Heterogeneity and Phenotypic Instability of Chemotherapeutic and Immunologic Sensitivity in Murine and Human Melanoma Cell Clones

Different effects of NK cells and NK-derived soluble factors on cell lines derived from primary or metastatic pancreatic cancers

Natural killer (NK) cells are cytotoxic lymphoid cells that play a key role in defenses against tumors. However, their function may be severely impaired in patients with pancreatic adenocarcinoma (PA). Indeed, PA cells release soluble factors, thereby generating an immunosuppressive environment that dysregulates NK-cell cytolytic function and favors tumor immune evasion. Here, we analyzed the interactions between NK and PA cells using the PANC-1 and CAPAN-1 cell lines derived from a ductal PA and metastatic lesion, respectively. Metastatic and nonmetastatic cell lines were both able to impair NK cytolytic activity. An analysis of the effect of NK cells and NK-cell-derived exosomes revealed substantial differences between the two cell lines. Thus, NK cells displayed higher cytotoxicity against nonmetastatic PA cells than metastatic PA cells in both 2D cultures and in a 3D extracellular matrix cell system. In addition, NK-derived exosomes could penetrate only PANC-1 spheroids and induce cell killing. Remarkably, when PANC-1 cells were exposed to NK-derived soluble factors, they displayed substantial changes in the expression of genes involved in epithelial-to-mesenchymal transition (EMT) and acquired resistance to NK-mediated cytolysis. These results, together with their correlation with poor clinical outcomes in PA patients, suggest that the induction of resistance to cytolysis upon exposure to NK-derived soluble factors could reflect the occurrence of EMT in tumor cells. Our data indicate that a deeper investigation of the interaction between NK cells and tumor cells may be crucial for immunotherapy, possibly improving the outcome of PA treatment by targeting critical steps of NK-tumor cell crosstalk.

Drug rechallenge and treatment beyond progression--implications for drug resistance

The established dogma in oncology for managing recurrent or refractory disease dictates that therapy is changed at disease progression, because the cancer is assumed to have become drug-resistant. Drug resistance, whether pre-existing or acquired, is largely thought to be a stable and heritable process; thus, reuse of therapeutic agents that have failed is generally contraindicated. Over the past few decades, clinical evidence has suggested a role for unstable, non-heritable mechanisms of acquired drug resistance pertaining to chemotherapy and targeted agents. There are many examples of circumstances where patients respond to reintroduction of the same therapy (drug rechallenge) after a drug holiday following disease relapse or progression during therapy. Additional, albeit limited, evidence suggests that, in certain circumstances, continuing a therapy beyond disease progression can also have antitumour activity. In this Review, we describe the anticancer agents used in these treatment strategies and discuss the potential mechanisms explaining the apparent tumour re-sensitization with reintroduced or continued therapy. The extensive number of malignancies and drugs that challenge the custom of permanently switching to different drugs at each line of therapy warrants a more in-depth examination of the definitions of disease progression and drug resistance and the resulting implications for patient care.

Telomere dynamics determine episodes of anticancer drug resistance in rat hepatoma cells

Clinical and experimental observations indicate that resistance to anticancer drugs may be spontaneously reversible over time, but the mechanisms of this reversal are unknown. The resistance of cultured hepatoma cells to methotrexate (MTX) and cisplatin was followed for 9 months. Cells were exposed to three treatments: MTX 200 nM for 24 h or 15 nM continuously and cisplatin 50 microM for 2 h. We investigated the relation between the temporal pattern of cell resistance and the previously reported fluctuations in cell proliferation rate, telomere length and telomerase activity. Spontaneous major peaks in resistance to each drug fell in time windows of 2-3 months (60-70 population doublings) and were at different times for each drug. The frequency of the fluctuations in drug resistance was the same as that of variations in cell growth rate, but amplitudes were unrelated. By contrast, resistance was directly related to telomere length dynamics in the same cells. MTX resistance occurred when telomeres shortened and cisplatin resistance when they were elongated. Furthermore, peaks of resistance to the continuous treatment with MTX were observed at 350-bp intervals of mean telomere length (9.06, 9.41, and 9.76 kbp) during the two 2-month phases of telomere shortening. Statistical analysis demonstrates the sinusoidal relationship between intermittent MTX resistance and telomere length. Possibly, erosion of telomeres encroaches on periodically spaced nucleosomal proteins, defining the onset of resistance phases. This evidence that resistance of tumoral cells to anticancer drugs may be intermittent and that onset of resistance is dictated by telomere length has major implications for clinical practice.

Retreatment of patients with the same chemotherapy: implications for clinical mechanisms of drug resistance

BACKGROUND

Patients who relapse after adjutant chemotherapy, or after attaining remission following treatment of advanced disease, are sometimes retreated with the same type of chemotherapy. The objective of the current review of published reports was to assess the probability of response to retreatment, and to examine evidence for transient rather than stable forms of clinical drug resistance.

METHODS

A Medline review of published clinical series where patients were retreated with the same chemotherapy that they had received previously.

RESULTS

We located 15 reports of patients with advanced disease who were retreated with the same chemotherapy following complete remission and subsequent relapse, and three reports where patients received the same chemotherapy that was given previously as adjuvant treatment for breast cancer. For patients with advanced disease the median time off-treatment was 48 weeks; response rates to retreatment using appropriate criteria were in the range of 18%-100% (median 51%), with a substantial proportion of second complete responses. For patients retreated after adjuvant chemotherapy for breast cancer the median interval between treatments was 84 weeks and the response rates were in the range of 40%-51%.

CONCLUSIONS

With the caveat that this type of review is subject to publication bias, retreatment of patients who relapse after complete response to initial therapy, or after adjuvant therapy, is associated with a substantial probability of response. Together with evidence that more prolonged or intensive initial therapy rarely leads to more frequent or more prolonged responses, the current review suggests that some patients may develop transient resistance to chemotherapy.