1
|
Nie C, He Y, Lv H, Gao M, Gao X, Chen B, Xu W, Wang J, Liu Y, Zhao J, Chen X. Clinical Study of Anlotinib as Third-Line or Above Therapy in Patients With Advanced or Metastatic Gastric Cancer: A Multicenter Retrospective Study. Front Oncol 2022; 12:885350. [PMID: 35860585 PMCID: PMC9289113 DOI: 10.3389/fonc.2022.885350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background The present study was conducted to evaluate the efficacy and safety of anlotinib as third-line or above therapy for patients with advanced or metastatic gastric cancer. Methods Patients with advanced or metastatic gastric cancer who have failed from second-line treatment and treated with anlotinib monotherapy or combined with chemotherapy or immunotherapy from June 2019 to January 2021 in 3 institutions across China were retrospectively analyzed. The primary end point was progression free survival (PFS). Secondary end points included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety. Results 43 patients with advanced or metastatic gastric cancer who have failed prior treatment received anlotinib monotherapy or combination therapy as third-line or above therapy. In the general population, 4 patients achieved PR, 21 patients had SD and 18 patients had PD. The overall ORR and DCR were 9.3% (4/43) and 58.1% (25/43), respectively. Median PFS and OS were 3.0 months (95% CI=2.5-3.5) and 6.0 months (95% CI=4.4-7.6), respectively. The incidence of Grade 3-4 adverse events(AEs) was 34.9%. Subgroup analysis suggested that the ORR of anlotinib combination therapy was superior than anlotinib monotherapy, but with similar PFS and OS. The clinical benefit of anlotinib was not associated with previously anti-angiogenesis therapy with apatinib. Conclusions Anlotinib monotherapy or combination therapy provide a feasible third-line or above therapeutic strategy in patients with advanced or metastatic gastric cancer a median PFS of 3.0 months and median OS of 6.0 months was obtained with well tolerated toxicity.
Collapse
Affiliation(s)
- Caiyun Nie
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
| | - Yunduan He
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
| | - Huifang Lv
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
| | - Ming Gao
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaohui Gao
- Department of Oncology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Beibei Chen
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
| | - Weifeng Xu
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
| | - Jianzheng Wang
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
| | - Yingjun Liu
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jing Zhao
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
| | - Xiaobing Chen
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, China
- Henan Engineering Research Center of Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, Zhengzhou, China
- *Correspondence: Xiaobing Chen,
| |
Collapse
|
2
|
Ma W, Chang N, Yu Y, Su Y, Chen G, Cheng W, Wu Y, Li C, Chang W, Yang J. Ursolic acid silences CYP19A1/aromatase to suppress gastric cancer growth. Cancer Med 2022; 11:2824-2835. [PMID: 35545835 PMCID: PMC9302273 DOI: 10.1002/cam4.4536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Gastric cancer (GCa) is a malignancy with few effective treatments. Ursolic acid (UA), a bioactive triterpenoid enriched in Hedyotis diffusa Willd, known to suppress GCa without identified target. CYP19A1 (cytochrome P450 family 19A1; also known as aromatase, Ar) was correlated to GCa prognosis. Relatedly, Ar silencers, which halt the expression of Ar exhibited anti-GCa effects in experimental models, are currently being investigated. METHOD The docking simulation score of UA was compared with Ar inhibitors, e.g., letrozole, exemestane, in Ar protein crystallization. Hedyotis diffusa Willd ethanol extract, UA, or 5-fluracil were applied onto AGS, SC-M1, MKN45 GCa cells for cancer inhibition tests. Immunoblot for measuring gene expressions upon drug treatments, or gene knockdown/overexpression. Treatments were also applied in a MKN45 implantation tumor model. A web-based GCa cohort for Ar expression association with prognosis was performed. RESULT The ethanol extracts of Hedyotis diffusa Willd, enrich with UA, exhibited cytotoxic activity against GCa cells. Molecular docking simulations with the 3D Ar structure revealed an excellent fitting score for UA. UA increase cytotoxic, and suppressed colony, in addition to its Ar silencing capacity. Moreover, UA synergistically facilitated 5-FU, (a standard GCa treatment) regimen in vitro. Consistent with those results, adding estradiol did not reverse the cancer-suppressing effects of UA, which confirmed UA acts as an Ar silencer. Furthermore, UA exhibited tumor-suppressing index (TSI) score of 90% over a 6-week treatment term when used for single dosing in xenograft tumor model. In the clinical setting, Ar expression was found to be higher in GCa tumors than normal parental tissue from the TCGA (The Cancer Genome Atlas) cohort, while high Ar expression associated with poor prognosis. Together, the results indicate UA could be used to treat GCa by silencing Ar expression in GCa. Hedyotis diffusa Willd ethanol extract could be an functional food supplements.
Collapse
Affiliation(s)
- Wen‐Lung Ma
- Graduate Institute of Biomedical SciencesCenter for Tumor BiologyDepartment of PharmacologyChinese Medicine Research CenterDrug Development Center, and Graduate Institute of Chinese MedicineGraduate Institute of Integrated MedicineSchool of MedicineChina Medical UniversityTaichungTaiwan
- Department of Medical ResearchChinese Medicine Research and Development Center, and Department of Obstetrics & GynecologyChina Medical University HospitalTaichungTaiwan
- Department of NursingDepartment of BiotechnologyCollege of Medical and Health ScienceAsia UniversityTaichungTaiwan
| | - Ning Chang
- Department of Medical ResearchChinese Medicine Research and Development Center, and Department of Obstetrics & GynecologyChina Medical University HospitalTaichungTaiwan
| | - Yingchun Yu
- Department of Medical ResearchChinese Medicine Research and Development Center, and Department of Obstetrics & GynecologyChina Medical University HospitalTaichungTaiwan
| | - Yu‐Ting Su
- Graduate Institute of Biomedical SciencesCenter for Tumor BiologyDepartment of PharmacologyChinese Medicine Research CenterDrug Development Center, and Graduate Institute of Chinese MedicineGraduate Institute of Integrated MedicineSchool of MedicineChina Medical UniversityTaichungTaiwan
- Department of Medical ResearchChinese Medicine Research and Development Center, and Department of Obstetrics & GynecologyChina Medical University HospitalTaichungTaiwan
| | - Guan‐Yu Chen
- Department of Medical ResearchChinese Medicine Research and Development Center, and Department of Obstetrics & GynecologyChina Medical University HospitalTaichungTaiwan
| | - Wei‐Chung Cheng
- Department of Medical ResearchChinese Medicine Research and Development Center, and Department of Obstetrics & GynecologyChina Medical University HospitalTaichungTaiwan
| | - Yang‐Chang Wu
- Graduate Institute of Biomedical SciencesCenter for Tumor BiologyDepartment of PharmacologyChinese Medicine Research CenterDrug Development Center, and Graduate Institute of Chinese MedicineGraduate Institute of Integrated MedicineSchool of MedicineChina Medical UniversityTaichungTaiwan
- Department of Medical ResearchChinese Medicine Research and Development Center, and Department of Obstetrics & GynecologyChina Medical University HospitalTaichungTaiwan
- Department of NursingDepartment of BiotechnologyCollege of Medical and Health ScienceAsia UniversityTaichungTaiwan
| | - Ching‐Chia Li
- Graduate Institute of Clinical MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Department of UrologyKaohsiung Medical University HospitalKaohsiungTaiwan
- Department of UrologySchool of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - Wei‐Chun Chang
- Department of Medical ResearchChinese Medicine Research and Development Center, and Department of Obstetrics & GynecologyChina Medical University HospitalTaichungTaiwan
- Department of NursingDepartment of BiotechnologyCollege of Medical and Health ScienceAsia UniversityTaichungTaiwan
- Department of Obstetrics and GynecologyAsia University HospitalTaichungTaiwan
| | - Juan‐Cheng Yang
- Graduate Institute of Biomedical SciencesCenter for Tumor BiologyDepartment of PharmacologyChinese Medicine Research CenterDrug Development Center, and Graduate Institute of Chinese MedicineGraduate Institute of Integrated MedicineSchool of MedicineChina Medical UniversityTaichungTaiwan
- School of Chinese MedicineChina Medical UniversityTaichungTaiwan
| |
Collapse
|
3
|
Yang JC, Chang N, Wu DC, Cheng WC, Chung WM, Chang WC, Lei FJ, Liu CJ, Wu IC, Lai HC, Ma WL. Preclinical evaluation of exemestane as a novel chemotherapy for gastric cancer. J Cell Mol Med 2019; 23:7417-7426. [PMID: 31557413 PMCID: PMC6815818 DOI: 10.1111/jcmm.14605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022] Open
Abstract
CYP19A1/aromatase (Ar) is a prognostic biomarker of gastric cancer (GCa). Ar is a critical enzyme for converting androstenedione to oestradiol in the steroidogenesis cascade. For decades, Ar has been targeted with Ar inhibitors (ARIs) in gynaecologic malignancies; however, it is unexplored in GCa. A single‐cohort tissue microarray examination was conducted to study the association between Ar expression and disease outcome in Asian patients with GCa. The results revealed that Ar was a prognostic promoter. Bioinformatics analyses conducted on a Caucasian‐based cDNA microarray databank showed Ar to be positively associated with GCa prognosis for multiple clinical modalities, including surgery, 5‐Fluorouracil (5‐FU) for adjuvant chemotherapy, or HER2 positivity. These findings imply that targeting Ar expression exhibits a potential for fulfilling unmet medical needs. Hence, Ar‐targeting compounds were tested, and the results showed that exemestane exhibited superior cancer‐suppressing efficacy to other ARIs. In addition, exemestane down‐regulated Ar expression. Ablating Ar abundance with short hairpin (sh)Ar could also suppress GCa cell growth, and adding 5‐FU could facilitate this effect. Notably, adding oestradiol could not prevent exemestane or shAr effects, implicating a nonenzymatic mechanism of Ar in cancer growth. Regarding translational research, treatment with exemestane alone exhibited tumour suppression efficacy in a dose‐dependent manner. Combining subminimal doses of 5‐FU and exemestane exerted an excellent tumour suppression effect without influencing bodyweight. This study validated the therapeutic potentials of exemestane in GCa. Combination of metronomic 5‐FU and exemestane for GCa therapy is recommended.
Collapse
Affiliation(s)
- Juan-Cheng Yang
- Department of Gastroenterology, Chinese Medicine Research and Development Center, Sex Hormone Research Center, Research Center for Tumor Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan
| | - Ning Chang
- Graduate Institute of Chinese Medicine, Graduate Institute of BioMedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Deng-Chyang Wu
- Department of Medicine, Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Chung Cheng
- Department of Gastroenterology, Chinese Medicine Research and Development Center, Sex Hormone Research Center, Research Center for Tumor Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Chinese Medicine, Graduate Institute of BioMedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Min Chung
- Department of Gastroenterology, Chinese Medicine Research and Development Center, Sex Hormone Research Center, Research Center for Tumor Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Chinese Medicine, Graduate Institute of BioMedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Chun Chang
- Department of Gastroenterology, Chinese Medicine Research and Development Center, Sex Hormone Research Center, Research Center for Tumor Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Chinese Medicine, Graduate Institute of BioMedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Fu-Ju Lei
- Department of Gastroenterology, Chinese Medicine Research and Development Center, Sex Hormone Research Center, Research Center for Tumor Medicine, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Chinese Medicine, Graduate Institute of BioMedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Chung-Jung Liu
- Department of Medicine, Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Chen Wu
- Department of Medicine, Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsueh-Chou Lai
- Department of Gastroenterology, Chinese Medicine Research and Development Center, Sex Hormone Research Center, Research Center for Tumor Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Chinese Medicine, Graduate Institute of BioMedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Lung Ma
- Department of Gastroenterology, Chinese Medicine Research and Development Center, Sex Hormone Research Center, Research Center for Tumor Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of OBS & GYN, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Chinese Medicine, Graduate Institute of BioMedical Sciences, School of Medicine, China Medical University, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan.,Department of Nursing, Asia University, Taichung, Taiwan
| |
Collapse
|