib in patients with metastatic or advanced renal cell carcinoma: a systematic review and meta-analysis. Proc AMIA Symp 2024; 37:822-830. [PMID: 39165809 PMCID: PMC11332639 DOI: 10.1080/08998280.2024.2363616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 08/22/2024] Open
Abstract
Background Cabozantinib, a new first-line treatment for advanced renal cell carcinoma (aRCC), targets essential tyrosine kinases and outperforms the established comparator (sunitinib) in various efficacy outcomes. This systematic review and meta-analysis aimed to assess the efficacy and safety of cabozantinib compared to other aRCC treatments. Methods Following PRISMA and Cochrane guidelines, our protocol was registered in PROSPERO. A systematic search, without date limits, was conducted on PubMed, Cochrane, Web of Science, and EMBASE until October 8, 2023. Data extraction encompassed study details, baseline information, and outcomes. Hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals were employed for each outcome, and a random-effects model was applied to account for expected heterogeneity. Results Three studies, encompassing 967 patients, were included in our analysis. In terms of efficacy, the pooled rate for overall survival significantly favored cabozantinib. However, in subgroup analyses, cabozantinib was only statistically superior to everolimus. For progression-free survival and tumor objective response rate, cabozantinib outperformed both everolimus and sunitinib. In adverse events, compared to sunitinib, cabozantinib exhibited inferiority in nearly all evaluated aspects, except for nausea and stomatitis, which showed no difference between the two groups. Conversely, it demonstrated a comparable risk profile with everolimus across various side effects. Conclusion Cabozantinib shows significant efficacy in extending overall survival, progression-free survival, and tumor objective response rate despite a potentially higher risk of adverse events compared to sunitinib. These findings support cabozantinib as a first-line therapy for aRCC, either as an initial treatment or after prior VEGFR-targeted therapies.
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Affiliation(s)
- Majd M. AlBarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yaman B. Ahmed
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sakhr Alshwayyat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Asmaa Ellaithy
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | | | - Hazem Rezq
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Arvind Kunadi
- Internal Medicine and Nephrology Departments, McLaren Health Care, Flint, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
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10
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Bloise F, Manfredi F, Zatteri L, Dima G, Carli C, Di Vita R, Olivieri M, Sammarco E, Ferrari M, Salfi A, Bonato A, Serafin D, Coccia N, Doni L, Galli L, Sisani M, Roviello G, Catalano M, Paolieri F. First-Line Treatments and Management of Metastatic Renal Cell Carcinoma Patients: An Italian Interdisciplinary Uro-Oncologic Group Algorithm. Cells 2024; 13:961. [PMID: 38891093 PMCID: PMC11172287 DOI: 10.3390/cells13110961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
The treatment landscape for metastatic renal cell carcinoma (mRCC) has undergone significant transformations in recent years. The introduction of novel combination therapies involving tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors has resulted in improved oncological outcomes compared to traditional TKI monotherapy. In this evolving paradigm, the pivotal role of the multidisciplinary tumor board is underscored, particularly in shaping the therapeutic trajectory for patients eligible for locoregional interventions like cytoreductive nephrectomy and metastasectomy. In cases where systemic treatment is deemed appropriate, the absence of direct comparisons among the various combination therapies complicates the selection of a first-line approach. The clinician is faced with the challenge of making decisions based on patient-specific factors such as performance status, risk classification according to the International Metastatic Renal Cell Carcinoma Database Consortium, comorbidities, and disease characteristics, including the number and location of metastases and tumor histology. Considering these concerns, we propose, as a member of a Tuscany Interdisciplinary Uro-Oncologic Group, an algorithm to streamline the decision-making process for mRCC patients, offering guidance to clinicians in their day-to-day clinical practice.
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Affiliation(s)
- Francesco Bloise
- Medical Oncology Unit, San Donato Hospital, Azienda Toscana Sud Est, 52100 Arezzo, Italy; (F.B.); (M.S.)
| | - Fiorella Manfredi
- Medical Oncology Unit, Sant’Andrea Hospital, Azienda Sanitaria Locale 5 Spezzino, 19124 La Spezia, Italy;
| | - Luca Zatteri
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Giovanni Dima
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Chiara Carli
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Rosanna Di Vita
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Maria Olivieri
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Enrico Sammarco
- Medical Oncology Unit, Livorno Hospital, Azienda Toscana Nord Ovest, 57124 Livorno, Italy;
| | - Marco Ferrari
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Alessia Salfi
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Adele Bonato
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Debora Serafin
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Natalia Coccia
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Laura Doni
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Luca Galli
- Medical Oncology Unit 2, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, 56124 Pisa, Italy; (L.Z.); (G.D.); (C.C.); (R.D.V.); (M.O.); (M.F.); (A.S.); (A.B.); (D.S.); (N.C.); (L.G.)
| | - Michele Sisani
- Medical Oncology Unit, San Donato Hospital, Azienda Toscana Sud Est, 52100 Arezzo, Italy; (F.B.); (M.S.)
| | | | - Martina Catalano
- Department of Health Sciences, University of Florence, 50134 Florence, Italy;
| | - Federico Paolieri
- Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, 59100 Prato, Italy;
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11
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De Palma M, Hanahan D. Milestones in tumor vascularization and its therapeutic targeting. NATURE CANCER 2024; 5:827-843. [PMID: 38918437 DOI: 10.1038/s43018-024-00780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/22/2024] [Indexed: 06/27/2024]
Abstract
Research into the mechanisms and manifestations of solid tumor vascularization was launched more than 50 years ago with the proposition and experimental demonstrations that angiogenesis is instrumental for tumor growth and was, therefore, a promising therapeutic target. The biological knowledge and therapeutic insights forthcoming have been remarkable, punctuated by new concepts, many of which were not foreseen in the early decades. This article presents a perspective on tumor vascularization and its therapeutic targeting but does not portray a historical timeline. Rather, we highlight eight conceptual milestones, integrating initial discoveries and recent progress and posing open questions for the future.
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Affiliation(s)
- Michele De Palma
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, Swiss Federal Institute of Technology in Lausanne (EPFL), Lausanne, Switzerland.
- Agora Cancer Research Center, Lausanne, Switzerland.
- Swiss Cancer Center Léman (SCCL), Lausanne, Switzerland.
| | - Douglas Hanahan
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, Swiss Federal Institute of Technology in Lausanne (EPFL), Lausanne, Switzerland.
- Agora Cancer Research Center, Lausanne, Switzerland.
- Swiss Cancer Center Léman (SCCL), Lausanne, Switzerland.
- Ludwig Institute for Cancer Research, Lausanne Branch, Lausanne, Switzerland.
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12
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Turner N, Hamidi S, Ouni R, Rico R, Henderson YC, Puche M, Alekseev S, Colunga-Minutti JG, Zafereo ME, Lai SY, Kim ST, Cabanillas ME, Nurieva R. Emerging therapeutic options for follicular-derived thyroid cancer in the era of immunotherapy. Front Immunol 2024; 15:1369780. [PMID: 38868771 PMCID: PMC11167082 DOI: 10.3389/fimmu.2024.1369780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 06/14/2024] Open
Abstract
Although most follicular-derived thyroid cancers are well differentiated and have an overall excellent prognosis following treatment with surgery and radioiodine, management of advanced thyroid cancers, including iodine refractory disease and poorly differentiated/undifferentiated subtypes, is more challenging. Over the past decade, better understanding of the genetic drivers and immune milieu of advanced thyroid cancers has led to significant progress in the management of these patients. Numerous targeted kinase inhibitors are now approved by the U.S Food and Drug administration (FDA) for the treatment of advanced, radioiodine refractory differentiated thyroid cancers (DTC) as well as anaplastic thyroid cancer (ATC). Immunotherapy has also been thoroughly studied and has shown promise in selected cases. In this review, we summarize the progress in the understanding of the genetic landscape and the cellular and molecular basis of radioiodine refractory-DTC and ATC, as well as discuss the current treatment options and future therapeutic avenues.
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Affiliation(s)
- Naimah Turner
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sarah Hamidi
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rim Ouni
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rene Rico
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ying C. Henderson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maria Puche
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Biology, College of Science and Engineering, Houston Christian University, Houston, TX, United States
| | - Sayan Alekseev
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Program of Biology, College of Sciences, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Jocelynn G. Colunga-Minutti
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Program of Immunology, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (GSBS), Houston, TX, United States
| | - Mark E. Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sang T. Kim
- Department of Rheumatology, Allergy and Immunology, Yale University, New Haven, CT, United States
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Roza Nurieva
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Program of Immunology, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (GSBS), Houston, TX, United States
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13
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Zaccagnino A, Vynnytska‐Myronovska B, Stöckle M, Junker K. Molecular and functional characterization of reversible-sunitinib-tolerance state in human renal cell carcinoma. J Cell Mol Med 2024; 28:e18329. [PMID: 38693863 PMCID: PMC11063727 DOI: 10.1111/jcmm.18329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/11/2024] [Accepted: 03/29/2024] [Indexed: 05/03/2024] Open
Abstract
Therapy failure with the tyrosine kinase inhibitor (TKI) sunitinib remains a great challenge in metastatic renal cell carcinoma (mRCC). Growing evidence indicates that the tumour subpopulation can enter a transient, non-mutagenic drug-tolerant state to endure the treatment underlying the minimal residual disease and tumour relapse. Drug tolerance to sunitinib remains largely unexplored in RCC. Here, we show that sunitinib-tolerant 786-O/S and Caki-2/S cells are induced by prolonged drug treatment showing reduced drug sensitivity, enhanced clonogenicity, and DNA synthesis. Sunitinib-tolerance developed via dynamic processes, including (i) engagement of c-MET and AXL pathways, (ii) alteration of stress-induced p38 kinase and pro-survival BCL-2 signalling, (iii) extensive actin remodelling, which was correlated with activation of focal adhesion proteins. Remarkably, the acute drug response in both sensitive and sunitinib-tolerant cell lines led to dramatic fine-tuning of the actin-cytoskeleton and boosted cellular migration and invasion, indicating that the drug-response might depend on cell state transition rather than pre-existing mutations. The drug-tolerant state was transiently acquired, as the cells resumed initial drug sensitivity after >10 passages under drug withdrawal, reinforcing the concept of dynamic regulation and phenotypic heterogeneity. Our study described molecular events contributing to the reversible switch into sunitinib-tolerance, providing possible novel therapeutic opportunities in RCC.
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Affiliation(s)
- Angela Zaccagnino
- Department of Urology and Pediatric UrologySaarland UniversityHomburgGermany
| | | | - Michael Stöckle
- Department of Urology and Pediatric UrologySaarland UniversityHomburgGermany
| | - Kerstin Junker
- Department of Urology and Pediatric UrologySaarland UniversityHomburgGermany
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14
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Doostmohammadi A, Jooya H, Ghorbanian K, Gohari S, Dadashpour M. Potentials and future perspectives of multi-target drugs in cancer treatment: the next generation anti-cancer agents. Cell Commun Signal 2024; 22:228. [PMID: 38622735 PMCID: PMC11020265 DOI: 10.1186/s12964-024-01607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
Cancer is a major public health problem worldwide with more than an estimated 19.3 million new cases in 2020. The occurrence rises dramatically with age, and the overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective in older individuals. Conventional cancer treatments, such as radiotherapy, surgery, and chemotherapy, have been used for decades to combat cancer. However, the emergence of novel fields of cancer research has led to the exploration of innovative treatment approaches focused on immunotherapy, epigenetic therapy, targeted therapy, multi-omics, and also multi-target therapy. The hypothesis was based on that drugs designed to act against individual targets cannot usually battle multigenic diseases like cancer. Multi-target therapies, either in combination or sequential order, have been recommended to combat acquired and intrinsic resistance to anti-cancer treatments. Several studies focused on multi-targeting treatments due to their advantages include; overcoming clonal heterogeneity, lower risk of multi-drug resistance (MDR), decreased drug toxicity, and thereby lower side effects. In this study, we'll discuss about multi-target drugs, their benefits in improving cancer treatments, and recent advances in the field of multi-targeted drugs. Also, we will study the research that performed clinical trials using multi-target therapeutic agents for cancer treatment.
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Affiliation(s)
- Ali Doostmohammadi
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Hossein Jooya
- Biochemistry Group, Department of Chemistry, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Kimia Ghorbanian
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Sargol Gohari
- Department of Biology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mehdi Dadashpour
- Department of Medical Biotechnology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran.
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15
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Bruchbacher A, Franke J, Alimohammadi A, Laukhtina E, Fajkovic H, Schmidinger M. Real-World Results of Cabozantinib Given as Alternative Schedule in Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2024; 22:98-108. [PMID: 37926597 DOI: 10.1016/j.clgc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The multikinase-inhibitor Cabozantinib is a widely used treatment strategy in metastatic renal cell carcinoma (mRCC), either in combination with the programmed cell death protein-1 (PD-1) inhibitor nivolumab or as monotherapy. Cabozantinib is given continuously at a dose of 60 mg once daily when used as a single agent and at 40 mg when combined with nivolumab. Treatment-related adverse events (TRAE's) were shown to occur frequently. OBJECTIVE We aimed to assess the safety and efficacy of cabozantinib in patients with mRCC. Patients were treated in various lines. Furthermore, we analyzed the impact of an alternative treatment schedule in patients not able to maintain continuous dosing. PATIENTS This is a single center retrospective study from the Medical University of Vienna. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Overall response rates (ORR), progression free survival (PFS) and overall survival (OS) were evaluated for the entire cohort, by treatment line and by treatment schedule. RESULTS Between January 2014 until April 2021, 71 patients received cabozantinib. Sixty-seven patients were eligible for full evaluation. By IMDC criteria, 32.4%, 59.2%, and 8.5% were classified as favorable, intermediate and poor risk respectively. Cabozantinib was offered as a 2nd-line or 3rd-line treatment in 38.0% and 32.4% of patients, respectively. An alternative treatment schedule was offered in 39.1% of patients. Objective responses were found in 43.3% (CR 6%) of patients and the median PFS was 10.8 months (95% CI: 5.5-16.2). When compared to continuous dosing, an alternative treatment schedule was associated with longer PFS (12.2 months (95% CI: 0-25.5) vs. 6.1 months (95% CI: 0.37-11.8) (P = .014, HR 0.46 (95% CI: 0.24-0.86), respectively) and a lower frequency and severity of TRAE's. CONCLUSIONS Safety and efficacy of cabozantinib in real world is comparable to what has been observed in the pivotal trials, irrespective of the treatment line. An alternative schedule may further improve efficacy and safety.
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Affiliation(s)
| | - Johannes Franke
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Arman Alimohammadi
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ekaterina Laukhtina
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Harun Fajkovic
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Manuela Schmidinger
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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16
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Barthélémy P, Dutailly P, Qvick B, Perrot V, Verzoni E. CaboCombo: a prospective, phase IV study of first-line cabozantinib + nivolumab for advanced renal cell carcinoma. Future Oncol 2024; 20:811-819. [PMID: 37403652 DOI: 10.2217/fon-2023-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Cabozantinib plus nivolumab was approved as a first-line (1L) treatment for advanced renal cell carcinoma (aRCC) following the CheckMate 9ER trial. CaboCombo (ClinicalTrials.gov identifier: NCT05361434) is a non-interventional study designed to evaluate the effectiveness and tolerability of cabozantinib plus nivolumab in a real-world setting. Overall, 311 patients with clear-cell aRCC receiving 1L cabozantinib plus nivolumab will be recruited from at least 70 centers in seven countries worldwide. The primary end point is overall survival at 18 months. Secondary end points include progression-free survival, objective response rate, safety, patterns of treatment, subsequent anticancer therapies and quality of life. CaboCombo will provide real-world evidence on the characteristics, treatment sequences, and outcomes of patients with aRCC receiving 1L cabozantinib plus nivolumab.
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Affiliation(s)
- Philippe Barthélémy
- Institut de Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, Strasbourg, 67200, France
| | - Pascale Dutailly
- Ipsen, 65 Quai Georges Gorse, Boulogne-Billancourt, 92100, France
| | - Bryan Qvick
- Ipsen, Einsteinstraße 174, München, 81677, Germany
| | - Valerie Perrot
- Ipsen, 65 Quai Georges Gorse, Boulogne-Billancourt, 92100, France
| | - Elena Verzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milano, 20133, Italy
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Dayyani F, Balangue J, Valerin J, Keating MJ, Zell JA, Taylor TH, Cho MT. A Phase 1 Study of Cabozantinib and Trifluridine/Tipiracil in Metastatic Colorectal Adenocarcinoma. Clin Colorectal Cancer 2024; 23:67-72. [PMID: 38103947 PMCID: PMC11265208 DOI: 10.1016/j.clcc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION This study determined the safety and recommended phase 2 dose (RP2D) of the multikinase inhibitor cabozantinib in combination with trifluridine/tipiracil (FTD/TPI) in refractory metastatic colorectal carcinoma (mCRC). PATIENTS AND METHODS Single institution investigator-initiated phase 1 study using 3+3 design. Eligible mCRC patients had received prior standard regimens. Cabozantinib was given orally (p.o.) at 20 mg (dose level [DL] 0) or 40 mg (DL 1) daily on days 1-28, and FTD/TPI p.o. at 35 mg/m2 on days 1-5 and 8-12 every 28 days. Prophylactic growth-factor support was allowed. RESULTS Fifteen patients were enrolled. Median age 56 years (31-80), male (12/15), ECOG 0/1 = 9/6. Three patients were treated at DL 0 and another nine were treated at DL 1, none exhibiting a DLT. Most common any grade (G) treatment related adverse events (TRAE) were diarrhea (50%), nausea (42%), neutropenia (42%), fatigue (33%), and rash (25%). G3-4 TRAE were neutropenia (25%) and thrombocytopenia, hypokalemia, and weight loss (each 8%). No serious TRAE or G5 were reported. The RP2D was determined to be DL 1. Median PFS was 3.8 months (95% CI 1.9-6.8) and disease control rate was 86.7%. CONCLUSION The combination of cabozantinib and FTD/TPI is feasible and tolerable at standard doses with the use of growth factors and showed encouraging clinical activity in refractory mCRC. CLINICALTRIALS GOV: NCT04868773.
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Affiliation(s)
- Farshid Dayyani
- Division of Hematology/Oncology, Department of Medicine and Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA.
| | - Jasmine Balangue
- Division of Hematology/Oncology, Department of Medicine and Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Jennifer Valerin
- Division of Hematology/Oncology, Department of Medicine and Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Matthew J Keating
- Division of Hematology/Oncology, Department of Medicine and Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Jason A Zell
- Division of Hematology/Oncology, Department of Medicine and Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | | | - May T Cho
- Division of Hematology/Oncology, Department of Medicine and Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
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Su JY, Huang T, Zhang JL, Lu JH, Wang ML, Yan J, Lin RB, Lin SY, Wang J. Leveraging molecular targeted drugs and immune checkpoint inhibitors treat advanced thyroid carcinoma to achieve thyroid carcinoma redifferentiation. Am J Cancer Res 2024; 14:407-428. [PMID: 38455407 PMCID: PMC10915323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
Thyroid cancer can be classified into three different types based on the degree of differentiation: well-differentiated, poorly differentiated, and anaplastic thyroid carcinoma. Well-differentiated thyroid cancer refers to cancer cells that closely resemble normal thyroid cells, while poorly differentiated and anaplastic thyroid carcinoma are characterized by cells that have lost their resemblance to normal thyroid cells. Advanced thyroid carcinoma, regardless of its degree of differentiation, is known to have a higher likelihood of disease progression and is generally associated with a poor prognosis. However, the process through which well-differentiated thyroid carcinoma transforms into anaplastic thyroid carcinoma, also known as "dedifferentiation", has been a subject of intensive research. In recent years, there have been significant breakthroughs in the treatment of refractory advanced thyroid cancer. Clinical studies have been conducted to evaluate the efficacy and safety of molecular targeted drugs and immune checkpoint inhibitors in the treatment of dedifferentiated thyroid cancer. These drugs work by targeting specific molecules or proteins in cancer cells to inhibit their growth or by enhancing the body's immune response against the cancer cells. This article aims to explore some of the possible mechanisms behind the dedifferentiation process in well-differentiated thyroid carcinoma. It also discusses the clinical effects of molecular targeted drugs and immune checkpoint inhibitors in thyroid cancer patients with different degrees of differentiation. Furthermore, it offers insights into the future trends in the treatment of advanced thyroid cancer, highlighting the potential for improved outcomes and better patient care.
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Affiliation(s)
- Jing-Yang Su
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityHangzhou 310007, Zhejiang, China
- Tongde Hospital of Zhejiang ProvinceHangzhou 310012, Zhejiang, China
| | - Ting Huang
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityHangzhou 310007, Zhejiang, China
| | - Jia-Lin Zhang
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityHangzhou 310007, Zhejiang, China
| | - Jin-Hua Lu
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityHangzhou 310007, Zhejiang, China
| | - Meng-Lei Wang
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityHangzhou 310007, Zhejiang, China
| | - Jiang Yan
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityHangzhou 310007, Zhejiang, China
| | - Ren-Bin Lin
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityHangzhou 310007, Zhejiang, China
| | - Sheng-You Lin
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310000, Zhejiang, China
| | - Jue Wang
- Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical UniversityHangzhou 310007, Zhejiang, China
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19
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Tutusaus A, Morales A, García de Frutos P, Marí M. GAS6/TAM Axis as Therapeutic Target in Liver Diseases. Semin Liver Dis 2024; 44:99-114. [PMID: 38395061 PMCID: PMC11027478 DOI: 10.1055/a-2275-0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
TAM (TYRO3, AXL, and MERTK) protein tyrosine kinase membrane receptors and their vitamin K-dependent ligands GAS6 and protein S (PROS) are well-known players in tumor biology and autoimmune diseases. In contrast, TAM regulation of fibrogenesis and the inflammation mechanisms underlying metabolic dysfunction-associated steatohepatitis (MASH), cirrhosis, and, ultimately, liver cancer has recently been revealed. GAS6 and PROS binding to phosphatidylserine exposed in outer membranes of apoptotic cells links TAMs, particularly MERTK, with hepatocellular damage. In addition, AXL and MERTK regulate the development of liver fibrosis and inflammation in chronic liver diseases. Acute hepatic injury is also mediated by the TAM system, as recent data regarding acetaminophen toxicity and acute-on-chronic liver failure have uncovered. Soluble TAM-related proteins, mainly released from activated macrophages and hepatic stellate cells after hepatic deterioration, are proposed as early serum markers for disease progression. In conclusion, the TAM system is becoming an interesting pharmacological target in liver pathology and a focus of future biomedical research in this field.
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Affiliation(s)
- Anna Tutusaus
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, Barcelona, Catalunya, Spain
- Barcelona Clinic Liver Cancer (BCLC) Group, Barcelona, Spain
| | - Albert Morales
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, Barcelona, Catalunya, Spain
- Barcelona Clinic Liver Cancer (BCLC) Group, Barcelona, Spain
| | - Pablo García de Frutos
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, Barcelona, Catalunya, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Cardiovasculares (CIBERCV), Barcelona, Comunidad de Madrid, Spain
| | - Montserrat Marí
- Department of Cell Death and Proliferation, IIBB-CSIC, IDIBAPS, Barcelona, Catalunya, Spain
- Barcelona Clinic Liver Cancer (BCLC) Group, Barcelona, Spain
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20
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Chocarro-Calvo A, Jociles-Ortega M, García-Martinez JM, Louphrasitthiphol P, Garcia YV, Ramírez-Sánchez A, Chauhan J, Fiuza MC, Duran M, García-Jiménez C, Goding CR. Phenotype-specific melanoma uptake of fatty acid from human adipocytes activates AXL and CAV1-dependent β-catenin nuclear accumulation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.21.576568. [PMID: 38328032 PMCID: PMC10849526 DOI: 10.1101/2024.01.21.576568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Phenotypic diversity of cancer cells within tumors generated through bi-directional interactions with the tumor microenvironment has emerged as a major driver of disease progression and therapy resistance. Nutrient availability plays a critical role in determining phenotype, but whether specific nutrients elicit different responses on distinct phenotypes is poorly understood. Here we show, using melanoma as a model, that only MITF Low undifferentiated cells, but not MITF High cells, are competent to drive lipolysis in human adipocytes. In contrast to MITF High melanomas, adipocyte-derived free fatty acids are taken up by undifferentiated MITF Low cells via a fatty acid transporter (FATP)-independent mechanism. Importantly, oleic acid (OA), a monounsaturated long chain fatty acid abundant in adipose tissue and lymph, reprograms MITF Low undifferentiated melanoma cells to a highly invasive state by ligand-independent activation of AXL, a receptor tyrosine kinase associated with therapy resistance in a wide range of cancers. AXL activation by OA then drives SRC-dependent formation and nuclear translocation of a β-catenin-CAV1 complex. The results highlight how a specific nutritional input drives phenotype-specific activation of a pro-metastasis program with implications for FATP-targeted therapies.
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21
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Chen M, Yin B, Liu Y, Li M, Shen S, Wu J, Li W, Fan J. ARRDC3 regulates the targeted therapy sensitivity of clear cell renal cell carcinoma by promoting AXL degradation. Cell Cycle 2024; 23:56-69. [PMID: 38389126 PMCID: PMC11005801 DOI: 10.1080/15384101.2024.2308411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
AXL plays crucial roles in the tumorigenesis, progression, and drug resistance of neoplasms; however, the mechanisms associated with AXL overexpression in tumors remain largely unknown. In this study, to investigate these molecular mechanisms, wildtype and mutant proteins of arrestin domain-containing protein 3 (ARRDC3) and AXL were expressed, and co-immunoprecipitation analyses were performed. ARRDC3-deficient cells generated using the CRISPR-Cas9 system were treated with different concentrations of the tyrosine kinase inhibitor sunitinib and subjected to cell biological, molecular, and pharmacological experiments. Furthermore, immunohistochemistry was used to analyze the correlation between ARRDC3 and AXL protein expressions in renal cancer tissue specimens. The experimental results demonstrated that ARRDC3 interacts with AXL to promote AXL ubiquitination and degradation, followed by the negative regulation of downstream signaling mechanisms, including the phosphorylation of protein kinase B and extracellular signal-regulated kinase. Notably, ARRDC3 deficiency decreased the sunitinib sensitivity of clear cell renal cell carcinoma (ccRCC) cells in a manner dependent on the regulation of AXL stability. Overall, our results suggest that ARRDC3 is a negative regulator of AXL and can serve as a novel predictor of sunitinib therapeutic response in patients with ccRCC.
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Affiliation(s)
- Mulin Chen
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Bingde Yin
- Department of Urology, Minhang Hospital, Fudan University, Shanghai, P.R. China
| | - Yao Liu
- School of Life Sciences, Fudan University, Shanghai, P.R. China
| | - Mingzi Li
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Suqin Shen
- School of Life Sciences, Fudan University, Shanghai, P.R. China
| | - Jiaxue Wu
- School of Life Sciences, Fudan University, Shanghai, P.R. China
| | - Weiguo Li
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Jie Fan
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
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22
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Jeong SU, Park JM, Yoon SY, Hwang HS, Go H, Shin DM, Ju H, Sung CO, Lee JL, Jeong G, Cho YM. IFITM3-mediated activation of TRAF6/MAPK/AP-1 pathways induces acquired TKI resistance in clear cell renal cell carcinoma. Investig Clin Urol 2024; 65:84-93. [PMID: 38197755 PMCID: PMC10789540 DOI: 10.4111/icu.20230294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/19/2023] [Accepted: 11/13/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Vascular endothelial growth factor tyrosine kinase inhibitors (TKIs) have been the standard of care for advanced and metastatic clear cell renal cell carcinoma (ccRCC). However, the therapeutic effect of TKI monotherapy remains unsatisfactory given the high rates of acquired resistance to TKI therapy despite favorable initial tumor response. MATERIALS AND METHODS To define the TKI-resistance mechanism and identify new therapeutic target for TKI-resistant ccRCC, an integrative differential gene expression analysis was performed using acquired resistant cohort and a public dataset. Sunitinib-resistant RCC cell lines were established and used to test their malignant behaviors of TKI resistance through in vitro and in vivo studies. Immunohistochemistry was conducted to compare expression between the tumor and normal kidney and verify expression of pathway-related proteins. RESULTS Integrated differential gene expression analysis revealed increased interferon-induced transmembrane protein 3 (IFITM3) expression in post-TKI samples. IFITM3 expression was increased in ccRCC compared with the normal kidney. TKI-resistant RCC cells showed high expression of IFITM3 compared with TKI-sensitive cells and displayed aggressive biologic features such as higher proliferative ability, clonogenic survival, migration, and invasion while being treated with sunitinib. These aggressive features were suppressed by the inhibition of IFITM3 expression and promoted by IFITM3 overexpression, and these findings were confirmed in a xenograft model. IFITM3-mediated TKI resistance was associated with the activation of TRAF6 and MAPK/AP-1 pathways. CONCLUSIONS These results demonstrate IFITM3-mediated activation of the TRAF6/MAPK/AP-1 pathways as a mechanism of acquired TKI resistance, and suggest IFITM3 as a new target for TKI-resistant ccRCC.
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Affiliation(s)
- Se Un Jeong
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ja-Min Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Young Yoon
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Myung Shin
- Department of Cell and Genetic Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyein Ju
- Department of Cell and Genetic Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ohk Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gowun Jeong
- AI Recommendation, T3K, SK Telecom, Seoul, Korea
| | - Yong Mee Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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23
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Sweeney PL, Suri Y, Basu A, Koshkin VS, Desai A. Mechanisms of tyrosine kinase inhibitor resistance in renal cell carcinoma. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2023; 6:858-873. [PMID: 38239394 PMCID: PMC10792482 DOI: 10.20517/cdr.2023.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024]
Abstract
Renal cell carcinoma (RCC), the most prevalent type of kidney cancer, is a significant cause of cancer morbidity and mortality worldwide. Antiangiogenic tyrosine kinase inhibitors (TKIs), in combination with immune checkpoint inhibitors (ICIs), are among the first-line treatment options for patients with advanced RCC. These therapies target the vascular endothelial growth factor receptor (VEGFR) tyrosine kinase pathway and other kinases crucial to cancer proliferation, survival, and metastasis. TKIs have yielded substantial improvements in progression-free survival (PFS) and overall survival (OS) for patients with advanced RCC. However, nearly all patients eventually progress on these drugs as resistance develops. This review provides an overview of TKI resistance in RCC and explores different mechanisms of resistance, including upregulation of alternative proangiogenic pathways, epithelial-mesenchymal transition (EMT), decreased intracellular drug concentrations due to efflux pumps and lysosomal sequestration, alterations in the tumor microenvironment including bone marrow-derived cells (BMDCs) and tumor-associated fibroblasts (TAFs), and genetic factors such as single nucleotide polymorphisms (SNPs). A comprehensive understanding of these mechanisms opens the door to the development of innovative therapeutic approaches that can effectively overcome TKI resistance, thereby improving outcomes for patients with advanced RCC.
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Affiliation(s)
- Patrick L. Sweeney
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Yash Suri
- University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Arnab Basu
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35233, USA
| | - Vadim S. Koshkin
- Division of Hematology and Oncology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA 94143, USA
| | - Arpita Desai
- Division of Hematology and Oncology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA 94143, USA
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24
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Wu Y, Chen S, Yang X, Sato K, Lal P, Wang Y, Shinkle AT, Wendl MC, Primeau TM, Zhao Y, Gould A, Sun H, Mudd JL, Hoog J, Mashl RJ, Wyczalkowski MA, Mo CK, Liu R, Herndon JM, Davies SR, Liu D, Ding X, Evrard YA, Welm BE, Lum D, Koh MY, Welm AL, Chuang JH, Moscow JA, Meric-Bernstam F, Govindan R, Li S, Hsieh J, Fields RC, Lim KH, Ma CX, Zhang H, Ding L, Chen F. Combining the Tyrosine Kinase Inhibitor Cabozantinib and the mTORC1/2 Inhibitor Sapanisertib Blocks ERK Pathway Activity and Suppresses Tumor Growth in Renal Cell Carcinoma. Cancer Res 2023; 83:4161-4178. [PMID: 38098449 PMCID: PMC10722140 DOI: 10.1158/0008-5472.can-23-0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 09/25/2023] [Indexed: 12/18/2023]
Abstract
Current treatment approaches for renal cell carcinoma (RCC) face challenges in achieving durable tumor responses due to tumor heterogeneity and drug resistance. Combination therapies that leverage tumor molecular profiles could offer an avenue for enhancing treatment efficacy and addressing the limitations of current therapies. To identify effective strategies for treating RCC, we selected ten drugs guided by tumor biology to test in six RCC patient-derived xenograft (PDX) models. The multitargeted tyrosine kinase inhibitor (TKI) cabozantinib and mTORC1/2 inhibitor sapanisertib emerged as the most effective drugs, particularly when combined. The combination demonstrated favorable tolerability and inhibited tumor growth or induced tumor regression in all models, including two from patients who experienced treatment failure with FDA-approved TKI and immunotherapy combinations. In cabozantinib-treated samples, imaging analysis revealed a significant reduction in vascular density, and single-nucleus RNA sequencing (snRNA-seq) analysis indicated a decreased proportion of endothelial cells in the tumors. SnRNA-seq data further identified a tumor subpopulation enriched with cell-cycle activity that exhibited heightened sensitivity to the cabozantinib and sapanisertib combination. Conversely, activation of the epithelial-mesenchymal transition pathway, detected at the protein level, was associated with drug resistance in residual tumors following combination treatment. The combination effectively restrained ERK phosphorylation and reduced expression of ERK downstream transcription factors and their target genes implicated in cell-cycle control and apoptosis. This study highlights the potential of the cabozantinib plus sapanisertib combination as a promising treatment approach for patients with RCC, particularly those whose tumors progressed on immune checkpoint inhibitors and other TKIs. SIGNIFICANCE The molecular-guided therapeutic strategy of combining cabozantinib and sapanisertib restrains ERK activity to effectively suppress growth of renal cell carcinomas, including those unresponsive to immune checkpoint inhibitors.
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Affiliation(s)
- Yige Wu
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - Siqi Chen
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - Xiaolu Yang
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Kazuhito Sato
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - Preet Lal
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Yuefan Wang
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Andrew T. Shinkle
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Michael C. Wendl
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
- McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri
| | - Tina M. Primeau
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Yanyan Zhao
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Alanna Gould
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Hua Sun
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - Jacqueline L. Mudd
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Jeremy Hoog
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - R. Jay Mashl
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - Matthew A. Wyczalkowski
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - Chia-Kuei Mo
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - Ruiyang Liu
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
| | - John M. Herndon
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Sherri R. Davies
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Di Liu
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Xi Ding
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Yvonne A. Evrard
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Bryan E. Welm
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - David Lum
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Mei Yee Koh
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Alana L. Welm
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jeffrey H. Chuang
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Jeffrey A. Moscow
- Investigational Drug Branch, National Cancer Institute, Bethesda, Maryland
| | | | - Ramaswamy Govindan
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
| | - Shunqiang Li
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
| | - James Hsieh
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Ryan C. Fields
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
| | - Kian-Huat Lim
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
| | - Cynthia X. Ma
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
| | - Hui Zhang
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Li Ding
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, Missouri
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Feng Chen
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Department of Genetics, Washington University in St. Louis, St. Louis, Missouri
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Chu H, Xie W, Guo C, Shi H, Gu J, Qin Z, Xie Y. Inhibiting stanniocalcin 2 reduces sunitinib resistance of Caki-1 renal cancer cells under hypoxia condition. Ann Med Surg (Lond) 2023; 85:5963-5971. [PMID: 38098599 PMCID: PMC10718379 DOI: 10.1097/ms9.0000000000001450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023] Open
Abstract
Background Our previous study has suggested that blocking stanniocalcin 2 (STC2) could reduce sunitinib resistance in clear cell renal cell carcinoma (ccRCC) under normoxia. The hypoxia is a particularly important environment for RCC occurrence and development, as well as sunitinib resistance. The authors proposed that STC2 also plays important roles in RCC sunitinib resistance under hypoxia conditions. Methods The ccRCC Caki-1 cells were treated within the hypoxia conditions. Real-time quantitative PCR and Western blotting were applied to detect the STC2 expression in ccRCC Caki-1 cells. STC2-neutralizing antibodies, STC2 siRNA, and the recombinant human STC2 (rhSTC2) were used to identify targeting regulation on STC2 in modulating sunitinib resistance, proliferation, epithelial-mesenchymal transition (EMT), migration, and invasion. In addition, autophagy flux and the lysosomal acidic environment were investigated by Western blotting and fluorescence staining, and the accumulation of sunitinib in cells was observed with the addition of STC2-neutralizing antibodies and autophagy modulators. Results Under hypoxia conditions, sunitinib disrupted the lysosomal acidic environment and accumulated in Caki-1 cells. Hypoxia-induced the STC2 mRNA and protein levels in Caki-1 cells. STC2-neutralizing antibodies and STC2 siRNA effectively aggravated sunitinib-reduced cell viability and proliferation, which were reversed by rhSTC2. In addition, sunitinib promoted EMT, migration, and invasion, which were reduced by STC2-neutralizing antibodies. Conclusion Inhibiting STC2 could reduce the sunitinib resistance of ccRCC cells under hypoxia conditions.
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Affiliation(s)
- Hezhen Chu
- Department of Urology, Yixing Traditional Chinese Medicine Hospital
| | - Wenchao Xie
- Department of Urology, Affiliated Hospital of Jiangsu University-Yixing People’s Hospital, Yixing
| | - Chuanzhi Guo
- School of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Haifeng Shi
- School of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Jie Gu
- School of Life Sciences, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Zhenqian Qin
- Department of Urology, Affiliated Hospital of Jiangsu University-Yixing People’s Hospital, Yixing
| | - Yimin Xie
- Department of Urology, Affiliated Hospital of Jiangsu University-Yixing People’s Hospital, Yixing
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Wang Y, Liu X, Gong L, Ding W, Hao W, Peng Y, Zhang J, Cai W, Gao Y. Mechanisms of sunitinib resistance in renal cell carcinoma and associated opportunities for therapeutics. Br J Pharmacol 2023; 180:2937-2955. [PMID: 37740648 DOI: 10.1111/bph.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 09/24/2023] Open
Abstract
Sunitinib is the first-line drug for renal cell carcinoma (RCC) treatment. However, patients who received sunitinib treatment will ultimately develop drug resistance after 6-15 months, creating a huge obstacle to the current treatment of renal cell carcinoma. Therefore, it is urgent to clarify the mechanisms of sunitinib resistance and develop new strategies to overcome it. In this review, the mechanisms of sunitinib resistance in renal cell carcinoma have been summarized based on five topics: activation of bypass or alternative pathway, inadequate drug accumulation, tumour microenvironment, metabolic reprogramming and epigenetic regulation. Furthermore, present and potential biomarkers, as well as potential treatment strategies for overcoming sunitinib resistance in renal cell carcinoma, are also covered.
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Affiliation(s)
- Yunxia Wang
- School of Pharmacy, Fudan University, Shanghai, China
| | - Xiaolin Liu
- School of Pharmacy, Fudan University, Shanghai, China
| | - Luyao Gong
- School of Pharmacy, Fudan University, Shanghai, China
| | - Weihong Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjing Hao
- School of Pharmacy, Fudan University, Shanghai, China
| | - Yeheng Peng
- School of Pharmacy, Fudan University, Shanghai, China
| | - Jun Zhang
- School of Pharmacy, Fudan University, Shanghai, China
| | - Weimin Cai
- School of Pharmacy, Fudan University, Shanghai, China
| | - Yuan Gao
- School of Pharmacy, Fudan University, Shanghai, China
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Ishihara H, Nemoto Y, Tachibana H, Fukuda H, Yoshida K, Kobayashi H, Iizuka J, Hashimoto Y, Kondo T, Takagi T. Real-world efficacy and safety of cabozantinib following immune checkpoint inhibitor failure in Japanese patients with advanced renal cell carcinoma. Jpn J Clin Oncol 2023; 53:977-983. [PMID: 37519060 DOI: 10.1093/jjco/hyad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Real-world data of cabozantinib after failure of immune checkpoint inhibitors for advanced renal cell carcinoma in Japanese population are limited. Additionally, prognostic factors of cabozantinib in this setting are still unknown. METHODS We retrospectively evaluated data of 56 patients treated with cabozantinib subsequent to failed immune checkpoint inhibitors at four institutions. Regarding the efficacy profile, progression-free survival, overall survival and objective response rate were assessed. In terms of the safety profile, rate of adverse events, dose reduction and treatment interruption were assessed. Furthermore, risk factors of progression-free survival were analyzed. RESULTS Twenty-nine patients (52%) were treated with cabozantinib as second-line therapy. Most frequent prior immune checkpoint inhibitor treatment was nivolumab plus ipilimumab combination therapy as first-line therapy (n = 30, 54%). Median progression-free survival and overall survival were 9.76 and 25.5 months, respectively, and objective response rate was 34%. All patients experienced at least one adverse event, and grade ≥ 3 adverse events were observed in 31 patients (55%). Forty-four (79%) and 31 (55%) patients needed dose reduction and treatment interruption, respectively. Multivariate analysis showed that reduced initial dose (i.e. <60 mg) (hazard ratio: 2.50, P = 0.0355) and presence of lymph node metastasis (hazard ratio: 2.50, P = 0.0172) were independent factors of shorter progression-free survival. CONCLUSION Cabozantinib in Japanese patients with advanced renal cell carcinoma who failed immune checkpoint inhibitors was efficacious and had a manageable safety profile. These results appear to be similar to those of previous clinical trials.
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Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yuki Nemoto
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
- Department of Urology, Tokyo Women's Medical University, Adachi Medical Center, Adachi-ku, Tokyo, Japan
| | | | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University, Adachi Medical Center, Adachi-ku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yasunobu Hashimoto
- Department of Urology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Adachi Medical Center, Adachi-ku, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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Saliby RM, Saad E, Labaki C, Xu W, Braun DA, Viswanathan SR, Bakouny Z. Novel Targeted Therapies for Renal Cell Carcinoma: Building on the Successes of Vascular Endothelial Growth Factor and mTOR Inhibition. Hematol Oncol Clin North Am 2023; 37:1015-1026. [PMID: 37385938 DOI: 10.1016/j.hoc.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Targeted therapies have revolutionized the treatment of renal cell carcinoma (RCC). The VHL/HIF pathway is responsible for the regulation of oxygen homeostasis and is frequently altered in RCC. Targeting this pathway as well as the mTOR pathway have yielded remarkable advances in the treatment of RCC. Here, we review the most promising novel targeted therapies for the treatment of RCC, including HIF2α, MET, metabolic targeting, and epigenomic reprogramming.
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Affiliation(s)
- Renée Maria Saliby
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Center of Molecular and Cellular Oncology, Yale Cancer Center, Yale School of Medicine, 300 George Street, Suite 6400, New Haven, CT 06510, USA
| | - Eddy Saad
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Wenxin Xu
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
| | - David A Braun
- Center of Molecular and Cellular Oncology, Yale Cancer Center, Yale School of Medicine, 300 George Street, Suite 6400, New Haven, CT 06510, USA
| | - Srinivas R Viswanathan
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA.
| | - Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Boussios S, Devo P, Goodall ICA, Sirlantzis K, Ghose A, Shinde SD, Papadopoulos V, Sanchez E, Rassy E, Ovsepian SV. Exosomes in the Diagnosis and Treatment of Renal Cell Cancer. Int J Mol Sci 2023; 24:14356. [PMID: 37762660 PMCID: PMC10531522 DOI: 10.3390/ijms241814356] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Renal cell carcinoma (RCC) is the most prevalent type of kidney cancer originating from renal tubular epithelial cells, with clear cell RCC comprising approximately 80% of cases. The primary treatment modalities for RCC are surgery and targeted therapy, albeit with suboptimal efficacies. Despite progress in RCC research, significant challenges persist, including advanced distant metastasis, delayed diagnosis, and drug resistance. Growing evidence suggests that extracellular vesicles (EVs) play a pivotal role in multiple aspects of RCC, including tumorigenesis, metastasis, immune evasion, and drug response. These membrane-bound vesicles are released into the extracellular environment by nearly all cell types and are capable of transferring various bioactive molecules, including RNA, DNA, proteins, and lipids, aiding intercellular communication. The molecular cargo carried by EVs renders them an attractive resource for biomarker identification, while their multifarious role in the RCC offers opportunities for diagnosis and targeted interventions, including EV-based therapies. As the most versatile type of EVs, exosomes have attracted much attention as nanocarriers of biologicals, with multi-range signaling effects. Despite the growing interest in exosomes, there is currently no widely accepted consensus on their subtypes and properties. The emerging heterogeneity of exosomes presents both methodological challenges and exciting opportunities for diagnostic and clinical interventions. This article reviews the characteristics and functions of exosomes, with a particular reference to the recent advances in their application to the diagnosis and treatment of RCC.
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Affiliation(s)
- Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; (A.G.); (E.S.)
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, Strand, London WC2R 2LS, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK
- AELIA Organization, 9th Km Thessaloniki–Thermi, 57001 Thessaloniki, Greece
| | - Perry Devo
- School of Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime ME4 4TB, UK; (P.D.); (I.C.A.G.); (S.V.O.)
| | - Iain C. A. Goodall
- School of Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime ME4 4TB, UK; (P.D.); (I.C.A.G.); (S.V.O.)
| | - Konstantinos Sirlantzis
- School of Engineering, Technology and Design, Canterbury Christ Church University, Canterbury CT1 1QU, UK;
| | - Aruni Ghose
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; (A.G.); (E.S.)
- Barts Cancer Centre, Barts Health NHS Trust, London EC1A 7BE, UK
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood HA6 2RN, UK
- Immuno-Oncology Clinical Network, London, UK
| | - Sayali D. Shinde
- Centre for Tumour Biology, Barts Cancer Institute, Cancer Research UK Barts Centre, Queen Mary University of London, London EC1M 6BQ, UK;
| | | | - Elisabet Sanchez
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; (A.G.); (E.S.)
| | - Elie Rassy
- Department of Medical Oncology, Gustave Roussy Institut, 94805 Villejuif, France;
| | - Saak V. Ovsepian
- School of Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime ME4 4TB, UK; (P.D.); (I.C.A.G.); (S.V.O.)
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Mogwera KSP, Chibale K, Arendse LB. Developing kinase inhibitors for malaria: an opportunity or liability? Trends Parasitol 2023; 39:720-731. [PMID: 37385921 DOI: 10.1016/j.pt.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
Highly druggable and essential to almost all aspects of cellular life, the protein and phosphoinositide kinase gene families offer a wealth of potential targets for pharmacological modulation for both noncommunicable and infectious diseases. Despite the success of kinase inhibitors in oncology and other disease indications, targeting kinases comes with significant challenges. Key hurdles for kinase drug discovery include selectivity and acquired resistance. The phosphatidylinositol 4-kinase beta inhibitor MMV390048 showed good efficacy in Phase 2a clinical trials, demonstrating the potential of kinase inhibitors for malaria treatment. Here we argue that the potential benefits of Plasmodium kinase inhibitors outweigh the risks, and we highlight the opportunity for designed polypharmacology to reduce the risk of resistance.
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Affiliation(s)
- Koketso S P Mogwera
- Drug Discovery and Development Centre (H3D), South African Medical Research Council Drug Discovery and Development Research Unit, Department of Chemistry and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - Kelly Chibale
- Drug Discovery and Development Centre (H3D), South African Medical Research Council Drug Discovery and Development Research Unit, Department of Chemistry and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - Lauren B Arendse
- Drug Discovery and Development Centre (H3D), South African Medical Research Council Drug Discovery and Development Research Unit, Department of Chemistry and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa.
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Hamidi S, Hofmann MC, Iyer PC, Cabanillas ME, Hu MI, Busaidy NL, Dadu R. Review article: new treatments for advanced differentiated thyroid cancers and potential mechanisms of drug resistance. Front Endocrinol (Lausanne) 2023; 14:1176731. [PMID: 37435488 PMCID: PMC10331470 DOI: 10.3389/fendo.2023.1176731] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
The treatment of advanced, radioiodine refractory, differentiated thyroid cancers (RR-DTCs) has undergone major advancements in the last decade, causing a paradigm shift in the management and prognosis of these patients. Better understanding of the molecular drivers of tumorigenesis and access to next generation sequencing of tumors have led to the development and Food and Drug Administration (FDA)-approval of numerous targeted therapies for RR-DTCs, including antiangiogenic multikinase inhibitors, and more recently, fusion-specific kinase inhibitors such as RET inhibitors and NTRK inhibitors. BRAF + MEK inhibitors have also been approved for BRAF-mutated solid tumors and are routinely used in RR-DTCs in many centers. However, none of the currently available treatments are curative, and most patients will ultimately show progression. Current research efforts are therefore focused on identifying resistance mechanisms to tyrosine kinase inhibitors and ways to overcome them. Various novel treatment strategies are under investigation, including immunotherapy, redifferentiation therapy, and second-generation kinase inhibitors. In this review, we will discuss currently available drugs for advanced RR-DTCs, potential mechanisms of drug resistance and future therapeutic avenues.
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Affiliation(s)
| | | | | | | | | | | | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Wang K, Duan P, Chen X, Yang Q, Feng G, Diao L, Zhang Z, Yao X. Comparison of tyrosine kinase inhibitors in the treatment of metastatic renal cell carcinoma with rhabdoid and sarcomatoid differentiations. Cancer Med 2023. [PMID: 37325945 DOI: 10.1002/cam4.6081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/08/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC) with rhabdoid (mRCC-R) and sarcomatoid (mRCC-S) differentiations. MATERIALS AND METHODS In this single-institutional cohort study, we included patients with RCC with rhabdoid (RCC-R) and sarcomatoid (RCC-S) differentiation, who were treated with TKIs after metastasis at our institute from 2013 to 2021. Patient characteristics, treatments, and clinical outcomes were recorded and analyzed. RESULTS We identified 111 patients with RCC-R or RCC-S differentiations, of which 23 patients were included in the final analysis. Of the 23 patients, 10 (43.5%) were grouped as mRCC-R and 13 (56.5%) as mRCC-S. At a median follow-up of 40 months, mRCC-R and mRCC-S progressed in 7 of 10 and 12 of 13 patients, respectively. In addition, four and eight patients died in the mRCC-R and mRCC-S groups, respectively. The median progression-free survival (PFS) of the two groups was 19 months (mRCC-R: 95% confidence interval [CI] 4.08-33.92) and 7 months (mRCC-S: 95% CI 2.03-11.96), while the median overall survival (OS) was 32 months and 21 months, respectively. mRCC-S had a worse prognosis than mRCC-R. Based on the univariate Cox regression model, single metastasis or multiple metastasis of tumor, rhabdoid differentiation, and sarcomatoid differentiation were predictors of PFS but not OS. CONCLUSION The efficacy of TKIs in the treatment of mRCC-R and mRCC-S may be different.
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Affiliation(s)
- Kun Wang
- Key Laboratory of Cancer Prevention and Therapy, Department of Geniturinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Pengqiang Duan
- Key Laboratory of Cancer Prevention and Therapy, Department of Geniturinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xusheng Chen
- Key Laboratory of Cancer Prevention and Therapy, Department of Geniturinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qing Yang
- Key Laboratory of Cancer Prevention and Therapy, Department of Geniturinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Guowei Feng
- Key Laboratory of Cancer Prevention and Therapy, Department of Geniturinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Lei Diao
- Key Laboratory of Cancer Prevention and Therapy, Department of Geniturinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhenting Zhang
- Key Laboratory of Cancer Prevention and Therapy, Department of Geniturinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xin Yao
- Key Laboratory of Cancer Prevention and Therapy, Department of Geniturinary Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Kruk L, Mamtimin M, Braun A, Anders HJ, Andrassy J, Gudermann T, Mammadova-Bach E. Inflammatory Networks in Renal Cell Carcinoma. Cancers (Basel) 2023; 15:cancers15082212. [PMID: 37190141 DOI: 10.3390/cancers15082212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
Cancer-associated inflammation has been established as a hallmark feature of almost all solid cancers. Tumor-extrinsic and intrinsic signaling pathways regulate the process of cancer-associated inflammation. Tumor-extrinsic inflammation is triggered by many factors, including infection, obesity, autoimmune disorders, and exposure to toxic and radioactive substances. Intrinsic inflammation can be induced by genomic mutation, genome instability and epigenetic remodeling in cancer cells that promote immunosuppressive traits, inducing the recruitment and activation of inflammatory immune cells. In RCC, many cancer cell-intrinsic alterations are assembled, upregulating inflammatory pathways, which enhance chemokine release and neoantigen expression. Furthermore, immune cells activate the endothelium and induce metabolic shifts, thereby amplifying both the paracrine and autocrine inflammatory loops to promote RCC tumor growth and progression. Together with tumor-extrinsic inflammatory factors, tumor-intrinsic signaling pathways trigger a Janus-faced tumor microenvironment, thereby simultaneously promoting or inhibiting tumor growth. For therapeutic success, it is important to understand the pathomechanisms of cancer-associated inflammation, which promote cancer progression. In this review, we describe the molecular mechanisms of cancer-associated inflammation that influence cancer and immune cell functions, thereby increasing tumor malignancy and anti-cancer resistance. We also discuss the potential of anti-inflammatory treatments, which may provide clinical benefits in RCCs and possible avenues for therapy and future research.
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Affiliation(s)
- Linus Kruk
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian-University, 80336 Munich, Germany
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilian-University, 80336 Munich, Germany
| | - Medina Mamtimin
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian-University, 80336 Munich, Germany
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilian-University, 80336 Munich, Germany
| | - Attila Braun
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian-University, 80336 Munich, Germany
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilian-University, 80336 Munich, Germany
| | - Joachim Andrassy
- Division of General, Visceral, Vascular and Transplant Surgery, Hospital of LMU, 81377 Munich, Germany
| | - Thomas Gudermann
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian-University, 80336 Munich, Germany
- German Center for Lung Research (DZL), 80336 Munich, Germany
| | - Elmina Mammadova-Bach
- Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian-University, 80336 Munich, Germany
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilian-University, 80336 Munich, Germany
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Pan C, Su Z, Xie H, Ning Y, Li S, Xiao H. Hsa_circ_0081069 facilitates tongue squamous cell carcinoma progression by modulating MAP2K4 expression via miR-634. Odontology 2023; 111:474-486. [PMID: 36181561 DOI: 10.1007/s10266-022-00746-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/09/2022] [Indexed: 01/10/2023]
Abstract
It has been demonstrated that circular RNA (circRNA) is involved in the progression of tongue squamous cell carcinoma (TSCC). The aim of this study was to investigate the intrinsic mechanism of circ_0081069 in TSCC progression. The expression levels of circ_00081069, miR-634, and mitogen-activated protein kinase kinase 4 (MAP2K4) in TSCC tissues and cells were detected by quantitative real-time PCR (qRT-PCR). Cell counting kit 8 assay, Edu assay, and flow cytometry assay were used to detect cell proliferation and cell cycle distribution. Transwell assay was used to detect cell migration and invasion abilities. Western blot analysis was performed to detect the protein expression. Dual-luciferase reporter assay was used to detect the targeting relationships of circ_0081069, miR-634 and MAP2K4. Immunohistochemical staining was used to measure MAP2K4-positive cells in tissues. The effect of circ_0081069 silencing on tumor formation in TSCC in vivo was explored by xenograft tumor assay. Circ_0081069 was highly expressed in TSCC tissues and cells. Silencing of circ_0081069 inhibited cell proliferation, cell cycle progress, cell migration and invasion in vitro, as well as hindered tumor growth in vivo. Mechanistically, circ_0081069 targeted miR-634 to negatively regulate miR-634 expression, and inhibition of miR-634 was able to weaken the inhibitory effect of circ_0081069 knockdown on proliferation, migration, and invasion of TSCC cells. MiR-634 targeted MAP2K4 and negatively regulated MAP2K4 expression, and overexpression of miR-634 inhibited TSCC cell proliferation, migration, and invasion, while co-overexpression of MAP2K4 was able to reverse the effects of miR-634 in TSCC cells. Circ_0081069 is involved in the regulation of proliferation, cycle progress, migration, and invasion of TSCC cells through the miR-634/MAP2K4 axis and has the potential to serve as a diagnostic biomarker and therapeutic target.
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Affiliation(s)
- Chao Pan
- Department of Endodontics, Changsha Stomatological Hospital, No. 389, Youyi Road, Tianxin District, Changsha City, 410008, Hunan Province, China
| | - Zhijian Su
- Department of Endodontics, Changsha Stomatological Hospital, No. 389, Youyi Road, Tianxin District, Changsha City, 410008, Hunan Province, China
| | - Honghui Xie
- Department of Endodontics, Changsha Stomatological Hospital, No. 389, Youyi Road, Tianxin District, Changsha City, 410008, Hunan Province, China
| | - Yanyang Ning
- Department of Endodontics, Changsha Stomatological Hospital, No. 389, Youyi Road, Tianxin District, Changsha City, 410008, Hunan Province, China
| | - Shuangjing Li
- Department of Endodontics, Changsha Stomatological Hospital, No. 389, Youyi Road, Tianxin District, Changsha City, 410008, Hunan Province, China
| | - Haibo Xiao
- Department of Endodontics, Changsha Stomatological Hospital, No. 389, Youyi Road, Tianxin District, Changsha City, 410008, Hunan Province, China.
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Lan Z, Li L, Sun Y, Meng X, Shi Z, Du M, Wang H, Sun Z, Cui Q, Wang L, Geng T, Zhou S, Wang Y, Hu F, Duan C, Geng Y, Zhu Y, Dai Y. A procedure for producing an anti-AXL nanobody in E. coli. Protein Expr Purif 2023; 207:106268. [PMID: 37023993 DOI: 10.1016/j.pep.2023.106268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/28/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
As one of the receptors of the TAM family, AXL plays a vital role in stem cell maintenance, angiogenesis, immune escape of viruses and drug resistance against tumors. In this study, the truncated extracellular segment containing two immunoglobulin-like domains of human AXL (AXL-IG), which has been confirmed to bind growth arrest specific 6 (GAS6) by structural studies [1], was expressed in a prokaryotic expression system and then purified. Immunizing camelid with the purified AXL-IG as antigen could lead to the production of unique nanobodies composed of only variable domain of heavy chain of heavy-chain antibody (VHH), which are around 15 kD and stable. We screened out a nanobody A-LY01 specific binding to AXL-IG. We further determined the affinity of A-LY01 to AXL-IG and revealed that A-LY01 could specifically recognize full-length AXL on the surface of HEK 293T/17 cells. Our study provides appropriate support for the development of diagnostic reagents and antibody therapeutics targeting AXL.
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Affiliation(s)
- Zhongyun Lan
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, 201306, China; Laboratory of Quality & Safety Risk Assessment for Aquatic Products on Storage and Preservation (Shanghai), Ministry of Agriculture, Shanghai, 201306, China; State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Lingyun Li
- State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yili Sun
- Drug Discovery Shandong Laboratory, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai, Shandong, 264117, China
| | - Xiangjing Meng
- Shandong Provincial Key Laboratory of Biopharmaceuticals, Shandong Academy of Pharmaceutical Sciences, Jinan, 250101, China
| | - Zhenzhong Shi
- State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Mengyang Du
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, 201306, China; State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Hui Wang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, 201306, China; State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Zengchao Sun
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, 201306, China; State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Qianqian Cui
- State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Lu Wang
- State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Tengjie Geng
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, 201306, China; State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Siyu Zhou
- State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yi'ang Wang
- State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Fangzheng Hu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, 201306, China; State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Chonggang Duan
- Shandong Provincial Key Laboratory of Biopharmaceuticals, Shandong Academy of Pharmaceutical Sciences, Jinan, 250101, China
| | - Yong Geng
- State Key Laboratory of Drug Research, The CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China; University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Yongheng Zhu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, 201306, China; Laboratory of Quality & Safety Risk Assessment for Aquatic Products on Storage and Preservation (Shanghai), Ministry of Agriculture, Shanghai, 201306, China.
| | - Yuanyuan Dai
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China.
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Huang YC, Hsieh PY, Wang LY, Tsai TH, Chen YJ, Hsieh CH. Local Liver Irradiation Concurrently Versus Sequentially with Cabozantinib on the Pharmacokinetics and Biodistribution in Rats. Int J Mol Sci 2023; 24:ijms24065849. [PMID: 36982920 PMCID: PMC10056485 DOI: 10.3390/ijms24065849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
The aim of this study was to evaluate the radiotherapy (RT)-pharmacokinetics (PK) effect of cabozantinib in concurrent or sequential regimens with external beam radiotherapy (EBRT) or stereotactic body radiation therapy (SBRT). Concurrent and sequential regimens involving RT and cabozantinib were designed. The RT–drug interactions of cabozantinib under RT were confirmed in a free-moving rat model. The drugs were separated on an Agilent ZORBAX SB-phenyl column with a mobile phase consisting of 10 mM potassium dihydrogen phosphate (KH2PO4)–methanol solution (27:73, v/v) for cabozantinib. There were no statistically significant differences in the concentration versus time curve of cabozantinib (AUCcabozantinib) between the control group and the RT2Gy×3 f’x and RT9Gy×3 f’x groups in the concurrent and the sequential regimens. However, compared to those in the control group, the Tmax, T1/2 and MRT decreased by 72.8% (p = 0.04), 49.0% (p = 0.04) and 48.5% (p = 0.04) with RT2Gy×3 f’x in the concurrent regimen, respectively. Additionally, the T1/2 and MRT decreased by 58.8% (p = 0.01) and 57.8% (p = 0.01) in the concurrent RT9Gy×3 f’x group when compared with the control group, respectively. The biodistribution of cabozantinib in the heart increased by 271.4% (p = 0.04) and 120.0% (p = 0.04) with RT2Gy×3 f’x in the concurrent and sequential regimens compared to the concurrent regimen, respectively. Additionally, the biodistribution of cabozantinib in the heart increased by 107.1% (p = 0.01) with the RT9Gy×3 f’x sequential regimen. Compared to the RT9Gy×3 f’x concurrent regimen, the RT9Gy×3 f’x sequential regimen increased the biodistribution of cabozantinib in the heart (81.3%, p = 0.02), liver (110.5%, p = 0.02), lung (125%, p = 0.004) and kidneys (87.5%, p = 0.048). No cabozantinib was detected in the brain in any of the groups. The AUC of cabozantinib is not modulated by irradiation and is not affected by treatment strategies. However, the biodistribution of cabozantinib in the heart is modulated by off-target irradiation and SBRT doses simultaneously. The impact of the biodistribution of cabozantinib with RT9Gy×3 f’x is more significant with the sequential regimen than with the concurrent regimen.
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Affiliation(s)
- Yu-Chuen Huang
- Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan (Y.-J.C.)
- School of Chinese Medicine, China Medical University, Taichung 404, Taiwan
| | - Pei-Ying Hsieh
- Department of Oncology and Hematology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Li-Ying Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Physical Therapy Center, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Tung-Hu Tsai
- Institute of Traditional Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Yu-Jen Chen
- Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan (Y.-J.C.)
- Institute of Traditional Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Department of Radiation Oncology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing, and Management, Taipei 112, Taiwan
| | - Chen-Hsi Hsieh
- Institute of Traditional Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Correspondence:
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An In Vitro Analysis of TKI-Based Sequence Therapy in Renal Cell Carcinoma Cell Lines. Int J Mol Sci 2023; 24:ijms24065648. [PMID: 36982721 PMCID: PMC10058472 DOI: 10.3390/ijms24065648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
The tyrosine kinase inhibitor (TKI) cabozantinib might impede the growth of the sunitinib-resistant cell lines by targeting MET and AXL overexpression in metastatic renal cell carcinoma (mRCC). We studied the role of MET and AXL in the response to cabozantinib, particularly following long-term administration with sunitinib. Two sunitinib-resistant cell lines, 786-O/S and Caki-2/S, and the matching 786-O/WT and Caki-2/WT cells were exposed to cabozantinib. The drug response was cell-line-specific. The 786-O/S cells were less growth-inhibited by cabozantinib than 786-O/WT cells (p-value = 0.02). In 786-O/S cells, the high level of phosphorylation of MET and AXL was not affected by cabozantinib. Despite cabozantinib hampering the high constitutive phosphorylation of MET, the Caki-2 cells showed low sensitivity to cabozantinib, and this was independent of sunitinib pretreatment. In both sunitinib-resistant cell lines, cabozantinib increased Src-FAK activation and impeded mTOR expression. The modulation of ERK and AKT was cell-line-specific, mirroring the heterogeneity among the patients. Overall, the MET- and AXL-driven status did not affect cell responsiveness to cabozantinib in the second-line treatment. The activation of Src-FAK might counteract cabozantinib activity and contribute to tumor survival and may be considered an early indicator of therapy response.
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Bae D, Chaudhary P, Been JH, Gautam J, Lee J, Shah S, Kim E, Lee H, Nam TG, Jeong BS, Kim JA. Antitumor effect of 3-(quinolin-2-ylmethylene)-4,6-dimethyl-5-hydroxy-7-azaoxindole down-regulating the Gas6-Axl axis. Eur J Med Chem 2023; 251:115274. [PMID: 36921529 DOI: 10.1016/j.ejmech.2023.115274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023]
Abstract
In this study, a new series of 3-arylidene-4,6-dimethyl-5-hydroxy-7-azaoxindole compounds with a wide range of functional groups were designed, synthesized, and evaluated for their antitumor activity. Among the 35 compounds, compound 6-15, with a quinoline moiety, showed cytotoxic IC50 values superior to those of sunitinib against the seven cancer cell lines (MCF-7, MDA-MB-231, HT-29, DU145, U937, A549, and PANC-1). However, its inhibitory activity against receptor tyrosine kinases (VEGFR2, PDGFRβ, c-KIT, FGFR1, FLT3, CSF1R, EGFR, Axl, and Axl mutant) was 100 -3000-fold weaker than that of sunitinib. Interestingly, compound 6-15 exerted a 3.6-fold stronger cytotoxicity than sunitinib in the gemcitabine-resistant PANC-1 cell line and significantly inhibited Axl, which was in contrast with the effect of sunitinib. Nonetheless, both compounds suppressed the expression of growth arrest-specific 6 (Gas6), the ligand of Axl. The inhibitory effect of compound 6-15 on the Gas6-Axl axis was similar to that of Gas6 knockdown by siRNA in PANC-1 cells in terms of apoptosis induction, increase in Bax/Bcl-2 ratio, Axl down-regulation, and PI3K/Akt inhibition. The inhibitory effect of compound 6-15 on tumor growth in mouse tumor models with A549 and PANC-1 xenografts was much greater than that of cisplatin or gemcitabine. Taken together, the current findings demonstrate that compound 6-15 is a promising anticancer drug candidate that acts by inhibiting the Gas6-Axl axis.
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Affiliation(s)
- Dawon Bae
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Prakash Chaudhary
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Jae-Hui Been
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Jaya Gautam
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Jisu Lee
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Sajita Shah
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Euijung Kim
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Hyunji Lee
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea; College of Pharmacy, Kyungsung University, Busan, 48434, Republic of Korea
| | - Tae-Gyu Nam
- Department of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, ERICA campus, Ansan, 15588, Republic of Korea
| | - Byeong-Seon Jeong
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
| | - Jung-Ae Kim
- College of Pharmacy and Institute for Drug Research, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
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Su J, Lu J, Zhang J, Wang M, Yan J, Lin S. A meta-analysis of the efficacy and toxicity of tyrosine kinase inhibitors in treating patients with different types of thyroid cancer: how to choose drugs appropriately? Curr Opin Oncol 2023; 35:132-144. [PMID: 36721897 DOI: 10.1097/cco.0000000000000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Because the high risk of death and poor prognosis of patients with refractory thyroid cancer (TC), studies related to tyrosine kinase inhibitors (TKIs) in treating different types of refractory TC have gradually attracted attention. Thus, we conducted a meta-analysis of published randomized controlled trials and single-arm trials to evaluate tyrosine kinase inhibitors' efficacy and safety profile treatment in TC patients. RECENT FINDINGS The studies of 29 in 287 met the criteria, 9 were randomized controlled trials and 20 were single-arm trials, involving 11 TKIs (Apatinib, Anlotinib, Cabozantinib, Imatinib, Lenvatinib, Motesanib, Pazopanib, Sorafenib, Sunitinib, Vandetanib, Vemurafenib). Treatment with TKIs significantly improved progression-free survival [hazard ratio [HR] 0.34 (95% confidence interval [CI]: 0.24, 0.48), P < 0.00001] and overall survival [OS] [HR 0.76, (95% CI: 0.64, 0.91), P = 0.003] in randomized controlled trials, but adverse events (AEs) were higher than those in the control group (P < 0.00001). The result of the objective response rate (ORR) in single-arm trials was statistically significant [odds ratio [OR] 0.49 (95% CI: 0.32, 0.75), P = 0.001]. SUMMARY TKIs significantly prolonged progression-free survival and OS or improved ORR in patients with different types of TC (P < 0.01). Our recommendation is to select appropriate TKIs to treat different types of TC patients, and to prevent and manage drug-related AEs after using TKIs.
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Affiliation(s)
- Jingyang Su
- Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University
| | - Jinhua Lu
- Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University
| | - Jialin Zhang
- Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University
| | - Menglei Wang
- Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University
| | - Jiang Yan
- Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University
| | - Shengyou Lin
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Downstream Targets of VHL/HIF-α Signaling in Renal Clear Cell Carcinoma Progression: Mechanisms and Therapeutic Relevance. Cancers (Basel) 2023; 15:cancers15041316. [PMID: 36831657 PMCID: PMC9953937 DOI: 10.3390/cancers15041316] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/22/2023] Open
Abstract
The clear cell variant of renal cell carcinoma (ccRCC) is the most common renal epithelial malignancy and responsible for most of the deaths from kidney cancer. Patients carrying inactivating mutations in the Von Hippel-Lindau (VHL) gene have an increased proclivity to develop several types of tumors including ccRCC. Normally, the Hypoxia Inducible Factor alpha (HIF-α) subunits of the HIF heterodimeric transcription factor complex are regulated by oxygen-dependent prolyl-hydroxylation, VHL-mediated ubiquitination and proteasomal degradation. Loss of pVHL function results in elevated levels of HIF-α due to increased stability, leading to RCC progression. While HIF-1α acts as a tumor suppressor, HIF-2α promotes oncogenic potential by driving tumor progression and metastasis through activation of hypoxia-sensitive signaling pathways and overexpression of HIF-2α target genes. One strategy to suppress ccRCC aggressiveness is directed at inhibition of HIF-2α and the associated molecular pathways leading to cell proliferation, angiogenesis, and metastasis. Indeed, clinical and pre-clinical data demonstrated the effectiveness of HIF-2α targeted therapy in attenuating ccRCC progression. This review focuses on the signaling pathways and the involved genes (cyclin D, c-Myc, VEGF-a, EGFR, TGF-α, GLUT-1) that confer oncogenic potential downstream of the VHL-HIF-2α signaling axis in ccRCC. Discussed as well are current treatment options (including receptor tyrosine kinase inhibitors such as sunitinib), the medical challenges (high prevalence of metastasis at the time of diagnosis, refractory nature of advanced disease to current treatment options), scientific challenges and future directions.
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Lei T, Xu T, Zhang N, Zou X, Kong Z, Wei C, Wang Z. Anlotinib combined with osimertinib reverses acquired osimertinib resistance in NSCLC by targeting the c-MET/MYC/AXL axis. Pharmacol Res 2023; 188:106668. [PMID: 36681369 DOI: 10.1016/j.phrs.2023.106668] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/19/2023]
Abstract
Favorable clinical evidence suggests that the next trend in new treatments for advanced non-small cell lung cancer (NSCLC) will be combination therapies. However, inevitable epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) resistance greatly limits the clinical efficacy of patients carrying EGFR-activating mutants. In this study, we found a patient with clinical osimertinib resistance who regained a positive response after osimertinib plus anlotinib treatment. Two osimertinib-resistant cell lines were constructed, and AXL conferred resistance to osimertinib in NSCLC cell lines. The combined effects of anlotinib and osimertinib restored sensitivity to osimertinib in two osimertinib-resistant NSCLC cell lines and in xenografts. Moreover, anlotinib inhibits the phosphorylation of AXL in both resistant cell lines. Mechanistically, we confirmed that MYC binds to the promoter of AXL to promote its transcription in NSCLC cells, and we demonstrated that anlotinib combined with osimertinib treatment enhances the anti-tumor effect by inactivating the c-MET/MYC/AXL axis to reverse osimertinib resistance in NSCLC. In conclusion, our results provide strong support that this combination therapy may be effective in enhancing the efficacy of treatments in patients with advanced NSCLC.
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Affiliation(s)
- Tianyao Lei
- Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu, PR China.
| | - Tianwei Xu
- Department of Respiratory Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu, PR China.
| | - Niu Zhang
- Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu, PR China.
| | - Xiaoteng Zou
- Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu, PR China.
| | - Ziyue Kong
- Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu, PR China.
| | - Chenchen Wei
- Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu, PR China.
| | - Zhaoxia Wang
- Department of Oncology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu, PR China.
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Gruver S, Rata S, Peshkin L, Kirschner MW. Identification of kinases activated by multiple pro-angiogenic growth factors. Front Pharmacol 2023; 13:1022722. [PMID: 36686695 PMCID: PMC9847502 DOI: 10.3389/fphar.2022.1022722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/25/2022] [Indexed: 01/05/2023] Open
Abstract
Antiangiogenic therapy began as an effort to inhibit VEGF signaling, which was thought to be the sole factor driving tumor angiogenesis. It has become clear that there are more pro-angiogenic growth factors that can substitute for VEGF during tumor vascularization. This has led to the development of multi-kinase inhibitors which simultaneously target multiple growth factor receptors. These inhibitors perform better than monotherapies yet to date no multi-kinase inhibitor targets all receptors known to be involved in pro-angiogenic signaling and resistance inevitably occurs. Given the large number of pro-angiogenic growth factors identified, it may be impossible to simultaneously target all pro-angiogenic growth factor receptors. Here we search for kinase targets, some which may be intracellularly localized, that are critical in endothelial cell proliferation irrespective of the growth factor used. We develop a quantitative endothelial cell proliferation assay and combine it with "kinome regression" or KIR, a recently developed method capable of identifying kinases that influence a quantitative phenotype. We report the kinases implicated by KIR and provide orthogonal evidence of their importance in endothelial cell proliferation. Our approach may point to a new strategy to develop a more complete anti-angiogenic blockade.
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Affiliation(s)
- Scott Gruver
- Department of Systems Biology, Harvard University Medical School, Boston, MA, United States
| | - Scott Rata
- Department of Systems Biology, Harvard University Medical School, Boston, MA, United States
| | - Leonid Peshkin
- Department of Systems Biology, Harvard University Medical School, Boston, MA, United States
| | - Marc W Kirschner
- Department of Systems Biology, Harvard University Medical School, Boston, MA, United States
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Delcuratolo MD, Tucci M, Turco F, Di Stefano RF, Ungaro A, Audisio M, Samuelly A, Brusa F, Audisio A, Di Maio M, Scagliotti GV, Buttigliero C. Therapeutic sequencing in advanced renal cell carcinoma: How to choose considering clinical and biological factors. Crit Rev Oncol Hematol 2023; 181:103881. [PMID: 36427772 DOI: 10.1016/j.critrevonc.2022.103881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022] Open
Abstract
In the last fifteen years a better understanding of the biological processes promoting tumour growth and progression led to an impressive revolution in metastatic renal cell carcinoma (mRCC) treatment landscape. Angiogenesis plays a critical role in the pathogenesis of RCC. These biological evidences led to targeted therapies interfering with vascular endothelial growth factor and mammalian target of rapamycin pathway. Another big step in the RCC therapeutic landscape was recently made because of the understanding of the interplay between angiogenesis and immune cells. Dual immune checkpoint inhibitors (ICIs) and ICIs plus tyrosine kinase inhibitors (TKI) combinations have been approved considering overall survival benefit compared to targeted therapies as first line treatment. We summarize the activity and the biological rationale of ICIs combinations as mRCC first line therapy. Additionally, we review the clinical and biological criteria useful to guide clinicians in the choice of treatment sequencing focusing on ICIs combinations resistance mechanisms.
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Affiliation(s)
- Marco Donatello Delcuratolo
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
| | - Marcello Tucci
- Medical Oncology Department, Cardinal Massaia Hospital, Asti 14100, Italy.
| | - Fabio Turco
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
| | - Rosario Francesco Di Stefano
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
| | - Antonio Ungaro
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
| | - Marco Audisio
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
| | - Alessandro Samuelly
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
| | - Federica Brusa
- Medical Oncology Department, Cardinal Massaia Hospital, Asti 14100, Italy
| | - Alessandro Audisio
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, at Division of Medical Oncology, Ordine Mauriziano Hospital, Via Magellano 1, Turin 10028, Italy
| | - Giorgio Vittorio Scagliotti
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
| | - Consuelo Buttigliero
- Department of Oncology, University of Turin, at Division of Medical Oncology, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano, Turin 10043, Italy
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Larroquette M, Lefort F, Heraudet L, Bernhard JC, Ravaud A, Domblides C, Gross-Goupil M. Therapeutic Management of Metastatic Clear Cell Renal Cell Carcinoma: A Revolution in Every Decade. Cancers (Basel) 2022; 14:6230. [PMID: 36551715 PMCID: PMC9777357 DOI: 10.3390/cancers14246230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Clear cell renal cell carcinoma (RCC) oncogenesis is mainly driven by VHL gene inactivation, leading to overexpression of vascular endothelial growth factor (VEGF). The use of tyrosine-kinase inhibitors (TKIs) directed against VEGF and its receptor (VEGFR) revolutionised the management of metastatic renal cancer in the 2000s. The more recent development of next-generation TKIs such as cabozantinib or lenvatinib has made it possible to bypass some of the mechanisms of resistance to first-generation anti-VEGFR TKIs. During the decade 2010-2020, the development of immune checkpoint blockade (ICB) therapies revolutionised the management of many solid cancers, including RCC, in first- and subsequent-line settings. Dual ICB or ICB plus anti-VEGFR TKI combinations are now the standard of care for patients with advanced clear cell RCC. To optimise these combination therapies while preserving patient quality of life, escalation and de-escalation strategies are being evaluated in prospective randomised trials, based on patient selection according to their prognosis risk. Finally, new therapeutic approaches, such as targeting hypoxia-inducible factor (HIF) and the development of innovative treatments using antibody-drug conjugates (ADCs), CAR-T cells, or radiopharmaceuticals, are all potential candidates to improve further patient survival.
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Affiliation(s)
- Mathieu Larroquette
- Department of Medical Oncology, University Hospital of Bordeaux, 33000 Bordeaux, France
- Faculty of Medicine, University of Bordeaux, 33000 Bordeaux, France
| | - Félix Lefort
- Department of Medical Oncology, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Luc Heraudet
- Department of Medical Oncology, University Hospital of Bordeaux, 33000 Bordeaux, France
- Faculty of Medicine, University of Bordeaux, 33000 Bordeaux, France
| | - Jean-Christophe Bernhard
- Faculty of Medicine, University of Bordeaux, 33000 Bordeaux, France
- Department of Urology, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Alain Ravaud
- Department of Medical Oncology, University Hospital of Bordeaux, 33000 Bordeaux, France
- Faculty of Medicine, University of Bordeaux, 33000 Bordeaux, France
| | - Charlotte Domblides
- Department of Medical Oncology, University Hospital of Bordeaux, 33000 Bordeaux, France
- Faculty of Medicine, University of Bordeaux, 33000 Bordeaux, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, University Hospital of Bordeaux, 33000 Bordeaux, France
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Renal Carcinoma and Angiogenesis: Therapeutic Target and Biomarkers of Response in Current Therapies. Cancers (Basel) 2022; 14:cancers14246167. [PMID: 36551652 PMCID: PMC9776425 DOI: 10.3390/cancers14246167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Due to the aberrant hypervascularization and the high immune infiltration of renal tumours, current therapeutic regimens of renal cell carcinoma (RCC) target angiogenic or immunosuppressive pathways or both. Tumour angiogenesis plays an essential role in tumour growth and immunosuppression. Indeed, the aberrant vasculature promotes hypoxia and can also exert immunosuppressive functions. In addition, pro-angiogenic factors, including VEGF-A, have an immunosuppressive action on immune cells. Despite the progress of treatments in RCC, there are still non responders or acquired resistance. Currently, no biomarkers are used in clinical practice to guide the choice between the different available treatments. Considering the role of angiogenesis in RCC, angiogenesis-related markers are interesting candidates. They have been studied in the response to antiangiogenic drugs (AA) and show interest in predicting the response. They have been less studied in immunotherapy alone or combined with AA. In this review, we will discuss the role of angiogenesis in tumour growth and immune escape and the place of angiogenesis-targeted biomarkers to predict response to current therapies in RCC.
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Xu W, Ye C, Qing X, Liu S, Lv X, Wang W, Dong X, Zhang Y. Multi-target tyrosine kinase inhibitor nanoparticle delivery systems for cancer therapy. Mater Today Bio 2022; 16:100358. [PMID: 35880099 PMCID: PMC9307458 DOI: 10.1016/j.mtbio.2022.100358] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/19/2022] Open
Abstract
Multi-target Tyrosine Kinase Inhibitors (MTKIs) have drawn substantial attention in tumor therapy. MTKIs could inhibit tumor cell proliferation and induce apoptosis by blocking the activity of tyrosine kinase. However, the toxicity and drug resistance of MTKIs severely restrict their further clinical application. The nano pharmaceutical technology based on MTKIs has attracted ever-increasing attention in recent years. Researchers deliver MTKIs through various types of nanocarriers to overcome drug resistance and improve considerably therapeutic efficiency. This review intends to summarize comprehensive applications of MTKIs nanoparticles in malignant tumor treatment. Firstly, the mechanism and toxicity were introduced. Secondly, various nanocarriers for MTKIs delivery were outlined. Thirdly, the combination treatment schemes and drug resistance reversal strategies were emphasized to improve the outcomes of cancer therapy. Finally, conclusions and perspectives were summarized to guide future research.
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Affiliation(s)
- Wenjing Xu
- School of Medicine, Southeast University, Nanjing, 210009, China
| | - Chunping Ye
- Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Qing
- School of Medicine, Southeast University, Nanjing, 210009, China
| | - Shengli Liu
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Xinyi Lv
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), Nanjing Tech University (NanjingTech), Nanjing, 211816, China
| | - Wenjun Wang
- School of Physical Science and Information Technology, Liaocheng University, Liaocheng, 252059, China
| | - Xiaochen Dong
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), Nanjing Tech University (NanjingTech), Nanjing, 211816, China
- School of Chemistry & Materials Science, Jiangsu Normal University, Xuzhou, 221116, China
| | - Yewei Zhang
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
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Sekino Y, Teishima J, Liang G, Hinata N. Molecular mechanisms of resistance to tyrosine kinase inhibitor in clear cell renal cell carcinoma. Int J Urol 2022; 29:1419-1428. [PMID: 36122306 PMCID: PMC10087189 DOI: 10.1111/iju.15042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022]
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal cell carcinoma (RCC). Loss of von Hippel-Lindau tumor suppressor gene is frequently observed in ccRCC and increases the expression of hypoxia-inducible factors and their targets, including epidermal growth factor, vascular endothelial growth factor, and platelet-derived growth factor. Tyrosine kinase inhibitors (TKIs) offer a survival benefit in metastatic renal cell carcinoma (mRCC). Recently, immune checkpoint inhibitors have been introduced in mRCC. Combination therapy with TKIs and immune checkpoint inhibitors significantly improved patient outcomes. Therefore, TKIs still play an essential role in mRCC treatment. However, the clinical utility of TKIs is compromised when primary and acquired resistance are encountered. The mechanism of resistance to TKI is not fully elucidated. Here, we comprehensively reviewed the molecular mechanisms of resistance to TKIs and a potential strategy to overcome this resistance. We outlined the involvement of angiogenesis, non-angiogenesis, epithelial-mesenchymal transition, activating bypass pathways, lysosomal sequestration, non-coding RNAs, epigenetic modifications and tumor microenvironment factors in the resistance to TKIs. Deep insight into the molecular mechanisms of resistance to TKIs will help to better understand the biology of RCC and can ultimately help in the development of more effective therapies.
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Affiliation(s)
- Yohei Sekino
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Urology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Gangning Liang
- Department of Urology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Nobuyuki Hinata
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Promalignant effects of antiangiogenics in the tumor microenvironment. Semin Cancer Biol 2022; 86:199-206. [PMID: 35248730 DOI: 10.1016/j.semcancer.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 02/07/2023]
Abstract
Antiangiogenic therapies are considered a promising strategy against solid tumors. Their aim is to inhibit the formation of new blood vasculature, thereby reducing the oxygen and nutrient supply to prevent further tumor growth and spreading. However, the strategy has seen limitations, as survival benefits are modest and often accompanied with increased tumor aggressiveness in form of invasion and metastasis. Antiangiogenic induced changes in the tumor microenvironment, such as hypoxia, mechanical stress or extracellular acidification can activate different receptors of tumoral and stromal cells and induce an extensive remodeling of the entire tumor microenvironment, with the overall goal to invade nearby tissues and regain access to the vasculature. In this regard, receptor tyrosine kinases have been studied intensively and especially the inhibition of c-Met has given promising results, characterized by a reduction in invasiveness and prolonged survival. Receptors that sense changes in the extracellular matrix like integrins or proteoglycans can also induce downstream signaling that stimulates the expression of remodeling factors such as new matrix components, enzymes or chemoattractants. Targeting multiple receptors and sensors of cancer cells simultaneously might represent an effective second line treatment that prevents the formation of malignant side effects.
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Vento JA, Rini BI. Treatment of Refractory Metastatic Renal Cell Carcinoma. Cancers (Basel) 2022; 14:5005. [PMID: 36291789 PMCID: PMC9599552 DOI: 10.3390/cancers14205005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
First-line treatment for metastatic renal cell carcinoma (mRCC) rapidly shifted in recent years with the advent of combination therapies, including immune checkpoint inhibitor (ICI) doublets and combinations of an ICI with a vascular endothelial growth factor receptor (VEGFR) targeted tyrosine kinase inhibitor (TKI). Despite improvements in overall survival and many durable responses, there exists a significant number of patients who fail to respond to these agents, and many patients eventually progress. Given the rapid changes in the front-line setting, it is essential to understand treatment options in refractory mRCC. Here, we review the evidence behind current options for later-line therapies, often involving additional VEGFR-TKIs alone or in combination with mammalian target of rapamycin (mTOR) targeted agents, as well as situations where consideration of immunotherapy rechallenge may be appropriate. Additionally, we describe ongoing clinical trials examining concurrent ICI and TKI in the refractory setting, as well as those studying novel agents, such as targeted drug-antibody conjugates and hypoxia inducible factor 2α (HIF-2α) inhibitors. Finally, we review considerations for non-clear cell histologies in the refractory setting and mechanisms of resistance in mRCC.
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Affiliation(s)
| | - Brian I. Rini
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Chen YW, Rini BI, Beckermann KE. Emerging Targets in Clear Cell Renal Cell Carcinoma. Cancers (Basel) 2022; 14:4843. [PMID: 36230766 PMCID: PMC9561986 DOI: 10.3390/cancers14194843] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
The dual immune checkpoint blockade targeting CTLA-4 and PD-1 (ipilimumab/nivolumab) or the IO combinations targeting PD-1 and anti-VEGF TKIs (pembrolizumab/axitinib, nivolumab/cabozantinib, pembrolizumab/lenvatinib) have demonstrated an overall survival benefit in advanced clear cell renal cell carcinoma (ccRCC). Despite this significant improvement in clinical outcomes in the frontline setting from IO/IO or the IO/TKI combinations, there is a subset of patients of advanced ccRCC that do not respond to such combinations or will lose the initial efficacy and have disease progression. Therefore, a remarkable unmet need exists to develop new therapeutics to improve outcomes. With an enhanced understanding of ccRCC biology and its interaction with the tumor microenvironment, several new therapies are under development targeting ccRCC metabolism, cytokine-signaling, alternative immune checkpoint proteins, and novel biological pathways. In addition, microbiome products enhancing IO response, antibody-drug conjugates, and targeted radionuclides are also being investigated. This review summarizes selected emerging agents that are under development in ccRCC.
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Affiliation(s)
- Yu-Wei Chen
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232, USA
| | - Brian I. Rini
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232, USA
| | - Kathryn E. Beckermann
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232, USA
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