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Vandewalle N, De Beule N, De Becker A, De Bruyne E, Menu E, Vanderkerken K, Breckpot K, Devoogdt N, De Veirman K. AXL as immune regulator and therapeutic target in Acute Myeloid Leukemia: from current progress to novel strategies. Exp Hematol Oncol 2024; 13:99. [PMID: 39367387 DOI: 10.1186/s40164-024-00566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 09/19/2024] [Indexed: 10/06/2024] Open
Abstract
Until recently, treatment options for patients diagnosed with Acute Myeloid Leukemia (AML) were limited and predominantly relied on various combinations, dosages, or schedules of traditional chemotherapeutic agents. Patients with advanced age, relapsed/refractory disease or comorbidities were often left without effective treatment options. Novel advances in the understanding of leukemogenesis at the molecular and genetic levels, alongside recent progress in drug development, have resulted in the emergence of novel therapeutic agents and strategies for AML patients. Among these innovations, the receptor tyrosine kinase AXL has been established as a promising therapeutic target for AML. AXL is a key regulator of several cellular functions, including epithelial-to-mesenchymal transition in tumor cells, immune regulation, apoptosis, angiogenesis and the development of chemoresistance. Clinical studies of AXL inhibitors, as single agents and in combination therapy, have demonstrated promising efficacy in treating AML. Additionally, novel AXL-targeted therapies, such as AXL-specific antibodies or antibody fragments, present potential solutions to overcome the limitations associated with traditional small-molecule AXL inhibitors or multikinase inhibitors. This review provides a comprehensive overview of the structure and biological functions of AXL under normal physiological conditions, including its role in immune regulation. We also summarize AXL's involvement in cancer, with a specific emphasis on its role in the pathogenesis of AML, its contribution to immune evasion and drug resistance. Moreover, we discuss the AXL inhibitors currently undergoing (pre)clinical evaluation for the treatment of AML.
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Affiliation(s)
- Niels Vandewalle
- Translational Oncology Research Center (TORC), Team Hematology and Immunology (HEIM), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Nathan De Beule
- Translational Oncology Research Center (TORC), Team Hematology and Immunology (HEIM), Hematology Department, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels, 1090, Belgium
| | - Ann De Becker
- Translational Oncology Research Center (TORC), Team Hematology and Immunology (HEIM), Hematology Department, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels, 1090, Belgium
| | - Elke De Bruyne
- Translational Oncology Research Center (TORC), Team Hematology and Immunology (HEIM), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Eline Menu
- Translational Oncology Research Center (TORC), Team Hematology and Immunology (HEIM), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Karin Vanderkerken
- Translational Oncology Research Center (TORC), Team Hematology and Immunology (HEIM), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Karine Breckpot
- Translational Oncology Research Center (TORC), Team Laboratory of Cellular and Molecular Therapy (LMCT), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Nick Devoogdt
- Laboratory of Molecular Imaging and Therapy (MITH), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Kim De Veirman
- Translational Oncology Research Center (TORC), Team Hematology and Immunology (HEIM), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium.
- Translational Oncology Research Center (TORC), Team Hematology and Immunology (HEIM), Hematology Department, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels, 1090, Belgium.
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2
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Tenstad O, Christakou E, Hodneland Nilsson L, Gausdal G, Micklem D, Kursula P, Lorens JB, Reed RK. In vivo turnover and biodistribution of soluble AXL: implications for biomarker development. Sci Rep 2024; 14:16141. [PMID: 38997436 PMCID: PMC11245488 DOI: 10.1038/s41598-024-66665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Soluble biomarkers are paramount to personalized medicine. However, the in vivo turnover and biodistribution of soluble proteins is seldom characterized. The cleaved extracellular domain of the AXL receptor (sAXL) is a prognostic biomarker in several diseases and a predictive marker of AXL targeting agents. Plasma sAXL reflects a balance between production in tissues with lymphatic transport into the circulation and removal from blood by degradation or excretion. It is unclear how this transport cycle affects plasma sAXL levels that are the metric for biomarker development. Radiolabeled mouse sAxl was monitored after intravenous injection to measure degradation and urinary excretion of sAxl, and after intradermal injection to mimic tissue or tumor production. sAxl was rapidly taken-up and degraded by the liver and kidney cortex. Surprisingly, intact sAxl was detectable in urine, indicating passage through the glomerular filter and a unique sampling opportunity. The structure of sAxl showed an elongated, flexible molecule with a length of 18 nm and a thickness of only 3 nm, allowing passage through the glomerulus and excretion into the urine. Intradermally injected sAxl passed through local and distant lymph nodes, followed by uptake in liver and kidney cortex. Low levels of sAxl were seen in the plasma, consistent with an extended transit time from local tissue to circulation. The rapid plasma clearance of sAxl suggests that steady-state levels in blood will sensitively and dynamically reflect the rate of production of sAxl in the tissues but will be influenced by perturbations of liver and kidney function.
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Affiliation(s)
- Olav Tenstad
- Department of Biomedicine, University of Bergen, Jonas Lies Vei 91, 5009, Bergen, Norway
| | - Eleni Christakou
- Department of Biomedicine, University of Bergen, Jonas Lies Vei 91, 5009, Bergen, Norway
- BerGenBio ASA, 5009, Bergen, Norway
| | | | | | | | - Petri Kursula
- Department of Biomedicine, University of Bergen, Jonas Lies Vei 91, 5009, Bergen, Norway
- Faculty of Biochemistry and Molecular Medicine & Biocenter Oulu, University of Oulu, 90014, Oulu, Finland
| | - James B Lorens
- Department of Biomedicine, University of Bergen, Jonas Lies Vei 91, 5009, Bergen, Norway.
- Centre for Cancer Biomarkers, Norwegian Centre of Excellence, University of Bergen, 5021, Bergen, Norway.
| | - Rolf K Reed
- Department of Biomedicine, University of Bergen, Jonas Lies Vei 91, 5009, Bergen, Norway
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Raymond D, Fukui M, Zwernik S, Kassam A, Rovin R, Akhtar P. Evaluating soluble Axl as a biomarker for glioblastoma: A pilot study. PLoS One 2024; 19:e0301739. [PMID: 38968207 PMCID: PMC11226040 DOI: 10.1371/journal.pone.0301739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/11/2024] [Indexed: 07/07/2024] Open
Abstract
With current imaging, discriminating tumor progression from treatment effect following immunotherapy or oncolytic virotherapy of glioblastoma (GBM) is challenging. A blood based diagnostic biomarker would therefore be helpful. Axl is a receptor tyrosine kinase that is highly expressed by many cancers including GBM. Axl expression is regulated through enzymatic cleavage of its extracellular domain. The resulting fragment can be detected in serum as soluble Axl (sAxl). sAxl levels can distinguish patients with melanoma, hepatocellular carcinoma, and pancreatic ductal adenocarcinoma from healthy controls. This is a pilot study to determine if sAxl is a candidate biomarker for GBM. The sAxl levels in the serum of 40 healthy volunteers and 20 GBM patients were determined using an enzyme-linked immunosorbent assay (ELISA). Pre- and post- operative sAxl levels were obtained. Volumetric MRI evaluation provided GBM tumor volume metrics. There was no significant difference in the sAxl levels of the volunteers (30.16±1.88 ng/ml) and GBM patients (30.74±1.96 ng/ml) p = 0.27. The postoperative sAxl levels were significantly higher than preoperative levels (32.32±2.26 ng/ml vs 30.74±1.96 ng/ml, p = 0.03). We found no correlation between tumor volume and sAxl levels. Axl expression was low or absent in 6 of 11 (55%) patient derived GBM cell lines. Given the wide range of Axl expression by GBM tumors, sAxl may not be a reliable indicator of GBM. However, given the small sample size in this study, a larger study may be considered.
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Affiliation(s)
- Daniel Raymond
- Department of Biology, Northern Michigan University, Marquette, Michigan, United States of America
| | - Melanie Fukui
- Aurora Neuroscience Innovation Institute, Milwaukee, Wisconsin, United States of America
| | - Samuel Zwernik
- Advocate Aurora Research Institute, Milwaukee, Wisconsin, United States of America
| | - Amin Kassam
- Aurora Neuroscience Innovation Institute, Milwaukee, Wisconsin, United States of America
| | - Richard Rovin
- Aurora Neuroscience Innovation Institute, Milwaukee, Wisconsin, United States of America
| | - Parvez Akhtar
- Advocate Aurora Research Institute, Milwaukee, Wisconsin, United States of America
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AlBarakat MM, Ahmed YB, Alshwayyat S, Ellaithy A, Y. Al-Shammari Y, Soliman Y, Rezq H, Abdelazeem B, Kunadi A. The efficacy and safety of cabozantinib in patients with metastatic or advanced renal cell carcinoma: a systematic review and meta-analysis. Proc AMIA Symp 2024; 37:822-830. [PMID: 39165809 PMCID: PMC11332639 DOI: 10.1080/08998280.2024.2363616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 08/22/2024] Open
Abstract
Background Cabozantinib, a new first-line treatment for advanced renal cell carcinoma (aRCC), targets essential tyrosine kinases and outperforms the established comparator (sunitinib) in various efficacy outcomes. This systematic review and meta-analysis aimed to assess the efficacy and safety of cabozantinib compared to other aRCC treatments. Methods Following PRISMA and Cochrane guidelines, our protocol was registered in PROSPERO. A systematic search, without date limits, was conducted on PubMed, Cochrane, Web of Science, and EMBASE until October 8, 2023. Data extraction encompassed study details, baseline information, and outcomes. Hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals were employed for each outcome, and a random-effects model was applied to account for expected heterogeneity. Results Three studies, encompassing 967 patients, were included in our analysis. In terms of efficacy, the pooled rate for overall survival significantly favored cabozantinib. However, in subgroup analyses, cabozantinib was only statistically superior to everolimus. For progression-free survival and tumor objective response rate, cabozantinib outperformed both everolimus and sunitinib. In adverse events, compared to sunitinib, cabozantinib exhibited inferiority in nearly all evaluated aspects, except for nausea and stomatitis, which showed no difference between the two groups. Conversely, it demonstrated a comparable risk profile with everolimus across various side effects. Conclusion Cabozantinib shows significant efficacy in extending overall survival, progression-free survival, and tumor objective response rate despite a potentially higher risk of adverse events compared to sunitinib. These findings support cabozantinib as a first-line therapy for aRCC, either as an initial treatment or after prior VEGFR-targeted therapies.
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Affiliation(s)
- Majd M. AlBarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yaman B. Ahmed
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sakhr Alshwayyat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Asmaa Ellaithy
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | | | - Hazem Rezq
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Arvind Kunadi
- Internal Medicine and Nephrology Departments, McLaren Health Care, Flint, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
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Knisely A, Hinchcliff EM, Gardiner E, Rangwala R, Lito K, Fellman B, Yuan Y, Sood AK, Westin SN, Lu KH, Jazaeri AA. Phase 1b study of batiraxcept in combination with durvalumab in patients with platinum-resistant ovarian cancer. iScience 2024; 27:109801. [PMID: 38726365 PMCID: PMC11079458 DOI: 10.1016/j.isci.2024.109801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
Combining an immune checkpoint inhibitor with batiraxcept (AVB-S6-500), an AXL inhibitor that acts via selective binding to growth arrest-specific protein 6 (GAS6), may improve anti-tumor immunity in platinum-resistant ovarian cancer (PROC). This phase 1b trial of durvalumab in combination with escalating doses of batiraxcept enrolled patients with recurrent PROC (NCT04019288). The primary objective was to determine the toxicity profile of the combination. Eleven patients were enrolled on the trial. No dose-limiting toxicities were observed, and no objective responses were noted. Median progression free survival (PFS) was 1.81 months (95% confidence interval (CI) 1.71-2.40), and median overall survival (OS) was 4.53 months (95% CI 2.10-24.74). Batiraxcept effectively reduced serum GAS6 levels at 1-h post-treatment, resulting in trough levels below the limit of detection in all cases but one. In conclusion, the combination of batiraxcept and durvalumab was safe and tolerable but did not demonstrate anti-tumor activity in a heterogenous population of patients with recurrent PROC.
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Affiliation(s)
- Anne Knisely
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily M. Hinchcliff
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Kathryn Lito
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anil K. Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shannon N. Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H. Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amir A. Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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Apostolo D, Ferreira LL, Vincenzi F, Vercellino N, Minisini R, Latini F, Ferrari B, Burlone ME, Pirisi M, Bellan M. From MASH to HCC: the role of Gas6/TAM receptors. Front Immunol 2024; 15:1332818. [PMID: 38298195 PMCID: PMC10827955 DOI: 10.3389/fimmu.2024.1332818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Metabolic dysfunction-associated steatohepatitis (MASH) is the replacement term for what used to be called nonalcoholic steatohepatitis (NASH). It is characterized by inflammation and injury of the liver in the presence of cardiometabolic risk factors and may eventually result in the development of hepatocellular carcinoma (HCC), the most common form of primary liver cancer. Several pathogenic mechanisms are involved in the transition from MASH to HCC, encompassing metabolic injury, inflammation, immune dysregulation and fibrosis. In this context, Gas6 (Growth Arrest-Specific 6) and TAM (Tyro3, Axl, and MerTK) receptors may play important roles. The Gas6/TAM family is involved in the modulation of inflammation, lipid metabolism, fibrosis, tumor progression and metastasis, processes which play an important role in the pathophysiology of acute and chronic liver diseases. In this review, we discuss MASH-associated HCC and the potential involvement of the Gas6/TAM system in disease development and progression. In addition, since therapeutic strategies for MASH and HCC are limited, we also speculate regarding possible future treatments involving the targeting of Gas6 or TAM receptors.
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Affiliation(s)
- Daria Apostolo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Luciana L Ferreira
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Federica Vincenzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nicole Vercellino
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Federico Latini
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Barbara Ferrari
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Michela E Burlone
- Department of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
- Center on Autoimmune and Allergic Diseases, Università del Piemonte Orientale, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
- Center on Autoimmune and Allergic Diseases, Università del Piemonte Orientale, Novara, Italy
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Kim TH, Lee D, Oh HJ, Ham IH, Lee DM, Lee Y, Zhang Z, Ke D, Hur H. Targeting GAS6/AXL signaling improves the response to immunotherapy by restoring the anti-immunogenic tumor microenvironment in gastric cancer. Life Sci 2023; 335:122230. [PMID: 37952835 DOI: 10.1016/j.lfs.2023.122230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
AIMS Immunotherapy has shown remarkable effects on several malignancies; however, its impact on gastric cancers has been limited. Therefore, a novel strategy to overcome resistance to immunotherapy is required. In this study, we compared the gene expression profiles of two murine GC cell lines that exhibited different effects on tumor immunity. The functions of specific genes related to negative tumor immunity and the impact of a specific inhibitor were evaluated in syngeneic GC mouse models. MATERIALS AND METHODS RT-PCR and Western blotting validated Gas6 and AXL expression in murine cell lines. RT-PCR compared YTN16 and YTN3 GC cell's impact on T cell activation. AXL, the receptor for GAS6 in YTN16, was validated by western blotting. Gas6 was inhibited in YTN16 cells using shRNA, and then the gene expression pattern, effects to T cell activation, and tumor growth were assessed. YTN16 cells were injected into mice and treated with CCB-3233, anti-PD-1 antibody, or both. Immunohistochemistry and flow cytometry evaluated tumor-infiltrating immune cells. KEY FINDINGS YTN16 cells expressed more Gas6 and had reduced T cell activation compared to YTN3 cells. AXL activation was higher in YTN16. CCB-3233 reduced AXL phosphorylation. Knocking down Gas6 in YTN16 reduced immunosuppression-related genes and increased tumor-infiltrating T cells. Combined CCB-3233 and anti-PD-1 treatment reduced tumor growth and increased T-cell infiltration. Human GC data revealed a negative correlation between GAS6 and immune activation-related genes. SIGNIFICANCE The GAS6/AXL pathway contributes to immunotherapy resistance in GC. Targeting this pathway may be a novel therapeutic strategy.
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Affiliation(s)
- Tae Hoon Kim
- Cancer Biology Graduate Program, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dagyeong Lee
- AI-Super Convergence KIURI Translational Research Center, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hye Jeong Oh
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - In-Hye Ham
- Inflamm-Aging Translational Research Center, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong Min Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yulim Lee
- Cancer Biology Graduate Program, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Zhang Zhang
- School of Pharmacy, Jinan University, Guangzhou, China
| | - Ding Ke
- School of Pharmacy, Jinan University, Guangzhou, China
| | - Hoon Hur
- Cancer Biology Graduate Program, Ajou University School of Medicine, Suwon, Republic of Korea; Inflamm-Aging Translational Research Center, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
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8
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Wang Y, Liu X, Gong L, Ding W, Hao W, Peng Y, Zhang J, Cai W, Gao Y. Mechanisms of sunitinib resistance in renal cell carcinoma and associated opportunities for therapeutics. Br J Pharmacol 2023; 180:2937-2955. [PMID: 37740648 DOI: 10.1111/bph.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 09/24/2023] Open
Abstract
Sunitinib is the first-line drug for renal cell carcinoma (RCC) treatment. However, patients who received sunitinib treatment will ultimately develop drug resistance after 6-15 months, creating a huge obstacle to the current treatment of renal cell carcinoma. Therefore, it is urgent to clarify the mechanisms of sunitinib resistance and develop new strategies to overcome it. In this review, the mechanisms of sunitinib resistance in renal cell carcinoma have been summarized based on five topics: activation of bypass or alternative pathway, inadequate drug accumulation, tumour microenvironment, metabolic reprogramming and epigenetic regulation. Furthermore, present and potential biomarkers, as well as potential treatment strategies for overcoming sunitinib resistance in renal cell carcinoma, are also covered.
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Affiliation(s)
- Yunxia Wang
- School of Pharmacy, Fudan University, Shanghai, China
| | - Xiaolin Liu
- School of Pharmacy, Fudan University, Shanghai, China
| | - Luyao Gong
- School of Pharmacy, Fudan University, Shanghai, China
| | - Weihong Ding
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjing Hao
- School of Pharmacy, Fudan University, Shanghai, China
| | - Yeheng Peng
- School of Pharmacy, Fudan University, Shanghai, China
| | - Jun Zhang
- School of Pharmacy, Fudan University, Shanghai, China
| | - Weimin Cai
- School of Pharmacy, Fudan University, Shanghai, China
| | - Yuan Gao
- School of Pharmacy, Fudan University, Shanghai, China
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9
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Zhang Y, Popel AS, Bazzazi H. Combining Multikinase Tyrosine Kinase Inhibitors Targeting the Vascular Endothelial Growth Factor and Cluster of Differentiation 47 Signaling Pathways Is Predicted to Increase the Efficacy of Antiangiogenic Combination Therapies. ACS Pharmacol Transl Sci 2023; 6:710-726. [PMID: 37200806 PMCID: PMC10186363 DOI: 10.1021/acsptsci.3c00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Indexed: 05/20/2023]
Abstract
Angiogenesis is a critical step in tumor growth, development, and invasion. Nascent tumor cells secrete vascular endothelial growth factor (VEGF) that significantly remodels the tumor microenvironment through interaction with multiple receptors on vascular endothelial cells, including type 2 VEGF receptor (VEGFR2). The complex pathways initiated by VEGF binding to VEGFR2 lead to enhanced proliferation, survival, and motility of vascular endothelial cells and formation of a new vascular network, enabling tumor growth. Antiangiogenic therapies that inhibit VEGF signaling pathways were among the first drugs that targeted stroma rather than tumor cells. Despite improvements in progression-free survival and higher response rates relative to chemotherapy in some types of solid tumors, the impact on overall survival (OS) has been limited, with the majority of tumors eventually relapsing due to resistance or activation of alternate angiogenic pathways. Here, we developed a molecularly detailed computational model of endothelial cell signaling and angiogenesis-driven tumor growth to investigate combination therapies targeting different nodes of the endothelial VEGF/VEGFR2 signaling pathway. Simulations predicted a strong threshold-like behavior in extracellular signal-regulated kinases 1/2 (ERK1/2) activation relative to phosphorylated VEGFR2 levels, as continuous inhibition of at least 95% of receptors was necessary to abrogate phosphorylated ERK1/2 (pERK1/2). Combinations with mitogen-activated protein kinase/ERK kinase (MEK) and spingosine-1-phosphate inhibitors were found to be effective in overcoming the ERK1/2 activation threshold and abolishing activation of the pathway. Modeling results also identified a mechanism of resistance whereby tumor cells could reduce pERK1/2 sensitivity to inhibitors of VEGFR2 by upregulation of Raf, MEK, and sphingosine kinase 1 (SphK1), thus highlighting the need for deeper investigation of the dynamics of the crosstalk between VEGFR2 and SphK1 pathways. Inhibition of VEGFR2 phosphorylation was found to be more effective at blocking protein kinase B, also known as AKT, activation; however, to effectively abolish AKT activation, simulations identified Axl autophosphorylation or the Src kinase domain as potent targets. Simulations also supported activating cluster of differentiation 47 (CD47) on endothelial cells as an effective combination partner with tyrosine kinase inhibitors to inhibit angiogenesis signaling and tumor growth. Virtual patient simulations supported the effectiveness of CD47 agonism in combination with inhibitors of VEGFR2 and SphK1 pathways. Overall, the rule-based system model developed here provides new insights, generates novel hypothesis, and makes predictions regarding combinations that may enhance the OS with currently approved antiangiogenic therapies.
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Affiliation(s)
- Yu Zhang
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Aleksander S. Popel
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Hojjat Bazzazi
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
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10
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Zhang J, Li W, Wang W, Chen Q, Xu Z, Deng M, Zhou L, He G. Dual roles of FAK in tumor angiogenesis: A review focused on pericyte FAK. Eur J Pharmacol 2023; 947:175694. [PMID: 36967077 DOI: 10.1016/j.ejphar.2023.175694] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
Focal adhesion kinase (FAK), also known as protein tyrosine kinase 2 (PTK2), is a ubiquitously expressed non-receptor tyrosine kinase, that plays a pivotal role in integrin-mediated signal transduction. Endothelial FAK is upregulated in many types of cancer and promotes tumorigenesis and tumor progression. However, recent studies have shown that pericyte FAK has the opposite effect. This review article dissects the mechanisms, by which endothelial cells (ECs) and pericyte FAK regulate angiogenesis, with an emphasis on the Gas6/Axl pathway. In particular, this article discusses the role of pericyte FAK loss on angiogenesis during tumorigenesis and metastasis. In addition, the existing challenges and future application of drug-based anti-FAK targeted therapies will be discussed to provide a theoretical basis for further development and use of FAK inhibitors.
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Chen YW, Rini BI, Beckermann KE. Emerging Targets in Clear Cell Renal Cell Carcinoma. Cancers (Basel) 2022; 14:4843. [PMID: 36230766 PMCID: PMC9561986 DOI: 10.3390/cancers14194843] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
The dual immune checkpoint blockade targeting CTLA-4 and PD-1 (ipilimumab/nivolumab) or the IO combinations targeting PD-1 and anti-VEGF TKIs (pembrolizumab/axitinib, nivolumab/cabozantinib, pembrolizumab/lenvatinib) have demonstrated an overall survival benefit in advanced clear cell renal cell carcinoma (ccRCC). Despite this significant improvement in clinical outcomes in the frontline setting from IO/IO or the IO/TKI combinations, there is a subset of patients of advanced ccRCC that do not respond to such combinations or will lose the initial efficacy and have disease progression. Therefore, a remarkable unmet need exists to develop new therapeutics to improve outcomes. With an enhanced understanding of ccRCC biology and its interaction with the tumor microenvironment, several new therapies are under development targeting ccRCC metabolism, cytokine-signaling, alternative immune checkpoint proteins, and novel biological pathways. In addition, microbiome products enhancing IO response, antibody-drug conjugates, and targeted radionuclides are also being investigated. This review summarizes selected emerging agents that are under development in ccRCC.
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Affiliation(s)
- Yu-Wei Chen
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232, USA
| | - Brian I. Rini
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232, USA
| | - Kathryn E. Beckermann
- Division of Hematology Oncology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, 777 Preston Research Building, Nashville, TN 37232, USA
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12
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Cheng L, Weng B, Jia C, Zhang L, Hu B, Deng L, Mou N, Sun F, Hu J. The expression and significance of efferocytosis and immune checkpoint related molecules in pancancer samples and the correlation of their expression with anticancer drug sensitivity. Front Pharmacol 2022; 13:977025. [PMID: 36059952 PMCID: PMC9437300 DOI: 10.3389/fphar.2022.977025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The efferocytosis-related molecules have been considered to be correlated with the resistance to cancer chemotherapy. The aim of this study was to investigate the expression and significance of efferocytosis-related molecules in cancers and the correlation of their expression with anticancer drug sensitivity, and provide new potential targets and treatment options for cancers.Methods: We investigated the differential expression of 15 efferocytosis-related molecules (Axl, Tyro3, MerTK, CX3CL1, Tim-4, BAI1, Stab2, Gas6, IDO1, Rac1, MFGE8, ICAM-1, CD47, CD31, and PD-L1) and other 12 common immune checkpoint-related molecules in tumor and normal tissues, the correlation between their expression and various clinicopathological features in 16 types of cancers using publicly available pancancer datasets in The Cancer Genome Atlas. We also analyzed the correlation of the expression of efferocytosis and immune checkpoint related molecules with 126 types of anticancer drugs sensitivity using drug-RNA-seq data.Results: There is a panel of circulating molecules among the 27 molecules. Based on the results of differential expression and correlation with various clinicopathological features of efferocytosis-related molecules in cancers, we identified new potential therapeutic targets for anticancer therapy, such as Axl for kidney renal clear cell carcinoma, Tyro3 for liver hepatocellular carcinoma, and IDO1 for renal papillary cell carcinoma. Except for BAI1, CD31, and MerTK, the enhanced expressions of Axl, Tyro3, Gas6, MFGE8, Stab2, Tim-4, CX3CL1, IDO1, Rac1, and PD-L1 were associated with decreased sensitivity of the cancer cells to many anti-cancer drugs; however, for other common immune checkpoint-related molecules, only enhanced expressions of PD-1, CD28, CTLA4, and HVEM were associated with decreased sensitivity of the cancer cells to a few drugs.Conclusion: The efferocytosis-related molecules were significantly associated with clinical outcomes in many types of cancers and played important roles in resistance to chemotherapy. Combination therapy targeting efferocytosis-related molecules and other immune checkpoint-related molecules is necessary to reduce resistance to chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jing Hu
- *Correspondence: Fengjun Sun, ; Jing Hu,
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Engelsen AST, Lotsberg ML, Abou Khouzam R, Thiery JP, Lorens JB, Chouaib S, Terry S. Dissecting the Role of AXL in Cancer Immune Escape and Resistance to Immune Checkpoint Inhibition. Front Immunol 2022; 13:869676. [PMID: 35572601 PMCID: PMC9092944 DOI: 10.3389/fimmu.2022.869676] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/16/2022] [Indexed: 12/12/2022] Open
Abstract
The development and implementation of Immune Checkpoint Inhibitors (ICI) in clinical oncology have significantly improved the survival of a subset of cancer patients with metastatic disease previously considered uniformly lethal. However, the low response rates and the low number of patients with durable clinical responses remain major concerns and underscore the limited understanding of mechanisms regulating anti-tumor immunity and tumor immune resistance. There is an urgent unmet need for novel approaches to enhance the efficacy of ICI in the clinic, and for predictive tools that can accurately predict ICI responders based on the composition of their tumor microenvironment. The receptor tyrosine kinase (RTK) AXL has been associated with poor prognosis in numerous malignancies and the emergence of therapy resistance. AXL is a member of the TYRO3-AXL-MERTK (TAM) kinase family. Upon binding to its ligand GAS6, AXL regulates cell signaling cascades and cellular communication between various components of the tumor microenvironment, including cancer cells, endothelial cells, and immune cells. Converging evidence points to AXL as an attractive molecular target to overcome therapy resistance and immunosuppression, supported by the potential of AXL inhibitors to improve ICI efficacy. Here, we review the current literature on the prominent role of AXL in regulating cancer progression, with particular attention to its effects on anti-tumor immune response and resistance to ICI. We discuss future directions with the aim to understand better the complex role of AXL and TAM receptors in cancer and the potential value of this knowledge and targeted inhibition for the benefit of cancer patients.
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Affiliation(s)
- Agnete S. T. Engelsen
- Centre for Cancer Biomarkers and Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Maria L. Lotsberg
- Centre for Cancer Biomarkers and Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Raefa Abou Khouzam
- Thumbay Research Institute for Precision Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Jean-Paul Thiery
- Centre for Cancer Biomarkers and Department of Biomedicine, University of Bergen, Bergen, Norway
- Guangzhou Laboratory, Guangzhou, China
- Inserm, UMR 1186, Integrative Tumor Immunology and Immunotherapy, Villejuif, France
| | - James B. Lorens
- Centre for Cancer Biomarkers and Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Salem Chouaib
- Thumbay Research Institute for Precision Medicine, Gulf Medical University, Ajman, United Arab Emirates
- Inserm, UMR 1186, Integrative Tumor Immunology and Immunotherapy, Villejuif, France
- Gustave Roussy, Villejuif, France
- Faculty of Medicine, University Paris Sud, Le Kremlin-Bicêtre, France
| | - Stéphane Terry
- Inserm, UMR 1186, Integrative Tumor Immunology and Immunotherapy, Villejuif, France
- Gustave Roussy, Villejuif, France
- Faculty of Medicine, University Paris Sud, Le Kremlin-Bicêtre, France
- Research Department, Inovarion, Paris, France
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van Aalen EA, Wouters SFA, Verzijl D, Merkx M. Bioluminescent RAPPID Sensors for the Single-Step Detection of Soluble Axl and Multiplex Analysis of Cell Surface Cancer Biomarkers. Anal Chem 2022; 94:6548-6556. [PMID: 35438976 PMCID: PMC9069438 DOI: 10.1021/acs.analchem.2c00297] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
![]()
Early diagnosis of
cancer is essential for the efficacy of treatment.
Our group recently developed RAPPID, a bioluminescent immunoassay
platform capable of measuring a wide panel of biomarkers directly
in solution. Here, we developed and systematically screened different
RAPPID sensors for sensitive detection of the soluble fraction of
Axl (sAxl), a cell surface receptor that is overexpressed in several
types of cancer. The best-performing RAPPID sensor, with a limit of
detection of 8 pM and a >9-fold maximal change in
emission
ratio, was applied to measure Axl in three different contexts: clinically
relevant sAxl levels (∼0.5 and ∼1 nM) in diluted blood
plasma, proteolytically cleaved Axl in the cell culture medium of
A431 and HeLa cancer cells, and Axl on the membrane of A431 cells.
We further extended the sensor toolbox by developing dual-color RAPPID
for simultaneous detection of Axl and EGFR on A431 and HeLa cells,
as well as an AND-gate RAPPID that measures the concurrent presence
of these two cell surface receptors on the same cell. These new RAPPID
sensors provide attractive alternatives for more laborious protein
detection and quantification methods such as FACS and immunostainings,
due to their simple practical implantation and low intrinsic background
signal.
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Affiliation(s)
- Eva A van Aalen
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O Box 513, 5600 MB Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O Box 513, 5600 MB Eindhoven, The Netherlands
| | - Simone F A Wouters
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O Box 513, 5600 MB Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O Box 513, 5600 MB Eindhoven, The Netherlands
| | | | - Maarten Merkx
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O Box 513, 5600 MB Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O Box 513, 5600 MB Eindhoven, The Netherlands
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Axl regulated survival/proliferation network and its therapeutic intervention in mouse models of glomerulonephritis. Arthritis Res Ther 2022; 24:284. [PMID: 36578056 PMCID: PMC9795606 DOI: 10.1186/s13075-022-02965-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/02/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lupus nephritis (LN) is the most common and serious complication of systemic lupus erythematosus (SLE). LN pathogenesis is not fully understood. Axl receptor tyrosine kinase is upregulated and contributes to the pathogenic progress in LN. We have reported that Axl disruption attenuates nephritis development in mice. METHODS In this study, we analyzed the gene expression profiles with RNA-seq using renal cortical samples from nephritic mice. Axl-KO mice were bred onto a B6.lpr spontaneous lupus background, and renal disease development was followed and compared to the Axl-sufficient B6.lpr mice. Finally, anti-glomerular basement membrane (anti-GBM) Ab-induced nephritic mice were treated with Axl small molecule inhibitor, R428, at different stages of nephritis development. Blood urine nitrogen levels and renal pathologies were evaluated. RESULTS Transcriptome analysis revealed that renal Axl activation contributed to cell proliferation, survival, and motility through regulation of the Akt, c-Jun, and actin pathways. Spontaneous lupus-prone B6.lpr mice with Axl deficiency showed significantly reduced kidney damages and decreased T cell infiltration compared to the renal damage and T cell infiltration in Axl-sufficient B6.lpr mice. The improved kidney function was independent of autoAb production. Moreover, R428 significantly reduced anti-GBM glomerulonephritis at different stages of GN development compared to the untreated nephritic control mice. R428 administration reduced inflammatory cytokine (IL-6) production, T cell infiltration, and nephritis disease activity. CONCLUSIONS Results from this study emphasize the important role of Axl signaling in LN and highlight Axl as an attractive target in LN.
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Chen TJ, Mydel P, Benedyk‐Machaczka M, Kamińska M, Kalucka U, Blø M, Furriol J, Gausdal G, Lorens J, Osman T, Marti H. AXL targeting by a specific small molecule or monoclonal antibody inhibits renal cell carcinoma progression in an orthotopic mice model. Physiol Rep 2021; 9:e15140. [PMID: 34877810 PMCID: PMC8652404 DOI: 10.14814/phy2.15140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
AXL tyrosine kinase activation enhances cancer cell survival, migration, invasiveness, and promotes drug resistance. AXL overexpression is typically detected in a high percentage of renal cell carcinomas (RCCs) and is strongly associated with poor prognosis. Therefore, AXL inhibition represents an attractive treatment option in these cancers. In this preclinical study, we investigated the antitumor role of a highly selective small molecule AXL inhibitor bemcentinib (BGB324, BerGenBio), and a newly developed humanized anti-AXL monoclonal function blocking antibody tilvestamab, (BGB149, BerGenBio), in vitro and an orthotopic RCC mice model. The 786-0-Luc human RCC cells showed high AXL expression. Both bemcentinib and tilvestamab significantly inhibited AXL activation induced by Gas6 stimulation in vitro. Furthermore, tilvestamab inhibited the downstream AKT phosphorylation in these cells. The 786-0-Luc human RCC cells generated tumors with high Ki67 and vimentin expression upon orthotopic implantation in athymic BALB/c nude mice. Most importantly, both bemcentinib and tilvestamab inhibited the progression of tumors induced by the orthotopically implanted 786-0 RCC cells. Remarkably, their in vivo antitumor effectiveness was not significantly enhanced by concomitant administration of a multi-target tyrosine kinase inhibitor. Bemcentinib and tilvestamab qualify as compounds of potentially high clinical interest in AXL overexpressing RCC.
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Affiliation(s)
- Tony J. Chen
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Piotr Mydel
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of MicrobiologyJagiellonian UniversityKrakowPoland
| | | | - Marta Kamińska
- Department of MicrobiologyJagiellonian UniversityKrakowPoland
| | - Urszula Kalucka
- Department of MicrobiologyJagiellonian UniversityKrakowPoland
| | | | - Jessica Furriol
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | | | - James Lorens
- Department of BiomedicineCentre for Cancer BiomarkersNorwegian Centre of ExcellenceUniversity of BergenBergenNorway
| | - Tarig Osman
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Hans‐Peter Marti
- Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of MedicineHaukeland University HospitalBergenNorway
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17
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Molecular Mechanisms of Resistance to Immunotherapy and Antiangiogenic Treatments in Clear Cell Renal Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13235981. [PMID: 34885091 PMCID: PMC8656474 DOI: 10.3390/cancers13235981] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most common histological subtype arising from renal cell carcinomas. This tumor is characterized by a predominant angiogenic and immunogenic microenvironment that interplay with stromal, immune cells, and tumoral cells. Despite the obscure prognosis traditionally related to this entity, strategies including angiogenesis inhibition with tyrosine kinase inhibitors (TKIs), as well as the enhancement of the immune system with the inhibition of immune checkpoint proteins, such as PD-1/PDL-1 and CTLA-4, have revolutionized the treatment landscape. This approach has achieved a substantial improvement in life expectancy and quality of life from patients with advanced ccRCC. Unfortunately, not all patients benefit from this success as most patients will finally progress to these therapies and, even worse, approximately 5 to 30% of patients will primarily progress. In the last few years, preclinical and clinical research have been conducted to decode the biological basis underlying the resistance mechanisms regarding angiogenic and immune-based therapy. In this review, we summarize the insights of these molecular alterations to understand the resistance pathways related to the treatment with TKI and immune checkpoint inhibitors (ICIs). Moreover, we include additional information on novel approaches that are currently under research to overcome these resistance alterations in preclinical studies and early phase clinical trials.
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Toboni MD, Lomonosova E, Bruce SF, Tankou JI, Mullen MM, Schab A, Oplt A, Noia H, Wilke D, Kuroki LM, Hagemann AR, McCourt CK, Thaker PH, Powell MA, Khabele D, Mutch DG, Fuh KC. Inhibition of AXL and VEGF-A Has Improved Therapeutic Efficacy in Uterine Serous Cancer. Cancers (Basel) 2021; 13:5877. [PMID: 34884986 PMCID: PMC8656641 DOI: 10.3390/cancers13235877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Endometrial cancer remains the most prevalent gynecologic cancer with continued rising incidence. A less common form of this cancer is uterine serous cancer, which represents 10% of endometrial cancer cases. However, this is the most aggressive cancer. The objective was to assess whether inhibiting the receptor tyrosine kinase AXL with AVB-500 in combination with bevacizumab would improve response in uterine serous cancer. To prove this, we conducted multiple angiogenesis assays including tube formation assays and angiogenesis invasion assays. In addition, we utilized mouse models with multiple cells lines and subsequently analyzed harvested tissue through immunohistochemistry CD31 staining to assess microvessel density. The combination treatment arms demonstrated decreased angiogenic potential in each assay. In addition, intraperitoneal mouse models demonstrated a significant decrease in tumor burden in two cell lines. The combination of AVB-500 and bevacizumab reduced tumor burden in vivo and reduced morphogenesis and migration in vitro which are vital to the process of angiogenesis.
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Affiliation(s)
- Michael D. Toboni
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Elena Lomonosova
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Shaina F. Bruce
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Jo’an I. Tankou
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Mary M. Mullen
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Angela Schab
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Alyssa Oplt
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Hollie Noia
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Danny Wilke
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
| | - Lindsay M. Kuroki
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Andrea R. Hagemann
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Carolyn K. McCourt
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Premal H. Thaker
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Matthew A. Powell
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Dineo Khabele
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - David G. Mutch
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
| | - Katherine C. Fuh
- Barnes Jewish Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO 63110, USA; (M.D.T.); (E.L.); (S.F.B.); (J.I.T.); (M.M.M.); (A.S.); (A.O.); (H.N.); (D.W.); (L.M.K.); (A.R.H.); (C.K.M.); (P.H.T.); (M.A.P.); (D.K.); (D.G.M.)
- Center for Reproductive Health Sciences, Division of Biology and Biomedical Sciences, Washington University, St. Louis, MO 63110, USA
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Therapeutic Targeting of the Gas6/Axl Signaling Pathway in Cancer. Int J Mol Sci 2021; 22:ijms22189953. [PMID: 34576116 PMCID: PMC8469858 DOI: 10.3390/ijms22189953] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/14/2022] Open
Abstract
Many signaling pathways are dysregulated in cancer cells and the host tumor microenvironment. Aberrant receptor tyrosine kinase (RTK) pathways promote cancer development, progression, and metastasis. Hence, numerous therapeutic interventions targeting RTKs have been actively pursued. Axl is an RTK that belongs to the Tyro3, Axl, MerTK (TAM) subfamily. Axl binds to a high affinity ligand growth arrest specific 6 (Gas6) that belongs to the vitamin K-dependent family of proteins. The Gas6/Axl signaling pathway has been implicated to promote progression, metastasis, immune evasion, and therapeutic resistance in many cancer types. Therapeutic agents targeting Gas6 and Axl have been developed, and promising results have been observed in both preclinical and clinical settings when such agents are used alone or in combination therapy. This review examines the current state of therapeutics targeting the Gas6/Axl pathway in cancer and discusses Gas6- and Axl-targeting agents that have been evaluated preclinically and clinically.
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20
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Santoni M, Iacovelli R, Colonna V, Klinz S, Mauri G, Nuti M. Antitumor effects of the multi-target tyrosine kinase inhibitor cabozantinib: a comprehensive review of the preclinical evidence. Expert Rev Anticancer Ther 2021; 21:1029-1054. [PMID: 34445927 DOI: 10.1080/14737140.2021.1919090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Altered receptor tyrosine kinase (RTK) signaling contributes to tumorigenesis and suppression of immune-mediated destruction of cancer cells. Cabozantinib is an oral tyrosine kinase inhibitor that inhibits several RTKs involved in tumorigenesis, and is approved for the treatment of patients with progressive metastatic medullary thyroid cancer, advanced renal cell carcinoma, and hepatocellular carcinoma that has been previously treated with sorafenib. AREAS COVERED We present an up-to-date evaluation of preclinical evidence for RTK inhibition with cabozantinib, specifically VEGFR, MET, KIT, RET, AXL, FLT3, and associated antitumor effects. Preclinical investigations of cabozantinib in combination with other anticancer drugs are also reviewed. EXPERT OPINION Preclinical evidence shows that cabozantinib has antitumor activity against various cancer cells and exhibits synergy with other anticancer agents, including immune checkpoint inhibitors and hormone receptor or metabolic pathway inhibitors. Further optimization of cabozantinib treatment requires the identification of biomarkers of response and resistance, and exploration of complementary drug targets. Investigation of mechanisms of adaptive resistance, such as epithelial to mesenchymal transition (cancer intrinsic) and immunomodulation by the tumor microenvironment (cancer extrinsic), as well as identification of novel drug targets based on characterization of cancer stem cell metabolomic phenotypes, appear to be promising approaches.
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Affiliation(s)
- Matteo Santoni
- MD, U.O.C. Medical Oncology, Macerata Hospital, Macerata, Italy
| | - Roberto Iacovelli
- Medical Oncologist, Medical Oncology Unit, Fondazione Policlinico Agostino Gemelli IRCCS, Roma, Italy
| | - Valentina Colonna
- Global Medical Development Director, Global Oncology R&D, Ipsen S.p.A., Milano, Italy
| | - Stephan Klinz
- Senior Director, Translational Medicine & Biomarkers, Ipsen, United States, MA, USA
| | - Giorgio Mauri
- Medical Advisor Oncology, Ipsen S.p.A., Milano, Italy
| | - Marianna Nuti
- Professor, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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21
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Powles T, Choueiri TK, Motzer RJ, Jonasch E, Pal S, Tannir NM, Signoretti S, Kaldate R, Scheffold C, Wang E, Aftab DT, Escudier B, George DJ. Outcomes based on plasma biomarkers in METEOR, a randomized phase 3 trial of cabozantinib vs everolimus in advanced renal cell carcinoma. BMC Cancer 2021; 21:904. [PMID: 34364385 PMCID: PMC8349489 DOI: 10.1186/s12885-021-08630-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In the phase 3 METEOR trial, cabozantinib improved progression-free survival (PFS) and overall survival (OS) versus everolimus in patients with advanced RCC after prior antiangiogenic therapy. METHODS In this exploratory analysis, plasma biomarkers from baseline and week 4 from 621 of 658 randomized patients were analyzed for CA9, HGF, MET, GAS6, AXL, VEGF, VEGFR2, and IL-8. PFS and OS were analyzed by baseline biomarker levels as both dichotomized and continuous variables using univariate and multivariable methods. For on-treatment changes, PFS and OS were analyzed using fold change in biomarker levels at week 4. Biomarkers were considered prognostic if p < 0.05 and predictive if pinteraction < 0.05 for the interaction between treatment and biomarker. RESULTS Hazard ratios for PFS and OS favored cabozantinib versus everolimus for both low and high baseline levels of all biomarkers (hazard ratios ≤0.78). In univariate analyses, low baseline HGF, AXL, and VEGF were prognostic for improvements in both PFS and OS with cabozantinib, and low HGF was prognostic for improvements in both PFS and OS with everolimus. Low AXL was predictive of relative improvement in PFS for cabozantinib versus everolimus. Results were generally consistent when baseline biomarkers were expressed as continuous variables, although none were predictive of benefit with treatment. In multivariable analysis, low baseline HGF was independently prognostic for improved PFS for both cabozantinib and everolimus; low HGF, GAS6, and VEGF were independently prognostic for improved OS with cabozantinib. No biomarkers were independently prognostic for OS with everolimus. On-treatment increases in some biomarkers appeared prognostic for PFS or OS with cabozantinib in univariate analyses; however, none were independently prognostic in multivariable analysis. CONCLUSIONS PFS and OS were improved with cabozantinib versus everolimus at high and low baseline levels of all biomarkers. Low baseline HGF was consistently identified as a prognostic biomarker for improved PFS or OS with cabozantinib or everolimus, supporting further prospective evaluation of the prognostic significance of HGF in advanced RCC. TRIAL REGISTRATION ClinicalTrials.gov NCT01865747 (registered on 05/31/2013).
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Affiliation(s)
- Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK.
| | | | | | - Eric Jonasch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sumanta Pal
- City of Hope National Medical Center, Duarte, CA, USA
| | - Nizar M Tannir
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Akgül M, Baykan Ö, Çağman Z, Özyürek M, Tinay İ, Akbal C, Uras F, Türkeri L. Gas6 expression and Tyrosine kinase Axl Sky receptors: Their relation with tumor stage and grade in patients with bladder cancer. Arch Ital Urol Androl 2021; 93:148-152. [PMID: 34286546 DOI: 10.4081/aiua.2021.2.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES It has been shown that the dysregulation of tyrosine kinase Axl receptor and its ligand growth arrest-specific gene (Gas6) are associated with poor prognosis in various types of tumors but there is not enough study about their importance in bladder cancer (BC). We evaluated the relation of Gas6 gene expression and tyrosine- kinase Axl and Sky (Tyro 3) receptors with tumor stage and grade in patients with BC. MATERIAL AND METHODS The study group consists of 55 patients whose transurethral resection of bladder (TUR-B) has been performed due to BC and the control group consists of 12 patients with normal bladder mucosa. In tissues mRNAs of Gas6, Axl, and Sky receptors were examined by quantitative (Real-Time) PCR (qPCR). Protein expression was measured by immunohistochemistry. Plasma Gas6 protein levels were compared with control group by ELISA method. RESULTS Patients with BC were grouped as Ta low (n=17), Ta high (n=5), T1 low (n=9), T1 high (n=8) and T2 (n=16) according to their TUR-B pathologies. The qPCR analysis showed that the expression of Gas6 gene and Axl receptor is higher in the tumor-positive group and the immune-histochemical showed that the bladder samples of the tumor-positive group stained significantly positive. When the patients are grouped according to the TUR-B pathologies, a statistical significant difference was observed among groups in the qPCR analysis ratios of Gas6 gene and Axl receptor by (p < 0.05) but no significance was found for Sky receptor (p > 0.05). When Gas6 protein levels in plasma samples were compared by ELISA method, a statistical significance was determined among groups (p = 0.001). CONCLUSIONS Our findings indicate that mRNAs of Gas6 and Axl receptor are closely related to tumor stage and grade in patients with BC. Further studies are needed for understanding the role of Gas6 and its receptors on the neoplastic transformation in terms of novel biomarkers and potential therapeutic targets.
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Affiliation(s)
- Murat Akgül
- Department of Urology, Tekirdag Namık Kemal University Medical School, Tekirdag.
| | - Özgür Baykan
- Department of Biochemistry, Balıkesir University Medical School, Balıkesir.
| | - Zeynep Çağman
- Department of Biochemistry, Bezmialem University, School of Pharmacy, Istanbul.
| | - Mustafa Özyürek
- Department of Physiology, Marmara University, School of Medicine, Istanbul.
| | | | - Cem Akbal
- Department of Urology, Acıbadem University, School of Medicine, Istanbul.
| | - Fikriye Uras
- Department of Biochemistry, Marmara University, School of Pharmacy, Istanbul.
| | - Levent Türkeri
- Department of Urology, Acıbadem University, School of Medicine, Istanbul.
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23
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Xu D, Sun D, Wang W, Peng X, Zhan Z, Ji Y, Shen Y, Geng M, Ai J, Duan W. Discovery of pyrrolo[2,3-d]pyrimidine derivatives as potent Axl inhibitors: Design, synthesis and biological evaluation. Eur J Med Chem 2021; 220:113497. [PMID: 33957388 DOI: 10.1016/j.ejmech.2021.113497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/30/2020] [Accepted: 04/16/2021] [Indexed: 12/18/2022]
Abstract
Axl has emerged as an attractive target for cancer therapy due to its strong correlation with tumor growth, metastasis, poor survival, and drug resistance. Herein, we report the design, synthesis and structure-activity relationship (SAR) investigation of a series of pyrrolo[2,3-d]pyrimidine derivatives as new Axl inhibitors. Among them, the most promising compound 13b showed high enzymatic and cellular Axl potencies. Furthermore, 13b possessed preferable pharmacokinetic properties and displayed promising therapeutic effect in BaF3/TEL-Axl xenograft tumor model. Compound 13b may serve as a lead compound for new antitumor drug discovery.
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Affiliation(s)
- Dandan Xu
- Department of Medicinal Chemistry, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, China
| | - Deqiao Sun
- Division of Antitumor Pharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, China; School of Life Science and Technology, Shanghai Tech University, 393 Middle Huaxia Road, Pudong New District, Shanghai, 201210, China
| | - Wei Wang
- Department of Medicinal Chemistry, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, China
| | - Xia Peng
- Division of Antitumor Pharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China
| | - Zhengsheng Zhan
- Department of Medicinal Chemistry, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China
| | - Yinchun Ji
- Division of Antitumor Pharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China
| | - Yanyan Shen
- Division of Antitumor Pharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China
| | - Meiyu Geng
- Division of Antitumor Pharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, China; School of Life Science and Technology, Shanghai Tech University, 393 Middle Huaxia Road, Pudong New District, Shanghai, 201210, China
| | - Jing Ai
- Division of Antitumor Pharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, China; Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, 1 Xiangshan Branch Lane, Xihu District, Hangzhou, 330106, China.
| | - Wenhu Duan
- Department of Medicinal Chemistry, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (CAS), 555 Zu Chong Zhi Road, Shanghai, 201203, China; University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049, China.
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24
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Tanaka M, Dykes SS, Siemann DW. Inhibition of the Axl pathway impairs breast and prostate cancer metastasis to the bones and bone remodeling. Clin Exp Metastasis 2021; 38:321-335. [PMID: 33791875 PMCID: PMC8179919 DOI: 10.1007/s10585-021-10093-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022]
Abstract
Approximately 90% of cancer-related deaths result from cancer metastasis. In prostate and breast cancers, bone is the most common site of cancer cell dissemination. Key steps in the metastatic cascade are promoted through upregulation of critical cell signaling pathways in neoplastic cells. The present study assessed the role of the receptor tyrosine kinase Axl in prostate and breast cancer cell metastasis to bones using (i) Axl knockdown neoplastic cells and osteoclast progenitor cells in vitro, (ii) intracardiac injection of Axl knockdown tumor cells in vivo, and (iii) selective Axl inhibitor BGB324. Axl inhibition in neoplastic cells significantly decreased their metastatic potential, and suppression of Axl signaling in osteoclast precursor cells also reduced the formation of mature osteoclasts. In vivo, Axl knockdown in prostate and breast cancer cells significantly suppressed the formation and progression of bone metastases. Hence, therapeutic targeting of Axl may impair tumor metastasis to the bones through neoplastic and host cell signaling axes.
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Affiliation(s)
- Mai Tanaka
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, 32610, USA.
| | - Samantha S Dykes
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, 32610, USA.,GenCure, a Subsidiary of BioBridge Global, San Antonio, TX, 78201, USA
| | - Dietmar W Siemann
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL, 32610, USA
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25
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Bufalin down-regulates Axl expression to inhibit cell proliferation and induce apoptosis in non-small-cell lung cancer cells. Biosci Rep 2021; 40:222485. [PMID: 32219334 PMCID: PMC7146032 DOI: 10.1042/bsr20193959] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 12/29/2022] Open
Abstract
Axl, a member of the TAM (Tyro3, AXL, Mer) receptor tyrosine kinase family, plays critical roles in cell growth, proliferation, apoptosis, and migration. In the present study, we demonstrated that the anti-cancer activity of bufalin, a major bioactive component of the Chinese traditional medicine Chan Su, is mediated by the down-regulation of Axl in non-small-cell lung cancer (NSCLC) cells. We observed the inhibitory effect of bufalin on the proliferation of A549 and H460 NSCLC cells and the clonogenicity of these cells was reduced by bufalin treatment in a dose-dependent manner. Next, we found that the protein level of Axl was decreased in proportion to the concentration of bufalin in both A549 and H460 cells. Moreover, the promoter activity of the Axl gene was decreased by bufalin in a dose- and time-dependent manner, indicating that bufalin down-regulates Axl gene expression at the transcriptional level. We further examined if the anti-proliferative property of bufalin is influenced by Axl at the protein level. Axl overexpression attenuated the effect of bufalin in inhibiting cell proliferation and colony formation and inducing apoptosis in H460 cells, while knockdown of Axl gene expression induced the opposite effect. Taken together, our data indicate that the anti-proliferative and pro-apoptotic effects of bufalin were associated with the protein level of Axl, suggesting that Axl is a potent therapeutic target of bufalin in suppressing proliferation and inducing apoptosis in NSCLC cells.
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26
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Kim NY, Yang IJ, Kim S, Lee C. Lotus (Nelumbo nucifera) seedpod extract inhibits cell proliferation and induces apoptosis in non-small cell lung cancer cells via downregulation of Axl. J Food Biochem 2020; 45:e13601. [PMID: 33381866 DOI: 10.1111/jfbc.13601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 12/26/2022]
Abstract
Non-small-cell lung cancer (NSCLC) is the most frequent cause of cancer-related death. In this study, we found the anticancer activity of lotus seedpod extract (LSPE) in NSCLC cells, since LSPE treatment inhibited cell proliferation of A549 and H460 cells in a dose-dependent manner and the clonogenic activities of LSPE-treated cells were also reduced. In LSPE-treated cells, the cleavage of poly (ADP-ribose) polymerase (PARP) and phosphorylation of H2X, were also observed, indicating the pro-apoptotic effect of LSPE. Next, we found that LPSE treatment diminished the levels of protein and mRNA of Axl, a receptor tyrosine kinase (RTK) that transduces critical signals for cell proliferation and inhibition of apoptosis. The promoter activity of Axl was found to be dose-dependently decreased in response to LSPE treatment, implying that LSPE inhibited Axl gene expression at transcriptional level. In addition, Axl overexpression was found to decrease the effects of LSPE on inhibition of cell proliferation and colony formation as well as induction of PARP cleavage and phosphorylation of H2AX, while the same activities of LPSE were increased by knockdown of Axl gene expression, indicating that the antiproliferative and pro-apoptotic effect of LSPE is inversely proportional to the protein level of Axl. Taken together, we found that the LSPE suppressed cell proliferation and induced apoptosis of NSCLC cells, which is attenuated or augmented by overexpression or RNA interference of Axl expression, respectively. Our data suggest that Axl is a novel therapeutic target of LSPE to inhibit cell proliferation and promote apoptosis in NSCLC cells. PRACTICAL APPLICATIONS: In this study, lotus seedpod extract (LSPE) was found to have the cytotoxic and apoptosis-inducing potentials in non-small-cell lung cancer (NSCLC) cells. LSPE downregulated the Axl expression at transcriptional level and the effects of LSPE on cell proliferation as well as apoptosis were affected by Axl protein level. Therefore, the inference of Axl-mediated intracellular signals by LSPE must be a novel approach to control NSCLC. Since our data imply that LSPE contains bioactive compounds targeting Axl, further studies to elucidate these compounds might discover a potent therapeutic agent.
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Affiliation(s)
- Nam-Yi Kim
- Department of Pharmacology, School of Medicine, Dongguk University, Gyeongju, South Korea
| | - In-Jun Yang
- Department of Physiology, College of Korean Medicine, Dongguk University, Gyeongju, South Korea
| | - Soyoung Kim
- Department of Pharmacology, School of Medicine, Dongguk University, Gyeongju, South Korea
| | - ChuHee Lee
- Department of Biochemistry and Molecular Biology, School of Medicine, Yeungnam University, Daegu, South Korea
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27
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Wang KH, Ding DC. Dual targeting of TAM receptors Tyro3, Axl, and MerTK: Role in tumors and the tumor immune microenvironment. Tzu Chi Med J 2020; 33:250-256. [PMID: 34386362 PMCID: PMC8323642 DOI: 10.4103/tcmj.tcmj_129_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/12/2020] [Accepted: 07/02/2020] [Indexed: 11/06/2022] Open
Abstract
In both normal and tumor tissues, receptor tyrosine kinases (RTKs) may be pleiotropically expressed. The RTKs not only regulate ordinary cellular processes, including proliferation, survival, adhesion, and migration, but also have a critical role in the development of many types of cancer. The Tyro3, Axl, and MerTK (TAM) family of RTKs (Tyro3, Axl, and MerTK) plays a pleiotropic role in phagocytosis, inflammation, and normal cellular processes. In this article, we highlight the cellular activities of TAM receptors and discuss their roles in cancer and immune cells. We also discuss cancer therapies that target TAM receptors. Further research is needed to elucidate the function of TAM receptors in immune cells toward the development of new targeted immunotherapies for cancer.
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Affiliation(s)
- Kai-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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28
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Rusanov VB, Pastushkova LK, Larina IM, Chernikova AG, Goncharova AG, Nosovsky AM, Kashirina DN, Brzhozovsky AG, Navasiolava N, Kononikhin AS, Kussmaul AR, Custaud MA, Nikolaev EN. The Effect of Five-Day Dry Immersion on the Nervous and Metabolic Mechanisms of the Circulatory System. Front Physiol 2020; 11:692. [PMID: 32754043 PMCID: PMC7366513 DOI: 10.3389/fphys.2020.00692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/27/2020] [Indexed: 12/26/2022] Open
Abstract
The purpose of the study was to investigate the regulatory and metabolic changes in the circulatory system when simulating microgravity conditions in a five-day dry immersion. These changes reflect the adaptation processes characteristic for the initial stages of a space flight or a short-duration space flight. Studies were conducted with 13 healthy male volunteers aged 21 to 29 years. The assessment of regulatory and metabolic processes in the circulatory system was based on the heart rate variability (HRV) and urine proteomic profile analysis. It was found that the restructuring of hemodynamics during 5 days hypogravity begins with the inclusion of the nervous circuit of regulation, and for manifestations at the body fluids protein composition level and activation of the metabolic regulation, these periods are apparently insufficient. Perhaps this is due to the fact that the metabolic regulation, being evolutionarily ancient and genetically determined, is more stable and requires more time for its pronounced activation when stimulated by extreme life conditions.
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Affiliation(s)
- Vasily B Rusanov
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | | | - Irina M Larina
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Anna G Chernikova
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Anna G Goncharova
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Andrei M Nosovsky
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Daria N Kashirina
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Alexander G Brzhozovsky
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia.,Skolkovo Institute of Science and Technology, Skolkovo, Russia
| | | | - Alexey S Kononikhin
- Skolkovo Institute of Science and Technology, Skolkovo, Russia.,V.L. Talrose Institute for Energy Problems of Chemical Physics, N.N. Semenov Federal Center of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Anna R Kussmaul
- Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
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29
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Rodriguez-Vida A, Bamias A, Esteban E, Saez MI, Lopez-Brea M, Castellano D, Caballero C, Gonzalez-Larriba JL, Calvo E, Macia S, Ravaud A, Bellmunt J. Randomised Phase II study comparing alternating cycles of sunitinib and everolimus vs standard sequential administration in first-line metastatic renal carcinoma (SUNRISES study). BJU Int 2020; 126:559-567. [PMID: 32654362 DOI: 10.1111/bju.15165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the efficacy of alternating cycles of sunitinib and everolimus vs standard sequential treatment of sunitinib followed by everolimus in first-line metastatic renal cell carcinoma (mRCC), as alternating blockade of vascular endothelial growth factor receptor (VEGFR) and mammalian target of rapamycin (mTOR) pathways could potentially prevent the occurrence of resistance to anti-VEGFR therapy in mRCC. PATIENTS AND METHODS SUNRISES, a randomised open-label Phase II study, investigated the efficacy of alternating cycles of sunitinib and everolimus vs standard sequential treatment of sunitinib followed by everolimus upon progression. Treatment-naïve patients with clear-cell mRCC were included. Alternating treatment consisted on 12 weeks of sunitinib, followed by 12 weeks of everolimus. The primary endpoint was the progression-free survival (PFS) rate at 1 year. The secondary endpoints included the median PFS, overall survival (OS), response rate, and safety. RESULTS Accrual was low due to the advent of new-generation therapies, and the study was stopped prematurely. Only 41 patients out of the planned 102 patients were accrued, and randomised in a 2:1 ratio (15 patients to the control arm, 26 to the experimental arm). In all, 60.9% of patients had performance status (PS) 0 and 39% PS 1; 63% had a favourable prognostic risk profile, while 36% were intermediate risk. The primary endpoint was not met. The 1-year PFS rate was 49.7% (experimental arm) vs 84.62% (control arm; P = 0.11). There was a trend towards fewer Grade ≥3 adverse events with the alternating approach (50% vs 73.3%; P = 0.14). The median OS was similar in both treatment arms. The other secondary endpoints favoured the control arm. CONCLUSIONS The study failed to show any benefit of alternating cycles of sunitinib and everolimus in patients with mRCC. The alternating approach using an mTOR inhibitor does not seem to prevent the occurrence of resistance to VEGFR blockade.
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Affiliation(s)
- Alejo Rodriguez-Vida
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Isabel Saez
- UGCI of Medical Oncology, Hospitales Regional and Universitario Virgen de la Victoria, Málaga, Spain.,Institute of Biomedical Research (IBIMA), Málaga, Spain
| | | | | | | | | | - Emiliano Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | | | - Alain Ravaud
- Hôpital Saint André, Bordeaux University Hospital, Bordeaux, France
| | - Joaquim Bellmunt
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.,Beth Israel Deaconess Medical Center and PSMAR_IMIM Research Lab, Harvard Medical School, Boston, MA, USA
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30
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Gas6/Axl Signaling Pathway in the Tumor Immune Microenvironment. Cancers (Basel) 2020; 12:cancers12071850. [PMID: 32660000 PMCID: PMC7408754 DOI: 10.3390/cancers12071850] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 01/19/2023] Open
Abstract
Receptor tyrosine kinases have been shown to dysregulate a number of pathways associated with tumor development, progression, and metastasis. Axl is a receptor tyrosine kinase expressed in many cancer types and has been associated with therapy resistance and poor clinical prognosis and outcomes. In addition, Axl and its ligand growth arrest specific 6 (Gas6) protein are expressed by a number of host cells. The Gas6/Axl signaling pathway has been implicated in the promotion of tumor cell proliferation, survival, migration, invasion, angiogenesis, and immune evasion. As a result, Axl is an attractive, novel therapeutic target to impair multiple stages of tumor progression from both neoplastic and host cell axes. This review focuses on the role of the Gas6/Axl signaling pathway in promoting the immunosuppressive tumor microenvironment, as immune evasion is considered one of the hallmarks of cancer. The review discusses the structure and activation of the Gas6/Axl signaling pathway, GAS6 and AXL expression patterns in the tumor microenvironment, mechanisms of Axl-mediated tumor immune response, and the role of Gas6/Axl signaling in immune cell recruitment.
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Mao S, Wu Y, Wang R, Guo Y, Bi D, Ma W, Zhang W, Zhang J, Yan Y, Yao X. Overexpression of GAS6 Promotes Cell Proliferation and Invasion in Bladder Cancer by Activation of the PI3K/AKT Pathway. Onco Targets Ther 2020; 13:4813-4824. [PMID: 32547108 PMCID: PMC7261663 DOI: 10.2147/ott.s237174] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background Growth arrest-specific 6 (GAS6) is a secreted vitamin K-dependent protein abnormally expressed in various human tumor tissues and can activate the receptor Tyro3, Axl, and Mer to promote cancer cell proliferation and invasion. Until now, the role of GAS6 has been poorly understood in bladder cancer (BCa). Materials and Methods Using bioinformatics analysis, we screened genes significantly associated with overall survival in BCa. The association between GAS6 and survival was evaluated by tissue microarray and IHC staining. We investigated the effect of GAS6 on the development of BCa through in vitro and in vivo experiments. Results Here, we report that GAS6 is highly expressed in bladder cancer and is significantly associated with tumor grade, T stage, and worse prognosis. We found that GAS6 depletion inhibited proliferation, migration, and invasion of BCa cells. In addition, bioinformatics analysis revealed that GAS6 may be involved in the regulation of PI3K-AKT signaling pathway by binding to receptor TAM and has a significant positive correlation with PI3K family gene expression. Furthermore, Western blot experiments have shown that GAS6 might modulate the PI3K-AKT signaling to regulate proliferation and invasion of BCa cells. Treatment of BCa cells with SC79, an AKT activator, partially restored the effect of GAS6 silencing on cell proliferation and invasion. Conclusion The present study suggests that GAS6 may play a pivotal role in the development of BCa and may be a potential target for its treatment.
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Affiliation(s)
- Shiyu Mao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
| | - Yuan Wu
- Department of Urology, Shanghai Tenth People's Hospital, Anhui Medical University, Hefei 230032, People's Republic of China
| | - Ruiliang Wang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
| | - Yadong Guo
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
| | - Dexi Bi
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
| | - Wenchao Ma
- Department of Urology, Shanghai Tenth People's Hospital, Anhui Medical University, Hefei 230032, People's Republic of China
| | - Wentao Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
| | - Junfeng Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
| | - Yang Yan
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
| | - Xudong Yao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, People's Republic of China
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Heme oxygenase-1 inhibition mediates Gas6 to enhance bortezomib-sensitivity in multiple myeloma via ERK/STAT3 axis. Aging (Albany NY) 2020; 12:6611-6629. [PMID: 32298237 PMCID: PMC7202511 DOI: 10.18632/aging.102996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/20/2020] [Indexed: 02/03/2023]
Abstract
Chemoresistance is still a critical challenge for efficient treatment of multiple myeloma (MM) during the bortezomib-based chemotherapy. Recent studies have suggested that heme oxygenase-1 (HO-1) is involved in apoptosis, proliferation and chemoresistance in cancer cells. Here we aim to investigate the role and mechanism of HO-1 in bortezomib-sensitivity to myeloma cells. In the study population, we found that HO-1 was highly expressed in CD138+ primary myeloma cells, which was positively associated with Gas6 expression and Gas6 plasma levels in MM patients. Downregulation of HO-1 using pharmacological inhibitor ZnPPIX or siRNA knockdown significantly enhanced myeloma cell sensitivity to bortezomib in human primary CD138+ cells, U266 and RPMI8226 cell lines. Mechanistically, HO-1 regulated Gas6 production via ERK/STAT3 axis. Combination with HO-1 inhibition increased bortezomib-induced apoptosis and antiproliferative effects via suppressing Gas6 production. These findings suggest that combination of bortezomib and HO-1 inhibitor may serve as a promising therapeutic target against bortezomib-resistant MM.
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Sarukhanyan E, Shityakov S, Dandekar T. Rational Drug Design of Axl Tyrosine Kinase Type I Inhibitors as Promising Candidates Against Cancer. Front Chem 2020; 7:920. [PMID: 32117858 PMCID: PMC7010640 DOI: 10.3389/fchem.2019.00920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 12/18/2019] [Indexed: 12/15/2022] Open
Abstract
The high level of Axl tyrosine kinase expression in various cancer cell lines makes it an attractive target for the development of anti-cancer drugs. In this study, we carried out several sets of in silico screening for the ATP-competitive Axl kinase inhibitors based on different molecular docking protocols. The best drug-like candidates were identified, after parental structure modifications, by their highest affinity to the target protein. We found that our newly designed compound R5, a derivative of the R428 patented analog, is the most promising inhibitor of the Axl kinase according to the three molecular docking algorithms applied in the study. The molecular docking results are in agreement with the molecular dynamics simulations using the MM-PBSA/GBSA implicit solvation models, which confirm the high affinity of R5 toward the protein receptor. Additionally, the selectivity test against other kinases also reveals a high affinity of R5 toward ABL1 and Tyro3 kinases, emphasizing its promising potential for the treatment of malignant tumors.
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Affiliation(s)
- Edita Sarukhanyan
- Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany
| | - Sergey Shityakov
- Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany.,Department of Anesthesia and Critical Care, University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Thomas Dandekar
- Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany
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Flem-Karlsen K, Nyakas M, Farstad IN, McFadden E, Wernhoff P, Jacobsen KD, Flørenes VA, Mælandsmo GM. Soluble AXL as a marker of disease progression and survival in melanoma. PLoS One 2020; 15:e0227187. [PMID: 31917795 PMCID: PMC6952099 DOI: 10.1371/journal.pone.0227187] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/14/2019] [Indexed: 12/14/2022] Open
Abstract
Receptor tyrosine kinase AXL is a one-pass transmembrane protein upregulated in cancers and associated with lower survival and therapy resistance. AXL can be cleaved by the A Disintegrin and Metalloproteinases (ADAM)10 and ADAM17, yielding a soluble version of the protein. Elevated soluble AXL (sAXL) has been reported to be associated with disease progression in hepatocellular carcinoma, renal cancer, neurofibromatosis type 1 and inflammatory diseases. In the present work, we analyzed sAXL levels in blood from melanoma patients and showed that sAXL increases with disease progression. Additionally, increased sAXL levels were found correlated with shorter two-year survival in stage IV patients treated with ipilimumab. Furthermore, we showed that sAXL levels were related to the percentage of cells expressing AXL in resected melanoma lymph node metastases. This finding was verified in vitro, where sAXL levels in the cell media corresponded to AXL expression in the cells. AXL inhibition using the small-molecular inhibitor BGB324 reduced sAXL levels, while the cellular expression was elevated through increased protein stability. Our findings signify that quantification of sAXL blood levels is a simple and easily assessable method to determine cellular AXL levels and should be further evaluated for its use as a biomarker of disease progression and treatment response.
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Affiliation(s)
- Karine Flem-Karlsen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Marta Nyakas
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Tumor Biology, Institute for Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Inger Nina Farstad
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erin McFadden
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Patrik Wernhoff
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kari Dolven Jacobsen
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Vivi Ann Flørenes
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Gunhild Mari Mælandsmo
- Department of Tumor Biology, Institute for Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Institute of Medical Biology, Faculty of Health Sciences, UiT–Arctic University of Norway, Tromsø, Norway
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Xiao Y, Zhao H, Tian L, Nolley R, Diep AN, Ernst A, Fuh KC, Miao YR, von Eyben R, Leppert JT, Brooks JD, Peehl DM, Giaccia AJ, Rankin EB. S100A10 Is a Critical Mediator of GAS6/AXL-Induced Angiogenesis in Renal Cell Carcinoma. Cancer Res 2019; 79:5758-5768. [PMID: 31585940 DOI: 10.1158/0008-5472.can-19-1366] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/09/2019] [Accepted: 09/25/2019] [Indexed: 12/24/2022]
Abstract
Angiogenesis is a hallmark of cancer that promotes tumor progression and metastasis. However, antiangiogenic agents have limited efficacy in cancer therapy due to the development of resistance. In clear cell renal cell carcinoma (ccRCC), AXL expression is associated with antiangiogenic resistance and poor survival. Here, we establish a role for GAS6/AXL signaling in promoting the angiogenic potential of ccRCC cells through the regulation of the plasminogen receptor S100A10. Genetic and therapeutic inhibition of AXL signaling in ccRCC tumor xenografts reduced tumor vessel density and growth under the renal capsule. GAS6/AXL signaling activated the expression of S100A10 through SRC to promote plasmin production, endothelial cell invasion, and angiogenesis. Importantly, treatment with the small molecule AXL inhibitor cabozantinib or an ultra-high affinity soluble AXL Fc fusion decoy receptor (sAXL) reduced the growth of a pazopanib-resistant ccRCC patient-derived xenograft. Moreover, the combination of sAXL synergized with pazopanib and axitinib to reduce ccRCC patient-derived xenograft growth and vessel density. These findings highlight a role for AXL/S100A10 signaling in mediating the angiogenic potential of ccRCC cells and support the combination of AXL inhibitors with antiangiogenic agents for advanced ccRCC. SIGNIFICANCE: These findings show that angiogenesis in renal cell carcinoma (RCC) is regulated through AXL/S100A10 signaling and support the combination of AXL inhibitors with antiangiogenic agents for the treatment of RCC.
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Affiliation(s)
- Yiren Xiao
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Hongjuan Zhao
- Department of Urology, Stanford University, Palo Alto, California
| | - Lei Tian
- Department of Medicine, Division of Cardiology, Stanford University, Palo Alto, California
| | - Rosalie Nolley
- Department of Urology, Stanford University, Palo Alto, California
| | - Anh N Diep
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Anne Ernst
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Katherine C Fuh
- Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri
| | - Yu Rebecca Miao
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - John T Leppert
- Department of Urology, Stanford University, Palo Alto, California
| | - James D Brooks
- Department of Urology, Stanford University, Palo Alto, California
| | - Donna M Peehl
- Department of Urology, Stanford University, Palo Alto, California
| | - Amato J Giaccia
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Erinn B Rankin
- Department of Radiation Oncology, Stanford University, Palo Alto, California.
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
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Nonagase Y, Takeda M, Azuma K, Hayashi H, Haratani K, Tanaka K, Yonesaka K, Ishii H, Hoshino T, Nakagawa K. Tumor tissue and plasma levels of AXL and GAS6 before and after tyrosine kinase inhibitor treatment in EGFR-mutated non-small cell lung cancer. Thorac Cancer 2019; 10:1928-1935. [PMID: 31419057 PMCID: PMC6775020 DOI: 10.1111/1759-7714.13166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/27/2019] [Accepted: 07/28/2019] [Indexed: 12/01/2022] Open
Abstract
Background Non‐small cell lung cancer (NSCLC) positive for activating mutations of the epidermal growth factor receptor (EGFR) gene is initially sensitive to EGFR‐tyrosine kinase inhibitors (TKIs) but eventually develops resistance to these drugs. Upregulation of the receptor tyrosine kinase AXL in tumor tissue has been detected in about one‐fifth of NSCLC patients with acquired resistance to EGFR‐TKIs. However, the clinical relevance of the levels of AXL and its ligand GAS6 in plasma remains unknown. Methods Tumor tissue and plasma specimens were collected from 25 EGFR‐mutated NSCLC patients before EGFR‐TKI treatment or after treatment failure. The levels of AXL and of GAS6 mRNA in tumor tissue were evaluated by immunohistochemistry and chromogenic in situ hybridization, respectively. The plasma concentrations of AXL and GAS6 were measured with enzyme‐linked immunosorbent assays. Results AXL expression was detected in three of 12 (25%) and nine of 19 (47%) tumor specimens obtained before and after EGFR‐TKI treatment, respectively. All tumor specimens assayed were positive for GAS6 mRNA. The median values for the plasma AXL concentration before and after EGFR TKI treatment were 1 635 and 1 460 pg/mL, respectively, and those for the plasma GAS6 concentration were 4 615 and 6 390 pg./mL, respectively. There was no significant correlation between the plasma levels of AXL or GAS6 and the corresponding expression levels in tumor tissue. Conclusion Plasma concentrations of AXL and GAS6 do not reflect tumor expression levels, and their measurement is thus not a viable alternative to direct analysis of tumor tissue in EGFR‐mutated NSCLC.
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Affiliation(s)
- Yoshikane Nonagase
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Koji Haratani
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kaoru Tanaka
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kimio Yonesaka
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Hidenobu Ishii
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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Silaghi CN, Ilyés T, Filip VP, Farcaș M, van Ballegooijen AJ, Crăciun AM. Vitamin K Dependent Proteins in Kidney Disease. Int J Mol Sci 2019; 20:ijms20071571. [PMID: 30934817 PMCID: PMC6479974 DOI: 10.3390/ijms20071571] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 12/12/2022] Open
Abstract
Patients with chronic kidney disease (CKD) have an increased risk of developing vascular calcifications, as well as bone dynamics impairment, leading to a poor quality of life and increased mortality. Certain vitamin K dependent proteins (VKDPs) act mainly as calcification inhibitors, but their involvement in the onset and progression of CKD are not completely elucidated. This review is an update of the current state of knowledge about the relationship between CKD and four extrahepatic VKDPs: matrix Gla protein, osteocalcin, growth-arrest specific protein 6 and Gla-rich protein. Based on published literature in the last ten years, the purpose of this review is to address fundamental aspects about the link between CKD and circulating VKDPs levels as well as to raise new topics about how the interplay between molecular weight and charge could influence the modifications of circulating VKDPs at the glomerular level, or whether distinct renal etiologies have effect on VKDPs. This review is the output of a systematic literature search and may open future research avenues in this niche domain.
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Affiliation(s)
- Ciprian N Silaghi
- Department of Molecular Sciences, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania.
| | - Tamás Ilyés
- Department of Molecular Sciences, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania.
| | - Vladimir P Filip
- Department of Molecular Sciences, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania.
| | - Marius Farcaș
- Department of Molecular Sciences, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania.
| | - Adriana J van Ballegooijen
- Department of Nephrology & Epidemiology and Biostatistics, Amsterdam University Medical Center, VUmc, 1117 HV Amsterdam, The Netherlands.
| | - Alexandra M Crăciun
- Department of Molecular Sciences, University of Medicine and Pharmacy "Iuliu Hațieganu", 400012 Cluj-Napoca, Romania.
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Tata P, Gondaliya P, Sunkaria A, Srivastava A, Kalia K. Modulation of CD44, EGFR and RAC Pathway Genes (WAVE Complex) in Epithelial Cancers. Curr Pharm Des 2019; 25:833-848. [PMID: 30799784 DOI: 10.2174/1381612825666190222143044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/13/2019] [Indexed: 12/12/2022]
Abstract
Cancer hallmarks help in understanding the diversity of various neoplasms. Epithelial cancers play an immense role in the tumor biology through Epithelial-Mesenchymal Transition (EMT) process. Receptor tyrosine kinase, as well as phosphatidyl ionositol-3 kinase pathways, play an important role in the regulation of cell proliferation, survival, and differentiation during EMT. Till date, numerous studies have shown modulation in the expression profile of potential targets like CD44, EGFR, and Rac in epithelial cancers. CD44 interacts with EGFR and recruits other molecules which further activate the Rac pathway intermediates. This review mainly focused on modulation of genes like CD44, EGFR, and Rac pathway intermediates which play a crucial role in the tumor progression, metastasis, proliferation, and invasion characteristics in epithelial cancers with EMT properties. Hence, targeting Rac pathway might be a more strategically relevant approach in treating epithelial cancers.
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Affiliation(s)
- Pranathi Tata
- National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Palaj, Opposite Air Force Station, Gandhinagar, Gujarat-382355, India
| | - Piyush Gondaliya
- National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Palaj, Opposite Air Force Station, Gandhinagar, Gujarat-382355, India
| | - Aditya Sunkaria
- National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Palaj, Opposite Air Force Station, Gandhinagar, Gujarat-382355, India
| | - Akshay Srivastava
- National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Palaj, Opposite Air Force Station, Gandhinagar, Gujarat-382355, India
| | - Kiran Kalia
- National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Palaj, Opposite Air Force Station, Gandhinagar, Gujarat-382355, India
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Abstract
IMPACT STATEMENT Cancer is among the leading causes of death worldwide. In 2016, 8.9 million people are estimated to have died from various forms of cancer. The current treatments, including surgery with chemotherapy and/or radiation therapy, are not effective enough to provide full protection from cancer, which highlights the need for developing novel therapy strategies. In this review, we summarize the molecular biology of a unique member of a subfamily of receptor tyrosine kinase, TYRO3 and discuss the new insights in TYRO3-targeted treatment for cancer therapy.
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Affiliation(s)
- Pei-Ling Hsu
- 1 Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Jonathan Jou
- 2 College of Medicine, University of Illinois, IL 60612, USA
| | - Shaw-Jenq Tsai
- 1 Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
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Flem Karlsen K, McFadden E, Flørenes VA, Davidson B. Soluble AXL is ubiquitously present in malignant serous effusions. Gynecol Oncol 2019; 152:408-415. [PMID: 30448261 DOI: 10.1016/j.ygyno.2018.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/02/2018] [Accepted: 11/09/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the expression level and clinical role of soluble AXL (sAXL) in cancers affecting the serosal surfaces, with focus on ovarian carcinoma. METHODS sAXL protein expression by ELISA was analyzed in 572 effusion supernatants, including 424 peritoneal, 147 pleural and 1 pericardial specimens. RESULTS sAXL was overexpressed in peritoneal effusions compared to pleural and pericardial specimens (p < 0.001). sAXL levels were additionally significantly higher in effusions from patients with ovarian carcinoma, malignant mesothelioma and breast carcinoma compared to specimens from patients with other cancers (predominantly carcinomas of lung, gastrointestinal or uterine corpus/cervix origin) or benign reactive effusions (p < 0.001). sAXL was further overexpressed in high-grade serous carcinoma (HGSC; n = 373) compared to low-grade serous carcinoma (LGSC; n = 32; p = 0.036). In HGSC, sAXL levels were significantly lower in post-chemotherapy effusions compared to primary diagnosis pre-chemotherapy specimens (p = 0.002). sAXL levels in HGSC were unrelated to chemoresponse at diagnosis, progression-free survival or overall survival. Levels were similarly unrelated to survival in LGSC and breast carcinoma. CONCLUSIONS sAXL is widely expressed in malignant effusions, particularly in ovarian and breast carcinoma and in malignant mesothelioma. sAXL is overexpressed in HGSC compared to LGSC and its levels are lower following exposure to chemotherapy. However, sAXL levels are not informative of chemoresponse or survival.
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Affiliation(s)
- Karine Flem Karlsen
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, N-0310 Oslo, Norway; University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, N-0316 Oslo, Norway
| | - Erin McFadden
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, N-0310 Oslo, Norway
| | - Vivi Ann Flørenes
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, N-0310 Oslo, Norway
| | - Ben Davidson
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, N-0310 Oslo, Norway; University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, N-0316 Oslo, Norway.
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Cabozantinib versus sunitinib as initial therapy for metastatic renal cell carcinoma of intermediate or poor risk (Alliance A031203 CABOSUN randomised trial): Progression-free survival by independent review and overall survival update. Eur J Cancer 2018; 94:115-125. [PMID: 29550566 PMCID: PMC6057479 DOI: 10.1016/j.ejca.2018.02.012] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/01/2018] [Accepted: 02/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The randomised phase 2 CABOSUN trial comparing cabozantinib with sunitinib as initial therapy for advanced renal cell carcinoma (RCC) of intermediate or poor risk met the primary end-point of improving progression-free survival (PFS) as assessed by investigator. We report PFS by independent radiology review committee (IRC) assessment, ORR per IRC and updated overall survival (OS). PATIENTS AND METHODS Previously untreated patients with advanced RCC of intermediate or poor risk by IMDC criteria were randomised 1:1 to cabozantinib 60 mg daily or sunitinib 50 mg daily (4 weeks on/2 weeks off). Stratification was by risk group and presence of bone metastases. RESULTS A total of 157 patients were randomised 1:1 to cabozantinib (n = 79) or sunitinib (n = 78). Median PFS per IRC was 8.6 months (95% confidence interval [CI] 6.8-14.0) versus 5.3 months (95% CI 3.0-8.2) for cabozantinib versus sunitinib (hazard ratio [HR] 0.48 [95% CI 0.31-0.74]; two-sided p = 0.0008), and ORR per IRC was 20% (95% CI 12.0-30.8) versus 9% (95% CI 3.7-17.6), respectively. Subgroup analyses of PFS by stratification factors and MET tumour expression were consistent with results for the overall population. With a median follow-up of 34.5 months, median OS was 26.6 months (95% CI 14.6-not estimable) with cabozantinib and 21.2 months (95% CI 16.3-27.4) with sunitinib (HR 0.80 [95% CI 0.53-1.21]. The incidence of grade 3 or 4 adverse events was 68% for cabozantinib and 65% for sunitinib. CONCLUSIONS In this phase 2 trial, cabozantinib treatment significantly prolonged PFS per IRC compared with sunitinib as initial systemic therapy for advanced RCC of poor or intermediate risk. TRIAL REGISTRATION NUMBER NCT01835158.
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Cella D, Escudier B, Tannir NM, Powles T, Donskov F, Peltola K, Schmidinger M, Heng DY, Mainwaring PN, Hammers HJ, Lee JL, Roth BJ, Marteau F, Williams P, Baer J, Mangeshkar M, Scheffold C, Hutson TE, Pal S, Motzer RJ, Choueiri TK. Quality of Life Outcomes for Cabozantinib Versus Everolimus in Patients With Metastatic Renal Cell Carcinoma: METEOR Phase III Randomized Trial. J Clin Oncol 2018; 36:757-764. [PMID: 29377755 PMCID: PMC6804841 DOI: 10.1200/jco.2017.75.2170] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose In the phase III METEOR trial ( ClinicalTrials.gov identifier: NCT01865747), 658 previously treated patients with advanced renal cell carcinoma were randomly assigned 1:1 to receive cabozantinib or everolimus. The cabozantinib arm had improved progression-free survival, overall survival, and objective response rate compared with everolimus. Changes in quality of life (QoL), an exploratory end point, are reported here. Patients and Methods Patients completed the 19-item Functional Assessment of Cancer Therapy-Kidney Symptom Index (FKSI-19) and the five-level EuroQol (EQ-5D-5L) questionnaires at baseline and throughout the study. The nine-item FKSI-Disease-Related Symptoms (FKSI-DRS), a subset of FKSI-19, was also investigated. Data were summarized descriptively and by repeated-measures analysis (for which a clinically relevant difference was an effect size ≥ 0.3). Time to deterioration (TTD) was defined as the earlier of date of death, radiographic progressive disease, or ≥ 4-point decrease from baseline in FKSI-DRS. Results The QoL questionnaire completion rates remained ≥ 75% through week 48 in each arm. There was no difference over time for FKSI-19 Total, FKSI-DRS, or EQ-5D data between the cabozantinib and everolimus arms. Among the individual FKSI-19 items, cabozantinib was associated with worse diarrhea and nausea; everolimus was associated with worse shortness of breath. These differences are consistent with the adverse event profile of each drug. Cabozantinib improved TTD overall, with a marked improvement in patients with bone metastases at baseline. Conclusion In patients with advanced renal cell carcinoma, relative to everolimus, cabozantinib generally maintained QoL to a similar extent. Compared with everolimus, cabozantinib extended TTD overall and markedly improved TTD in patients with bone metastases.
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Affiliation(s)
- David Cella
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Bernard Escudier
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Nizar M. Tannir
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Thomas Powles
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Frede Donskov
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Katriina Peltola
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Manuela Schmidinger
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Daniel Y.C. Heng
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Paul N. Mainwaring
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Hans J. Hammers
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Jae Lyun Lee
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Bruce J. Roth
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Florence Marteau
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Paul Williams
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - John Baer
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Milan Mangeshkar
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Christian Scheffold
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Thomas E. Hutson
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Sumanta Pal
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Robert J. Motzer
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K. Choueiri
- David Cella, Northwestern University Feinberg School of Medicine, Chicago, IL; Bernard Escudier, Institut Gustave Roussy, Villejuif; Florence Marteau, Ipsen Pharma, Boulogne-Billancourt; Paul Williams, Mapi Group, Lyon, France; Nizar M. Tannir, University of Texas MD Anderson Cancer Center Hospital, Houston; Hans J. Hammers, University of Texas Southwestern Medical Center; Thomas E. Hutson, Texas Oncology-Baylor Sammons Cancer Center, Dallas, TX; Thomas Powles, Queen Mary University of London, London, United Kingdom; Frede Donskov, Aarhus University Hospital, Aarhus, Denmark; Katriina Peltola, Helsinki University Hospital Cancer Center, Helsinki, Finland; Manuela Schmidinger, Medical University of Vienna, Vienna, Austria; Daniel Y.C. Heng, University of Calgary, Calgary, Alberta, Canada; Paul N. Mainwaring, Icon Cancer Care, Brisbane, Queensland, Australia; Jae Lyun Lee, University of Ulsan College of Medicine, Seoul, South Korea; Bruce J. Roth, Washington University in St Louis, St Louis, MO; John Baer, Milan Mangeshkar, and Christian Scheffold, Exelixis, South San Francisco; Sumanta Pal, City of Hope National Medical Center, Duarte, CA; Robert J. Motzer, Memorial Sloan Kettering Cancer Center, New York, NY; and Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA
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Tannir NM, Pal SK, Atkins MB. Second-Line Treatment Landscape for Renal Cell Carcinoma: A Comprehensive Review. Oncologist 2018; 23:540-555. [PMID: 29487224 DOI: 10.1634/theoncologist.2017-0534] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022] Open
Abstract
The management of advanced clear-cell renal cell carcinoma has steadily improved over the past decade with the introduction of antiangiogenic and targeted therapies. Recently, three new therapies have been approved for use as second-line options that further advance the treatment armamentarium: nivolumab, a monoclonal antibody targeting the programmed cell death receptor; cabozantinib, a small-molecule tyrosine kinase inhibitor (TKI) of vascular endothelial growth factor receptor (VEGFR), MET, and AXL; and lenvatinib, a small-molecule TKI of VEGF and fibroblast growth factor receptors that is used in combination with everolimus, an inhibitor of the mechanistic target of rapamycin. Together, these and previously approved second-line treatments offer clinicians the ability to better individualize treatment for patients after progression on first-line VEGFR-targeted therapies. In this comprehensive review, we discuss the efficacy and safety results from the pivotal trials of these newly approved therapies, including the quality of study design, the level of evidence, subgroup analyses, and how these data can help to guide clinicians to select the most appropriate second-line therapy for their patients. IMPLICATIONS FOR PRACTICE This review article provides the reader with a comprehensive overview of current treatment options for patients with advanced clear-cell renal cell carcinoma (RCC) whose disease has progressed after their first therapy. As many patients with RCC experience disease progression with initial treatments, effective second-line therapies are critical. Nivolumab, cabozantinib, and lenvatinib plus everolimus have recently been approved as second-line treatments. The new agents discussed in this review increase the therapeutic options available and provide physicians with opportunities to individualize treatments for their patients, with a view to improving disease control and survival outcomes.
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Affiliation(s)
- Nizar M Tannir
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C., USA
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Shen Y, Chen X, He J, Liao D, Zu X. Axl inhibitors as novel cancer therapeutic agents. Life Sci 2018; 198:99-111. [PMID: 29496493 DOI: 10.1016/j.lfs.2018.02.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/07/2018] [Accepted: 02/23/2018] [Indexed: 12/17/2022]
Abstract
Overexpression and activation of Axl receptor tyrosine kinase have been widely accepted to promote cell proliferation, chemotherapy resistance, invasion, and metastasis in several human cancers, such as lung, breast, and pancreatic cancers. Axl, a member of the TAM (Tyro3, Axl, Mer) family, and its inhibitors can specifically break the kinase signaling nodes, allowing advanced patients to regain drug sensitivity with improved therapeutic efficacy. Therefore, the research on Axl is promising and it is worthy of further investigations. In this review, we present an update on the Axl inhibitors and provide new insights into their latent application.
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Affiliation(s)
- Yingying Shen
- Institute of Clinical Medicine, The First Affiliated Hospital of University of South China, Hengyang, Hunan 421001, PR China
| | - Xiguang Chen
- Institute of Clinical Medicine, The First Affiliated Hospital of University of South China, Hengyang, Hunan 421001, PR China
| | - Jun He
- Department of Spine Surgery, the Affiliated Nanhua Hospital of University of South China, Hengyang, Hunan 421001, PR China
| | - Duanfang Liao
- Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha 410208, Hunan, PR China
| | - Xuyu Zu
- Institute of Clinical Medicine, The First Affiliated Hospital of University of South China, Hengyang, Hunan 421001, PR China.
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Zhang S, Xu XS, Yang JX, Guo JH, Chao TF, Tong Y. The prognostic role of Gas6/Axl axis in solid malignancies: a meta-analysis and literature review. Onco Targets Ther 2018; 11:509-519. [PMID: 29416351 PMCID: PMC5789043 DOI: 10.2147/ott.s150952] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Axl is a receptor tyrosine kinase that is involved in many pathological conditions and carcinogenesis. Gas6 is the major ligand of Axl. Activation of Gas6/Axl pathway is essential for cancer development. However, its prognostic significance in solid tumors remains unclear. Therefore, we performed this meta-analysis to elucidate the prognostic impact of Axl. Methods Published studies on Axl or Gas6 expression and overall survival (OS) and/or disease-free survival (DFS) were searched from databases. The outcome measurement is hazard ratio (HR) for OS or DFS related to Axl/Gas6 expression. Meta-analysis was performed using RevMan. The pooled HR was calculated by fixed-/random-effect models. Results A total of 3,344 patients from 25 studies were included. The results of meta-analysis showed that Axl overexpression was correlated with shorter OS (HR: 2.03, p<0.0001) and DFS (HR: 1.85, p<0.0001). In subgroup analysis, Axl expression was significantly correlated with poor prognosis in hepatocellular, esophageal and lung cancer. Axl expression was associated with differentiation grade, TNM stage, lymph node and distant metastasis. Conclusion These results suggest that Axl overexpression is correlated with poor prognosis in solid tumors. This correlation varies among different types of cancers. More studies are needed to further investigate the prognostic value of Axl.
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Affiliation(s)
- Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Shang Xu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Xi Yang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Hui Guo
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Teng Fei Chao
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - YiXin Tong
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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TAM receptors Tyro3 and Mer as novel targets in colorectal cancer. Oncotarget 2018; 7:56355-56370. [PMID: 27486820 PMCID: PMC5302919 DOI: 10.18632/oncotarget.10889] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/26/2016] [Indexed: 02/05/2023] Open
Abstract
Purpose CRC remains the third most common cancer worldwide with a high 5-year mortality rate in advanced cases. Combined with chemotherapy, targeted therapy is an additional treatment option. However as CRC still escapes targeted therapy the vigorous search for new targets is warranted to increase patients' overall survival. Results In this study we describe a new role for Gas6/protein S-TAM receptor interaction in CRC. Gas6, expressed by tumor-infiltrating M2-like macrophages, enhances malignant properties of tumor cells including proliferation, invasion and colony formation. Upon chemotherapy macrophages increase Gas6 synthesis, which significantly attenuates the cytotoxic effect of 5-FU chemotherapy on tumor cells. The anti-coagulant protein S has similar effects as Gas6. In CRC patient samples Tyro3 was overexpressed within the tumor. In-vitro inhibition of Tyro3 and Mer reduces tumor cell proliferation and sensitizes tumor cells to chemotherapy. Moreover high expression of Tyro3 and Mer in tumor tissue significantly shortens CRC patients' survival. Experimental design Various in vitro models were used to investigate the role of Gas6 and its TAM receptors in human CRC cells, by stimulation (rhGas6) and knockdown (siRNA) of Axl, Tyro3 and Mer. In terms of a translational research, we additionally performed an expression analysis in human CRC tissue and analyzed the medical record of these patients. Conclusions Tyro3 and Mer represent novel therapeutic targets in CRC and warrant further preclinical and clinical investigation in the future.
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Jung Y, Decker AM, Wang J, Lee E, Kana LA, Yumoto K, Cackowski FC, Rhee J, Carmeliet P, Buttitta L, Morgan TM, Taichman RS. Endogenous GAS6 and Mer receptor signaling regulate prostate cancer stem cells in bone marrow. Oncotarget 2017; 7:25698-711. [PMID: 27028863 PMCID: PMC5041937 DOI: 10.18632/oncotarget.8365] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/07/2016] [Indexed: 12/29/2022] Open
Abstract
GAS6 and its receptors (Tryo 3, Axl, Mer or “TAM”) are known to play a role in regulating tumor progression in a number of settings. Previously we have demonstrated that GAS6 signaling regulates invasion, proliferation, chemotherapy-induced apoptosis of prostate cancer (PCa) cells. We have also demonstrated that GAS6 secreted from osteoblasts in the bone marrow environment plays a critical role in establishing prostate tumor cell dormancy. Here we investigated the role that endogenous GAS6 and Mer receptor signaling plays in establishing prostate cancer stem cells in the bone marrow microenvironment. We first observed that high levels of endogenous GAS6 are expressed by disseminated tumor cells (DTCs) in the bone marrow, whereas relatively low levels of endogenous GAS6 are expressed in PCa tumors grown in a s.c. setting. Interestingly, elevated levels of endogenous GAS6 were identified in putative cancer stem cells (CSCs, CD133+/CD44+) compared to non-CSCs (CD133–/CD44–) isolated from PCa/osteoblast cocultures in vitro and in DTCs isolated from the bone marrow 24 hours after intracardiac injection. Moreover, we found that endogenous GAS6 expression is associated with Mer receptor expression in growth arrested (G1) PCa cells, which correlates with the increase of the CSC populations. Importantly, we found that overexpression of GAS6 activates phosphorylation of Mer receptor signaling and subsequent induction of the CSC phenotype in vitro and in vivo. Together these data suggest that endogenous GAS6 and Mer receptor signaling contribute to the establishment of PCa CSCs in the bone marrow microenvironment, which may have important implications for targeting metastatic disease.
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Affiliation(s)
- Younghun Jung
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Ann M Decker
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Jingcheng Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Eunsohl Lee
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Lulia A Kana
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Kenji Yumoto
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Frank C Cackowski
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - James Rhee
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Vesalius Research Center (VRC), VIB, K.U. Leuven, Belgium.,Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, K.U. Leuven, Belgium
| | - Laura Buttitta
- Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Todd M Morgan
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Russell S Taichman
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Zucca LE, Morini Matushita MA, da Silva Oliveira RJ, Scapulatempo-Neto C, de Lima MA, Ribeiro GG, Viana CR, Cárcano FM, Reis RM. Expression of tyrosine kinase receptor AXL is associated with worse outcome of metastatic renal cell carcinomas treated with sunitinib. Urol Oncol 2017; 36:11.e13-11.e21. [PMID: 28986088 DOI: 10.1016/j.urolonc.2017.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) represents 2%-3% of all cancers of the Western countries. Currently, sunitinib, a receptor tyrosine kinase inhibitor, particularly of PDGF and VEGF receptors, is the first-line therapy for metastatic RCC (mRCC), with significant improvement in clinical outcome. However, there is a lack of predictive biomarkers of sunitinib response. Recently, others and our group suggested that the receptor tyrosine kinase AXL may modify the response to sunitinib. OBJECTIVE To study the expression of AXL in a series patients with of mRCC treated with sunitinib and to correlate it with patient's clinic-pathological features and therapeutic response. MATERIAL AND METHODS Sixty-four patients with mRCC (51 clear cell carcinomas (CCCs) and 13 non-CCCs) were evaluated for AXL expression by immunohistochemistry in the primary tumor. RESULTS AXL positivity was observed in 47% (30/64) of cases, namely in 43% (22/51) of CCCs and 61% (8/13) of non-CCC. Considering only the clear cell subtype, the univariate analysis showed that AXL expression was statistically associated with a poor prognosis, with a median overall survival of 13 months vs. 43 months in patients with negative AXL. In this subtype, along with the AXL positivity, other prognostic factors were absence of nephrectomy, Karnofsky performance status, more than 1 site of metastasis and liver metastasis. Moreover, AXL expression was associated with shorter progression to sunitinib. Overall, the multivariate survival analysis showed that absence of nephrectomy (HR = 4.85, P = 0.001), more than 1 site of metastasis (HR = 2.99, P = 0.002), bone metastasis (HR = 2.95, P = 0.001), together with AXL expression (HR = 2.01, P = 0.048) were independent poor prognostic factor in patients with mRCC. CONCLUSION AXL expression was associated with worse clinical outcome and may be an important prognostic biomarker in sunitinib-treated patients with metastatic renal cell carcinoma.
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Affiliation(s)
- Luís Eduardo Zucca
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Medical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | | | - Cristovam Scapulatempo-Neto
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Pathology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marcos Alves de Lima
- Nucleous of Epidemiology and Statistics, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | | | - Flavio Mavignier Cárcano
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Medical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Barretos School of Health Sciences, Dr. Paulo Prata-FACISB, Barretos, São Paulo, Brazil
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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Abstract
Clear cell renal cell carcinoma (RCC) is characterized by inactivation of the von Hippel-Lindau (VHL) tumor suppressor gene. VHL loss drives tumor angiogenesis and accounts for the clinical activity of VEGF receptor (VEGFR) tyrosine kinase inhibitors (TKIs), the first-line standard of care for advanced RCC. Within the last year, three new second-line treatments have received FDA approval for use after anti-angiogenic therapy: the immune checkpoint inhibitor nivolumab, the TKI cabozantinib, and the combination of the TKI lenvatinib and the mTOR inhibitor everolimus. Cabozantinib inhibits VEGFRs, MET, and AXL, kinases that promote tumorigenesis, angiogenesis, metastasis, and drug resistance. Compared with everolimus, cabozantinib has shown statistically significant improvements in the three key efficacy endpoints of overall survival, progression-free survival, and objective response rate in patients with RCC who were previously treated with a VEGFR TKI. Herein, we summarize the translational research and clinical development that led to approval of cabozantinib as second-line therapy in RCC.
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Affiliation(s)
- Nizar M. Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1374, Houston, TX 77030 USA
| | - Gisela Schwab
- Exelixis, Inc., 210 E. Grand Avenue, South San Francisco, CA 94080 USA
| | - Viktor Grünwald
- Departments of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Medical School Hannover (MHH), OE6860 Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Abstract
The influx of multiple novel therapeutic options in the mRCC field has brought a challenge for treatment sequencing in this disease. In the past few years, cabozantinib, nivolumab and the combination of lenvatinib and everolimus have been approved in the second-line setting. As there is no direct comparison between these agents and the studies have failed to show improved benefit among a biomarker-selected patient population, appropriate patient selection based on clinical factors for individualized therapy is critical. Herein we provide a comprehensive overview of current data from each agent through the discussion of disease biology, clinical trials, potential biomarkers and distilling future perspectives in the field.
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Affiliation(s)
- Manuel Caitano Maia
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nazli Dizman
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Meghan Salgia
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta Kumar Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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