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Sugawara T, Nevedomskaya E, Heller S, Böhme A, Lesche R, von Ahsen O, Grünewald S, Nguyen HM, Corey E, Baumgart SJ, Georgi V, Pütter V, Fernández‐Montalván A, Vasta JD, Robers MB, Politz O, Mumberg D, Haendler B. Dual targeting of the androgen receptor and PI3K/AKT/mTOR pathways in prostate cancer models improves antitumor efficacy and promotes cell apoptosis. Mol Oncol 2024; 18:726-742. [PMID: 38225213 PMCID: PMC10920092 DOI: 10.1002/1878-0261.13577] [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: 08/08/2023] [Revised: 11/27/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024] Open
Abstract
Prostate cancer is a frequent malignancy in older men and has a very high 5-year survival rate if diagnosed early. The prognosis is much less promising if the tumor has already spread outside the prostate gland. Targeted treatments mainly aim at blocking androgen receptor (AR) signaling and initially show good efficacy. However, tumor progression due to AR-dependent and AR-independent mechanisms is often observed after some time, and novel treatment strategies are urgently needed. Dysregulation of the PI3K/AKT/mTOR pathway in advanced prostate cancer and its implication in treatment resistance has been reported. We compared the impact of PI3K/AKT/mTOR pathway inhibitors with different selectivity profiles on in vitro cell proliferation and on caspase 3/7 activation as a marker for apoptosis induction, and observed the strongest effects in the androgen-sensitive prostate cancer cell lines VCaP and LNCaP. Combination treatment with the AR inhibitor darolutamide led to enhanced apoptosis in these cell lines, the effects being most pronounced upon cotreatment with the pan-PI3K inhibitor copanlisib. A subsequent transcriptomic analysis performed in VCaP cells revealed that combining darolutamide with copanlisib impacted gene expression much more than individual treatment. A comprehensive reversal of the androgen response and the mTORC1 transcriptional programs as well as a marked induction of DNA damage was observed. Next, an in vivo efficacy study was performed using the androgen-sensitive patient-derived prostate cancer (PDX) model LuCaP 35 and a superior efficacy was observed after the combined treatment with copanlisib and darolutamide. Importantly, immunohistochemistry analysis of these treated tumors showed increased apoptosis, as revealed by elevated levels of cleaved caspase 3 and Bcl-2-binding component 3 (BBC3). In conclusion, these data demonstrate that concurrent blockade of the PI3K/AKT/mTOR and AR pathways has superior antitumor efficacy and induces apoptosis in androgen-sensitive prostate cancer cell lines and PDX models.
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Affiliation(s)
- Tatsuo Sugawara
- Bayer AG, Pharmaceuticals, Research & Early Development OncologyBerlinGermany
| | | | | | | | | | | | | | | | - Eva Corey
- Department of UrologyUniversity of WashingtonSeattleWAUSA
| | - Simon J. Baumgart
- Bayer AG, Pharmaceuticals, Research & Early Development OncologyBerlinGermany
| | - Victoria Georgi
- Bayer AG, Pharmaceuticals, Research & Early Development OncologyBerlinGermany
| | - Vera Pütter
- Bayer AG, Pharmaceuticals, Research & Early Development OncologyBerlinGermany
| | - Amaury Fernández‐Montalván
- Bayer AG, Pharmaceuticals, Research & Early Development OncologyBerlinGermany
- Present address:
Boehringer Ingelheim Pharma GmbH & Co. KGBiberach an der RißGermany
| | | | | | - Oliver Politz
- Bayer AG, Pharmaceuticals, Research & Early Development OncologyBerlinGermany
| | - Dominik Mumberg
- Bayer AG, Pharmaceuticals, Research & Early Development OncologyBerlinGermany
- Present address:
Adcento ApSCopenhagenDenmark
| | - Bernard Haendler
- Bayer AG, Pharmaceuticals, Research & Early Development OncologyBerlinGermany
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Palmedo H, Ahmadzadehfar H, Eschmann S, Niesen A, Schönberger J, Barsegian V, Liepe K, Mottaghy FM, Guan R, Pinkert J, Sandström P, Herrmann K. Pain Outcomes in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with 223Ra: PARABO, a Prospective, Noninterventional Study. J Nucl Med 2023; 64:1392-1398. [PMID: 37385670 PMCID: PMC10478815 DOI: 10.2967/jnumed.123.265557] [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: 02/14/2023] [Revised: 04/20/2023] [Indexed: 07/01/2023] Open
Abstract
223Ra, a targeted α-therapy, is approved for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) who have bone metastases. In the phase 3 ALSYMPCA study, 223Ra prolonged survival and improved quality of life versus placebo. Our real-world study, PARABO, investigated pain and bone pain-related quality of life in patients with mCRPC and symptomatic bone metastases receiving 223Ra in clinical practice. Methods: PARABO was a prospective, observational, noninterventional single-arm study conducted in nuclear medicine centers across Germany (NCT02398526). The primary endpoint was a clinically meaningful pain response (≥2-point improvement from baseline for the worst-pain item score in the Brief Pain Inventory-Short Form). Results: The analysis included 354 patients, who received a median of 6 223Ra injections (range, 1-6). Sixty-seven percent (236/354) received 5-6 injections, and 33% (118/354) received 1-4 injections. Of 216 patients with a baseline worst-pain score of more than 1, 59% (128) had a clinically meaningful pain response during treatment. Corresponding rates were 67% (range, 98/146) with 5-6 223Ra injections versus 43% (range, 30/70) with 1-4 injections, 60% (range, 60/100) in patients with no more than 20 lesions versus 59% (range, 65/111) in those with more than 20 lesions, and 65% (range, 69/106) in patients without prior or concomitant opioid use versus 54% (range, 59/110) in those with prior or concomitant opioid use. Mean subscale scores (pain severity and pain interference) on the Brief Pain Inventory-Short Form improved during treatment. Conclusion: 223Ra reduced pain in patients with mCRPC and symptomatic bone metastases, particularly in patients who received 5-6 injections. The extent of metastatic disease did not impact pain response.
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Affiliation(s)
- Holger Palmedo
- Institute of Radiology and Nuclear Medicine Kaiser Passage and PET/CT Centre, Johanniter Hospital, Bonn, Germany;
| | | | | | | | | | | | - Knut Liepe
- Department of Nuclear Medicine, Klinikum Frankfurt (Oder) GmbH, Frankfurt, Germany
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen University, Aachen, Germany, and Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rongjin Guan
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | | | - Per Sandström
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, and German Cancer Consortium-University Hospital Essen, Essen, Germany
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