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Kim JH, Ahn DH, Moon JS, Han HJ, Bae K, Yoon KA. Longitudinal assessment of B-RAF V595E levels in the peripheral cell-free tumor DNA of a 10-year-old spayed female Korean Jindo dog with unresectable metastatic urethral transitional cell carcinoma for monitoring the treatment response to a RAF inhibitor (sorafenib). Vet Q 2021; 41:153-162. [PMID: 33764261 PMCID: PMC8118428 DOI: 10.1080/01652176.2021.1905194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Transitional cell carcinoma (TCC) is the most common malignant tumor of the canine urinary tract. In this case study, a dog with metastatic urethral TCC was treated with sorafenib. The tumor expression levels of receptor tyrosine kinase genes, including VEGFR-1, VEGFR-2, PDGFR-α, PDGFR-β, ALK, EGFR, ErbB2, and B-RAF, were analyzed. VEGFR was overexpressed in tumor tissues compared to the normal tissues. Considering the high frequency of B-RAF mutation in canine urological tumors, the B-RAF gene was examined, and the B-RAF V595E mutation was detected in the tumor tissue. Therefore, the antitumor effect of sorafenib, a multi-tyrosine kinase inhibitor, on unresectable metastatic urethral TCC characterized by B-RAF V595E was evaluated and circulating cell-free tumor DNA (ctDNA) was assessed for monitoring the treatment response. After the initiation of oral sorafenib therapy (4 mg/kg/day escalated to 10 mg/kg/day), the dysuria was alleviated gradually, and the patient remained stable for 3 months. During that treatment period, the patient showed various levels of changes associated with B-RAF V595E mutation in ctDNA as evident from longitudinal plasma samples after initiation of sorafenib therapy. The findings of this study suggest that ctDNA may serve as a useful non-invasive tool for monitoring the treatment response to anticancer drugs.
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Affiliation(s)
- Jung-Hyun Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Dana Hyunjung Ahn
- Department of Veterinary Internal Medicine, Konkuk University Veterinary Medical Teaching Hospital, Seoul, South Korea
| | - Je-Sung Moon
- Veterinary Emergency Medicine and Critical Care, Konkuk University Veterinary Medical Teaching Hospital, Seoul, South Korea
| | - Hyun-Jung Han
- Veterinary Emergency Medicine and Critical Care, Konkuk University Veterinary Medical Teaching Hospital, Seoul, South Korea
| | - Kieun Bae
- Department of Veterinary Biochemistry, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Kyong-Ah Yoon
- Department of Veterinary Biochemistry, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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Mollica V, Rizzo A, Montironi R, Cheng L, Giunchi F, Schiavina R, Santoni M, Fiorentino M, Lopez-Beltran A, Brunocilla E, Brandi G, Massari F. Current Strategies and Novel Therapeutic Approaches for Metastatic Urothelial Carcinoma. Cancers (Basel) 2020; 12:E1449. [PMID: 32498352 PMCID: PMC7352972 DOI: 10.3390/cancers12061449] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
Urothelial carcinoma (UC) is a frequent cause of cancer-related deaths worldwide. Metastatic UC has been historically associated with poor prognosis, with a median overall survival of approximately 15 months and a 5-year survival rate of 18%. Although platinum-based chemotherapy remains the mainstay of medical treatment for patients with metastatic UC, chemotherapy clinical trials produced modest benefit with short-lived, disappointing responses. In recent years, the better understanding of the role of immune system in cancer control has led to the development and approval of several immunotherapeutic approaches in UC therapy, where immune checkpoint inhibitors have been revolutionizing the treatment of metastatic UC. Because of a better tumor molecular profiling, FGFR inhibitors, PARP inhibitors, anti-HER2 agents, and antibody drug conjugates targeting Nectin-4 are also emerging as new therapeutic options. Moreover, a wide number of trials is ongoing with the aim to evaluate several other alterations and pathways as new potential targets in metastatic UC. In this review, we will discuss the recent advances and highlight future directions of the medical treatment of UC, with a particular focus on recently published data and ongoing active and recruiting trials.
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Affiliation(s)
- Veronica Mollica
- Division of Oncology, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (A.R.); (G.B.)
- Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Alessandro Rizzo
- Division of Oncology, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (A.R.); (G.B.)
- Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, 60121 Ancona, Italy;
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Francesca Giunchi
- Pathology Service, Addarii Institute of Oncology, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (R.S.); (E.B.)
| | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62100 Macerata, Italy;
| | | | - Antonio Lopez-Beltran
- Unit of Anatomical Pathology, Faculty of Medicine, Cordoba University, 14071 Cordoba, Spain;
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (R.S.); (E.B.)
| | - Giovanni Brandi
- Division of Oncology, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (A.R.); (G.B.)
- Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Francesco Massari
- Division of Oncology, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy; (V.M.); (A.R.); (G.B.)
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Petrylak DP, de Wit R, Chi KN, Drakaki A, Sternberg CN, Nishiyama H, Castellano D, Hussain SA, Fléchon A, Bamias A, Yu EY, van der Heijden MS, Matsubara N, Alekseev B, Necchi A, Géczi L, Ou YC, Coskun HS, Su WP, Bedke J, Gakis G, Percent IJ, Lee JL, Tucci M, Semenov A, Laestadius F, Peer A, Tortora G, Safina S, Garcia Del Muro X, Rodriguez-Vida A, Cicin I, Harputluoglu H, Tagawa ST, Vaishampayan U, Aragon-Ching JB, Hamid O, Liepa AM, Wijayawardana S, Russo F, Walgren RA, Zimmermann AH, Hozak RR, Bell-McGuinn KM, Powles T. Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): overall survival and updated results of a randomised, double-blind, phase 3 trial. Lancet Oncol 2020; 21:105-120. [PMID: 31753727 PMCID: PMC6946880 DOI: 10.1016/s1470-2045(19)30668-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Ramucirumab-an IgG1 vascular endothelial growth factor receptor 2 antagonist-plus docetaxel was previously reported to improve progression-free survival in platinum-refractory, advanced urothelial carcinoma. Here, we report the secondary endpoint of overall survival results for the RANGE trial. METHODS We did a randomised, double-blind, phase 3 trial in patients with advanced or metastatic urothelial carcinoma who progressed during or after platinum-based chemotherapy. Patients were enrolled from 124 investigative sites (hospitals, clinics, and academic centres) in 23 countries. Previous treatment with one immune checkpoint inhibitor was permitted. Patients were randomly assigned (1:1) using an interactive web response system to receive intravenous ramucirumab 10 mg/kg or placebo 10 mg/kg volume equivalent followed by intravenous docetaxel 75 mg/m2 (60 mg/m2 in Korea, Taiwan, and Japan) on day 1 of a 21-day cycle. Treatment continued until disease progression, unacceptable toxicity, or other discontinuation criteria were met. Randomisation was stratified by geographical region, Eastern Cooperative Oncology Group performance status at baseline, and visceral metastasis. Progression-free survival (the primary endpoint) and overall survival (a key secondary endpoint) were assessed in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT02426125; patient enrolment is complete and the last patient on treatment is being followed up for safety issues. FINDINGS Between July 20, 2015, and April 4, 2017, 530 patients were randomly allocated to ramucirumab plus docetaxel (n=263) or placebo plus docetaxel (n=267) and comprised the intention-to-treat population. At database lock (March 21, 2018) for the final overall survival analysis, median follow-up was 7·4 months (IQR 3·5-13·9). In our sensitivity analysis of investigator-assessed progression-free survival at the overall survival database lock, median progression-free survival remained significantly improved with ramucirumab compared with placebo (4·1 months [95% CI 3·3-4·8] vs 2·8 months [2·6-2·9]; HR 0·696 [95% CI 0·573-0·845]; p=0·0002). Median overall survival was 9·4 months (95% CI 7·9-11·4) in the ramucirumab group versus 7·9 months (7·0-9·3) in the placebo group (stratified HR 0·887 [95% CI 0·724-1·086]; p=0·25). Grade 3 or worse treatment-related treatment-emergent adverse events in 5% or more of patients and with an incidence more than 2% higher with ramucirumab than with placebo were febrile neutropenia (24 [9%] of 258 patients in the ramucirumab group vs 16 [6%] of 265 patients in the placebo group) and neutropenia (17 [7%] of 258 vs six [2%] of 265). Serious adverse events were similar between groups (112 [43%] of 258 patients in the ramucirumab group vs 107 [40%] of 265 patients in the placebo group). Adverse events related to study treatment and leading to death occurred in eight (3%) patients in the ramucirumab group versus five (2%) patients in the placebo group. INTERPRETATION Additional follow-up supports that ramucirumab plus docetaxel significantly improves progression-free survival, without a significant improvement in overall survival, for patients with platinum-refractory advanced urothelial carcinoma. Clinically meaningful benefit might be restricted in an unselected population. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | - Kim N Chi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Alexandra Drakaki
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Syed A Hussain
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | | | | | - Evan Y Yu
- University of Washington, Seattle, WA, USA
| | | | | | - Boris Alekseev
- P.A. Herzen Moscow Oncological Research Institute, Moscow, Russia
| | - Andrea Necchi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Lajos Géczi
- National Institute of Oncology, Budapest, Hungary
| | - Yen-Chuan Ou
- Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan
| | | | - Wen-Pin Su
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University & Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jens Bedke
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Georgios Gakis
- Department of Urology, University of Tübingen, Tübingen, Germany; Pediatric Urology, Julius Maximillians University, Würzburg, Germany
| | | | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Andrey Semenov
- RBHI Ivanovo Regional Oncology Dispensary, Ivanovo, Russia
| | | | | | - Giampaolo Tortora
- University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Xavier Garcia Del Muro
- Institut Català d'Oncologia L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge, University of Barcelona, Barcelona, Spain
| | | | | | | | - Scott T Tagawa
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | | | | | - Oday Hamid
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | | | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
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Zahoor H, Mir MC, Barata PC, Stephenson AJ, Campbell SC, Fergany A, Dreicer R, Garcia JA. Phase II trial of continuous treatment with sunitinib in patients with high-risk (BCG-refractory) non-muscle invasive bladder cancer. Invest New Drugs 2019; 37:1231-1238. [PMID: 31231785 DOI: 10.1007/s10637-018-00716-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/13/2018] [Indexed: 01/17/2023]
Abstract
Purpose Sunitinib is a vascular endothelial growth factor receptor (VEGFR) inhibitor with antitumor activity against bladder cancer. We hypothesized that treatment with sunitinib may decrease progression or recurrence in non-muscle invasive bladder cancer (NMIBC) refractory to intra-vesical BCG. Patients and Methods This is a single-arm phase II study of sunitinib in patients (pts) with NMIBC who progressed after BCG. Treatment included sunitinib 37.5 g daily for 12 weeks followed by 12± 2-week cystoscopy and surveillance for one year. The primary endpoint was the complete response rate at 12 months. Secondary endpoints included recurrence free survival (RFS), progression free survival (PFS), overall survival (OS), and safety of sunitinib. Correlative studies on effects of sunitinib on myeloid derived suppressor cells (MDSC) and humoral immune responses were also performed. This trial was registered on ClinicalTrials.gov, number NCT01118351. Results Between June 2011 and September 2011, 15/19 pts. completed 12 weeks of therapy. The remaining 4 pts. had treatment related adverse events leading to discontinuation of sunitinib with one patient withdrawing consent. On the 12-week cystoscopy, 44% (8/18) of the pts. showed remission, 50% (9/18) progression and 1/18 recurrence. Overall, 22% (4/18) of pts. remained free of progression for >12 months. Grade (G) 4 toxicities were noted in 2 pts. (anemia and thrombocytopenia) while G3 were noted in 58%. Sunitinib resulted in reversal of MDSC mediated immunosuppression. Conclusions In NMIBC refractory to BCG, treatment with sunitinib was safe but not associated with improved clinical outcomes. The immune effects of sunitinib deserve further investigation.
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Affiliation(s)
- Haris Zahoor
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Maria C Mir
- Urology Department, IMED Valencia Hospital, Valencia, Spain
| | - Pedro C Barata
- Department of Internal Medicine, Section of Hematology and Medical Oncology, Tulane Medical School, New Orleans, Louisiana, USA
| | - Andrew J Stephenson
- Cleveland Clinic, Glickman Urological and Kidney Institute, 9500 Euclid Avenue/R35, Cleveland, OH, 44195, USA
| | - Steven C Campbell
- Cleveland Clinic, Glickman Urological and Kidney Institute, 9500 Euclid Avenue/R35, Cleveland, OH, 44195, USA
| | - Amr Fergany
- Cleveland Clinic, Glickman Urological and Kidney Institute, 9500 Euclid Avenue/R35, Cleveland, OH, 44195, USA
| | - Robert Dreicer
- Division Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jorge A Garcia
- Cleveland Clinic, Glickman Urological and Kidney Institute, 9500 Euclid Avenue/R35, Cleveland, OH, 44195, USA. .,Department of Solid Tumor Oncology and Urology, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue/R35, Cleveland, OH, 44195, USA.
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van Dijk N, Funt SA, Blank CU, Powles T, Rosenberg JE, van der Heijden MS. The Cancer Immunogram as a Framework for Personalized Immunotherapy in Urothelial Cancer. Eur Urol 2018; 75:435-444. [PMID: 30274701 DOI: 10.1016/j.eururo.2018.09.022] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/12/2018] [Indexed: 01/05/2023]
Abstract
CONTEXT The abysmal outlook of urothelial cancer (UC) has changed with the introduction of immunotherapy. Still, many patients do not respond and distinctive biomarkers are currently lacking. The rise of this novel armamentarium of immunotherapy treatments, in combination with the complex biology of an immunological tumor response, warrants the development of a comprehensive framework that can provide an overview of important immunological processes at play in individual patients. OBJECTIVE To develop a comprehensive framework based on tumor- and host-specific parameters to understand immunotherapy response in UC. This framework can inform rational, biology-driven clinical trials and ultimately guide us toward individualized patient treatment. EVIDENCE ACQUISITION A literature review was conducted on UC immunotherapy, clinical trial data, and biomarkers of response to checkpoint inhibition. EVIDENCE SYNTHESIS Here, we propose a UC immunogram, based on currently available clinical and translational data. The UC immunogram describes several tumor- and host-specific parameters that are required for successful immunotherapy treatment. These seven parameters are tumor foreignness, immune cell infiltration, absence of inhibitory checkpoints, general performance and immune status, absence of soluble inhibitors, absence of inhibitory tumor metabolism, and tumor sensitivity to immune effectors. CONCLUSIONS Longitudinal integration of individual patient parameters may ultimately lead to personalized and dynamic immunotherapy, to adjust to the Darwinian forces that drive tumor evolution. Incorporating multiparameter biomarkers into quantitative predictive models will be a key challenge to integrate the immunogram into daily clinical practice. PATIENT SUMMARY Here, we propose the urothelial cancer immunogram, a novel way of describing important immunological characteristics of urothelial cancer patients and their tumors. Seven characteristics determine the chance of having an immunological tumor response. Using this immunogram, we aim to better understand why some patients respond to immunotherapy and some do not, to ultimately improve anticancer therapy.
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Affiliation(s)
- Nick van Dijk
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Samuel A Funt
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Powles
- Department of Medical Oncology, Barts Cancer Institute, London, UK
| | - Jonathan E Rosenberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Hurwitz ME, Markowski P, Yao X, Deshpande H, Patel J, Mortazavi A, Donadio A, Stein MN, Kelly WK, Petrylak DP, Mehnert JM. Multicenter Phase 2 Trial of Gemcitabine, Carboplatin, and Sorafenib in Patients With Metastatic or Unresectable Transitional-Cell Carcinoma. Clin Genitourin Cancer 2018; 16:437-444.e6. [PMID: 30177237 DOI: 10.1016/j.clgc.2018.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/19/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Sorafenib, an oral tyrosine kinase inhibitor, may enhance the antitumor activity of platinum-based chemotherapy in transitional-cell carcinoma. This study investigated the safety and clinical outcome of adding sorafenib to gemcitabine and carboplatin for patients with advanced transitional-cell carcinoma. PATIENTS AND METHODS Subjects with metastatic or unresectable chemotherapy-naive TCC with Eastern Cooperative Oncology Group performance status 0 or 1 received gemcitabine (1000 mg/m2 on days 1 and 8) and carboplatin (area under the curve of 5 on day 1) with sorafenib (400 mg 2 times a day on days 2-19 every 21 days) for 6 cycles. Subjects with stable disease or partial or complete response continued to receive sorafenib until disease progression. The primary end point was progression-free survival (PFS) at 5 months with a secondary end point of response (partial or complete). RESULTS Seventeen subjects were enrolled. The median number of cycles of gemcitabine and carboplatin with sorafenib provided was 4.4. A total of 15, 5, and 8 subjects required reductions of gemcitabine, carboplatin, and sorafenib, respectively. Thirteen subjects (76%) required multiple dose reductions. Eleven subjects (65%) were free of progression at 5 months. The overall response rate was 54% (95% confidence interval [CI], 0.28-077), with 4 patients experiencing complete response (24%; 95% CI, 0.07-0.50) and 5 partial response (29%; 95% CI, 0.10-0.56); 7 subjects (41%) had stable disease. Median PFS was 9.5 months (95% CI, 0.43-1.26), and median overall survival was 25.2 months (95% CI, 0.96-5.65). One-year PFS was 31%, and 1-year overall survival was 72%. Eleven subjects (65%) discontinued treatment because of toxicity. There were no toxic deaths. CONCLUSION Gemcitabine and carboplatin with sorafenib showed clinical activity in advanced TCC, with some prolonged progression-free intervals. However, gemcitabine and carboplatin with sorafenib was associated with significant toxicity, causing discontinuation of therapy in most patients.
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Affiliation(s)
| | - Paul Markowski
- Department of Medicine, Rutgers Cancer Institute of New Jersey, NJ
| | | | | | | | | | | | - Mark N Stein
- Department of Medicine, Rutgers Cancer Institute of New Jersey, NJ
| | | | | | - Janice M Mehnert
- Department of Medicine, Rutgers Cancer Institute of New Jersey, NJ.
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Fanelli M, Locopo N, Gattuso D, Gasparini G. Assessment of Tumor Vascularization: Immunohistochemical and Non-Invasive Methods. Int J Biol Markers 2018; 14:218-31. [PMID: 10669950 DOI: 10.1177/172460089901400405] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Growth of solid tumors beyond a certain mass is dependent on the vascular bed from pre-existing host vasculature. The process of angiogenesis is essential not only for primary tumor growth but also for metastasis. The number of microvessels within the invasive component of a primary tumor reflects the degree of tumor angiogenesis. At present the most widely used method to assess neovascularization is the quantitation of intratumoral microvessel density (IMD) by immunohistochemical methods in which specific markers for endothelial cells are employed. In this paper we analyze the different methods used to assess IMD, as well as their advantages and potential methodological pitfalls. Several studies have shown a close correlation between IMD, tumor growth and the occurrence of metastasis, suggesting that IMD is a prognostic indicator of clinical relevance. Furthermore, preliminary studies suggest that determination of angiogenesis may predict responsiveness to some forms of conventional anticancer therapy. Although the histological microvessel density technique is the current gold standard to characterize tumor angiogenesis, it may not be the ideal tool for clinical purposes because it needs to be performed on biopsy material and does not assess the functional pathways involved in the angiogenic activity of tumors. Non-invasive assessment of tumor vascularity is possible in vivo by means of Doppler sonography, dynamic contrast-enhanced magnetic resonance imaging (MRI) and positron emission tomography (PET). These methods may be preferable to histological assay because they are non-invasive, survey the entire tumor, reflect both anatomic and physiologic characteristics, and may be useful to monitor the activity of antiangiogenic therapies.
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Affiliation(s)
- M Fanelli
- Division of Medical Oncology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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8
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Petrylak DP, de Wit R, Chi KN, Drakaki A, Sternberg CN, Nishiyama H, Castellano D, Hussain S, Fléchon A, Bamias A, Yu EY, van der Heijden MS, Matsubara N, Alekseev B, Necchi A, Géczi L, Ou YC, Coskun HS, Su WP, Hegemann M, Percent IJ, Lee JL, Tucci M, Semenov A, Laestadius F, Peer A, Tortora G, Safina S, Del Muro XG, Rodriguez-Vida A, Cicin I, Harputluoglu H, Widau RC, Liepa AM, Walgren RA, Hamid O, Zimmermann AH, Bell-McGuinn KM, Powles T. Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial. Lancet 2017; 390:2266-2277. [PMID: 28916371 DOI: 10.1016/s0140-6736(17)32365-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Few treatments with a distinct mechanism of action are available for patients with platinum-refractory advanced or metastatic urothelial carcinoma. We assessed the efficacy and safety of treatment with docetaxel plus either ramucirumab-a human IgG1 VEGFR-2 antagonist-or placebo in this patient population. METHODS We did a randomised, double-blind, phase 3 trial in patients with advanced or metastatic urothelial carcinoma who progressed during or after platinum-based chemotherapy. Patients were enrolled from 124 sites in 23 countries. Previous treatment with one immune-checkpoint inhibitor was permitted. Patients were randomised (1:1) using an interactive web response system to receive intravenous docetaxel 75 mg/m2 plus either intravenous ramucirumab 10 mg/kg or matching placebo on day 1 of repeating 21-day cycles, until disease progression or other discontinuation criteria were met. The primary endpoint was investigator-assessed progression-free survival, analysed by intention-to-treat in the first 437 randomised patients. This study is registered with ClinicalTrials.gov, number NCT02426125. FINDINGS Between July, 2015, and April, 2017, 530 patients were randomly allocated either ramucirumab plus docetaxel (n=263) or placebo plus docetaxel (n=267). Progression-free survival was prolonged significantly in patients allocated ramucirumab plus docetaxel versus placebo plus docetaxel (median 4·07 months [95% CI 2·96-4·47] vs 2·76 months [2·60-2·96]; hazard ratio [HR] 0·757, 95% CI 0·607-0·943; p=0·0118). A blinded independent central analysis was consistent with these results. An objective response was achieved by 53 (24·5%, 95% CI 18·8-30·3) of 216 patients allocated ramucirumab and 31 (14·0%, 9·4-18·6) of 221 assigned placebo. The most frequently reported treatment-emergent adverse events, regardless of causality, in either treatment group (any grade) were fatigue, alopecia, diarrhoea, decreased appetite, and nausea. These events occurred predominantly at grade 1-2 severity. The frequency of grade 3 or worse adverse events was similar for patients allocated ramucirumab and placebo (156 [60%] of 258 vs 163 [62%] of 265 had an adverse event), with no unexpected toxic effects. 63 (24%) of 258 patients allocated ramucirumab and 54 (20%) of 265 assigned placebo had a serious adverse event that was judged by the investigator to be related to treatment. 38 (15%) of 258 patients allocated ramucirumab and 43 (16%) of 265 assigned placebo died on treatment or within 30 days of discontinuation, of which eight (3%) and five (2%) deaths were deemed related to treatment by the investigator. Sepsis was the most common adverse event leading to death on treatment (four [2%] vs none [0%]). One fatal event of neutropenic sepsis was reported in a patient allocated ramucirumab. INTERPRETATION To the best of our knowledge, ramucirumab plus docetaxel is the first regimen in a phase 3 study to show superior progression-free survival over chemotherapy in patients with platinum-refractory advanced urothelial carcinoma. These data validate inhibition of VEGFR-2 signalling as a potential new therapeutic treatment option for patients with urothelial carcinoma. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | - Kim N Chi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | | | | | - Syed Hussain
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - Evan Y Yu
- University of Washington, Seattle, WA, USA
| | | | | | - Boris Alekseev
- PA Herzen Moscow Oncological Research Institute, Moscow, Russia
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lajos Géczi
- National Institute of Oncology, Budapest, Hungary
| | - Yen-Chuan Ou
- Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Wen-Pin Su
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | | | | | - Jae-Lyun Lee
- Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Andrey Semenov
- RBHI Ivanovo Regional Oncology Dispensary, Ivanovo, Russia
| | | | | | - Giampaolo Tortora
- University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Xavier Garcia Del Muro
- Institut Català d'Oncologia L'Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Oday Hamid
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
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9
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Dematei A, Fernandes R, Soares R, Alves H, Richter J, Botelho MC. Angiogenesis in Schistosoma haematobium-associated urinary bladder cancer. APMIS 2017; 125:1056-1062. [PMID: 28960560 DOI: 10.1111/apm.12756] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/28/2017] [Indexed: 12/19/2022]
Abstract
Schistosoma haematobium, a parasitic flatworm that infects more than 100 million people, mostly in the developing world, is the causative agent of urogenital schistosomiasis, and is associated with a high incidence of squamous cell carcinoma (SCC) of the bladder. During infection, eggs are deposited in the bladder causing an intense inflammatory reaction. Angiogenesis is defined as the formation of new blood vessels from preexisting ones and is recognized as a key event in cell proliferation and carcinogenesis and spread of malignant lesions. A growing amount of evidence points to angiogenesis playing a key role in schistosomiasis-associated bladder cancer. Thus, identifying biomarkers of this process plays an important role in the study of cancer. Here, we review recent findings on the role of angiogenesis in bladder cancer and the growth factors that induce and assist in their development, particularly SCC of the bladder associated to urogenital schistosomiasis.
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Affiliation(s)
- Anderson Dematei
- Ciências Químicas e das Biomoléculas, Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
| | - Rúben Fernandes
- Ciências Químicas e das Biomoléculas, Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal.,I3S, Instituto de Investigação e Inovação da Universidade do Porto, Porto, Portugal
| | - Raquel Soares
- I3S, Instituto de Investigação e Inovação da Universidade do Porto, Porto, Portugal.,Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Helena Alves
- Department of Health Promotion and Chronic Diseases, INSA - National Institute of Health Dr. Ricardo Jorge, Porto, Portugal.,Fundação Professor Ernesto Morais, Porto, Portugal
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Monica C Botelho
- I3S, Instituto de Investigação e Inovação da Universidade do Porto, Porto, Portugal.,Department of Health Promotion and Chronic Diseases, INSA - National Institute of Health Dr. Ricardo Jorge, Porto, Portugal
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10
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Xiong Y, Huang F, Li X, Chen Z, Feng D, Jiang H, Chen W, Zhang X. CCL21/CCR7 interaction promotes cellular migration and invasion via modulation of the MEK/ERK1/2 signaling pathway and correlates with lymphatic metastatic spread and poor prognosis in urinary bladder cancer. Int J Oncol 2017; 51:75-90. [PMID: 28534984 PMCID: PMC5467787 DOI: 10.3892/ijo.2017.4003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/02/2017] [Indexed: 12/22/2022] Open
Abstract
Lymph node metastasis in patients with urinary bladder cancer (UBC) is always associated with poor prognosis and is the determinant for tumor staging and the development of treatment regimens; however, its underlying mechanisms remain to be studied. Immunohistochemical staining of tumor sections from 62 UBC patients was performed using CCR7, D2-40 and CD34 antibodies. We showed that increased CCR7 expression was significantly associated with positive lymph node status (P=0.008), pT3-T4 tumor stage (P=0.015), tumor grade (P=0.010) and worse overall survival (OS, P<0.001) and that both CCR7 expression and lymph node metastasis were independent prognostic factors for OS (P=0.031 and P=0.001, respectively) based on multivariate analysis. We found that there was a significant association between MLVD and lymph node status (P=0.006), but this relation was not observed for MVD. Furthermore, we showed that increased CCR7 expression correlated significantly with higher MLVD (P=0.014) and MVD (P=0.002). Wound-healing and Matrigel Transwell assays indicated that activation of CCR7 with CCL21 significantly enhanced the invasion and migration abilities of UM-UC-3 cells, and this enhanced effect was significantly abrogated by CCR7 knockdown using siRNA. Western blot analysis revealed that the phospho-ERK1/2 level was markedly increased when UM-UC-3 cells were treated with CCL21 and significantly decreased when the CCR7 gene was silenced. MEK/ERK1/2 inhibition with PD98059 significantly suppressed the migration and invasion abilities of UM-UC-3 cells and also significantly abrogated the effects of CCL21/CCR7 on cell migration and invasion. Based on these results, we conclude that activation of the CCL21/CCR7 chemoaxis promotes lymph node metastasis of UBC in at least two ways. Firstly, although CCR7 is a promoting factor that induces both lymphangiogenesis and angiogenesis, it may promote lymph node metastasis through its lymphangiogenic effect rather than through its angiogenic effect. Secondly, the CCL21/CCR7 chemoaxis promotes the migration and invasion of UBC cells via the MEK/ERK1/2 signaling pathway rather than the PI3K/AKT pathway.
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Affiliation(s)
- Yang Xiong
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Fang Huang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiaozhou Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Zhi Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Deyun Feng
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Haiying Jiang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Wei Chen
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiangyang Zhang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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11
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A Phase II Clinical Trial of TRC105 (Anti-Endoglin Antibody) in Adults With Advanced/Metastatic Urothelial Carcinoma. Clin Genitourin Cancer 2016; 15:77-85. [PMID: 27328856 DOI: 10.1016/j.clgc.2016.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/06/2016] [Accepted: 05/18/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND In this trial we assessed the efficacy and tolerability of TRC105, a chimeric monoclonal antibody that targets CD105 (endoglin) in patients with advanced, previously treated urothelial carcinoma (UC). PATIENTS AND METHODS Patients received TRC105 15 mg/kg every 2 weeks on days 1 and 15 of each 28-day cycle. The primary end point was progression-free survival (PFS) at 6 months. Secondary end points included safety, toxicity, and overall survival (OS). CD105 expression was evaluated using immunohistochemistry (IHC) in a separate cohort of 50 UC patients. Biomarker studies included immune subsets, circulating tumor cells (CTCs), circulating endothelial cells (CECs), circulating endothelial progenitor cells (CEPs), and osteopontin. RESULTS Of 13 patients enrolled, 12 were evaluable for OS and PFS. The 3-month PFS probability was 18.2% (median PFS, 1.9 months [95% confidence interval (CI), 1.8-2.1 months). This met the criterion for ending accrual on the basis of the 2-stage design. Median OS was 8.3 months (95% CI, 3.3-17.0 months). IHC for CD105 scores was not associated with T stage (P = .26) or presence of lymph nodes (P = .64). Baseline levels of regulatory T and B cells, CEPs, and changes in CEC level after TRC105 exhibited trends toward an association with PFS or OS. CTCs pre- and post-TRC105 were detected in 4 of 4 patients. CONCLUSION Although TRC105 was well tolerated, it did not improve 6-month PFS in heavily pretreated patients with advanced UC. CD105 staining was present in 50% of UC tumors at different intensities. Our observations on the pharmacodynamic significance of immune subsets, CECs, and CTCs warrant further study.
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12
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Petrylak DP, Tagawa ST, Kohli M, Eisen A, Canil C, Sridhar SS, Spira A, Yu EY, Burke JM, Shaffer D, Pan CX, Kim JJ, Aragon-Ching JB, Quinn DI, Vogelzang NJ, Tang S, Zhang H, Cavanaugh CT, Gao L, Kauh JS, Walgren RA, Chi KN. Docetaxel As Monotherapy or Combined With Ramucirumab or Icrucumab in Second-Line Treatment for Locally Advanced or Metastatic Urothelial Carcinoma: An Open-Label, Three-Arm, Randomized Controlled Phase II Trial. J Clin Oncol 2016; 34:1500-9. [PMID: 26926681 DOI: 10.1200/jco.2015.65.0218] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE This trial assessed the efficacy and safety of docetaxel monotherapy or docetaxel in combination with ramucirumab (vascular endothelial growth factor receptor 2 antibody) or icrucumab (vascular endothelial growth factor receptor 1 antibody) after progression during or within 12 months of platinum-based regimens for patients with locally advanced or metastatic urothelial carcinoma. PATIENTS AND METHODS Patients were randomly assigned (1:1:1) to receive docetaxel 75 mg/m(2) intravenously (IV) on day 1 of a 3-week cycle (arm A), docetaxel 75 mg/m(2) IV plus ramucirumab 10 mg/kg IV on day 1 of a 3-week cycle (arm B), or docetaxel 75 mg/m(2) IV on day 1 plus icrucumab 12 mg/kg IV on days 1 and 8 of a 3-week cycle (arm C). Treatment continued until disease progression or unacceptable toxicity. The primary end point was investigator-assessed progression-free survival (PFS). RESULTS A total of 140 patients were randomly assigned and treated in arms A (n = 45), B (n = 46), or C (n = 49). PFS was significantly longer in arm B compared with arm A (median, 5.4 months; 95% CI, 3.1 to 6.9 months v 2.8 months; 95% CI, 1.9 to 3.6 months; stratified hazard ratio, 0.389; 95% CI, 0.235 to 0.643; P = .0002). Arm C did not experience improved PFS compared with arm A (1.6 months; 95% CI, 1.4 to 2.9; stratified hazard ratio, 0.863; 95% CI, 0.550 to 1.357; P = .5053). The most common grade 3 or worse adverse events (arms A, B, and C) were neutropenia (36%, 33%, and 39%), fatigue (13%, 30%, and 20%), febrile neutropenia (13%, 17%, and 6.1%), and anemia (6.7%, 13%, and 14%, respectively). CONCLUSION The addition of ramucirumab to docetaxel met the prespecified efficacy end point for prolonging PFS in patients with locally advanced or metastatic urothelial carcinoma receiving second-line treatment and warrants further investigation in the phase III setting.
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Affiliation(s)
- Daniel P Petrylak
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN.
| | - Scott T Tagawa
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Manish Kohli
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Andrea Eisen
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Christina Canil
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Srikala S Sridhar
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Alexander Spira
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Evan Y Yu
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - John M Burke
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - David Shaffer
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Chong-Xian Pan
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Jenny J Kim
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Jeanny B Aragon-Ching
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - David I Quinn
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Nicholas J Vogelzang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Shande Tang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Hui Zhang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Christopher T Cavanaugh
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Ling Gao
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - John S Kauh
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Richard A Walgren
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Kim N Chi
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
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13
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Abstract
Tumor neovascularization acquires their vessels through a number of processes including angiogenesis, vasculogenesis, vascular remodeling, intussusception, and possibly vascular mimicry in certain tumors. The end result of the tumor vasculature has been quantified by counting the number of immunohistochemically identified microvessels in areas of maximal vascularity, so-called hot spot. Other techniques have been developed such as Chalkley counting and the use of image analysis systems that are robust and reproducible as well as being more objective. Many of the molecular pathways that govern tumor neovascularization have been identified and many reagents are now available to study these tissue sections. These include angiogenic growth factors and their receptors and cell adhesion molecules, proteases, and markers of activated, proliferating, cytokine-stimulated, or angiogenic vessels, such as CD105. It is also possible to differentiate quiescent from active vessels. Other reagents that can identify proteins involved in microenvironmental influences such as hypoxia have also been generated. Although the histological assessment of tumor vascularity is used mostly in the research context, it may also have clinical applications if appropriate methodology and trained observers perform the studies.
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Affiliation(s)
- Jia-Min Pang
- Department of Pathology, Peter MacCallum Cancer Centre, 2 St Andrews Place, Melbourne, 3002, Australia
| | - Nicholas Jene
- Department of Pathology, Peter MacCallum Cancer Centre, 2 St Andrews Place, Melbourne, 3002, Australia
| | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, 2 St Andrews Place, Melbourne, 3002, Australia.
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14
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Kim EH, Kim MS, Jeong YK, Cho I, You SH, Cho SH, Lee H, Jung WG, Kim HD, Kim J. Mechanisms for SU5416 as a radiosensitizer of endothelial cells. Int J Oncol 2015; 47:1440-50. [PMID: 26314590 DOI: 10.3892/ijo.2015.3127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/22/2015] [Indexed: 11/06/2022] Open
Abstract
Endothelial cells (ECs), that comprise the tumor vasculature, are critical targets for anticancer radiotherapy. The aim of this work was to study the mechanism by which SU5416, a known anti-angiogenesis inhibitor, modifies the radiation responses of human vascular ECs. Two human endothelial cell lines (HUVEC and 2H11) were treated with SU5416 alone, radiation alone, or a combination of both. In vitro tests were performed using colony forming assays, FACS analysis, western blotting, immunohistochemistry, migration assay, invasion assays and endothelial tube formation assays. The combination of radiation and SU5416 significantly inhibited cell survival, the repair of radiation-induced DNA damage, and induced apoptosis. It also caused cell cycle arrest, inhibited cell migration and invasion, and suppressed angiogenesis. In this study, our results first provide a scientific rationale to combine SU5416 with radiotherapy to target ECs and suggest its clinical application in combination cancer treatment with radiotherapy.
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Affiliation(s)
- Eun Ho Kim
- Division of Heavy Ion Clinical Research, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Mi-Sook Kim
- Division of Heavy Ion Clinical Research, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Youn Kyoung Jeong
- Research Center for Radiotherapy, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Ilsung Cho
- Division of Heavy Ion Clinical Research, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Seung Hoon You
- Division of Heavy Ion Clinical Research, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Sung Ho Cho
- Division of Heavy Ion Clinical Research, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Hanna Lee
- Division of Heavy Ion Clinical Research, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Won-Gyun Jung
- Division of Heavy Ion Clinical Research, Korea Institute of Radiological and Medical Sciences, Seoul 139-706, Republic of Korea
| | - Hag Dong Kim
- Laboratory of Biochemistry, Division of Life Sciences, Korea University, Seoul 136-701, Republic of Korea
| | - Joon Kim
- Laboratory of Biochemistry, Division of Life Sciences, Korea University, Seoul 136-701, Republic of Korea
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15
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Tommaso Cai, Gabriella Nesi, Sandra Mazzoli, Francesca Meacci, Galliano Tinacci, Cesare Selli, Riccardo Bartoletti. Inflammation and Urothelial Bladder Cancer: What we Need to Known? (Review). JOURNAL OF ANALYTICAL ONCOLOGY 2015. [DOI: 10.6000/1927-7229.2015.04.02.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The association between inflammation and bladder cancer has been debated in several studies, highlighting that inflammation may be a crucial component both in tumor development or progression. On the other hand, several authors suggest that the presence of an inflammatory cell infiltrate within the urothelial bladder cancer is a good prognostic predictor in terms of recurrence-free survival time. The question is: What is the prognostic role of inflammation in patients affected by urothelial bladder cancer? On one hand, chronic inflammation should be considered a risk factor in developing bladder cancer, as demonstrated by Schistosoma haematobium infection and, on the other hand, the inflammation induced by the Bacillus Calmette-Guérin intravesical therapy has a protective effect on cancer recurrence. Recently, some authors highlight that the presence of an inflammatory cell infiltrate within the urothelial bladder cancer is a good prognostic predictor in terms of recurrence-free survival time, due to the host generating angiogenic stimulation of a local inflammatory reaction against cancer. This is probably due to the angiogenetic stimulation of a local inflammatory reaction generated by the host against superficial bladder cancer. However, the debate is still open. This review will summarize recent data regarding inflammation and urothelial cell carcinoma, with special emphasis on the role that the inflammatory response is likely to have on recurrence risk and progression in superficial bladder cancer patients.
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16
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Zaitsu M, Toyokawa S, Tonooka A, Nakamura F, Takeuchi T, Homma Y, Kobayashi Y. Sex differences in bladder cancer pathology and survival: analysis of a population-based cancer registry. Cancer Med 2014; 4:363-70. [PMID: 25533611 PMCID: PMC4380962 DOI: 10.1002/cam4.379] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 11/10/2022] Open
Abstract
Sex differences in bladder cancer pathology and epidemiology have been the focus of recent research. We investigated the epidemiological characteristics and compared bladder cancer pathology and survival between men and women in Japan. A total of 13,184 patients with primary bladder cancer diagnosed from 1954 to 2010 were identified in a large-scale cancer registry database in Kanagawa Prefecture. Using this database, we compared the odds ratios (ORs) for nonurothelial carcinoma (non-UC) using a multiple logistic regression model adjusted for age and diagnosis periods. We also compared hazard ratios (HRs) for overall death and cancer-specific death using a Cox proportional hazards model adjusted for non-UC, age, and diagnosis period. The proportion of non-UC was significantly higher in female compared with male patients (OR = 2.14, 95% confidence interval [CI]: 1.81-2.52). Furthermore, survival was significantly poorer in female patients than in male patients after adjusting for UC or non-UC (HR for overall death = 1.15, 95% CI: 1.06-1.23; HR for cancer-specific death = 1.39, 95% CI: 1.28-1.52). Sex differences exist in the epidemiological characteristics of bladder cancer in Japan, with female patients having less favorable pathology and poorer survival compared with male patients.
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Affiliation(s)
- Masayoshi Zaitsu
- Department of Public Health, The University of Tokyo, Tokyo, Japan; Department of Urology, Kanto Rosai Hospital, Kawasaki, Japan; Department of Urology, The University of Tokyo, Tokyo, Japan
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17
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Increased angiogenesis and FGFR protein expression indicate a favourable prognosis in bladder cancer. Virchows Arch 2014; 465:687-95. [PMID: 25326864 DOI: 10.1007/s00428-014-1672-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/18/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
Compared to other members of the fibroblast growth factor receptor (FGFR) family, only few studies investigate FGFR3 in tumour angiogenesis. We investigated the connection between angiogenesis and FGF/FGFR expression including FGFR3 mutation status in urothelial carcinomas. Immunohistochemistry was performed in invasive and non-invasive urothelial cancers of 61 patients. Protein expression of CD31, factor VIII (FVIII), FGF-1/2, FGFR1, FGFR3 and FGFR4 and FGFR3 mutation status were evaluated. Morphometric assessment of angiogenesis including microvessel count (MVC) and vascular surface area (VSA) was analysed. Correlation and survival analyses (overall survival (OS) and disease-free survival (DFS)) with univariate and multivariate analyses were performed. CD31 values (MVC and VSA) significantly correlated with OS and DFS. OS and DFS were significantly better in patients with FGFR3 overexpression. Multivariate analysis revealed FGFR3 protein expression and tumour grading (WHO classification 2004) as independent prognostic factors of OS and VSA of CD31 and FGFR3 protein expression of DFS. FGFR3 mutation status was correlated with VSA measured by FVIII. FGFR3 may be able to induce a pro-angiogenic phenotype in urothelial carcinomas and significantly influence prognosis. Consequently, FGFR3 is a potential therapeutic target also from the angiogenesis perspective.
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18
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Diagnosis of Urothelial Tumors With a Dedicated Dual-Source Dual-Energy MDCT Protocol: Preliminary Results. AJR Am J Roentgenol 2014; 202:W357-64. [DOI: 10.2214/ajr.13.11145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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19
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Abstract
Carcinoma of the bladder is the second most prevalent genitourinary malignancy and the fifth most common solid malignancy in the USA. Combination chemotherapy is used in most patients with advanced disease. Traditionally, on the basis of favorable response rates and survival data, cisplatin-based regimens have been the preferred chemotherapy for patients with metastatic bladder cancer. However, the toxicity profile of cisplatin precludes its use in a significant subset of patients with advanced bladder cancer. Conversely, noncisplatin-containing regimens have been shown to have a more favorable toxicity profile and to have activity in advanced bladder cancer. Here, various nonplatinum chemotherapy regimens for advanced disease are reviewed.
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Affiliation(s)
- Sandy Srinivas
- Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305, USA.
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20
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Bladder cancer. Mol Oncol 2013. [DOI: 10.1017/cbo9781139046947.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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21
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Grivas PD, Daignault S, Tagawa ST, Nanus DM, Stadler WM, Dreicer R, Kohli M, Petrylak DP, Vaughn DJ, Bylow KA, Wong SG, Sottnik JL, Keller ET, Al-Hawary M, Smith DC, Hussain M. Double-blind, randomized, phase 2 trial of maintenance sunitinib versus placebo after response to chemotherapy in patients with advanced urothelial carcinoma. Cancer 2013; 120:692-701. [DOI: 10.1002/cncr.28477] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 09/30/2013] [Accepted: 10/04/2013] [Indexed: 01/05/2023]
Affiliation(s)
- Petros D. Grivas
- Department of Internal Medicine; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan
| | - Stephanie Daignault
- Biostatistics Department; University of Michigan Comprehensive Cancer Center; Ann Arbor, Michigan
| | - Scott T. Tagawa
- Departments of Medicine and Urology; Weill Cornell Medical College; New York
| | - David M. Nanus
- Departments of Medicine and Urology; Weill Cornell Medical College; New York
| | | | - Robert Dreicer
- Department of Solid Tumor Oncology; Cleveland Clinic; Cleveland Ohio
| | - Manish Kohli
- Department of Oncology; Mayo Clinic; Rochester Minnesota
| | - Daniel P. Petrylak
- Departments of Medical Oncology and Urology; Yale University Cancer Center; New Haven Connecticut
| | - David J. Vaughn
- Department of Medicine; University of Pennsylvania Abramson Cancer Center; Philadelphia Pennsylvania
| | - Kathryn A. Bylow
- Department of Medicine; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Steven G. Wong
- Department of Medicine; University of California at Los Angeles School of Medicine; Los Angeles California
| | - Joseph L. Sottnik
- Department of Urology; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan
| | - Evan T. Keller
- Departments of Urology and Pathology; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan
| | - Mahmoud Al-Hawary
- Department of Radiology; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan
| | - David C. Smith
- Department of Internal Medicine; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan
| | - Maha Hussain
- Department of Internal Medicine; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan
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22
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Analysis of plasma cytokines and angiogenic factors in patients with pretreated urothelial cancer receiving Pazopanib: the role of circulating interleukin-8 to enhance the prognostic accuracy. Br J Cancer 2013; 110:26-33. [PMID: 24231947 PMCID: PMC3887307 DOI: 10.1038/bjc.2013.719] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/14/2013] [Accepted: 10/21/2013] [Indexed: 01/03/2023] Open
Abstract
Background: Pazopanib achieved the end point of clinical activity in pretreated patients with urothelial cancer in a single-group, phase 2 trial. The objective was to identify biological predictors of clinical benefit to pazopanib in these patients. Methods: EDTA blood samples were collected at baseline (T0) and after 4 weeks (T1) of treatment, together with radiological imaging in all 41 patients to analyse plasma circulating angiogenic factor levels by multiplex ELISA plates. Changes from T0 to T1 in marker levels were matched with response with the covariance analysis. Univariable and multivariable analyses evaluated the association with overall survival (OS), adjusted for prespecified clinical variables. Net reclassification improvement (NRI) tested the performance of the recognised Cox model. Results: Increasing IL8T1 level associated with lower response probability at covariance analysis (P=0.010). Both IL8T0 (P=0.019) and IL8T1 (P=0.004) associated with OS and the prognostic model, including clinical variables and IL8T1 best-predicted OS after backward selection. The NRI for this model was 39%. When analysed as a time-varying covariate, IL8T1 level<80 pg ml−1 portended significantly greater response (∼80%) and 6-month OS (∼60%) probability than level⩾80. Conclusion: IL8-level changes during pazopanib allowed for a prognostic improvement and were associated with response probability.
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23
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Sarhaddi D, Poushanchi B, Merati M, Tchanque-Fossuo C, Donneys A, Baker J, Buchman SR. Validation of Histologic Bone Analysis Following Microfil Vessel Perfusion. J Histotechnol 2013. [PMID: 26207077 DOI: 10.1179/2046023612y.0000000012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The ability to examine bone vascularity using Micro-Computed Tomography (μCT) following vessel perfusion with Microfil® and to subsequently perform histologic bone analysis in the same specimen would provide an efficient method by which the vascular and cellular environment of bone can be examined simultaneously. The purpose of this report is to determine if the administration of Microfil® precludes accurate histologic assessment of bone quality via osteocyte count and empty lacunae count. Sprague-Dawley rats (n=6) underwent perfusion with Microfil®. Left hemi-mandibles were harvested, decalcified and underwent vascular analysis via μCT prior to sectioning and staining with Gomori's Trichrome. Quantitative Histomorphometric evaluation was performed. Ninety-five percent confidence intervals were used to determine statistical differences from an established set of controls (n=12). Histologic analyses were successfully performed on specimens that had undergone previous perfusion. Quantitative measures of bone cellularity of perfused versus control specimens revealed no statistical difference in osteocyte count per high-power field (95.33 versus 94.66; 95 percent CI,-7.64 to 6.30) or empty lacunae per high-power field (2.73 versus 1.89, 95 percent CI, -1.81 to 0.13). Here we report a statistical validation allowing for histological analysis of cell counts in specimens in which Microfil® perfusion has previously been performed.
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Affiliation(s)
- D Sarhaddi
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - B Poushanchi
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - M Merati
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - C Tchanque-Fossuo
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - A Donneys
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - J Baker
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - S R Buchman
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
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Abstract
INTRODUCTION Advanced urothelial carcinoma is associated with a poor prognosis. In the metastatic setting, the response rate to first-line, cisplatin-containing chemotherapy is high, but survival is poor. Second-line treatment options are limited. Advanced age at diagnosis and the presence of comorbidities often preclude treatment with cisplatin-containing regimens. AREAS COVERED This review addresses the current therapy of urothelial carcinoma, the unmet needs in treatment and the status of drug development in this disease. The molecular targets identified and efforts to incorporate targeted agents into therapy will be addressed. EXPERT OPINION There have been no major advances in the treatment of urothelial carcinoma in three decades. Despite high response rates in the first-line setting, survival is limited. Major impediments to improved outcomes include poor durability of response to first-line chemotherapy and lack of second-line treatments. Better understanding in tumor biology has identified multiple targets in urothelial carcinoma; however, such discoveries have yet to lead to the incorporation of targeted agents into the routine treatment of urothelial carcinoma. Multiple ongoing clinical trials are investigating the use of targeted agents in urothelial carcinoma. Continued efforts are underway to better understand the molecular drivers of disease and such efforts are likely to identify additional therapeutic targets.
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Affiliation(s)
- Benjamin A Gartrell
- Albert Einstein College of Medicine, Montefiore Medical Center, Department of Medical Oncology , 111 E 210th St, Bronx, NY, 10467 , USA +1 718 920 4826 ; +1 718 798 7474 ;
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Biomarkers in bladder cancer: translational and clinical implications. Crit Rev Oncol Hematol 2013; 89:73-111. [PMID: 24029603 DOI: 10.1016/j.critrevonc.2013.08.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/23/2013] [Accepted: 08/13/2013] [Indexed: 01/15/2023] Open
Abstract
Bladder cancer is associated with high recurrence and mortality rates. These tumors show vast heterogeneity reflected by diverse morphologic manifestations and various molecular alterations associated with these disease phenotypes. Biomarkers that prospectively evaluate disease aggressiveness, progression risk, probability of recurrence and overall prognosis would improve patient care. Integration of molecular markers with conventional pathologic staging of bladder cancers may refine clinical decision making for the selection of adjuvant and salvage therapy. In the past decade, numerous bladder cancer biomarkers have been identified, including various tumor suppressor genes, oncogenes, growth factors, growth factor receptors, hormone receptors, proliferation and apoptosis markers, cell adhesion molecules, stromal factors, and oncoproteins. Recognition of two distinct pathways for urothelial carcinogenesis represents a major advance in the understanding and management of this disease. Nomograms for combining results from multiple biomarkers have been proposed to increase the accuracy of clinical predictions. The scope of this review is to summarize the major biomarker findings that may have translational and clinical implications.
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Balar AV, Apolo AB, Ostrovnaya I, Mironov S, Iasonos A, Trout A, Regazzi AM, Garcia-Grossman IR, Gallagher DJ, Milowsky MI, Bajorin DF. Phase II study of gemcitabine, carboplatin, and bevacizumab in patients with advanced unresectable or metastatic urothelial cancer. J Clin Oncol 2013; 31:724-30. [PMID: 23341513 PMCID: PMC3574268 DOI: 10.1200/jco.2012.42.5215] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Although gemcitabine and carboplatin (GCa) is a standard option for patients with advanced urothelial cancer (UC) who are ineligible for cisplatin, outcomes remain poor. This trial evaluated the efficacy and safety of bevacizumab with GCa in advanced UC. PATIENTS AND METHODS Patients with Karnofsky performance status of 60% to 70%, creatinine clearance less than 60 mL/min, visceral metastasis, or solitary kidney were eligible and received a lead-in dose of bevacizumab 10 mg/kg followed 2 weeks later by gemcitabine 1,000 mg/m(2) on days 1 and 8 and carboplatin at area under the [concentration-time] curve (AUC) 5.0 or 4.5 and bevacizumab 15 mg/kg on day 1 every 21 days for six cycles. Patients achieving at least stable disease (SD) continued bevacizumab 15 mg/kg every 21 days for 18 additional cycles. The study was powered to detect a 50% improvement in median progression-free survival (PFS) over a historical control. RESULTS Fifty-one patients, median age 67 years (range, 42 to 83 years), were enrolled onto the study and were evaluable for toxicity. Twenty (39%) experienced grade 3 to 4 toxicity, and 10 (20%) had thromboembolic events (deep venous thrombosis or pulmonary embolism). Four received one or fewer cycles leaving 47 evaluable for outcomes. Twenty-three (49%) achieved response (three complete; 20 partial), and 11 had SD. Median PFS was 6.5 months (95% CI, 4.7 to 7.8 months); PFS was greater in the carboplatin AUC 5.0 group (P = .04). Median overall survival (OS) was 13.9 months. CONCLUSION The 95% one-sided lower confidence bound of 4.77 months for median PFS did not meet the predesignated PFS of more than 4.8 months considered sufficient for further study. Median OS was greater than expected. An ongoing phase III trial in patients who are eligible for therapy with cisplatin will define the role of bevacizumab in UC.
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Affiliation(s)
- Arjun V. Balar
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Andrea B. Apolo
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Irina Ostrovnaya
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Svetlana Mironov
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Alexia Iasonos
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Alisa Trout
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Ashley M. Regazzi
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Ilana R. Garcia-Grossman
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - David J. Gallagher
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Matthew I. Milowsky
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
| | - Dean F. Bajorin
- Arjun V. Balar, Andrea B. Apolo, Irina Ostrovnaya, Svetlana Mironov, Alexia Iasonos, Alisa Trout, Ashley M. Regazzi, Ilana R. Garcia-Grossman, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Memorial Sloan-Kettering Cancer Center; Arjun V. Balar, Andrea B. Apolo, David J. Gallagher, Matthew I. Milowsky, and Dean F. Bajorin, Weill Medical College of Cornell University, New York, NY
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Roudnicky F, Poyet C, Wild P, Krampitz S, Negrini F, Huggenberger R, Rogler A, Stöhr R, Hartmann A, Provenzano M, Otto VI, Detmar M. Endocan is upregulated on tumor vessels in invasive bladder cancer where it mediates VEGF-A-induced angiogenesis. Cancer Res 2012; 73:1097-106. [PMID: 23243026 DOI: 10.1158/0008-5472.can-12-1855] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Tumor-associated blood vessels differ from normal vessels and proteins present only on tumor vessels may serve as biomarkers or targets for antiangiogenic therapy in cancer. Comparing the transcriptional profiles of blood vascular endothelium from human invasive bladder cancer with normal bladder tissue, we found that the endothelial cell-specific molecule endocan (ESM1) was highly elevated on tumor vessels. Endocan was associated with filopodia of angiogenic endothelial tip cells in invasive bladder cancer. Notably, endocan expression on tumor vessels correlated strongly with staging and invasiveness, predicting a shorter recurrence-free survival time in noninvasive bladder cancers. Both endocan and VEGF-A levels were higher in plasma of patients with invasive bladder cancer than healthy individuals. Mechanistic investigations in cultured blood vascular endothelial cells or transgenic mice revealed that endocan expression was stimulated by VEGF-A through the phosphorylation and activation of VEGFR-2, which was required to promote cell migration and tube formation by VEGF-A. Taken together, our findings suggest that disrupting endocan interaction with VEGFR-2 or VEGF-A could offer a novel rational strategy to inhibit tumor angiogenesis. Furthermore, they suggest that endocan might serve as a useful biomarker to monitor disease progression and the efficacy of VEGF-A-targeting therapies in patients with bladder cancer.
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Affiliation(s)
- Filip Roudnicky
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
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Galsky MD, Hahn NM, Powles T, Hellerstedt BA, Lerner SP, Gardner TA, Yu M, O'Rourke M, Vogelzang NJ, Kocs D, McKenney SA, Melnyk AM, Hutson TE, Rauch M, Wang Y, Asmar L, Sonpavde G. Gemcitabine, Cisplatin, and sunitinib for metastatic urothelial carcinoma and as preoperative therapy for muscle-invasive bladder cancer. Clin Genitourin Cancer 2012; 11:175-81. [PMID: 23228446 DOI: 10.1016/j.clgc.2012.10.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/28/2012] [Accepted: 10/01/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Data support chemotherapy combined with antiangiogenic therapy in metastatic urothelial cancer (mUC) and muscle-invasive bladder cancer (MIBC). We investigated the efficacy and safety of gemcitabine, cisplatin, and sunitinib (GCS) in mUC and MIBC in parallel phase II trials. PATIENTS AND METHODS Trial 1 enrolled 36 patients with mUC who were chemotherapy naive; trial 2 enrolled 9 patients with MIBC. The primary endpoints for trials 1 and 2 were response rate and pathologic complete response, respectively. GCS was given as first-line treatment for patients with mUC and as neoadjuvant therapy for patients with MIBC. The Simon minimax 2-stage design was used for an objective response rate in trial 1 and for the pathologic complete response rate in trial 2. RESULTS The initial trial 1 GCS dose was gemcitabine 1000 mg/m(2) intravenously, days 1 and 8; cisplatin 70 mg/m(2) intravenously, day 1; and sunitinib 37.5 mg orally daily, days 1 to 14 of a 21-day cycle. These doses proved intolerable. The doses of gemcitabine and cisplatin were subsequently reduced to 800 and 60 mg/m(2), respectively, without an improvement in drug delivery, and the trial was closed. This lower-dose regimen was applied in trial 2, which was stopped early due to excess toxicity. Grade 3 to 4 hematologic toxicities occurred in 70% (23/33) of patients in trial 1 and 22% (2/9) of patients in trial 2. In trial 1, the response rate was 49% (95% CI, 31%-67%); in trial 2, the pathologic complete response was 22% (2/9). Due to early closure secondary to toxicity, the sample sizes of both trials were small. CONCLUSIONS Delivery of GCS was hampered by excessive toxicity in both advanced and neoadjuvant settings.
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Affiliation(s)
- Matthew D Galsky
- US Oncology Research, McKesson Specialty Health, The Woodlands, TX, USA.
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Abstract
Biomarkers are increasingly being applied to the clinical management of patients with bladder cancer. The biomarkers in current clinical use focus on bladder cancer detection. Biomarkers for prognosis and as intermediate endpoints for chemoprevention are being evaluated in clinical trials. This review provides an overview of the performance characteristics of current clinical markers and other markers that are currently under evaluation.
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Affiliation(s)
- H B Grossman
- The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 110, Houston, TX 77030-4095, USA
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Pazopanib in advanced and platinum-resistant urothelial cancer: an open-label, single group, phase 2 trial. Lancet Oncol 2012; 13:810-6. [PMID: 22819172 DOI: 10.1016/s1470-2045(12)70294-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The development of new drugs for patients with refractory urothelial cancer is still an unmet medical need. Preclinical evidence lends support to a rationale for targeting of the VEGF or platelet-derived growth-factor axis. We therefore investigated the activity and safety of pazopanib, a multitarget drug with antiangiogenic activity, in patients with urothelial cancer. METHODS In an open-label, single-group, phase 2 study, patients (aged ≥18 years) with relapsed or refractory urothelial cancer were given pazopanib 800 mg per day, orally. They were treated until disease progression or prohibitive toxicity occurred. The primary endpoint was the proportion of patients who achieved a confirmed objective response, defined as complete or partial response, after independent review, and was analysed by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT01031875. FINDINGS The trial has been completed. 21 (51%) of 41 patients enrolled were given pazopanib as third-line or further-line treatment. 26 (63%) patients had an Eastern Cooperative Oncology Group performance status of 1 or 2. Seven patients had a confirmed objective response (17·1%, 95% CI 7·2-32·1), all of which were partial responses. The most frequent treatment-related grade 3 adverse events were hypertension (three [7%]), fatigue (two [5%]), and gastrointestinal and vaginal fistulisations (two each [5%]). One patient died as a result of duodenal fistulisation that was related to tissue response of bulky tumour masses. INTERPRETATION Pazopanib has single-agent activity in patients with heavily pretreated metastatic urothelial cancer, and warrants further study in this setting. Particular attention should be paid to patients with bulky tumour masses adjacent to viscera because fistulisation is probably related to the response to pazopanib and is the most frequent serious adverse event. FUNDING Fondazione IRCCS Istituto Nazionale dei Tumori provided the grant. GlaxoSmithKline provided the study drug and provided funding for the independent radiological review.
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Qin L, Bromberg-White JL, Qian CN. Opportunities and challenges in tumor angiogenesis research: back and forth between bench and bed. Adv Cancer Res 2012; 113:191-239. [PMID: 22429856 DOI: 10.1016/b978-0-12-394280-7.00006-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Angiogenesis is essential for tumor growth and metastasis. Many signaling pathways are involved in regulating tumor angiogenesis, with the vascular endothelial growth factor pathway being of particular interest. The recognition of the heterogeneity in tumor vasculature has led to better predictions of prognosis through differential analyses of the vasculature. However, the clinical benefits from antiangiogenic therapy are limited, because many antiangiogenic agents cannot provide long-term survival benefits, suggesting the development of drug resistance. Activation of the hypoxia and c-Met pathways, as well as other proangiogenic factors, has been shown to be responsible for such resistance. Vessel co-option could be another important mechanism. For future development, research to improve the efficacy of antiangiogenic therapy includes (a) using tumor-derived endothelial cells for drug screening; (b) developing the drugs focusing on specific tumor types; (c) developing a better preclinical model for drug study; (d) developing more accurate biomarkers for patient selection; (e) targeting the c-Met pathway or other pathways; and (f) optimizing the dose and schedule of antiangiogenic therapy. In summary, the future of antiangiogenic therapy for cancer patients depends on our efforts to develop the right drugs, select the right patients, and optimize the treatment conditions.
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Affiliation(s)
- Li Qin
- State Key Laboratory on Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
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Ajili F, Kacem M, Tounsi H, Darouiche A, Enayfer E, Chebi M, Manai M, Boubaker S. Prognostic Impact of Angiogenesis in Nonmuscle Invasive Bladder Cancer as Defined by Microvessel Density after Immunohistochemical Staining for CD34. Ultrastruct Pathol 2012; 36:336-42. [DOI: 10.3109/01913123.2012.672847] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
In the last few years, angiogenesis has confirmed its critical role in the development of malignant neoplasms. Antiangiogenic drugs, mainly bevacizumab, sorafenib, or sunitinib, are currently approved in a wide number of tumor types, such as breast, colorectal, liver, or kidney cancer, and have changed dramatically the evolution of our patients. Unfortunately, in urothelial carcinoma, which is a very common neoplasm, antiangiogenic agents are still in a very preliminary phase of clinical research. In this study, we focus on the biological basis of angiogenesis in urothelial tumors, its influence in the prognosis of these malignancies, and the available evidence about the use of antiangiogenic drugs in urothelial carcinoma.
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Zee YK, O'Connor JPB, Parker GJM, Jackson A, Clamp AR, Taylor MB, Clarke NW, Jayson GC. Imaging angiogenesis of genitourinary tumors. Nat Rev Urol 2010; 7:69-82. [PMID: 20084077 DOI: 10.1038/nrurol.2009.262] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Angiogenesis is a key process in the growth and metastasis of cancer, and genitourinary tumors are no exception. The evolution of angiogenesis as an important target for novel anticancer therapeutics has brought with it new challenges for in vivo imaging. Most imaging techniques quantify physiological parameters, such as blood volume and capillary endothelial permeability. Although CT, PET and ultrasonography have shown promise, MRI is the most common method used to evaluate angiogenesis in clinical trials of genitourinary tumors. Pilot studies of MRI, CT and ultrasonography in patients with renal cancer have produced promising results; reductions in vascular permeability and blood flow have been correlated with progression-free survival. The vascular characteristics of prostate cancer have been evaluated by MRI, and this has been suggested as a means of assessing tumor response to hormone deprivation therapy. Current evidence highlights the potential of angiogenesis imaging in the diagnosis, staging and possibly response monitoring of bladder cancer. In the future, assessment of the angiogenic process at the structural, functional and molecular levels, before, during and after antiangiogenic therapy will undoubtedly be integrated into wider clinical practice.
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Affiliation(s)
- Ying-Kiat Zee
- Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
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Understanding and Targeting the Eukaryotic Translation Initiation Factor eIF4E in Head and Neck Cancer. JOURNAL OF ONCOLOGY 2009; 2009:981679. [PMID: 20049173 PMCID: PMC2798714 DOI: 10.1155/2009/981679] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 09/30/2009] [Indexed: 01/08/2023]
Abstract
The eukaryotic translation initiation factor eIF4E is elevated in about 30% of human malignancies including HNSCC where its levels correlate with poor prognosis. Here, we discuss the biochemical and molecular underpinnings of the oncogenic potential of eIF4E. Studies in human leukemia specimens, and later in a mouse model of prostate cancer, strongly suggest that cells with elevated eIF4E develop an oncogene dependency to it, making them more sensitive to targeting eIF4E than normal cells. We describe several strategies that have been suggested for eIF4E targeting in the clinic: the use of a small molecule antagonist of eIF4E (ribavirin), siRNA or antisense oligonucleotide strategies, suicide gene therapy, and the use of a tissue-targeting 4EBP fusion peptide. The first clinical trial targeting eIF4E indicates that ribavirin effectively targets eIF4E in poor prognosis leukemia patients and more importantly leads to striking clinical responses including complete and partial remissions. Finally, we discuss the relevance of these findings to HNSCC.
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Sprindzuk M, Dmitruk A, Kovalev V, Bogush A, Tuzikov A, Liakhovski V, Fridman M. Computer-aided Image Processing of Angiogenic Histological. J Clin Med Res 2009; 1:249-61. [PMID: 22481986 PMCID: PMC3311439 DOI: 10.4021/jocmr2009.12.1274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2009] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED This article reviews the questions regarding the image evaluation of angiogeneic histological samples, particularly the ovarian epithelial cancer. Review is focused on the principles of image analysis in the field of histology and pathology. The definition, classification, pathogenesis and angiogenesis regulation in the ovaries are also briefly discussed. It is hoped that the complex image analysis together with the patient's clinical parameters will allow an acquiring of a clear pathogenic picture of the disease, extension of the differential diagnosis and become a useful tool for the evaluation of drug effects. The challenge of the assessment of angiogenesis activity is the heterogeneity of several objects: parameters derived from patient's anamnesis as well as of pathology samples. The other unresolved problems are the subjectivity of the region of interest selection and performance of the whole slide scanning. KEYWORDS Angiogenesis; Image processing; Microvessel density; Cancer; Pathology.
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Affiliation(s)
- Matvey Sprindzuk
- United Institute of Informatics Problems, National Academy of Sciences of Belarus, Belarus
| | - Alexander Dmitruk
- United Institute of Informatics Problems, National Academy of Sciences of Belarus, Belarus
| | - Vassili Kovalev
- United Institute of Informatics Problems, National Academy of Sciences of Belarus, Belarus
| | - Armen Bogush
- United Institute of Informatics Problems, National Academy of Sciences of Belarus, Belarus
| | - Alexander Tuzikov
- United Institute of Informatics Problems, National Academy of Sciences of Belarus, Belarus
| | - Victor Liakhovski
- United Institute of Informatics Problems, National Academy of Sciences of Belarus, Belarus
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Sonpavde G, Elfiky AA. Novel agents for advanced bladder cancer. Ther Adv Med Oncol 2009; 1:37-50. [PMID: 21789112 PMCID: PMC3125992 DOI: 10.1177/1758834009337776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Conventional front-line platinum-based combination chemotherapy yields high response rates but suboptimal long-term outcomes for advanced transitional cell carcinoma. Salvage therapy is an unmet need with disappointing outcomes. The emergence of novel biologic agents offers the promise of improved outcomes. Neoadjuvant therapy preceding cystectomy for muscle-invasive bladder cancer provides an important paradigm and an interesting approach in developing novel agents. Patients who are not candidates for cisplatin require special attention. A multidisciplinary approach and collaboration among laboratory scientists, oncologists, urologists and radiation oncologists is necessary to make therapeutic advances. Recent and ongoing trials of novel chemotherapeutic and biologic agents are reviewed.
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Affiliation(s)
- Guru Sonpavde
- Genitourinary Oncology Program, Texas Oncology, Veterans Affairs Medical Center, Baylor College of Medicine, 501 Medical Center Blvd, Webster, TX 77598, USA
| | - Aymen A. Elfiky
- Genitourinary Oncology Program, Texas Oncology, Veterans Affairs Medical Center, Baylor College of Medicine, 501 Medical Center Blvd, Webster, TX 77598, USA
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Becker M, Tilki D, Szarvas T, Rübben H, Ergün S. Urinbasierte Angiogenesemarker beim Urothelkarzinom der Harnblase. Urologe A 2009; 48:609-14. [DOI: 10.1007/s00120-009-1989-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Circulating endothelial cells in non-small cell lung cancer patients treated with carboplatin and paclitaxel. J Thorac Oncol 2009; 4:208-13. [PMID: 19179898 DOI: 10.1097/jto.0b013e318193030d] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Circulating endothelial cells (CECs) increase in cancer patients and play an important role in tumor neovascularization. METHODS This study was designed to investigate the role of CEC as a marker for predicting the effectiveness of a carboplatin plus paclitaxel based first line chemotherapy in advanced non-small cell lung cancer (NSCLC). RESULTS The CEC count in 4 ml of peripheral blood before starting chemotherapy (baseline value) was significantly higher in NSCLC patients, ranging from 32 to 4501/4 ml (n = 31, mean +/- SD = 595 +/- 832), than in healthy volunteers (n = 53, 46.2 +/- 86.3). We did not detect a significant correlation between the CEC count and estimated tumor volume. CECs were significantly decreased by chemotherapy as compared with pretreatment values (175.6 +/- 24 and 173.0 +/- 24, day +8, +22, respectively). We investigated the correlation between baseline CEC and the clinical effectiveness of chemotherapy. CEC values are significantly higher in patients with clinical benefit (partial response and stable disease, 516 +/- 458, 870.8 +/- 1215, respectively) than in progressive disease patients (211 +/- 150). Furthermore, a statistically significant decrease in CECs, on day 22, was observed only in patients with partial response. Patients who had a baseline CEC count greater than 400/4 ml showed a longer progression-free survival (>400, 271 days [range: 181-361] versus <400, 34 [range: 81-186], p = 0.019). CONCLUSION CEC is suggested to be a promising predictive marker of the clinical efficacy of the CBDCA plus paclitaxel regimen in patients with NSCLC.
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Value of dynamic contrast-enhanced MRI and correlation with tumor angiogenesis in bladder cancer. AJR Am J Roentgenol 2009; 192:949-55. [PMID: 19304699 DOI: 10.2214/ajr.08.1332] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate dynamic contrast-enhanced MRI (DCE-MRI) for the noninvasive measurement of bladder cancer angiogenesis by correlation with microvessel density, histologic grade, and tumor staging, and to predict the outcome of local recurrence. MATERIALS AND METHODS Twenty-four patients with bladder cancer were examined using DCE-MRI. Hemodynamic parameters obtained by DCE-MRI included peak time enhancement in the first minute (E(max/1)) after contrast administration, second minute (E(max/2)), third minute (E(max/3)), fourth minute (E(max/4)), and fifth minute (E(max/5)), and the steepest slope. Microvessel density was identified by immunostaining of endothelial cells using FVIII-related antigen. The Mann-Whitney U test, multivariate discriminant analysis, Spearman's correlation coefficient, and analysis of variance were used for statistical analysis. RESULTS Correlation was seen between DCE-MRI parameters (E(max/1) and steepest slope) and microvessel density (p < 0.05). E(max/1) and steepest slope were found to have a statistically significant correlation with histologic grade (p < 0.05 and p < 0.01, respectively). A significant difference was seen between groups of patients with and without local recurrence with regard to two of the DCE-MRI parameters (p < 0.05 for E(max/1) and E(max/2)). CONCLUSION The contrast enhancement patterns on DCE-MRI are influenced by tumor angiogenesis, as reflected by elevated microvessel density expression. Therefore, they are valuable indicators for assessing tumor angiogenic activity and tumor neovascularization in bladder cancers.
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Kumagai J, Urano T, Ogushi T, Takahashi S, Horie-Inoue K, Fujimura T, Azuma K, Muramatsu M, Ouchi Y, Kitamura T, Inoue S. EBAG9 is a tumor-promoting and prognostic factor for bladder cancer. Int J Cancer 2009; 124:799-805. [DOI: 10.1002/ijc.23982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Tumor neovascularization acquires vessels through a number of processes, including angiogenesis, vasculogenesis, vascular remodelling, intussusception, and possibly vascular mimicry in certain tumors. The end result of the tumor vasculature has been quantified by counting the number of immunohistochemically identified microvessels in areas of maximal vascularity so-called hot spots. Other techniques have been developed, such as Chalkley counting and the use of image analysis systems that are robust and reproducible as well as more objective. Many of the molecular pathways that govern tumor neovascularization have been identified, and many reagents are now available to study these tissue sections. These include angiogenic growth factors and their receptors, cell adhesion molecules, proteases, and markers of activated, proliferating, cytokine-stimulated, or angiogenic vessels, such as CD105. It is also possible to differentiate quiescent from active vessels. Other reagents that can identify proteins involved in microenvironmental influences such as hypoxia have also been generated. Although the histological assessment of tumor vascularity is used mostly in the research context, it may also have clinical applications if appropriate methodology and trained observers perform the studies.
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Affiliation(s)
- Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Milowsky MI, Stadler WM, Bajorin DF. Integration of neoadjuvant and adjuvant chemotherapy and cystectomy in the treatment of muscle-invasive bladder cancer. BJU Int 2008; 102:1339-44. [PMID: 19035902 DOI: 10.1111/j.1464-410x.2008.07980.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bladder cancer is a potentially curable malignancy but for those patients who present with or develop muscle-invasive disease, there is a high risk of metastases and cancer-related death. The treatment of patients with muscle-invasive bladder cancer uses a multimodal approach, including radical cystectomy with pelvic lymph node dissection and perioperative chemotherapy. Neoadjuvant cisplatin combination chemotherapy has a modest survival benefit, with those patients achieving a complete pathological response after chemotherapy having the best outcome. Adjuvant chemotherapy, although less well substantiated, is a reasonable option for patients with extravesical disease or lymph node involvement after cystectomy. Perioperative chemotherapy is substantially underused despite the level-1 evidence showing a survival benefit. Ongoing research will focus on individualized patient care, with biomarkers to predict a pathological complete response and the development of novel targeted therapies.
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Affiliation(s)
- Matthew I Milowsky
- Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Youssef RF, Mitra AP, Bartsch G, Jones PA, Skinner DG, Cote RJ. Molecular targets and targeted therapies in bladder cancer management. World J Urol 2008; 27:9-20. [PMID: 19039591 DOI: 10.1007/s00345-008-0357-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 11/04/2008] [Indexed: 01/29/2023] Open
Abstract
Bladder cancer remains a significant health problem. Currently, conventional histopathologic evaluation criteria (tumor grade and stage) are limited in their ability to accurately predict tumor behavior. A significant number of patients with muscle-invasive or extravesical disease treated by radical cystectomy alone die of metastasis. Intense research efforts are being made to better identify and categorize tumors by their molecular alterations and biological characteristics. A majority of the aggressive, invasive bladder carcinomas have alterations in the p53 and retinoblastoma pathways that regulate the cell cycle by interacting with signal transduction pathways. Angiogenesis further contributes to the neoplastic growth by providing a constant supply of oxygen and nutrients. It is becoming apparent that the accumulation of genetic and molecular changes ultimately determines a tumor's phenotype and subsequent clinical behavior. We provide a contemporary outline of our current understanding of the molecular and genetic events associated with tumorigenesis and progression. We emphasize the ways by which molecular biology is likely to affect the development of future therapies that will be able to target molecular alterations in individual tumors based on their respective profiles. The current status of targeted therapies for bladder cancer is also presented as well as the ongoing clinical trials.
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Affiliation(s)
- Ramy F Youssef
- Departments of Pathology, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Los Angeles, CA, 90033, USA
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Holm N, Byrnes K, Johnson L, Abreo F, Sehon K, Alley J, Meschonat C, Md QC, Li BDL. A prospective trial on initiation factor 4E (eIF4E) overexpression and cancer recurrence in node-negative breast cancer. Ann Surg Oncol 2008; 15:3207-15. [PMID: 18719964 DOI: 10.1245/s10434-008-0086-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Revised: 07/01/2008] [Accepted: 07/02/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND Eukaryotic Initiation Factor 4E (eIF4E) plays a crucial role in translation control. High eIF4E increase in tumor specimens independently predicted recurrence by multivariate analysis. This prospective trial of node-negative only breast cancer patients was initiated to test the hypothesis that high eIF4E increase predicts cancer recurrence and death, independent of nodal status. METHODS The trial was powered to detect a 2.4-fold increase in relative risk for cancer recurrence in 240 node-negative patients on the basis of high versus low eIF4E increase in tumor specimens (type I error = .05, statistical power = .08). eIF4E level was quantified by using Western blot test. Treatment and surveillance regimens were standardized. Primary endpoints were cancer recurrence and cancer-related death. RESULTS Of the 242 patients accrued, 112 were in the low eIF4E group (<7.5-fold), 82 were in the intermediate eIF4E group (7.5- to 15-fold), and 48 were in the high eIF4E group (>15-fold). Patients in the high eIF4E group had a statistically significant higher rate of cancer recurrence and cancer-related death (P = .0001 and P < or = .0001, log rank test). The relative risk for cancer recurrence was 2.2-fold higher in the high eIF4E group (P = .001, Cox model), and 3.7-fold higher for cancer-related death (P = .0009). CONCLUSIONS In node-negative breast cancer, high eIF4E increase predicted a higher rate of cancer recurrence and death. High eIF4E patients had a >2-fold increase in relative risk for cancer recurrence and nearly a 4-fold increase in relative risk for death. This supports our hypothesis that high eIF4E is an independent predictor for breast cancer outcome independent of nodal status.
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Affiliation(s)
- Neal Holm
- Louisiana State University Health Sciences Center and Feist-Weiller Cancer Center, 1501 Kings Highway, Shreveport, LA 71130, USA
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El Sobky E, Gomha M, El-Baz M, Abol-Enein H, Shaaban A. Prognostic significance of tumour angiogenesis in schistosoma-associated adenocarcinoma of the urinary bladder. BJU Int 2008. [DOI: 10.1046/j.1464-410x.2002.02549.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bradley DA, Dunn R, Nanus D, Stadler W, Dreicer R, Rosenberg J, Smith DC, Hussain M. Randomized, double-blind, placebo-controlled phase II trial of maintenance sunitinib versus placebo after chemotherapy for patients with advanced urothelial carcinoma: scientific rationale and study design. Clin Genitourin Cancer 2008; 5:460-3. [PMID: 18272031 DOI: 10.3816/cgc.2007.n.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Systemic chemotherapy is the primary treatment modality for patients with advanced urothelial cancer. However, despite a high initial response rate, durable responses are rare. Angiogenesis has been shown to be important in the development and progression of urothelial cancer. Sunitinib, an oral, multi-targeted, small-molecule inhibitor of multiple tyrosine kinases, is known to inhibit angiogenesis and therefore might decrease progression of urothelial cancer. This phase II trial was designed to investigate the role of sunitinib as maintenance therapy in patients with advanced urothelial cancer. The specific hypothesis of this trial is that sunitinib will decrease progression rates in patients with advanced urothelial cancer who have obtained stable disease or better after standard chemotherapy.
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Black PC, Dinney CPN. Bladder cancer angiogenesis and metastasis--translation from murine model to clinical trial. Cancer Metastasis Rev 2008; 26:623-34. [PMID: 17726580 DOI: 10.1007/s10555-007-9084-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the majority of cases, death from bladder cancer results from metastatic disease. Understanding the closely linked mechanisms of invasion, metastasis and angiogenesis in bladder cancer has allowed us to develop new therapeutic strategies that harbor the promise of decisive improvements in patient survival. The essential link between cell based experiments and the translation of novel agents into human patients with bladder cancer is the animal model. With emphasis on the orthotopic xenograft model, this review outlines some key mechanisms relevant to angiogenesis and the development of metastasis in bladder cancer. We highlight especially pathways related to MMP-9, IL-8, VEGF and EGFR. Most commonly, expression patterns of these markers in patients have correlated to disease progression and patient survival, which has led to laboratory investigations of these markers and eventually novel targeted therapies that are translated back into the clinic by means of clinical trials. Although imperfect in their translatability into clinical efficacy, animal models remain a critical tool in bladder cancer research.
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Affiliation(s)
- Peter C Black
- Department of Urology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX 77030, USA
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Abstract
For a tumor to grow beyond a limited volume of 1-2 mm(3), the tumor cells must not only proliferate, but they must be able to induce the growth of new capillary blood vessels from the host. As early as 1971, it was proposed that tumor growth was dependent on angiogenesis; and, that tumor cells and blood vessels composed a highly integrated ecosystem, that endothelial cells could be switched from a resting state to one of rapid growth by a diffusible signal from tumor cells, and that anti-angiogenesis may become an effective anti-cancer therapy. Indeed, now there is considerable indirect and direct evidence to show that tumor growth is angiogenesis dependent, that tumor cells can produce diffusible angiogenic regulatory molecules, and that angiogenesis inhibitors can slow or prevent tumor growth, and that angiogenesis is a relevant target for anti-cancer therapy. Measuring intratumoral microvessel density (iMVD) in vascular "hot spots" has been shown to correlate with aggressive tumor behavior. This chapter reviews the techniques available for measuring iMVD.
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Affiliation(s)
- Noel Weidner
- Department of Pathology, University of California, San Diego, San Diego, California, USA
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