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Chen CW, Ou TS, Chen WS, Jiang JK, Yang SH, Wang HS, Chang SC, Lan YT, Lin CC, Lin HH, Huang SC, Cheng HH, Yang YW, Lin YZ, Chao Y, Wang LW, Teng HW. Anti-VEGF Therapy Possibly Extends Survival in Patients With Colorectal Brain Metastasis by Protecting Patients From Neurologic Disability. Clin Colorectal Cancer 2023; 22:267-279. [PMID: 37098452 DOI: 10.1016/j.clcc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Colorectal brain metastases (CBMs) are rare with poor prognosis. There is still no standard systemic treatment for multiple or unresectable CBM. our study aimed to explore the impact of anti-VEGF therapy on overall survival, brain-specific disease control, and neurologic symptom burden in patients with CBM. METHODS A total of 65 patients with CBM under treatment were retrospectively enrolled and divided into anti-VEGF based systemic therapy or non-anti-VEGF based therapy. A total of 25 patients who received at least 3 cycles of anti-VEGF agent and 40 patients without anti-VEGF therapy were analyzed by endpoints of overall survival (OS), progression-free survival (PFS), intracranial PFS (iPFS) and neurogenic event-free survival (nEFS). Gene expression in paired primary metastatic colorectal cancer (mCRC), liver, lung and brain metastasis from NCBI data was analyzed using top Gene Ontology (GO) and cBioPortal. RESULTS Patients who treated with anti-VEGF therapy had significantly longer OS (19.5 vs. 5.5 months, P = .009), iPFS (14.6 vs. 4.1 months, P < .001) and nEFS (17.6 vs. 4.4 months, P < .001). Patients who received anti-VEGF therapy beyond any disease progression presented with superior OS (19.7 vs. 9.4 months, P = .039). Top GO and cBioPortal analysis revealed a stronger molecular function of angiogenesis in intracranial metastasis. CONCLUSIONS Anti-VEGF based systemic therapy showed favorable efficacy that was reflected in longer overall survival, iPFS and NEFS in patients with CBM.
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Affiliation(s)
- Chih-Wen Chen
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tao-Shen Ou
- Division of Allergy, Immunology, Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huann-Sheng Wang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ching Chang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuan-Tzu Lan
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Chieh Huang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hou-Hsuan Cheng
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Wen Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Zu Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yee Chao
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling-Wei Wang
- Department Heavy Particles and Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Hao-Wei Teng
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Evaluation of Anti-angiogenic Agent F16 for Targeting Glioblastoma Xenograft Tumors. Cancer Genet 2022; 264-265:71-89. [DOI: 10.1016/j.cancergen.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022]
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3
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Shah N, Mohammad AS, Saralkar P, Sprowls SA, Vickers SD, John D, Tallman RM, Lucke-Wold BP, Jarrell KE, Pinti M, Nolan RL, Lockman PR. Investigational chemotherapy and novel pharmacokinetic mechanisms for the treatment of breast cancer brain metastases. Pharmacol Res 2018; 132:47-68. [PMID: 29604436 PMCID: PMC5997530 DOI: 10.1016/j.phrs.2018.03.021] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 02/08/2023]
Abstract
In women, breast cancer is the most common cancer diagnosis and second most common cause of cancer death. More than half of breast cancer patients will develop metastases to the bone, liver, lung, or brain. Breast cancer brain metastases (BCBM) confers a poor prognosis, as current therapeutic options of surgery, radiation, and chemotherapy rarely significantly extend life and are considered palliative. Within the realm of chemotherapy, the last decade has seen an explosion of novel chemotherapeutics involving targeting agents and unique dosage forms. We provide a historical overview of BCBM chemotherapy, review the mechanisms of new agents such as poly-ADP ribose polymerase inhibitors, cyclin-dependent kinase 4/6 inhibitors, phosphatidyl inositol 3-kinaseinhibitors, estrogen pathway antagonists for hormone-receptor positive BCBM; tyrosine kinase inhibitors, antibodies, and conjugates for HER2+ BCBM; repurposed cytotoxic chemotherapy for triple negative BCBM; and the utilization of these new agents and formulations in ongoing clinical trials. The mechanisms of novel dosage formulations such as nanoparticles, liposomes, pegylation, the concepts of enhanced permeation and retention, and drugs utilizing these concepts involved in clinical trials are also discussed. These new treatments provide a promising outlook in the treatment of BCBM.
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Affiliation(s)
- Neal Shah
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Afroz S Mohammad
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Pushkar Saralkar
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Samuel A Sprowls
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Schuyler D Vickers
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Devin John
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Rachel M Tallman
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Brandon P Lucke-Wold
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Katherine E Jarrell
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Mark Pinti
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Richard L Nolan
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
| | - Paul R Lockman
- West Virginia University, Health Sciences Center, School of Pharmacy, Department of Basic Pharmaceutical Sciences, Morgantown, WV 26506, USA.
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Askoxylakis V, Arvanitis CD, Wong CSF, Ferraro GB, Jain RK. Emerging strategies for delivering antiangiogenic therapies to primary and metastatic brain tumors. Adv Drug Deliv Rev 2017. [PMID: 28648712 DOI: 10.1016/j.addr.2017.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Five-year survival rates have not increased appreciably for patients with primary and metastatic brain tumors. Nearly 17,000 patients die from primary brain tumors, whereas approximately 200,000 cases are diagnosed with brain metastasis every year in the US alone. At the same time, with improved control of systemic disease, the incidence of brain metastasis is increasing. Thus, novel approaches for improving the treatment outcome for these uniformly fatal diseases are needed urgently. In the review, we summarize the challenges in the treatment of these diseases using antiangiogenic therapies alone or in combination with radio-, chemo- and immuno-therapies. We also discuss the emerging strategies to improve the treatment outcome using both pharmacological approaches to normalize the tumor microenvironment and physical approaches (e.g., focused ultrasound) to modulate the blood-tumor-barrier, along with limitations of each approach. Finally, we offer some new avenues of future research.
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Affiliation(s)
- Vasileios Askoxylakis
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, 02114, USA
| | - Costas D Arvanitis
- School of Mechanical Engineering, Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Christina S F Wong
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, 02114, USA
| | - Gino B Ferraro
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, 02114, USA
| | - Rakesh K Jain
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), Boston, MA, 02114, USA.
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Rostami R, Mittal S, Rostami P, Tavassoli F, Jabbari B. Brain metastasis in breast cancer: a comprehensive literature review. J Neurooncol 2016; 127:407-14. [PMID: 26909695 DOI: 10.1007/s11060-016-2075-3] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
This comprehensive review provides information on epidemiology, size, grade, cerebral localization, clinical symptoms, treatments, and factors associated with longer survival in 14,599 patients with brain metastasis from breast cancer; the molecular features of breast cancers most likely to develop brain metastases and the potential use of these predictive molecular alterations for patient management and future therapeutic targets are also addressed. The review covers the data from 106 articles representing this subject in the era of modern neuroimaging (past 35 years). The incidence of brain metastasis from breast cancer (24 % in this review) is increasing due to advances in both imaging technologies leading to earlier detection of the brain metastases and introduction of novel therapies resulting in longer survival from the primary breast cancer. The mean age at the time of breast cancer and brain metastasis diagnoses was 50.3 and 48.8 years respectively. Axillary node metastasis was noted in 32.8 % of the patients who developed brain metastasis. The median time intervals between the diagnosis of breast cancer to identification of brain metastasis and from identification of brain metastasis to death were 34 and 15 months, respectively. The most common symptoms experienced in patients with brain metastasis consisted of headache (35 %), vomiting (26 %), nausea (23 %), hemiparesis (22 %), visual changes (13 %) and seizures (12 %). A majority of the patients had multiple metastases (54.2 %). Cerebellum and frontal lobes were the most common sites of metastasis (33 and 16 %, respectively). Of the primary tumors for which biomarkers were recorded, 37 % were estrogen receptor (ER)+, 41 % ER-, 36 % progesterone receptor (PR)+, 34 % PR-, 35 % human epithelial growth factor receptor 2 (HER2)+, 41 % HER2-, 27 % triple negative and 18 % triple positive (TP). Treatment in most patients consisted of a multimodality approach often with two or more of the following: whole brain radiation therapy (52 %), chemotherapy (51 %), stereotactic radiosurgery (20 %), surgical resection (14 %), trastuzumab (39 %) for HER2 positive tumors, and hormonal therapy (34 %) for ER and/or PR positive tumors. Factors that had an impact on prognosis included grade and size of the tumor, multiple metastases, presence of extra-cranial metastasis, triple negative or HER2+ biomarker status, and high Karnovsky score. Novel therapies such as application of agents to reduce tumor angiogenesis or alter permeability of the blood brain barrier are being explored with preliminary results suggesting a potential to improve survival after brain metastasis. Other potential therapies based on genetic alterations in the tumor and the microenvironment in the brain are being investigated; these are briefly discussed.
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Affiliation(s)
- Rezvan Rostami
- Department of Neurology, Yale University School of Medicine, 15 York Street, LCI Building, New Haven, CT, 06520, USA.
| | - Shivam Mittal
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, 44106-5040, USA
| | - Pooya Rostami
- School of Medicine, St. George University, St. George's, Grenada, West Indies
| | - Fattaneh Tavassoli
- Department of Pathology, Yale University School of Medicine, 20 York Street, Ste East Pavilion Suite 2608, New Haven, CT, 06510, USA
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, 15 York Street, LCI Building, New Haven, CT, 06520, USA
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Retrospective analysis of bevacizumab in combination with fotemustine in chinese patients with recurrent glioblastoma multiforme. BIOMED RESEARCH INTERNATIONAL 2015; 2015:723612. [PMID: 25789324 PMCID: PMC4348597 DOI: 10.1155/2015/723612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 01/22/2015] [Accepted: 01/29/2015] [Indexed: 11/21/2022]
Abstract
The aim of this study was to assess the activity and safety of bevacizumab (BEV) and fotemustine (FTM) for the treatment of recurrent glioblastoma multiforme (GBM) patients and explore the potential prognostic parameters on survival. This study retrospectively analyzed all patients with GBM who were treated with at least one cycle of BEV and FTM from July 2010 to October 2012. A total of 176 patients with recurrent GBM were enrolled. The response rate and disease control rate were 46.6% and 90.9%, respectively. A 6-month PFS rate of 33.3% (95% CI: 26.5%–40.3%) and a median PFS of 5.0 (95% CI: 2.4–7.5) months were observed. The median OS was 8.0 (95% CI: 6.7–9.2) months. Multivariate analysis showed that risk factors with a significant influence on the PFS of all patients were Karnofsky Performance Status (KPS) (≥70 versus <70, HR = 0.53, 95% CI: 0.39–0.73, and P = 0.01) and MGMT status (methylated versus unmethylated, HR = 0.69, 95% CI: 0.52–0.97, and P = 0.04). The most common treatment-related adverse events were fatigue, proteinuria, hypophonia, hypertension, thrombocytopenia, anemia, and neutropenia. In conclusion, combination of BEV with FTM is well tolerated and may derive some clinical benefits in recurrent GBM patients. Higher KPS and MGMT promoter hypermethylation were suggested to be associated with prolonged survival.
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Le Rhun E, Taillibert S, Boulanger T, Zairi F, Bonneterre J, Chamberlain MC. Prolonged Response and Restoration of Functional Independence with Bevacizumab plus Vinorelbine as Third-Line Treatment for Breast Cancer-Related Leptomeningeal Metastases. Case Rep Oncol 2015; 8:72-7. [PMID: 25848355 PMCID: PMC4361905 DOI: 10.1159/000375293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Survival of patients with leptomeningeal metastases (LM) and impaired functional status is limited to several months, and rarely does neurological function improve with treatment. Case Report A 34-year-old female with hormone-negative and HER2-positive metastatic breast cancer was diagnosed with bulky radiographic LM 45 months after initial diagnosis. She was treated with intra-CSF trastuzumab followed by intra-CSF liposomal cytarabine; however, the cancer progressed 8 months after the diagnosis of LM. At the time of the third LM progression, the patient presented with a cauda equina syndrome and cerebellar impairment resulting in an inability to walk. She was treated with CNS-directed radiotherapy (lumbosacral and cerebellar) and bevacizumab plus vinorelbine. Rapid functional improvement occurred, and the patient regained the ability to walk and independently manage her daily activities. Twelve months later, she presented with rapid progression of the LM resulting in death within several weeks. Conclusion In radiographically defined bulky LM, the combination of systemic therapy and CNS-directed radiotherapy likely is more active than intra-CSF therapy only. In lieu of the rapid and significant improvement in neurological function combined with the prolonged response, bevacizumab alone or in combination with chemotherapy and CNS-directed radiotherapy may be considered in select patients with radiographically bulky breast cancer-related LM.
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Affiliation(s)
- Emilie Le Rhun
- Breast Cancer Department, University Hospital - CHRU, Paris, France ; Neuro-Oncology, Department of Neurosurgery, University Hospital - CHRU, Paris, France ; Inserm U-1192, Proteomic, Inflammatory Response, Mass Spectrometry Laboratory (PRISM), Lille 1 University, Villeneuve D'Ascq, Paris, France
| | - Sophie Taillibert
- Department of Neurology Mazarin, Pitié-Salpétrière Hospital, Paris, France ; Department of Radiation Oncology, Pitié-Salpétrière Hospital, Paris, France
| | - Thomas Boulanger
- Department of Radiology, Oscar Lambret Center, University Hospital - CHRU, Paris, France
| | - Fahed Zairi
- Department of Neurosurgery, Roger Salengro Hospital, University Hospital - CHRU, Paris, France
| | - Jacques Bonneterre
- Breast Cancer Department, University Hospital - CHRU, Paris, France ; Lille 2 North of France University, Lille, Paris, France
| | - Marc C Chamberlain
- Department of Neurology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Wash., USA
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Kodack DP, Askoxylakis V, Ferraro GB, Fukumura D, Jain RK. Emerging strategies for treating brain metastases from breast cancer. Cancer Cell 2015; 27:163-75. [PMID: 25670078 PMCID: PMC4325273 DOI: 10.1016/j.ccell.2015.01.001] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/25/2014] [Accepted: 01/06/2015] [Indexed: 12/20/2022]
Abstract
Brain metastasis is an end stage in breast cancer progression. Traditional treatment options have minimal efficacy, and overall survival is on the order of months. The incidence of brain metastatic disease is increasing with the improved management of systemic disease and prolongation of survival. Unfortunately, the targeted therapies that control systemic disease have diminished efficacy against brain lesions. There are reasons to be optimistic, however, as emerging therapies have shown promise in preclinical and early clinical settings. This review discusses recent advances in breast cancer brain metastasis therapy and potential approaches for successful treatment.
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Affiliation(s)
- David P Kodack
- Edwin L. Steele Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Vasileios Askoxylakis
- Edwin L. Steele Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Gino B Ferraro
- Edwin L. Steele Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Dai Fukumura
- Edwin L. Steele Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Rakesh K Jain
- Edwin L. Steele Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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9
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Brain metastasis: new opportunities to tackle therapeutic resistance. Mol Oncol 2014; 8:1120-31. [PMID: 24953014 DOI: 10.1016/j.molonc.2014.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/15/2014] [Accepted: 05/21/2014] [Indexed: 01/14/2023] Open
Abstract
Brain metastasis is a devastating complication of cancer with unmet therapeutic needs. The incidence of brain metastasis has been rising in cancer patients and its response to treatment is limited due to the singular characteristics of brain metastasis (i.e., blood-brain-barrier, immune system, stroma). Despite improvements in the treatment and control of extracranial disease, the outcomes of patients with brain metastasis remain dismal. The mechanisms that allow tumor cells to promulgate metastases to the brain remain poorly understood. Further work is required to identify the molecular alterations inherent to brain metastasis in order to identify novel therapeutic targets and explicate the mechanisms of resistance to systemic therapeutics. In this article, we review current knowledge of the unique characteristics of brain metastasis, implications in therapeutic resistance, and the possibility of developing biomarkers to rationally guide the use of targeted agents.
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10
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Barresi V, Branca G, Caffo M, Caltabiano R, Ieni A, Vitarelli E, Lanzafame S, Tuccari G. Immuno-expression of endoglin and smooth muscle actin in the vessels of brain metastases. Is there a rational for anti-angiogenic therapy? Int J Mol Sci 2014; 15:5663-79. [PMID: 24699047 PMCID: PMC4013588 DOI: 10.3390/ijms15045663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 12/19/2022] Open
Abstract
Despite ongoing clinical trials, the efficacy of anti-angiogenic drugs for the treatment of brain metastases (BM) is still questionable. The lower response rate to anti-angiogenic therapy in the presence of BM than in metastatic disease involving other sites suggests that BM may be insensitive to these drugs, although the biological reasons underlining this phenomenon are still to be clarified. With the aim of assessing whether the targets of anti-angiogenic therapies are actually present in BM, in the present study, we analyzed the microvessel density (MVD), a measure of neo-angiogenesis, and the vascular phenotype (mature vs. immature) in the tumor tissue of a series of BM derived from different primary tumors. By using immunohistochemistry against endoglin, a specific marker for newly formed vessels, we found that neo-angiogenesis widely varies in BM depending on the site of the primary tumor, as well as on its histotype. According to our results, BM from lung cancer displayed the highest MVD counts, while those from renal carcinoma had the lowest. Then, among BM from lung cancer, those from large cell and adenocarcinoma histotypes had significantly higher MVD counts than those originating from squamous cell carcinoma (p = 0.0043; p = 0.0063). Of note, MVD counts were inversely correlated with the maturation index of the endoglin-stained vessels, reflected by the coverage of smooth muscle actin (SMA) positive pericytes (r = −0.693; p < 0.0001). Accordingly, all the endoglin-positive vessels in BM from pulmonary squamous cell carcinoma and renal carcinoma, displayed a mature phenotype, while vessels with an immature phenotype were found in highly vascularized BM from pulmonary large cell and adenocarcinoma. The low MVD and mature phenotype observed in BM from some primary tumors may account for their low sensitivity to anti-angiogenic therapies. Although our findings need to be validated in correlative studies with a clinical response, this should be taken into account in therapeutic protocols in order to avoid the adverse effects of useless therapies.
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Affiliation(s)
- Valeria Barresi
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Giovanni Branca
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Maria Caffo
- Department of Neurosciences, University of Messina, Messina 98125, Italy.
| | - Rosario Caltabiano
- Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, Catania 95123, Italy.
| | - Antonio Ieni
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Enrica Vitarelli
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
| | - Salvatore Lanzafame
- Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, Catania 95123, Italy.
| | - Giovanni Tuccari
- Department of Human Pathology "G. Barresi", University of Messina, Messina 98125, Italy.
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11
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Yoshida Y, Hoshino S, Aisu N, Naito M, Tanimura S, Sasaki T, Takeno S, Yamashita Y. Efficacy of XELOX plus Bevacizumab in Brain Metastasis from Rectal Cancer. Case Rep Oncol 2014; 7:117-21. [PMID: 24707258 PMCID: PMC3975757 DOI: 10.1159/000360132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Brain metastasis (BM) is rare in colorectal cancer (CRC) patients. Although BM from CRC is a late-stage phenomenon with an extremely poor prognosis, some subsets of patients would benefit from a multidisciplinary management strategy. The prognosis of patients with BM from CRC was associated with the curability of the therapy for BM and the number of metastatic organs. Metastatic brain tumors are generally treated with radiotherapy because many anticancer drugs cannot cross the blood-brain barrier. Here, we present a case treated with XELOX (capecitabine and oxaliplatin) plus bevacizumab for BM from rectal cancer. To our knowledge, this is the first report of a patient who was successfully treated for BM from CRC without radiotherapy. The findings could lead to a paradigm shift in the use of chemotherapy for BM from CRC.
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Affiliation(s)
- Yoichiro Yoshida
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Seiichiro Hoshino
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Masayasu Naito
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Syu Tanimura
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takamitsu Sasaki
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shinsuke Takeno
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuichi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Le Saux O, You B, Freyer G. Antiangiogenic therapy in patients with HER2-positive metastatic breast cancer: a case series. Clin Breast Cancer 2014; 14:e89-94. [PMID: 24424314 DOI: 10.1016/j.clbc.2013.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/11/2013] [Accepted: 11/17/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Olivia Le Saux
- Department of Medical Oncology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
| | - Benoît You
- Department of Medical Oncology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Gilles Freyer
- Department of Medical Oncology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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Franceschi E, Bartolotti M, Poggi R, Battista MD, Palleschi D, Brandes AA. The role of systemic and targeted therapies in brain metastases. Expert Rev Anticancer Ther 2013; 14:93-103. [DOI: 10.1586/14737140.2014.856760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bartsch R, Berghoff AS, Preusser M, Steger GG, Zielinski CC. Antiangiogenic treatment approaches in breast cancer. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The term ‘breast cancer’, as it is understood today, comprises heterogeneous disease entities with major disparities in terms of underlying tumor biology, treatment options and outcome. Nonetheless, all breast cancer subtypes depend upon neovascularization for growth and metastatic spreading, indicating that antiangiogenic strategies may constitute a highly effective treatment approach. Currently, the only antiangiogenic agent approved for breast cancer treatment is bevacizumab, a humanized monoclonal antibody targeting VEGF-A. In combination with chemotherapy, bevacizumab improved outcomes in terms of progression-free survival and response rate in the first- and second-line palliative setting, while overall survival remained unchanged. This fact prompted the US FDA to withdraw their approval for bevacizumab in breast cancer, while approval was retained in Europe. Other antiangiogenic agents, such as sunitinib, sorafenib or aflibercept, were either of limited effectiveness in breast cancer or concerns were raised due to the high toxicity rates. In order to fully exploit the potential benefit of antiangiogenesis, the identification of reliable predictive markers is urgently warranted. This article reviews the data on antiangiogenic treatment approaches in breast cancer, with an emphasis on bevacizumab, and discusses potential future treatment options.
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Affiliation(s)
- Rupert Bartsch
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria
| | - Anna S Berghoff
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria
| | - Matthias Preusser
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria
| | - Guenther G Steger
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Department of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18–20, A-1090 Vienna, Austria
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Kim YH, Nagai H, Ozasa H, Sakamori Y, Mishima M. Therapeutic strategy for non-small-cell lung cancer patients with brain metastases (Review). Biomed Rep 2013; 1:691-696. [PMID: 24649011 DOI: 10.3892/br.2013.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/08/2013] [Indexed: 12/25/2022] Open
Abstract
Brain metastases are frequently encountered in patients with non-small-cell lung cancer (NSCLC) and are a significant cause of morbidity and mortality. Chemotherapy has been deemed ineffective under the hypothesis that the blood-brain barrier (BBB) limits the delivery of chemotherapeutic agents to the brain. Thus, radiotherapy and occasionally surgery have been selected for the treatment of brain metastases. However, recent clinical data suggested that chemotherapy may be an effective treatment option for patients with brain metastases, since patients who have developed brain metastases may have an inherently compromised BBB. The prognosis of NSCLC patients with brain metastases is generally poor and more effective treatment is required to improve their prognosis. Bevacizumab (Avastin) is a humanized monoclonal antibody that inhibits tumor angiogenesis by neutralizing the vascular endothelial growth factor. Preclinical data indicated that bevacizumab may be effective in preventing as well as treating preexisting brain metastases. Although safety concerns regarding intracranial hemorrhage have been a barrier for the use of bevacizumab in patients with brain metastases, safety data have gradually been accumulated through recent clinical trials. In this review, we aimed to summarize the currently available treatment options and present a therapeutic strategy for NSCLC patients with brain metastases, with a special emphasis on bevacizumab.
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Affiliation(s)
- Young Hak Kim
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hiroki Nagai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hiroaki Ozasa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Yuichi Sakamori
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Rinne ML, Lee EQ, Nayak L, Norden AD, Beroukhim R, Wen PY, Reardon DA. Update on bevacizumab and other angiogenesis inhibitors for brain cancer. Expert Opin Emerg Drugs 2013; 18:137-53. [PMID: 23668489 DOI: 10.1517/14728214.2013.794784] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Primary and metastatic brain tumors remain a major challenge. The most common primary adult malignant brain tumor, glioblastoma (GBM), confers a dismal prognosis as does the development of CNS metastases for most systemic malignancies. Anti-angiogenic therapy has been a major clinical research focus in neuro-oncology over the past 5 years. AREAS COVERED Culmination of this work includes US FDA accelerated approval of bevacizumab for recurrent GBM and the completion of two placebo-controlled Phase III studies of bevacizumab for newly diagnosed GBM. A multitude of anti-angiogenics are in evaluation for neuro-oncology patients but none has thus far surpassed the therapeutic benefit of bevacizumab. EXPERT OPINION These agents demonstrate adequate safety and the majority of GBM patients derive benefit. Furthermore, their anti-permeability effect can substantially decrease tumor-associated edema leading to stable or improved neurologic function and quality of life. In particular, anti-angiogenics significantly prolong progression-free survival - a noteworthy achievement in the context of infiltrative and destructive brain tumors like GBM; however, in a manner analogous to other cancers, their impact on overall survival for GBM patients is modest at best. Despite substantial clinical research efforts, many fundamental questions regarding anti-angiogenic agents in brain tumor patients remain unanswered.
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Affiliation(s)
- Mikael L Rinne
- Dana-Farber/Brigham and Women's Cancer Center, Center for Neuro-Oncology, Boston, MA, USA
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Narita Y. Drug review: Safety and efficacy of bevacizumab for glioblastoma and other brain tumors. Jpn J Clin Oncol 2013; 43:587-95. [PMID: 23585688 DOI: 10.1093/jjco/hyt051] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Glioblastoma is a highly vascular tumor that expresses vascular endothelial growth factor, a key regulator of angiogenesis and tumor blood vessel permeability. Bevacizumab is a monoclonal antibody that inhibits vascular endothelial growth factor and the growth of gliomas. Bevacizumab monotherapy has proven effective for recurrent glioblastoma, and it extended progression-free survival and improved patient quality of life in various clinical trials. Some patients who receive bevacizumab experience improvements in neurological symptoms and steroid dose reductions. Bevacizumab induces a dramatic and rapid radiological response, but non-enhancing lesions are often detected on magnetic resonance imaging without enhancing lesions. Rebound phenomena such as rapid tumor regrowth are occasionally observed after the discontinuation of bevacizumab therapy. Therefore, Response Assessment in Neuro-Oncology criteria were recently devised to evaluate the efficacy and radiological response of bevacizumab treatment. Hypertension and proteinuria are characteristic adverse events associated with bevacizumab therapy. In addition, many fatal adverse events such as intracranial hemorrhage and venous thromboembolism are reported in patients treated with bevacizumab. However, these events are also associated with glioma itself, and careful attention needs to be paid to these events. Bevacizumab is used to treat various diseases including radiation necrosis and recurrent brain tumors such as brain metastases, schwannoma and meningioma, but additional clinical trials are necessary. The efficacy and current problems associated with bevacizumab in the treatment of glioblastoma and other brain tumors are reviewed.
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Affiliation(s)
- Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Caffo M, Barresi V, Caruso G, Cutugno M, La Fata G, Venza M, Alafaci C, Tomasello F. Innovative therapeutic strategies in the treatment of brain metastases. Int J Mol Sci 2013; 14:2135-74. [PMID: 23340652 PMCID: PMC3565370 DOI: 10.3390/ijms14012135] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 12/29/2022] Open
Abstract
Brain metastases (BM) are the most common intracranial tumors and their incidence is increasing. Untreated brain metastases are associated with a poor prognosis and a poor performance status. Metastasis development involves the migration of a cancer cell from the bulk tumor into the surrounding tissue, extravasation from the blood into tissue elsewhere in the body, and formation of a secondary tumor. In the recent past, important results have been obtained in the management of patients affected by BM, using surgery, radiation therapy, or both. Conventional chemotherapies have generally produced disappointing results, possibly due to their limited ability to penetrate the blood-brain barrier. The advent of new technologies has led to the discovery of novel molecules and pathways that have better depicted the metastatic process. Targeted therapies such as bevacizumab, erlotinib, gefitinib, sunitinib and sorafenib, are all licensed and have demonstrated improved survival in patients with metastatic disease. In this review, we will report current data on targeted therapies. A brief review about brain metastatic process will be also presented.
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Affiliation(s)
- Maria Caffo
- Department of Neurosciences, School of Medicine, University of Messina, A.O.U. Policlinico “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; E-Mails: (M.C.); (M.C.); (G.L.F.); (M.V.); (C.A.); (F.T.)
| | - Valeria Barresi
- Department of Human Pathology, School of Medicine, University of Messina, A.O.U. Policlinico “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; E-Mail:
| | - Gerardo Caruso
- Department of Neurosciences, School of Medicine, University of Messina, A.O.U. Policlinico “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; E-Mails: (M.C.); (M.C.); (G.L.F.); (M.V.); (C.A.); (F.T.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-090-2217167; Fax: +39-090-693714
| | - Mariano Cutugno
- Department of Neurosciences, School of Medicine, University of Messina, A.O.U. Policlinico “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; E-Mails: (M.C.); (M.C.); (G.L.F.); (M.V.); (C.A.); (F.T.)
| | - Giuseppe La Fata
- Department of Neurosciences, School of Medicine, University of Messina, A.O.U. Policlinico “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; E-Mails: (M.C.); (M.C.); (G.L.F.); (M.V.); (C.A.); (F.T.)
| | - Mario Venza
- Department of Neurosciences, School of Medicine, University of Messina, A.O.U. Policlinico “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; E-Mails: (M.C.); (M.C.); (G.L.F.); (M.V.); (C.A.); (F.T.)
| | - Concetta Alafaci
- Department of Neurosciences, School of Medicine, University of Messina, A.O.U. Policlinico “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; E-Mails: (M.C.); (M.C.); (G.L.F.); (M.V.); (C.A.); (F.T.)
| | - Francesco Tomasello
- Department of Neurosciences, School of Medicine, University of Messina, A.O.U. Policlinico “G. Martino”, via Consolare Valeria, 1, 98125 Messina, Italy; E-Mails: (M.C.); (M.C.); (G.L.F.); (M.V.); (C.A.); (F.T.)
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