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Seront E, Rottey S, Sautois B, Kerger J, D'Hondt LA, Verschaeve V, Canon JL, Dopchie C, Vandenbulcke JM, Whenham N, Goeminne JC, Clausse M, Verhoeven D, Glorieux P, Branders S, Dupont P, Schoonjans J, Feron O, Machiels JP. Phase II study of everolimus in patients with locally advanced or metastatic transitional cell carcinoma of the urothelial tract: clinical activity, molecular response, and biomarkers. Ann Oncol 2012; 23:2663-2670. [PMID: 22473592 DOI: 10.1093/annonc/mds057] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This phase II study assessed the safety and efficacy of everolimus, an oral mammalian target of rapamycin inhibitor in advanced transitional carcinoma cell (TCC) after failure of platinum-based therapy. PATIENTS AND METHODS Thirty-seven patients with advanced TCC received everolimus 10 mg/day until progressive disease (PD) or unacceptable toxicity. The primary end point was the disease control rate (DCR), defined as either stable disease (SD), partial response (PR), or complete response at 8 weeks. Angiogenesis-related proteins were detected in plasma and changes during everolimus treatment were analyzed. PTEN expression and PIK3CA mutations were correlated to disease control. RESULTS Two confirmed PR and eight SD were observed, resulting in a DCR of 27% at 8 weeks. Everolimus was well tolerated. Compared with patients with noncontrolled disease, we observed in patients with controlled disease a significant higher baseline level of angiopoietin-1 and a significant early plasma decrease in angiopoietin-1, endoglin, and platelet-derived growth factor-AB. PTEN loss was observed only in patients with PD. CONCLUSIONS Everolimus showed clinical activity in advanced TCC. The profile of the plasma angiogenesis-related proteins suggested a role of the everolimus antiangiogenic properties in disease control. PTEN loss might be associated with everolimus resistance.
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Affiliation(s)
- E Seront
- Department of Medical Oncology, Centre du Cancer, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels; Angiogenesis and Cancer Research Laboratory, Pole of Pharmacology and Therapeutics, Université catholique de Louvain, Brussels
| | - S Rottey
- Department of Medical Oncology, University Hospital Gent, Gent
| | - B Sautois
- Department of Medical Oncology, Centre Hospitalier Universitaire Sart-Tilman, Liège
| | - J Kerger
- Department of Medical Oncology, Centre Hospitalier Universitaire Mont-Godinne, Namur
| | - L A D'Hondt
- Department of Medical Oncology, Centre Hospitalier Universitaire Mont-Godinne, Namur
| | - V Verschaeve
- Department of Medical Oncology, Grand Hôpital de Charleroi, Charleroi
| | - J-L Canon
- Department of Medical Oncology, Grand Hôpital de Charleroi, Charleroi
| | - C Dopchie
- Department of Medical Oncology, Réseau Hospitalier de Médecine Sociale, Tournai
| | - J M Vandenbulcke
- Department of Medical Oncology, Réseau Hospitalier de Médecine Sociale, Tournai
| | - N Whenham
- Department of Medical Oncology, Clinique Saint-Pierre Ottignies, Ottignies
| | - J C Goeminne
- Department of Medical Oncology, Centre de Maternité Saint Elisabeth, Namur
| | - M Clausse
- Department of Medical Oncology, Clinique Saint-Luc, Bouge
| | - D Verhoeven
- Department of Medical Oncology, AZ Klina, Braschaat
| | - P Glorieux
- Department of Medical Oncology, Clinique Saint Joseph, Arlon
| | - S Branders
- Machine Learning Group, Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Université catholique de Louvain, Louvain-la-Neuve
| | - P Dupont
- Machine Learning Group, Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Université catholique de Louvain, Louvain-la-Neuve
| | - J Schoonjans
- Department of radiology, Centre Hospitalier de Jolimont, Haine Saint Paul, Belgium
| | - O Feron
- Angiogenesis and Cancer Research Laboratory, Pole of Pharmacology and Therapeutics, Université catholique de Louvain, Brussels
| | - J-P Machiels
- Department of Medical Oncology, Centre du Cancer, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels.
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Abstract
In the last few years, angiogenesis has confirmed its critical role in the development of malignant neoplasms. Antiangiogenic drugs, mainly bevacizumab, sorafenib, or sunitinib, are currently approved in a wide number of tumor types, such as breast, colorectal, liver, or kidney cancer, and have changed dramatically the evolution of our patients. Unfortunately, in urothelial carcinoma, which is a very common neoplasm, antiangiogenic agents are still in a very preliminary phase of clinical research. In this study, we focus on the biological basis of angiogenesis in urothelial tumors, its influence in the prognosis of these malignancies, and the available evidence about the use of antiangiogenic drugs in urothelial carcinoma.
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Zachos I, Konstantinopoulos PA, Tzortzis V, Gravas S, Karatzas A, Karamouzis MV, Melekos M, Papavassiliou AG. Systemic therapy of metastatic bladder cancer in the molecular era: current status and future promise. Expert Opin Investig Drugs 2010; 19:875-87. [PMID: 20528482 DOI: 10.1517/13543784.2010.496450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Platinum-based chemotherapy is considered the standard-of-care first-line therapy for metastatic bladder cancer. Despite the initial high response rate, the vast majority of patients eventually progress and succumb to their disease, urging the need for development of novel therapies. AREAS COVERED IN THIS REVIEW This article discusses the main signaling pathways implicated in the pathogenesis of bladder carcinomas, reviews recently completed and ongoing clinical trials, and anticipates the future direction of molecularly targeted agents. WHAT THE READER WILL GAIN This manuscript presents the current status of conventional chemotherapy in advanced bladder cancer, and provides a comprehensive review of molecular targeted agents currently in clinical development for this disease. TAKE HOME MESSAGE Improved understanding of the biology of urothelial carcinogenesis has paved the way for the development of novel molecularly targeted therapies, several of which are currently tested in clinical trials. In this regard, VEGF and EGFR pathways are emerging as important therapeutic targets for metastatic bladder cancer, either alone or in combination with conventional chemotherapeutics. Other therapies, including aurora kinase inhibitors, endothelin receptor antagonists, RAS/MAPK pathway inhibitors and novel immunologic strategies, may also prove helpful in the treatment of this disease.
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Affiliation(s)
- Ioannis Zachos
- University of Thessalia, Department of Urology, Larissa, Greece
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