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Wang S, Gan L, Han L, Deng P, Li Y, He D, Chi H, Zhu L, Li Y, Long R, Gan Z. Design, synthesis, and biological evaluation of naphthalene imidazo[1,2-b]pyridazine hybrid derivatives as VEGFR selective inhibitors. Arch Pharm (Weinheim) 2024:e2400411. [PMID: 39008876 DOI: 10.1002/ardp.202400411] [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: 05/24/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/17/2024]
Abstract
The vascular endothelial growth factor receptor (VEGFR) is a receptor tyrosine kinase that is regarded as an emerging target for abnormal angiogenesis diseases. In this study, novel naphthalene imidazo[1,2-b]pyridazine hybrids as VEGFR selective inhibitors were designed and synthesized using a scaffold hopping strategy based on ponatinib, a multitarget kinase inhibitor. Among the evaluated compounds, derivative 9k (WS-011) demonstrated the most potent inhibitory potency against VEGFR-2 (IC50 = 8.4 nM) and displayed superior VEGFR selectivity over a panel of 70 kinases compared with ponatinib. Furthermore, 9k possessed good cytotoxic effects on various cancer cell lines, especially the colon cancer HT-29 cells, with an acceptable oral bioavailability. Moreover, 9k significantly inhibited the migration and invasion of human umbilical vein endothelial cells (HUVEC) cells and induced apoptosis through the upregulation of apoptotic proteins in HT-29 cells. 9k also effectively suppressed the activation of VEGFR-2 signaling pathways, which in turn inhibited the growth of HT-29 cells and the tube formation of HUVECs in vitro. All of the findings revealed that 9k could be considered a promising antiangiogenesis lead that merits further investigation.
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Affiliation(s)
- Shuang Wang
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
| | - LinLing Gan
- Chongqing Engineering Research Center of Pharmaceutical Sciences, School of Pharmacy, Chongqing Medical and Pharmaceutical College, Chongqing, People's Republic of China
| | - Lei Han
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ping Deng
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yihao Li
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
| | - Dongxiao He
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
| | - Haoze Chi
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
| | - Liwei Zhu
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuehui Li
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
| | - Rui Long
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zongjie Gan
- Department of Medicinal Chemistry, College of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China
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Metabolomic Analysis to Elucidate Mechanisms of Sunitinib Resistance in Renal Cell Carcinoma. Metabolites 2020; 11:metabo11010001. [PMID: 33374949 PMCID: PMC7821950 DOI: 10.3390/metabo11010001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023] Open
Abstract
Metabolomics analysis possibly identifies new therapeutic targets in treatment resistance by measuring changes in metabolites accompanying cancer progression. We previously conducted a global metabolomics (G-Met) study of renal cell carcinoma (RCC) and identified metabolites that may be involved in sunitinib resistance in RCC. Here, we aimed to elucidate possible mechanisms of sunitinib resistance in RCC through intracellular metabolites. We established sunitinib-resistant and control RCC cell lines from tumor tissues of RCC cell (786-O)-injected mice. We also quantified characteristic metabolites identified in our G-Met study to compare intracellular metabolism between the two cell lines using liquid chromatography-mass spectrometry. The established sunitinib-resistant RCC cell line demonstrated significantly desuppressed protein kinase B (Akt) and mesenchymal-to-epithelial transition (MET) phosphorylation compared with the control RCC cell line under sunitinib exposure. Among identified metabolites, glutamine, glutamic acid, and α-KG (involved in glutamine uptake into the tricarboxylic acid (TCA) cycle for energy metabolism); fructose 6-phosphate, D-sedoheptulose 7-phosphate, and glucose 1-phosphate (involved in increased glycolysis and its intermediate metabolites); and glutathione and myoinositol (antioxidant effects) were significantly increased in the sunitinib-resistant RCC cell line. Particularly, glutamine transporter (SLC1A5) expression was significantly increased in sunitinib-resistant RCC cells compared with control cells. In this study, we demonstrated energy metabolism with glutamine uptake and glycolysis upregulation, as well as antioxidant activity, was also associated with sunitinib resistance in RCC cells.
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Mishan MA, Tabari MAK, Parnian J, Fallahi J, Mahrooz A, Bagheri A. Functional mechanisms of miR-192 family in cancer. Genes Chromosomes Cancer 2020; 59:722-735. [PMID: 32706406 DOI: 10.1002/gcc.22889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022] Open
Abstract
By growing research on the mechanisms and functions of microRNAs (miRNAs, miRs), the role of these noncoding RNAs gained more attention in healthcare. Due to the remarkable regulatory role of miRNAs, any dysregulation in their expression causes cellular functional impairment. In recent years, it has become increasingly apparent that these small molecules contribute to development, cell differentiation, proliferation, apoptosis, and tumor growth. In many studies, the miR-192 family has been suggested as a potential prognostic and diagnostic biomarker and even as a possible therapeutic target for several cancers. However, the mechanistic effects of the miR-192 family on cancer cells are still controversial. Here, we have reviewed each family member of the miR-192 including miR-192, miR-194, and miR-215, and discussed their mechanistic roles in various cancers.
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Affiliation(s)
- Mohammad Amir Mishan
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Khazeei Tabari
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
- USERN Office, Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Parnian
- Department of Biotechnology, Iranian Research Organization for Science and Technology, Tehran, Iran
| | - Jafar Fallahi
- Molecular Medicine Department, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolkarim Mahrooz
- Department of Clinical Biochemistry and Medical Genetics, Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abouzar Bagheri
- Department of Clinical Biochemistry and Medical Genetics, Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Weiss A, Boehm M, Egemnazarov B, Grimminger F, Savai Pullamsetti S, Kwapiszewska G, Schermuly RT. Kinases as potential targets for treatment of pulmonary hypertension and right ventricular dysfunction. Br J Pharmacol 2020; 178:31-53. [PMID: 31709514 DOI: 10.1111/bph.14919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/07/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022] Open
Abstract
Pulmonary hypertension (PH) is a progressive pulmonary vasculopathy that causes chronic right ventricular pressure overload and often leads to right ventricular failure. Various kinase inhibitors have been studied in the setting of PH and either improved or worsened the disease, highlighting the importance of understanding the specific role of the respective kinases in a spatiotemporal cellular context. In this review, we will summarize the knowledge on the role of kinases in PH and focus on druggable targets for which certain criteria are met: (a) deregulation of the kinase in PH; (b) small-molecule inhibitors are available (e.g. from the oncology field); (c) preclinical studies have shown their efficacy in PH models; and (d) when available, therapeutic exploitation in human PH has been initiated. Along this line, clinical considerations such as personalized medicine approaches to predict therapy response and adverse side events such as cardiotoxicity together with their clinical management are discussed. LINKED ARTICLES: This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.1/issuetoc.
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Affiliation(s)
- Astrid Weiss
- Department of Internal Medicine, Justus-Liebig University Giessen, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Mario Boehm
- Department of Internal Medicine, Justus-Liebig University Giessen, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | | | - Friedrich Grimminger
- Department of Internal Medicine, Justus-Liebig University Giessen, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | | | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Otto Loewi Center, Physiology, Medical University of Graz, Graz, Austria
| | - Ralph T Schermuly
- Department of Internal Medicine, Justus-Liebig University Giessen, Giessen, Germany
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Bruchbacher A, Nachbargauer S, Fajkovic H, Schmidinger M. Sunitinib Dose Escalation in Metastatic Renal Cell Carcinoma. KIDNEY CANCER 2019. [DOI: 10.3233/kca-190055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Andreas Bruchbacher
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Sebastian Nachbargauer
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Austria
| | - Manuela Schmidinger
- Department of Medicine I, Clinical Division of Oncology and Comprehensive Cancer Center, Medical University of Vienna, Austria
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Lin HY, Chen YR, Li ZL, Shih YJ, Davis P, Whang-Peng J, Wang K. Thyroid hormone, PD-L1, and cancer. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_26_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Li J, Wang M, Zhang B, Wu X, Lin TL, Liu XF, Zhou Y, Zhang XH, Xu H, Shen LJ, Zou J, Lu P, Zhang D, Gu WJ, Zhang MX, Pan J, Cao H. Chinese consensus on management of tyrosine kinase inhibitor-associated side effects in gastrointestinal stromal tumors. World J Gastroenterol 2018; 24:5189-5202. [PMID: 30581268 PMCID: PMC6295840 DOI: 10.3748/wjg.v24.i46.5189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have improved the overall survival of patients with gastrointestinal stromal tumors (GISTs), but their side effects can impact dose intensity and, consequently, the clinical benefit. To date, no guideline or consensus has been published on the TKI-associated adverse reactions. Therefore, the Chinese Society of Surgeons for Gastrointestinal Stromal Tumor of the Chinese Medical Doctor Association organized an expert panel discussion involving representatives from gastrointestinal surgery, medical oncology, cardiology, dermatology, nephrology, endocrinology, and ophthalmology to consider the systemic clinical symptoms, molecular and cellular mechanisms, and treatment recommendations of GISTs. Here, we present the resultant evidence- and experience-based consensus to guide the management of TKI-associated side events in clinical practice.
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Affiliation(s)
- Jian Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Ming Wang
- Department of Gastrointestinal Surgery, Reiji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin Wu
- Department of General Surgery, the General Hospital of the People’s Liberation Army, Beijing 100853, China
| | - Tian-Long Lin
- Department of Gastrointestinal Surgery, Reiji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Xiu-Feng Liu
- Department of Oncology, The Chinese People’s Liberation Army 81st Hospital, Nanjing 210031, Jiangsu Province, China
| | - Ye Zhou
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xin-Hua Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Hao Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 320100, Jiangsu Province, China
| | - Li-Jing Shen
- Department of Hematology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Jing Zou
- Department of Respirology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Ping Lu
- Department of Dermatology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200240, China
| | - Dong Zhang
- Department of Nephrology, The General Hospital of the People’s Liberation Army, Beijing 100853, China
| | - Wei-Jun Gu
- Department of Endocrinology, The General Hospital of the People’s Liberation Army, Beijing 100853, China
| | - Mei-Xia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jian Pan
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hui Cao
- Department of Gastrointestinal Surgery, Reiji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
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Characterisation of the Morphological, Functional and Molecular Changes in Sunitinib-Resistant Renal Cell Carcinoma Cells. J Kidney Cancer VHL 2018; 5:1-9. [PMID: 30109169 PMCID: PMC6088203 DOI: 10.15586/jkcvhl.2018.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/16/2018] [Indexed: 12/12/2022] Open
Abstract
Sunitinib resistance is a major clinical problem hampering the treatment of renal cell carcinoma (RCC). Studies on the comprehensive characterisation of morphological, functional and molecular changes in sunitinib-resistant RCC cells are lacking. The aim of the current study was to develop sunitinib resistance in four human RCC cell lines (786-0, Caki-1, Caki-2 and SN12K1), and to characterise the changed cell biology with sunitinib resistance. RCC cells were made resistant by continuous, chronic exposure to 10 μM of sunitinib over a period of 12 months. Cell proliferation, morphology, transmigration, and gene expression for interleukin-6 (IL-6), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), Bcl-2 and Bax were studied. There was no significant difference in growth rate or transmigration between the parental and resistant cells. Sunitinib-resistant cells were significantly hypertrophic compared with parental cells as evidenced by increases in the surface areas of the whole cells and the nuclei. IL-6 was significantly increased in all resistant cells. IL-8 was increased in sunitinib-resistant Caki-2 and SN12K1 cells and decreased in 786-0 without any significant changes in Caki-1. VEGF was increased in resistant Caki-2 and SN12K1 cells but not in 786-0 and Caki-1. The Bcl2/Bax ratio was increased in Caki-1, Caki-2 and SN12K1 cells but decreased in 786-0 cells. The increased IL-6 may contribute to sunitinib resistance either via VEGF-mediated angiogenesis or through shifting of the Bcl2/Bax balance in favour of anti-apoptosis.
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Simard H, Sabbagh R, Ouellet S, Richard P, Jeldres C. The impact of targeted therapy on healthcare resource use in patients with metastatic renal cell carcinoma: The University of Sherbrooke experience. Can Urol Assoc J 2018; 12:E373-E377. [PMID: 29787371 DOI: 10.5489/cuaj.4924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We assessed the impact of targeted therapies on healthcare resource use and compared treatment regimens used in patients diagnosed with metastatic renal cell carcinoma (mRCC). METHODS Clinicopathological and administrative data of patients with mRCC from our institution were retrospectively collected from January 2000 to August 2014. Patients were divided into two groups based on the use of targeted therapies. Healthcare resource use (HCRU) data included non-scheduled total number of hospitalizations, total days hospitalized, emergency department visits, and healthcare professional consultations. Each variable was presented with absolute and relative values (i.e., per month of survival). Statistics relied on the use of t-student and Chi-square tests. RESULTS Ninety-nine patients were included in the study; 60 were treated with targeted therapy. There were no statistically significant differences between the two groups for demographic features and clinicopathological stage. HCRU analysis revealed an absolute increase in the median number of healthcare consultants (6 vs. 4; p<0.01) and emergency department visits (1 vs. 0; p=0.02) for the targeted therapy group. However, analysis per month of survival showed the targeted therapy group had fewer consultants (0.33 vs. 0.40; p=0.04) and hospitalizations (0.09 vs. 0.13; p=0.03) than their counterpart. Population size, non-randomization, treatment selection bias, and heterogeneity were the main limitations of this study. CONCLUSIONS Monthly use of HCRU is lower in mRCC patients treated with targeted therapies. However, because of a greater overall survival, their absolute total HCRU will be higher than those not exposed to targeted agents.
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Affiliation(s)
- Hugo Simard
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Robert Sabbagh
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Simon Ouellet
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Patrick Richard
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Claudio Jeldres
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
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Pharmacogenetics-based area-under-curve model can predict efficacy and adverse events from axitinib in individual patients with advanced renal cell carcinoma. Oncotarget 2018; 9:17160-17170. [PMID: 29682213 PMCID: PMC5908314 DOI: 10.18632/oncotarget.24715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/26/2018] [Indexed: 12/22/2022] Open
Abstract
We investigated the relationship between axitinib pharmacogenetics and clinical efficacy/adverse events in advanced renal cell carcinoma (RCC) and established a model to predict clinical efficacy and adverse events using pharmacokinetic and gene polymorphisms related to drug metabolism and efflux in a phase II trial. We prospectively evaluated the area under the plasma concentration–time curve (AUC) of axitinib, objective response rate, and adverse events in 44 consecutive advanced RCC patients treated with axitinib. To establish a model for predicting clinical efficacy and adverse events, polymorphisms in genes including ABC transporters (ABCB1 and ABCG2), UGT1A, and OR2B11 were analyzed by whole-exome sequencing, Sanger sequencing, and DNA microarray. To validate this prediction model, calculated AUC by 6 gene polymorphisms was compared with actual AUC in 16 additional consecutive patients prospectively. Actual AUC significantly correlated with the objective response rate (P = 0.0002) and adverse events (hand-foot syndrome, P = 0.0055; and hypothyroidism, P = 0.0381). Calculated AUC significantly correlated with actual AUC (P < 0.0001), and correctly predicted objective response rate (P = 0.0044) as well as adverse events (P = 0.0191 and 0.0082, respectively). In the validation study, calculated AUC prior to axitinib treatment precisely predicted actual AUC after axitinib treatment (P = 0.0066). Our pharmacogenetics-based AUC prediction model may determine the optimal initial dose of axitinib, and thus facilitate better treatment of patients with advanced RCC.
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Maráz A, Cserháti A, Uhercsák G, Szilágyi É, Varga Z, Révész J, Kószó R, Varga L, Kahán Z. Dose escalation can maximize therapeutic potential of sunitinib in patients with metastatic renal cell carcinoma. BMC Cancer 2018; 18:296. [PMID: 29544452 PMCID: PMC5856318 DOI: 10.1186/s12885-018-4209-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/09/2018] [Indexed: 12/24/2022] Open
Abstract
Background In patients with metastatic renal cell cancer, based on limited evidence, increased sunitinib exposure is associated with better outcome. The survival and toxicity data of patients receiving individualized dose escalated sunitinib therapy as compared to standard management were analyzed in this study. Methods From July 2013, the data of metastatic renal cell cancer patients with slight progression but still a stable disease according to RECIST 1.1 criteria treated with an escalated dose of sunitinib (first level: 62.5 mg/day in 4/2 or 2 × 2/1 scheme, second level: 75 mg/day in 4/2 or 2 × 2/1 scheme) were collected prospectively. Regarding characteristics, outcome, and toxicity data, an explorative retrospective analysis of the register was carried out, comparing treatments after and before July 1, 2013 in the study (selected patients for escalated dose) and control (standard dose) groups, respectively. Results The study involved 103 patients receiving sunitinib therapy with a median overall and progression free survival of 25.36 ± 2.62 and 14.2 ± 3.22 months, respectively. Slight progression was detected in 48.5% of them. First and second-level dose escalation were indicated in 18.2% and 4.1% of patients, respectively. The dosing scheme was modified in 22.2%. The median progression free survival (39.7 ± 5.1 vs 14.2 ± 1.3 months (p = 0.037)) and the overall survival (57.5 ± 10.7 vs 27.9 ± 2.5 months (p = 0.044)) were significantly better in the study group (with dose escalation) than in the control group. Patients with nephrectomy and lower Memorial Sloan Kettering Cancer Center (MSKCC) scores showed more favorable outcomes. After dose escalation, the most common adverse events were worsening or development of fatigue, hypertension, stomatitis, and weight loss of over 10%. Conclusions Escalation of sunitinib dosing in selected patients with metastatic renal cell cancer, especially in case of slight progression, based on tolerable toxicity is safe and improves outcome. Dose escalation in 12.5 mg steps may be recommended for properly educated patients.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary.
| | - Adrienn Cserháti
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Gabriella Uhercsák
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Éva Szilágyi
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Zoltán Varga
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - János Révész
- Institute of Radiotherapy and Clinical Oncology, Borsod County Hospital and University Academic Hospital, Szentpéteri Kapu 72-76, Miskolc, H-3526, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Linda Varga
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
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Yumioka T, Osaki M, Sasaki R, Yamaguchi N, Onuma K, Iwamoto H, Morizane S, Honda M, Takenaka A, Okada F. Lysosome-associated membrane protein 2 (LAMP-2) expression induced by miR-194-5p downregulation contributes to sunitinib resistance in human renal cell carcinoma cells. Oncol Lett 2017; 15:893-900. [PMID: 29399154 PMCID: PMC5772808 DOI: 10.3892/ol.2017.7423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/07/2017] [Indexed: 12/31/2022] Open
Abstract
Sunitinib is a tyrosine kinase inhibitor that is used as the primary treatment in metastatic renal cell carcinoma (RCC). The main difficulty associated with its use is the development of drug resistance. In the present study, ACHN cells, a human renal cell carcinoma cell line, were used to establish sunitinib-resistant (SR) cells. Microarray analysis and reverse transcription-quantitative polymerase chain reaction revealed that miR-194-5p expression was significantly decreased in SR-ACHN cells when compared with that observed in ACHN cells (P<0.05). Transfection of miR-194-5p, though not with negative control miR, in SR-ACHN cells could significantly inhibit cell proliferation following sunitinib treatment (2.5–40 µM; P<0.05). Western blotting demonstrated that the expression of lysosome-associated membrane protein-2 (LAMP-2), which attenuates the anti-proliferative effect of sunitinib, was significantly higher in SR-ACHN than in ACHN cells (P<0.01). In addition, LAMP-2 expression was suppressed by miR-194-5p transfection in SR-ACHN cells. These data suggested that miR-194-5p downregulation may be associated with sunitinib resistance via the induction of LAMP-2 expression in human RCC.
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Affiliation(s)
- Tetsuya Yumioka
- Division of Pathological Biochemistry, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan.,Division of Urology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan
| | - Mitsuhiko Osaki
- Division of Pathological Biochemistry, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan.,Chromosome Engineering Research Center, Tottori University, Tottori 683-8503, Japan
| | - Ryo Sasaki
- Division of Pathological Biochemistry, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan
| | - Noriya Yamaguchi
- Division of Pathological Biochemistry, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan.,Division of Urology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan
| | - Kunishige Onuma
- Division of Pathological Biochemistry, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan
| | - Hideto Iwamoto
- Division of Urology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan
| | - Shuichi Morizane
- Division of Urology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan
| | - Masashi Honda
- Division of Urology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan
| | - Atsushi Takenaka
- Division of Urology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan
| | - Futoshi Okada
- Division of Pathological Biochemistry, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan.,Chromosome Engineering Research Center, Tottori University, Tottori 683-8503, Japan
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Nagyiványi K, Budai B, Küronya Z, Gyergyay F, Bíró K, Bodrogi I, Géczi L. Outcome of Restarted Sunitinib Treatment in Patients with Metastatic Renal Cell Carcinoma: a Retrospective Trial and Combined Case Reports from Literature. Pathol Oncol Res 2017; 25:241-247. [PMID: 29086352 DOI: 10.1007/s12253-017-0345-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/20/2017] [Indexed: 12/01/2022]
Abstract
In practice it is still not clear whether a drug holiday in sunitinib (Su) treatment can be safety, without impairing the overall outcome of patients with metastatic renal cell carcinoma (mRCC). The aim was to retrospectively evaluate the outcome in patients who restarted Su after an interruption of ≥3 months and a combined analysis of case studies from literature. From 556 patients treated between January 2006 and March 2016 a group of 38 patients were selected whose treatment was interrupted for other reasons than disease progression. During interruption Su was restarted in case of RECIST-defined progression. The primary objective was the objective response (OR) and progression free survival (PFS) of baseline and restarted therapy. The secondary objective was the overall survival (OS) calculated from the start of baseline treatment. Multivariate survival analysis was also applied. The major causes of interruption were toxicity (39%) and patient' choice (24%). Median duration of interruption was 7 (range 3-41) months. The OR of baseline and restarted treatment was 63% and 39%, respectively. After a median follow-up of 76 (95% CI 65-79) months the median PFS of baseline and restarted treatment was 21 (18-27) and 14 (10-18) months, respectively. The median OS was 61 (56-80) months. In multivariate analysis the lack of OR of restated treatment was an independent predictor of shorter PFS of restarted Su. According to our findings and also on combined case studies from literature restarted Su can be effective in selected cases of patients who progressed during treatment holiday.
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Affiliation(s)
| | - Barna Budai
- National Institute of Oncology, Ráth Gy. u. 7-9, Budapest, 1122, Hungary.
| | - Zsófia Küronya
- National Institute of Oncology, Ráth Gy. u. 7-9, Budapest, 1122, Hungary
| | - Fruzsina Gyergyay
- National Institute of Oncology, Ráth Gy. u. 7-9, Budapest, 1122, Hungary
| | - Krisztina Bíró
- National Institute of Oncology, Ráth Gy. u. 7-9, Budapest, 1122, Hungary
| | - István Bodrogi
- National Institute of Oncology, Ráth Gy. u. 7-9, Budapest, 1122, Hungary
| | - Lajos Géczi
- National Institute of Oncology, Ráth Gy. u. 7-9, Budapest, 1122, Hungary
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Murtaza G, Faqah A, Konowitz N, Lu H, Kuruvilla A, Adhikari S. Acute Pancreatitis Related to a Chemotherapy Drug. World J Oncol 2017; 8:18-19. [PMID: 28983380 PMCID: PMC5624657 DOI: 10.14740/wjon1006e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 12/20/2022] Open
Abstract
Drug-induced acute pancreatitis is a rare cause of pancreatitis. We present a case of pancreatitis caused by pazopanib, a tyrosine kinase inhibitor used in the treatment of renal cell carcinoma. A 57-year-old male with no risk factors for pancreatitis and a past medical history of renal cell carcinoma who was being treated with pazopanib presented with epigastric pain with radiation to the back. Lipase was elevated to 7,960 units/L. Pazopanib was discontinued on arrival and his lipase levels decreased from 7,960 to 3,380 units/L one day after discontinuation. Abdominal pain resolved and patient tolerated a diet. This case illustrates the importance that medical professionals should be aware of acute pancreatitis as a rare but severe side effect of pazopanib and therefore should monitor and educate their patients accordingly.
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Affiliation(s)
- Ghulam Murtaza
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Anadil Faqah
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Nicholas Konowitz
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Hannah Lu
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Aneesh Kuruvilla
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Sujeen Adhikari
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
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Lin H, Chin Y, Yang YSH, Lai H, Whang‐Peng J, Liu LF, Tang H, Davis PJ. Thyroid Hormone, Cancer, and Apoptosis. Compr Physiol 2016; 6:1221-37. [DOI: 10.1002/cphy.c150035] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Sikic D, Lüdecke G, Lieb V, Keck B. [Side effect management of tyrosine kinase inhibitors in urology : Fatigue and hypothyroidism]. Urologe A 2016; 55:648-52. [PMID: 27119958 DOI: 10.1007/s00120-016-0088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Not only has the use of tyrosine kinase inhibitors (TKI) for the treatment of metastatic renal cell carcinomas (mRCC) changed the therapeutic options for this disease significantly, but with the occurrence of typical side effects this therapy also poses a challenge for the treating physician. Fatigue und hypothyroidism are two common side effects of TKI therapy that can often appear simultaneously. By reducing the patients' quality of life these side effects often lead to a discontinuation of therapy. With this review we want to give the treating physician an overview of the classification and the specific treatment of TKI-induced fatigue and hypothyroidism in order to maximize patients' compliance and the therapeutic efficacy of TKI therapy.
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Affiliation(s)
- D Sikic
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - G Lüdecke
- Urologische Universitätsklinik Gießen, Justus-Liebig Universität Gießen, Gießen, Deutschland
| | - V Lieb
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - B Keck
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland.
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17
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Yoshimura K, Uemura H. Pharmacotherapies for renal cell carcinoma in Japan. Int J Urol 2015; 23:194-202. [PMID: 26663209 DOI: 10.1111/iju.13008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/12/2015] [Indexed: 01/10/2023]
Abstract
The standard treatment for advanced renal cell carcinoma has changed dramatically in the past decade, from cytokine therapy to targeted therapy. Since sorafenib was approved in April 2008, four tyrosine kinase inhibitors and two mammalian target of rapamycin inhibitors have become available in Japan. Most Japanese renal cell carcinoma patients are treated by urologists who are involved in not only kidney surgeries, but also targeted therapy using tyrosine kinase inhibitors, as well as mammalian target of rapamycin inhibitors. Optimal treatment methods are selected from theoretically-based global recommendations, such as the National Comprehensive Cancer Network and European Society for Medical Oncology guidelines; however, real-world clinical practice might be different from that in non-Asian countries. This might be because of different practical conditions; for example, different adverse events and efficacy profiles, different healthcare system, and so on. In the present review, we examine current pharmacotherapy for renal cell carcinoma from evidence-based global data, and compare the reality of Japanese clinical practice to explore the importance of individualized patient therapy.
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Affiliation(s)
- Kazuhiro Yoshimura
- Department of Urology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kinki University Faculty of Medicine, Osaka-sayama, Osaka, Japan
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18
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Miyazaki A, Miyake H, Fujisawa M. Molecular mechanism mediating cytotoxic activity of axitinib in sunitinib-resistant human renal cell carcinoma cells. Clin Transl Oncol 2015; 18:893-900. [PMID: 26597115 DOI: 10.1007/s12094-015-1457-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/16/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed to clarify the molecular mechanism mediating the cytotoxicity of axitinib, a selective inhibitor of the vascular endothelial growth factor receptor (VEGFR), in sunitinib-resistant renal cell carcinoma (RCC). METHODS In our previous study (Sakai et al. in BJU Int 112:E211-E220, 2013), a human RCC cell line, ACHN, resistant to sunitinib (ACHN/R), was developed from a parental cell line (ACHN/P). Differences in molecular phenotypes following treatment with sunitinib or axitinib between these two cell lines were compared. RESULTS ACHN/R showed an approximately fivefold higher IC50 of sunitinib than ACHN/P; however, there was no significant difference in the sensitivity to axitinib between these two cell lines. In ACHN/R, despite the lack of a difference in the phosphorylated (p)-Akt or STAT-3 expression between treatment with sunitinib and axitinib, the expression of p-p44/42 mitogen-activated protein kinase (MAPK) and p-VEGFR-2 after treatment with axitinib was markedly down-regulated compared with those after treatment with sunitinib. Furthermore, additional treatment of ACHN/R with an inhibitor of MAPK kinase significantly enhanced the cytotoxic activity of sunitinib, but not that of axitinib. In vivo growth of ACHN/R in nude mice after treatment with axitinib was significantly inhibited compared with that following treatment with sunitinib, accompanying the marked inhibition of angiogenesis. CONCLUSIONS Antitumor activity of axitinib in RCC cells even after the acquisition of resistance to sunitinib could be explained, at least in part, by the inactivation of p44/42 MAPK and VEGFR-2, which were persistently phosphorylated in sunitinib-resistant RCC cells under treatment with sunitinib.
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Affiliation(s)
- A Miyazaki
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - H Miyake
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - M Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Atkins MB, Gravis G, Drosik K, Demkow T, Tomczak P, Wong SS, Michaelson MD, Choueiri TK, Wu B, Navale L, Warner D, Ravaud A. Trebananib (AMG 386) in Combination With Sunitinib in Patients With Metastatic Renal Cell Cancer: An Open-Label, Multicenter, Phase II Study. J Clin Oncol 2015; 33:3431-8. [PMID: 26304872 DOI: 10.1200/jco.2014.60.6012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Trebananib, an investigational recombinant peptide-Fc fusion protein, neutralizes the receptor-ligand interaction between Tie2 and angiopoietin-1/2. This phase II study was conducted to evaluate trebananib plus sunitinib, a vascular endothelial growth factor receptor inhibitor, in patients with metastatic clear cell renal cell carcinoma. PATIENTS AND METHODS Adults with metastatic renal cell carcinoma were enrolled sequentially onto two cohorts that received sunitinib 50 mg once per day for 4 weeks on and 2 weeks off and intravenous trebananib once per week at a dose of 10 mg/kg in cohort A or 15 mg/kg in cohort B. The primary end points were incidences of adverse events (AEs) and dose interruptions of sunitinib during the first 12 weeks of treatment. Secondary end points included objective response rate and progression-free survival. RESULTS Eighty-five patients were enrolled: 43 in cohort A, and 42 in cohort B. During the first 12 weeks of treatment, 58% and 57% of patients in cohorts A and B, respectively, had sunitinib dose interruptions (dose decrease, withholding, or withdrawal). The most frequent AEs were diarrhea (cohort A, 74%; cohort B, 67%), mucosal inflammation (cohort A, 49%; cohort B, 60%), and hypertension (cohort A, 52%; cohort B, 45%). AEs of grade 3 or greater occurred in 58% of patients in cohort A and in 69% of patients in cohort B. The objective response rate was 58% and 63% in cohorts A and B, respectively. The median progression-free survival time was 13.9 months (95% CI, 10.4 to 19.2) and 16.3 months (95% CI, 13.1 to 21.4) in cohorts A and B, respectively. The median overall survival time was 36 months (95% CI, 25.2 to not estimable) in cohort A and was not estimable (median follow-up, 25 months) in cohort B. CONCLUSION Trebananib plus sunitinib seemed to increase toxicity at the tested doses. Efficacy results suggest a potential benefit for the addition of trebananib to sunitinib.
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Affiliation(s)
- Michael B Atkins
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA.
| | - Gwenaelle Gravis
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Kazimierz Drosik
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Tomasz Demkow
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Piotr Tomczak
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Shirley S Wong
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - M Dror Michaelson
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Toni K Choueiri
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Benjamin Wu
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Lynn Navale
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Douglas Warner
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
| | - Alain Ravaud
- Michael B. Atkins, Georgetown University, Washington, DC; Gwenaelle Gravis, Institut Paoli Calmettes, Marseille; Alain Ravaud, Centre Hospitalier Universitaire de Bordeaux, Hôpital Saint André, Bordeaux, France; Kazimierz Drosik, Regional Cancer Center, Opole; Tomasz Demkow, Maria Skłodowska-Curie Memorial Cancer Center, Warsaw; Piotr Tomczak, University of Medical Sciences, Poznan, Poland; Shirley S. Wong, Western Hospital, Footscray, Victoria, Australia; M. Dror Michaelson, Massachusetts General Hospital; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Benjamin Wu, Lynn Navale, and Douglas Warner, Amgen, Thousand Oaks, CA
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Zekri J, Dreosti LM, Ghosn M, Hamada E, Jaloudi M, Khorshid O, Larbaoui B. Multidisciplinary management of clear-cell renal cell carcinoma in Africa and the Middle East: current practice and recommendations for improvement. J Multidiscip Healthc 2015; 8:335-44. [PMID: 26251610 PMCID: PMC4524587 DOI: 10.2147/jmdh.s85538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The management of renal cell carcinoma (RCC) has evolved considerably in recent years. This report represents the consensus of 22 relevant medical specialists from Africa and the Middle East region engaged in the management of RCC. Partial or radical nephrectomy is the standard of care for most patients with localized RCC. It is essential that patients are followed up appropriately after surgery to enable local and distant relapses to be identified and treated promptly. The treatment of advanced/metastatic disease has changed dramatically with the introduction of targeted therapies. Follow-up of these patients enables therapy optimization and assessment of response to treatment. There was universal agreement on the importance of management of RCC by a multidisciplinary team supported by a multidisciplinary tumor board. Barriers hindering this approach were identified. These included lack of awareness of the benefits of multidisciplinary team role, poor communication among relevant disciplines, time constraints, and specifics of private practice. Other challenges include shortage of expert specialists as urologists and oncologists and lack of local management guidelines in some countries. Solutions were proposed and discussed. Medical educational initiatives and awareness activities were highlighted as keys to encouraging cooperation between specialties to improve patients’ outcome. Establishing combined genitourinary cancer clinics and formal referral systems should encourage a culture of effective communication. Joining forces with professionals in peripheral areas and the private sector is likely to help standardize care. Sustained action will be required to ensure that all patients with RCC in the region benefit from up-to-date care.
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Affiliation(s)
- Jamal Zekri
- College of Medicine, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Jeddah, Saudi Arabia
| | - Lydia M Dreosti
- Department of Medical Oncology, University of Pretoria, Pretoria, South Africa
| | - Marwan Ghosn
- Faculty of Medicine Hematology, Oncology Department, Saint Joseph University, Beirut, Lebanon
| | - Emad Hamada
- Faculty of Medicine, Cairo University, Kasr Alainy, Cairo, Egypt
| | - Mohamed Jaloudi
- Oncology Hematology Department, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Ola Khorshid
- National Cancer Institute, Cairo University, Kasr El Ainy, Cairo, Egypt
| | - Blaha Larbaoui
- Oncology Service, Université Djillali Liabés, Sidi Bel Abbés, Algeria
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Anand D, Escalante CP. Ongoing Screening and Treatment to Potentially Reduce Tyrosine Kinase Inhibitor-Related Fatigue in Renal Cell Carcinoma. J Pain Symptom Manage 2015; 50:108-17. [PMID: 25701692 DOI: 10.1016/j.jpainsymman.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/20/2015] [Accepted: 02/02/2015] [Indexed: 01/03/2023]
Abstract
CONTEXT Renal cell carcinoma (RCC) represents 1% to 4% of adult malignancies, and approximately 33% of patients with RCC present with metastatic disease and have a poor prognosis. Better understanding of RCC tumor biology has led to the development of several molecularly targeted agents, such as tyrosine kinase inhibitors (TKIs), to manage advanced disease. Although evolving data suggest these drugs may be beneficial in RCC, they are associated with significant toxicities. Cancer-related fatigue (CRF) is one of the most common toxicities associated with the TKIs used in RCC. OBJECTIVES To review the incidence, pathophysiology, and management of CRF in patients with RCC who are undergoing targeted therapy with TKIs. METHODS A comprehensive database search was performed using PubMed, Ovid, Embase, and MEDLINE. References of all cited articles also were reviewed. Data from articles published between 1975 and June 2014 were considered. A narrative review regarding the incidence, pathophysiology, and management of CRF in patients with RCC undergoing targeted therapy with TKIs was performed. RESULTS CRF is one of the most common TKI toxicities in patients with metastatic RCC and often is the dose-limiting toxicity. Management of TKI-related CRF can be difficult and may necessitate various nonpharmacologic and pharmacologic interventions. CONCLUSION TKI-related CRF in patients with RCC is a highly distressing complication of cancer therapy. CRF can substantially influence drug compliance, the ability to maximally treat, and quality of life. It is important to recognize this common, yet frequently underdiagnosed complication and initiate appropriate management strategies, to increase the likelihood for optimal outcomes.
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Affiliation(s)
- Deepa Anand
- Department of General Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Carmen P Escalante
- Department of General Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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22
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Mitchell N, Fong PC, Broom RJ. Clinical experience with sunitinib dose escalation in metastatic renal cell carcinoma. Asia Pac J Clin Oncol 2015; 11:e1-5. [PMID: 25560278 DOI: 10.1111/ajco.12296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 11/26/2022]
Abstract
The oral multi-targeted tyrosine kinase inhibitor sunitinib malate is a standard first-line therapy in clear-cell metastatic renal cell carcinoma (mRCC). Sunitinib is usually administered daily for 4 weeks, followed by 2 weeks without treatment. Some patients experience worsening of disease symptoms during the treatment break. We report three cases of mRCC in whom continuous daily dosing and dose escalation were evaluated. In two cases, sunitinib was well tolerated at doses of 75 mg continuously and in all cases escalation of dose enabled regain of disease control. This suggests that continuous higher daily dosing of sunitinib is feasible and may provide additional clinical benefit for selected patients who experience minimal toxicity on the standard schedule.
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23
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Vrdoljak E, Géczi L, Mardiak J, Ciuleanu TE, Leyman S, Zhang K, Sajben P, Torday L. Central and Eastern European experience with sunitinib in metastatic renal cell carcinoma: a sub-analysis of the global expanded-access trial. Pathol Oncol Res 2015; 21:775-82. [PMID: 25557271 DOI: 10.1007/s12253-014-9889-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
Abstract
A global, open-label, expanded-access trial (EAT) provided sunitinib treatment on a compassionate-use basis to patients with metastatic renal cell carcinoma (mRCC) between 2005 and 2011. This retrospective analysis examines outcomes in patients from Central and East European (CEE) countries participating in the global EAT. Sunitinib (starting dose 50 mg orally once daily, with dose reduction for toxicity) was administered in repeated 6-week cycles (4 weeks on and 2 weeks off) until occurrence of disease progression or unacceptable toxicity. Tumor assessments were guided by Response Evaluation Criteria in Solid Tumors (RECIST) criteria but were performed according to local standards of care. In total, 401 CEE patients received sunitinib (median treatment duration 9.6 months), of whom 378 were evaluable for tumor response. The most frequent grade ≥3 toxicities were fatigue (7.5 %), hypertension (7.0 %), thrombocytopenia (6.5 %), diarrhea (4.2 %), nausea and hand-foot syndrome (both 3.7 %) and neutropenia (3.0 %). Median overall survival was 30.7 months (95 % CI 23.3, ‒ months). Overall survival tended to be longer in cytokine-naïve than cytokine-experienced patients (median 60.8 vs. 27.5 months; P = 0.1324). Among patients with evaluable tumors, 4.0 % achieved a complete and 14.6 % a partial response [objective response rate (ORR) 18.5 % (95 % CI 14.7, 22.8 %)]. Median progression-free survival was 11.6 months (95 % CI 10.3, 12.8 months). Sunitinib demonstrates safety and effectiveness in real-world mRCC patients in CEE countries. Expanded-access program patients showed a lower tumor response rate but similar survival outcomes to patients in the pivotal Phase III clinical trial of sunitinib in mRCC.
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Affiliation(s)
- Eduard Vrdoljak
- Medical School Split, Center of Oncology, University Hospital Split, Spinciceva 1, 21000, Split, Croatia,
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De Giorgi U, Scarpi E, Sacco C, Aieta M, Lo Re G, Sava T, Masini C, De Vincenzo F, Baldazzi V, Camerini A, Fornarini G, Burattini L, Rosti G, Ferrari V, Moscetti L, Chiuri VE, Luzi Fedeli S, Amadori D, Basso U. Standard vs Adapted Sunitinib Regimen in Elderly Patients With Metastatic Renal Cell Cancer: Results From a Large Retrospective Analysis. Clin Genitourin Cancer 2014; 12:182-9. [DOI: 10.1016/j.clgc.2013.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/27/2013] [Accepted: 11/08/2013] [Indexed: 11/28/2022]
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Quintyne KI, Neenan T, Casserly L, Gupta R. Uncommon side effect with a commonly used targeted agent: sunitinib-induced nephrotic syndrome in a patient with metastatic renal cell carcinoma. BMJ Case Rep 2014; 2014:bcr-2013-201183. [PMID: 24872478 DOI: 10.1136/bcr-2013-201183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The authors report the case of a 67-year-old woman with metastatic renal cell carcinoma (RCC) without prior nephrectomy, who had received long-term exposure (38 months) to the oral multi-targeted tyrosine kinase inhibitor (TKI), sunitinib. She had a sustained clinical and radiological response to her therapy, but had this therapy discontinued due to the rare development of nephrotic syndrome.
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Affiliation(s)
- Keith Ian Quintyne
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Triona Neenan
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Liam Casserly
- Department of Nephrology, University Hospital Limerick, Limerick, Ireland
| | - Rajnish Gupta
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
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Schmidinger M. Understanding and managing toxicities of vascular endothelial growth factor (VEGF) inhibitors. EJC Suppl 2013; 11:172-91. [PMID: 26217127 PMCID: PMC4041401 DOI: 10.1016/j.ejcsup.2013.07.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Abstract
Cardiovascular toxicity is one of the most feared complications of cancer treatment. Recent advances in oncologic therapies have resulted in improved cancer outcomes but also a new set of cardiovascular adverse effects. Common toxicities include left ventricular dysfunction/heart failure, hypertension, and myocardial ischemia. Accurate risk stratification allows avoidance of potentially harmful treatments in those patients at greatest risk while maintaining the ability to deliver high doses of effective therapies to the lower-risk population. Cardiac investigations, including echocardiography, nuclear imaging, magnetic resonance imaging, biomarker measurement, blood pressure monitoring, electrocardiography, stress testing, and invasive angiography, can help to risk-stratify selected patients. In this review, common complications are discussed in terms of the factors used to identify patients with elevated risk, the monitoring strategies available, and selected interventions that have been used to modify outcomes in patients identified as being at high risk for cardiac complications of cancer treatment.
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Affiliation(s)
- Margot Davis
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305-5406, USA
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