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Zila N, Eichhoff OM, Steiner I, Mohr T, Bileck A, Cheng PF, Leitner A, Gillet L, Sajic T, Goetze S, Friedrich B, Bortel P, Strobl J, Reitermaier R, Hogan SA, Martínez Gómez JM, Staeger R, Tuchmann F, Peters S, Stary G, Kuttke M, Elbe-Bürger A, Hoeller C, Kunstfeld R, Weninger W, Wollscheid B, Dummer R, French LE, Gerner C, Aebersold R, Levesque MP, Paulitschke V. Proteomic Profiling of Advanced Melanoma Patients to Predict Therapeutic Response to Anti-PD-1 Therapy. Clin Cancer Res 2024; 30:159-175. [PMID: 37861398 DOI: 10.1158/1078-0432.ccr-23-0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Despite high clinical need, there are no biomarkers that accurately predict the response of patients with metastatic melanoma to anti-PD-1 therapy. EXPERIMENTAL DESIGN In this multicenter study, we applied protein depletion and enrichment methods prior to various proteomic techniques to analyze a serum discovery cohort (n = 56) and three independent serum validation cohorts (n = 80, n = 12, n = 17). Further validation analyses by literature and survival analysis followed. RESULTS We identified several significantly regulated proteins as well as biological processes such as neutrophil degranulation, cell-substrate adhesion, and extracellular matrix organization. Analysis of the three independent serum validation cohorts confirmed the significant differences between responders (R) and nonresponders (NR) observed in the initial discovery cohort. In addition, literature-based validation highlighted 30 markers overlapping with previously published signatures. Survival analysis using the TCGA database showed that overexpression of 17 of the markers we identified correlated with lower overall survival in patients with melanoma. CONCLUSIONS Ultimately, this multilayered serum analysis led to a potential marker signature with 10 key markers significantly altered in at least two independent serum cohorts: CRP, LYVE1, SAA2, C1RL, CFHR3, LBP, LDHB, S100A8, S100A9, and SAA1, which will serve as the basis for further investigation. In addition to patient serum, we analyzed primary melanoma tumor cells from NR and found a potential marker signature with four key markers: LAMC1, PXDN, SERPINE1, and VCAN.
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Affiliation(s)
- Nina Zila
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- Division of Biomedical Science, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Ossia M Eichhoff
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Irene Steiner
- Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Thomas Mohr
- Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Andrea Bileck
- Department of Analytical Chemistry, University of Vienna, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Phil F Cheng
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Leitner
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Ludovic Gillet
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Tatjana Sajic
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Sandra Goetze
- Department of Health Sciences and Technology, Institute of Translational Medicine, ETH Zurich, Zurich, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- ETH PHRT Swiss Multi-Omics Center (SMOC), Zurich, Switzerland
| | - Betty Friedrich
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Patricia Bortel
- Department of Analytical Chemistry, University of Vienna, Vienna, Austria
| | - Johanna Strobl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - René Reitermaier
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Sabrina A Hogan
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia M Martínez Gómez
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ramon Staeger
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Felix Tuchmann
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Sophie Peters
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Mario Kuttke
- Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria
| | | | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Rainer Kunstfeld
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Bernd Wollscheid
- Department of Health Sciences and Technology, Institute of Translational Medicine, ETH Zurich, Zurich, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lars E French
- Department of Dermatology and Allergy University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher Gerner
- Department of Analytical Chemistry, University of Vienna, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Ruedi Aebersold
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Mitchell P Levesque
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Verena Paulitschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Pellacani G, Schlesinger T, Bhatia N, Berman B, Lebwohl M, Cohen JL, Patel GK, Kunstfeld R, Hadshiew I, Lear JT. Efficacy and safety of tirbanibulin 1% ointment in actinic keratoses: Data from two phase-III trials and the real-life clinical practice presented at the European Academy of Dermatology and Venereology Congress 2022. J Eur Acad Dermatol Venereol 2024; 38 Suppl 1:3-15. [PMID: 38116638 DOI: 10.1111/jdv.19636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The 31st European Academy of Dermatology and Venereology (EADV) Congress took place between 7th and 10th of September 2022 in Milan, Italy. OBJECTIVES We report presented clinical data on the efficacy/effectiveness, safety and tolerability of tirbanibulin 1% ointment that has recently been licensed for actinic keratosis (AK) of the face or scalp in adults. METHODS Summary of presentations given at the EADV Congress. RESULTS Prof. Pellacani presented two post hoc analyses from two phase-III trials with AK patients (NCT03285477 [N = 351] and NCT03285490 [N = 351]): A descriptive analysis of medical history, concomitant medications, and safety results confirming a favourable profile for tirbanibulin showing that number of baseline AK lesions was not correlated to severity of local skin reactions. The latter analysis showed that cases of tirbanibulin application site pain or pruritus were few, and most were found to be mild. Prof. Kunstfeld reported six real-life clinical cases in Austria showing good tirbanibulin effectiveness, safety and tolerability for the treatment of new or recurring AK lesions. Results demonstrated that after 2- to 4-month follow-up, tirbanibulin was well tolerated and effective in AK patients. Presentations by Dr. Patel confirmed good outcomes and tolerability of tirbanibulin in Olsen grade 1-2 AK (N = 12) and porokeratosis patients (N = 4) treated once daily for 5 consecutive days in the United Kingdom. Furthermore, real-world experience in solid organ transplant recipients (N = 2) demonstrated effectiveness of tirbanibulin in skin field cancerization treatment. A symposium sponsored by Almirall was conducted during the congress in which Dr. Hadshiew and Dr. Lear brought together their clinical experience in Germany and the United Kingdom respectively. Interesting clinical cases of 5 consecutive days of tirbanibulin treatment compared to other treatments were discussed with attendees, as well as current treatment needs of AK patients. CONCLUSIONS This article provides an overview of presentations and symposium discussions, summarizing key phase-III results and real-life clinical experience with tirbanibulin shared by dermatologists across Europe.
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Affiliation(s)
- G Pellacani
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - T Schlesinger
- Clinical Research Center of the Carolinas, Charleston, South Carolina, USA
| | - N Bhatia
- Therapeutics Clinical Research, San Diego, California, USA
| | - B Berman
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - M Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J L Cohen
- Department of Dermatology, University of California, Irvine, California, USA
- AboutSkin Dermatology and DermSurgery, Greenwood Village, Colorado, USA
| | - G K Patel
- Welsh Institute of Dermatology, University Hospital Wales, Cardiff, UK
| | - R Kunstfeld
- Dermatology Department, Medical University Vienna, Vienna, Austria
| | | | - J T Lear
- Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
- MAHSC, Manchester University, Manchester, UK
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3
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Kunstfeld R, Nguyen VA. Neue Entwicklungen in der Behandlung des Basalzellkarzinoms. J Dtsch Dermatol Ges 2023; 21:382-385. [PMID: 37070498 DOI: 10.1111/ddg.15020_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/22/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Rainer Kunstfeld
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Van Anh Nguyen
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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Abstract
In 2013, systemic therapy was introduced into the treatment of locally advanced (laBCC) and metastatic basal cell carcinoma (mBCC). Meanwhile, immunotherapy has been approved in this indication as well. Additional immunotherapies and other classes of drugs including combination regimens are currently being investigated in clinical trials. These agents might considerably expand the therapeutic armamentarium for laBCC and mBCC in the future.
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Affiliation(s)
- Rainer Kunstfeld
- University Hospital for Dermatology, Medical University Vienna, Vienna, Austria
| | - Van Anh Nguyen
- University Hospital for Dermatology, Venereology and Allergology, Medical University Innsbruck, Innsbruck, Austria
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Schadendorf D, Hauschild A, Fosko S, Zloty D, Labeille B, Grob J, Puig S, Makrutzki M, Gilberg F, Hong A, Dréno B, Rogers G, Kunstfeld R. Quality‐of‐life analysis with intermittent vismodegib regimens in patients with multiple basal cell carcinomas: patient‐reported outcomes from the MIKIE study. J Eur Acad Dermatol Venereol 2020; 34:e526-e529. [DOI: 10.1111/jdv.16446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - A. Hauschild
- University Hospital Schleswig‐Holstein Kiel Germany
| | - S. Fosko
- Saint Louis University Medical School St. Louis MO USA
| | - D. Zloty
- University of British Columbia Vancouver BC Canada
| | - B. Labeille
- University Hospital of Saint‐Etienne Saint‐Priest‐en‐Jarez France
| | - J.‐J. Grob
- Aix‐Marseille University Marseille France
- Timone Hospital Marseille France
| | - S. Puig
- Hospital Clinic de Barcelona University of BarcelonaIDIBAPS (Institut d’Investigacions Biomediques August Pi i Sunyer) Barcelona Spain
- Centro de Investigación Biomedica en Red de Enfermedades Raras (CIBER ER) Barcelona Spain
| | | | - F. Gilberg
- F. Hoffmann‐La Roche Ltd Basel Switzerland
| | - A. Hong
- Genentech, Inc. South San Francisco CA USA
| | | | - G. Rogers
- Tufts University School of Medicine Boston MA USA
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Gollnick H, Dirschka T, Ostendorf R, Kerl H, Kunstfeld R. Long-term clinical outcomes of imiquimod 5% cream vs. diclofenac 3% gel for actinic keratosis on the face or scalp: a pooled analysis of two randomized controlled trials. J Eur Acad Dermatol Venereol 2019; 34:82-89. [PMID: 31407414 DOI: 10.1111/jdv.15868] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/08/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Actinic keratosis (AK) is an early in situ epidermal cancer which can progress to invasive squamous cell carcinoma (SCC). Imiquimod 5% cream (IMIQ) and diclofenac 3% gel (DIC) are frequently used to treat AK; however, their long-term effects following repeated treatment cycles have never been compared. OBJECTIVE To compare IMIQ and DIC in the treatment of AK with respect to the risk of change to grade III AK or invasive SCC, after 3 years. METHODS Data were pooled from two randomized, active-controlled, open-label, multicentre, multinational, phase IV studies (Clinicaltrials.gov NCT00777127/NCT01453179), with two parallel groups. Studies were conducted between 2008 and 2015 and were almost identical in design. Patients eligible for inclusion were immunocompetent adults with 5-10 visible AK lesions on the face/scalp and grade I/II AK. The primary endpoint was inhibition of histological change to grade III AK or invasive SCC in the study treatment area, observed until month 36. Patients applied either IMIQ or DIC for a maximum of six treatment cycles. RESULTS In total, 479 patients (IMIQ 242; DIC 237) were included in the full analysis set. Histological change to grade III AK or invasive SCC was observed until month 36 in 13 (5.4%) patients treated with IMIQ, compared with 26 (11.0%) patients treated with DIC (absolute risk difference -5.6% [95% confidence interval -10.7%, -0.7%]). Time to histological change was greater in the IMIQ group than the DIC group (P = 0.0266). Frequency of progression to invasive SCC was lower with IMIQ than with DIC at all time points. Initial clearance rate was higher in the IMIQ group compared with the DIC group, while recurrence rate was lower. Both treatments were well tolerated. CONCLUSIONS Over 3 years, IMIQ was superior to DIC in clearing AK lesions and preventing histological change to grade III AK or invasive SCC and recurrence.
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Affiliation(s)
- H Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke University, Magdeburg, Germany
| | - T Dirschka
- Centroderm Clinic, Wuppertal, Germany.,Faculty of Health, University of Witten-Herdecke, Witten, Germany
| | | | - H Kerl
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - R Kunstfeld
- Dermatology Clinic, General Hospital, Vienna, Austria
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7
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Paulitschke V, Eichhoff O, Gerner C, Paulitschke P, Bileck A, Mohr T, Cheng PF, Leitner A, Guenova E, Saulite I, Freiberger SN, Irmisch A, Knapp B, Zila N, Chatziisaak TP, Stephan J, Mangana J, Kunstfeld R, Pehamberger H, Aebersold R, Dummer R, Levesque MP. Proteomic identification of a marker signature for MAPKi resistance in melanoma. EMBO J 2019; 38:e95874. [PMID: 31267558 DOI: 10.15252/embj.201695874] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 12/21/2022] Open
Abstract
MAPK inhibitors (MAPKi) show outstanding clinical response rates in melanoma patients harbouring BRAF mutations, but resistance is common. The ability of melanoma cells to switch from melanocytic to mesenchymal phenotypes appears to be associated with therapeutic resistance. High-throughput, subcellular proteome analyses and RNAseq on two panels of primary melanoma cells that were either sensitive or resistant to MAPKi revealed that only 15 proteins were sufficient to distinguish between these phenotypes. The two proteins with the highest discriminatory power were PTRF and IGFBP7, which were both highly upregulated in the mesenchymal-resistant cells. Proteomic analysis of CRISPR/Cas-derived PTRF knockouts revealed targets involved in lysosomal activation, endocytosis, pH regulation, EMT, TGFβ signalling and cell migration and adhesion, as well as a significantly reduced invasive index and ability to form spheres in 3D culture. Overexpression of PTRF led to MAPKi resistance, increased cell adhesion and sphere formation. In addition, immunohistochemistry of patient samples showed that PTRF expression levels were a significant biomarker of poor progression-free survival, and IGFBP7 levels in patient sera were shown to be higher after relapse.
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Affiliation(s)
- Verena Paulitschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.,Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland.,Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Ossia Eichhoff
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Philipp Paulitschke
- Institute of Physics, Center for NanoScience, Ludwig Maximilians University, Munich, Germany
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Thomas Mohr
- Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Phil F Cheng
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
| | - Alexander Leitner
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
| | - Ieva Saulite
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
| | - Sandra N Freiberger
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
| | - Anja Irmisch
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
| | - Bernhard Knapp
- Department of Statistics, Protein Informatics Group, University of Oxford, Oxford, UK
| | - Nina Zila
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Jürgen Stephan
- Institute of Physics, Center for NanoScience, Ludwig Maximilians University, Munich, Germany
| | - Joanna Mangana
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
| | - Rainer Kunstfeld
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Hubert Pehamberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Ruedi Aebersold
- Department of Biology, Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland.,Faculty of Science, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
| | - Mitchell P Levesque
- Department of Dermatology, University of Zurich Hospital, University of Zurich, Zurich, Switzerland
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Mickel M, Kunstfeld R, Crevenna R. Granuloma Annulare and Radial Pulse Therapy: Preliminary Findings. J Clin Aesthet Dermatol 2018; 11:32-34. [PMID: 29410728 PMCID: PMC5788266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this case report, the authors describe a first-time trial of a variation of extracorporeal shockwave therapy in a patient with disseminated granuloma annulare. Radial pulse therapy was administered in an outpatient clinic of a university hospital to a 72-year-old woman with a 14-year history of disseminated granuloma annulare. The authors describe changes in clinical appearance and results of histological evaluation, reporting observable positive changes in all four treated plaques. The authors conclude that radial pulse therapy was well-tolerated and seemed to influence the course of disseminated granuloma annulare plaques positively.
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Affiliation(s)
- Michael Mickel
- Drs. Mickel and Crevenna are with the Department of Physical Medicine, Rehabilitation, and Occupational Medicine at the Medical University of Vienna in Austria
- Dr. Kunstfeld is with the Department of Dermatology at the Medical University of Vienna
| | - Rainer Kunstfeld
- Drs. Mickel and Crevenna are with the Department of Physical Medicine, Rehabilitation, and Occupational Medicine at the Medical University of Vienna in Austria
- Dr. Kunstfeld is with the Department of Dermatology at the Medical University of Vienna
| | - Richard Crevenna
- Drs. Mickel and Crevenna are with the Department of Physical Medicine, Rehabilitation, and Occupational Medicine at the Medical University of Vienna in Austria
- Dr. Kunstfeld is with the Department of Dermatology at the Medical University of Vienna
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9
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Basset-Séguin N, Hauschild A, Kunstfeld R, Grob J, Dréno B, Mortier L, Ascierto PA, Licitra L, Dutriaux C, Thomas L, Meyer N, Guillot B, Dummer R, Arenberger P, Fife K, Raimundo A, Dika E, Dimier N, Fittipaldo A, Xynos I, Hansson J. Vismodegib in patients with advanced basal cell carcinoma: Primary analysis of STEVIE, an international, open-label trial. Eur J Cancer 2017; 86:334-348. [PMID: 29073584 DOI: 10.1016/j.ejca.2017.08.022] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/04/2017] [Accepted: 08/28/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND The SafeTy Events in VIsmodEgib study (STEVIE, ClinicalTrials.gov, NCT01367665), assessed safety and efficacy of vismodegib-a first-in-class Hedgehog pathway inhibitor demonstrating clinical benefit in advanced basal cell carcinoma (BCC)-in a patient population representative of clinical practice. Primary analysis data are presented. PATIENTS AND METHODS Patients with locally advanced or metastatic BCC received oral vismodegib 150 mg/d until progressive disease, unacceptable toxicity, or withdrawal. Primary objective was safety. Efficacy variables were assessed as secondary end-points. RESULTS Evaluable adult patients (N = 1215, 1119 locally advanced; 96 metastatic BCC) from 36 countries were treated; 147 patients (12%) remained on study at time of reporting. Median (range) treatment duration was 8.6 (0-44) months. Most patients (98%) had ≥1 treatment-emergent adverse event (TEAE). The incidence of the most common TEAEs was consistent with reports in previous analyses. No association between creatine phosphokinase (CPK) abnormalities and muscle spasm was observed. Serious TEAEs occurred in 289 patients (23.8%). Exposure ≥12 months did not lead to increased incidence or severity of new TEAEs. The majority of the most common TEAEs ongoing at time of treatment discontinuation resolved by 12 months afterwards, regardless of Gorlin syndrome status. Response rates (investigator-assessed) in patients with histologically confirmed measurable baseline disease were 68.5% (95% confidence interval (CI) 65.7-71.3) in patients with locally advanced BCC and 36.9% (95% CI 26.6-48.1) in patients with metastatic BCC. CONCLUSIONS The primary analysis of STEVIE demonstrates that vismodegib is tolerable in typical patients in clinical practice; safety profile is consistent with that in previous reports. Long-term exposure was not associated with worsening severity/frequency of TEAEs. Investigator-assessed response rates showed high rate of tumour control. CLINICALTRIALS.GOV: NCT01367665.
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Affiliation(s)
- N Basset-Séguin
- Department of Dermatology, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75475, Paris, France.
| | - A Hauschild
- Department of Dermatology, University of Kiel, Rosalind-Franklin-Str 7, D-24105, Kiel, Germany.
| | - R Kunstfeld
- University Dermatology Clinic, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
| | - J Grob
- Dermatology and Oncology Service, Aix Marseille University and Timone Hospital, 264 Rue St. Pierre, 13385, Cedex 05 Marseille, France.
| | - B Dréno
- Department of Dermato Oncology, University Hospital Nantes, Hotel Dieu, Place Alexis Ricordeau, 44093, Cedex 01 Nantes, France.
| | - L Mortier
- Dermatology Service, University of Lille 2, Lille Regional University Hospital, Hôpital Huriez, 2 Avenue Oscar Lambret, 59037, Lille, France.
| | - P A Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori Fondazione Pascale, Via Mariano Semmola, 80131, Naples, Italy.
| | - L Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, and University of Milan, Via Giacomo Venezian 1, 20133, Italy.
| | - C Dutriaux
- Dermatology Service, University Hospital of Bordeaux, 1 Rue Jean Burguet, 33075, Bordeaux, France.
| | - L Thomas
- Dermatology Service, Centre Hospitalier Universitaire de Lyon, Centre Hospitalier Lyon Sud, 69495, Pierre Bénite, Lyon, France.
| | - N Meyer
- Skin Cancer Unit, Paul Sabatier University and Toulouse University Cancer Institute, 24 Chemin de Pouvourville TSA30030, 31059, Toulouse, France.
| | - B Guillot
- Dermatology Department, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
| | - R Dummer
- Dermatology Department, University Hospital Zurich, Gloriastr. 31, 8091, Zurich, Switzerland.
| | - P Arenberger
- Dermatology Department, Charles University Third Faculty of Medicine, Šrobárova 1150/50, 100 34, Praha 10, Prague, Czech Republic.
| | - K Fife
- Oncology Centre, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2OQ, UK.
| | - A Raimundo
- Oncology Department, Instituto Portugues de Oncologia, R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.
| | - E Dika
- Dermatology, Department of Diagnostic, Experimental and Specialty Medicine, University of Bologna, Via Massarenti 1, 40138, Bologna, Italy.
| | - N Dimier
- Roche Products Ltd., 6 Falcon Way, Shire Park, Welwyn Garden City, Hertfordshire, AL7 1TW, UK.
| | - A Fittipaldo
- Roche Products Ltd., 6 Falcon Way, Shire Park, Welwyn Garden City, Hertfordshire, AL7 1TW, UK.
| | - I Xynos
- Roche Products Ltd., 6 Falcon Way, Shire Park, Welwyn Garden City, Hertfordshire, AL7 1TW, UK.
| | - J Hansson
- Department of Oncology-Pathology, Karolinska University Hospital, Hospital Solma, 171 76, Stockholm, Sweden.
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Dréno B, Kunstfeld R, Hauschild A, Fosko S, Zloty D, Labeille B, Grob JJ, Puig S, Gilberg F, Bergström D, Page DR, Rogers G, Schadendorf D. Two intermittent vismodegib dosing regimens in patients with multiple basal-cell carcinomas (MIKIE): a randomised, regimen-controlled, double-blind, phase 2 trial. Lancet Oncol 2017; 18:404-412. [PMID: 28188086 DOI: 10.1016/s1470-2045(17)30072-4] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vismodegib, a first-in-class Hedgehog-pathway inhibitor, is approved for use in adults with advanced basal-cell carcinoma. Patients with multiple basal-cell carcinomas, including those with basal-cell nevus (Gorlin) syndrome, need extended treatment. We assessed the safety and activity of two long-term intermittent vismodegib dosing regimens in patients with multiple basal-cell carcinomas. METHODS In this randomised, regimen-controlled, double-blind, phase 2 trial, we enrolled adult patients with multiple basal-cell carcinomas, including those with basal-cell nevus syndrome, who had one or more histopathologically confirmed and at least six clinically evident basal-cell carcinomas. From a centralised randomisation schedule accessed via an interactive voice or web-based response system, patients were randomly assigned (1:1) to treatment group A (150 mg oral vismodegib per day for 12 weeks, then three rounds of 8 weeks of placebo daily followed by 12 weeks of 150 mg vismodegib daily) or treatment group B (150 mg oral vismodegib per day for 24 weeks, then three rounds of 8 weeks of placebo daily followed by 8 weeks of 150 mg vismodegib daily). Treatment assignment was stratified by diagnosis of basal-cell nevus syndrome, geographical region, and immunosuppression status. The primary endpoint was percentage reduction from baseline in the number of clinically evident basal-cell carcinomas at week 73. The primary analysis was by intention to treat. The safety population included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT01815840, and the study is ongoing. FINDINGS Between April 30, 2013, and April 9, 2014, 229 patients were randomly assigned treatment, 116 in treatment group A and 113 in treatment group B. The mean number of basal-cell carcinoma lesions at week 73 was reduced from baseline by 62·7% (95% CI 53·0-72·3) in treatment group A and 54·0% (43·6-64·4) in treatment group B. 216 (95%) of 227 patients included in the safety analysis had at least one treatment-emergent adverse event deemed to be related to study treatment (107 [94%] of 114 in treatment group A and 109 [97%] of 113 in treatment group B). The most common grade 3 or worse treatment-related adverse events were muscle spasms (four [4%] patients in treatment group A vs 12 [11%] in treatment group B), increased blood creatine phosphokinase (one [1%] vs four [4%]), and hypophosphataemia (zero vs three [3%]). Serious treatment-emergent events were noted in 22 (19%) patients in treatment group A and 19 (17%) patients in treatment group B. Four (2%) patients died from adverse events; one (pulmonary embolism in treatment group A) was possibly related to treatment. INTERPRETATION Both intermittent dosing schedules of vismodegib seemed to show good activity in long-term regimens in patients with multiple basal-cell carcinomas. Further study is warranted. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
- Brigitte Dréno
- Service de Dermato-Cancérologie, Nantes University, Nantes, France.
| | - Rainer Kunstfeld
- University Dermatology Clinic, Medical University of Vienna, Vienna, Austria
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Scott Fosko
- Department of Dermatology, Saint Louis University Medical School, St Louis, MO, USA; Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA
| | - David Zloty
- Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Bruno Labeille
- Dermatology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Jean-Jacques Grob
- Service de Dermatologie, Aix Marseille University and Timone Hospital, Marseille, France
| | - Susana Puig
- Department of Dermatology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Research, Oncology and Haematology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Frank Gilberg
- Biostatistics, F Hoffmann-La Roche, Basel, Switzerland
| | - Daniel Bergström
- Global Product Development, Medical Affairs, Oncology, F Hoffmann-La Roche, Basel, Switzerland
| | - Damian R Page
- Global Product Development, Medical Affairs, Oncology and Haematology, F Hoffmann-La Roche, Basel, Switzerland
| | - Gary Rogers
- Department of Surgery, Oncology Center, Tufts University School of Medicine, Boston, MA, USA
| | - Dirk Schadendorf
- Klinik für Dermatologie, Venereologie und Allergologie, Universitätsklinikum Essen, Essen, Germany
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Schadendorf D, Hauschild A, Fosko S, Zloty D, Labeille B, Grob J, Puig S, Makrutzki M, Templeton I, Rogers G, Dreno B, Kunstfeld R. Evaluation of the pharmacokinetic (PK) profile of vismodegib (VISMO) in patients (pts) with multiple basal cell carcinomas (BCCs) across two intermittent treatment regimens in the MIKIE study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Basset-Seguin N, Hansson J, Kunstfeld R, Grob J, Dreno B, Mortier L, Ascierto P, Dimier N, Fittipaldo A, Xynos I, Hauschild A. Subgroup analysis of patients (pts) with Gorlin syndrome treated with vismodegib (VISMO) in the STEVIE study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dittrich C, Kosty M, Jezdic S, Pyle D, Berardi R, Bergh J, El-Saghir N, Lotz JP, Österlund P, Pavlidis N, Purkalne G, Awada A, Banerjee S, Bhatia S, Bogaerts J, Buckner J, Cardoso F, Casali P, Chu E, Close JL, Coiffier B, Connolly R, Coupland S, De Petris L, De Santis M, de Vries EGE, Dizon DS, Duff J, Duska LR, Eniu A, Ernstoff M, Felip E, Fey MF, Gilbert J, Girard N, Glaudemans AWJM, Gopalan PK, Grothey A, Hahn SM, Hanna D, Herold C, Herrstedt J, Homicsko K, Jones DV, Jost L, Keilholz U, Khan S, Kiss A, Köhne CH, Kunstfeld R, Lenz HJ, Lichtman S, Licitra L, Lion T, Litière S, Liu L, Loehrer PJ, Markham MJ, Markman B, Mayerhoefer M, Meran JG, Michielin O, Moser EC, Mountzios G, Moynihan T, Nielsen T, Ohe Y, Öberg K, Palumbo A, Peccatori FA, Pfeilstöcker M, Raut C, Remick SC, Robson M, Rutkowski P, Salgado R, Schapira L, Schernhammer E, Schlumberger M, Schmoll HJ, Schnipper L, Sessa C, Shapiro CL, Steele J, Sternberg CN, Stiefel F, Strasser F, Stupp R, Sullivan R, Tabernero J, Travado L, Verheij M, Voest E, Vokes E, Von Roenn J, Weber JS, Wildiers H, Yarden Y. ESMO / ASCO Recommendations for a Global Curriculum in Medical Oncology Edition 2016. ESMO Open 2016; 1:e000097. [PMID: 27843641 PMCID: PMC5070299 DOI: 10.1136/esmoopen-2016-000097] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 12/05/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) are publishing a new edition of the ESMO/ASCO Global Curriculum (GC) thanks to contribution of 64 ESMO-appointed and 32 ASCO-appointed authors. First published in 2004 and updated in 2010, the GC edition 2016 answers to the need for updated recommendations for the training of physicians in medical oncology by defining the standard to be fulfilled to qualify as medical oncologists. At times of internationalisation of healthcare and increased mobility of patients and physicians, the GC aims to provide state-of-the-art cancer care to all patients wherever they live. Recent progress in the field of cancer research has indeed resulted in diagnostic and therapeutic innovations such as targeted therapies as a standard therapeutic approach or personalised cancer medicine apart from the revival of immunotherapy, requiring specialised training for medical oncology trainees. Thus, several new chapters on technical contents such as molecular pathology, translational research or molecular imaging and on conceptual attitudes towards human principles like genetic counselling or survivorship have been integrated in the GC. The GC edition 2016 consists of 12 sections with 17 subsections, 44 chapters and 35 subchapters, respectively. Besides renewal in its contents, the GC underwent a principal formal change taking into consideration modern didactic principles. It is presented in a template-based format that subcategorises the detailed outcome requirements into learning objectives, awareness, knowledge and skills. Consecutive steps will be those of harmonising and implementing teaching and assessment strategies.
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Affiliation(s)
- Christian Dittrich
- 3rd Medical Department , Centre for Oncology and Haematology, Kaiser Franz Josef-Spital , Vienna , Austria
| | - Michael Kosty
- Division of Hematology/Oncology , Scripps Green Cancer Center, Scripps Clinic , La Jolla, California , USA
| | - Svetlana Jezdic
- European Society for Medical Oncology (ESMO) , Lugano , Switzerland
| | - Doug Pyle
- American Society of Clinical Oncology (ASCO) , Alexandria, Virginia , USA
| | - Rossana Berardi
- Department of Medical Oncology , Università Politecnica delle Marche, Ospedali Riuniti Ancona , Ancona , Italy
| | - Jonas Bergh
- The Strategic Research Programme in Cancer, Karolinska Institutet and University Hospital , Stockholm , Sweden
| | - Nagi El-Saghir
- Department of Internal Medicine , NK Basile Cancer Institute, American University of Beirut Medical Center , Beirut , Lebanon
| | - Jean-Pierre Lotz
- Department of Medical Oncology and Cellular Therapy, Medical Oncology Department , Tenon Assistance Publique-Hôpitaux de Paris , Paris , France
| | - Pia Österlund
- Department of Oncology , HUCH Helsinki University Central Hospital and University of Helsinki , Helsinki, Finland
| | - Nicholas Pavlidis
- Department of Medical Oncology , University of Ioannina , Ioannina , Greece
| | - Gunta Purkalne
- Clinic of Oncology , Pauls Stradins Clinical University Hospital , Riga , Latvia
| | - Ahmad Awada
- Medical Oncology Clinic , Jules Bordet Institute, Université Libre de Bruxelles , Brussels , Belgium
| | | | - Smita Bhatia
- Division of Pediatric Hematology/Oncology, Department of Pediatrics , Institute of Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, UAB Comprehensive Cancer Center , Birmingham, Alabama , USA
| | - Jan Bogaerts
- The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Jan Buckner
- Department of Oncology , Cancer Practice-Mayo Clinic Cancer Center , Rochester, Minnesota , USA
| | - Fatima Cardoso
- Breast Unit , Champalimaud Clinical Center , Lisbon , Portugal
| | - Paolo Casali
- Medical Oncology Unit 2 (Adult Mesenchymal Tumours and Rare Cancers) , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Edward Chu
- University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA
| | - Julia Lee Close
- UF Department of Medicine Division of Hematology/Oncology, UF Hematology/Oncology Fellowship Program, Gainesville, Florida, USA; Medical Service, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Bertrand Coiffier
- Department of Hematology , University Claude Bernard Lyon 1, Centre Hospitalier Lyon-Sud , Lyon , France
| | - Roisin Connolly
- Breast and Ovarian Cancer Program , Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University , Baltimore, Maryland , USA
| | - Sarah Coupland
- Pathology, Molecular and Clinical Cancer Medicine , University of Liverpool , Liverpool , UK
| | - Luigi De Petris
- Department of Oncology , Radiumhemmet, Karolinska Institutet and University Hospital , Stockholm , Sweden
| | - Maria De Santis
- University of Warwick, Cancer Research Centre , Coventry , UK
| | - Elisabeth G E de Vries
- Department of Medical Oncology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Don S Dizon
- The Oncology Sexual Health Clinic, Harvard Medical School, Department of Medicine , Massachusetts General Hospital , Boston, Massachusetts , USA
| | - Jennifer Duff
- Department of Medicine , University of Florida , Gainesville, Florida , USA
| | - Linda R Duska
- Division of Gynecologic Oncology , University of Virginia School of Medicine , Charlottesville, Virginia , USA
| | - Alexandru Eniu
- Department of Breast Tumors , Cancer Institute "Ion Chiricuta" , Cluj-Napoca , Romania
| | - Marc Ernstoff
- Department of Medicine , Roswell Park Cancer Institute , Buffalo, New York , USA
| | - Enriqueta Felip
- Medical Oncology Department , Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Martin F Fey
- Inselspital and University Hospital of Bern , Bern , Switzerland
| | - Jill Gilbert
- Vanderbilt University School of Medicine , Nashville, Tennessee , USA
| | - Nicolas Girard
- Department of Respiratory Medicine, Thoracic Oncology , Institute of Oncology, Hospices Civils de Lyon , Lyon , France
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine & Molecular Imaging , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Priya K Gopalan
- Department of Medicine , University of Florida and Section of Medicine, Malcom Randall VA Medical Center , Gainesville, Florida , USA
| | - Axel Grothey
- Mayo Clinic Rochester , Rochester, Minnesota , USA
| | - Stephen M Hahn
- Division of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Diana Hanna
- Division of Medical Oncology , University of Southern California, Hoag Family Cancer Institute , Newport Beach, California , USA
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy , Medical University Vienna, Vienna General Hospital , Vienna , Austria
| | - Jørn Herrstedt
- Department of Oncology , Odense University Hospital, University of Southern Denmark , Odense , Denmark
| | - Krisztian Homicsko
- Department of Oncology , University Hospital of Lausanne , Lausanne , Switzerland
| | - Dennie V Jones
- Department of Medicine, Division of Hematology/Oncology/Stem Cell Transplant, University of Florida, Gainesville, Florida, USA; Section of Hematology and Oncology, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Lorenz Jost
- Cantonal Hospital Baselland , Bruderholz , Switzerland
| | | | - Saad Khan
- Hematology and Oncology, Internal Medicine , UT Southwestern Medical Center , Dallas, Texas , USA
| | - Alexander Kiss
- Department of Psychosomatic Division , University Hospital Basel , Basel , Switzerland
| | - Claus-Henning Köhne
- University Clinic for Internal Medicine-Oncology and Hematology, Klinikum Oldenburg , Oldenburg , Germany
| | - Rainer Kunstfeld
- Clinic of Dermatology/Vienna General Hospital, Medical University Vienna , Vienna , Austria
| | - Heinz-Josef Lenz
- Department of Medical Oncology , Norris Comprehensive Cancer Center, University of Southern California , Los Angeles, California , USA
| | - Stuart Lichtman
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College , New York, New York , USA
| | | | - Thomas Lion
- Division for Molecular Microbiology, Children'sCancer Research Institute (CCRI), Vienna, Austria; LabDia Laboratoriumsdiagnostik GmbH, Vienna, Austria
| | - Saskia Litière
- The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Lifang Liu
- Department of Statistics , The European Organisation for Research and Treatment of Cancer (EORTC) , Brussels , Belgium
| | - Patrick J Loehrer
- Indiana University Melvin and Bren Simon Cancer Center, Indiana University School of Medicine , Indianapolis, Indiana , USA
| | - Merry Jennifer Markham
- Division of Hematology & Oncology , University of Florida College of Medicine , Gainesville, Florida , USA
| | - Ben Markman
- Monash Cancer Centre, Monash Health , Melbourne , Australia
| | - Marius Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy , Medical University of Vienna, Vienna General Hospital , Vienna , Austria
| | - Johannes G Meran
- Internal Department, Krankenhaus Barmherzige Brüder , Vienna , Austria
| | | | | | | | - Timothy Moynihan
- Department of Medical Oncology , Mayo Clinic , Rochester, Minnesota , USA
| | - Torsten Nielsen
- University of British Columbia , Vancouver, British Columbia , Canada
| | - Yuichiro Ohe
- Department of Thoracic Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - Kjell Öberg
- Department of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | | | - Fedro Alessandro Peccatori
- Fertility & Procreation Unit, Gynecologic Oncology Department , European Institute of Oncology , Milan , Italy
| | | | - Chandrajit Raut
- Division of Surgical Oncology, Department of Surgery , Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital , Boston, Massachusetts , USA
| | - Scot C Remick
- Department of Medicine , Maine Medical Center Cancer Institute , Scarborough, Maine , USA
| | - Mark Robson
- Clinical Genetics Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York, New York , USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma , Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology , Warsaw , Poland
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory, Jules Bordet Institute, Brussels, Belgium; Department of Pathology, TCRU, GZA Antwerp, Antwerp, Belgium
| | - Lidia Schapira
- Harvard Medical School , Massachusetts General Hospital , Boston, Massachusetts , USA
| | - Eva Schernhammer
- Department of Epidemiology , Center for Public Health, Medical University of Vienna , Vienna , Austria
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology , Institut Gustave Roussy, Université Paris-Sud , Villejuif , France
| | - Hans-Joachim Schmoll
- Division Clinical Oncology Research , University Clinic Halle (Saale), Martin-Luther-University, Halle-Wittenberg , Halle , Germany
| | - Lowell Schnipper
- Department of Medicine , Beth Israel Deaconess Medical Center , Boston, Massachusetts , USA
| | - Cristiana Sessa
- Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
| | - Charles L Shapiro
- Dubin Breast Center, Division of Hematology/Medical Oncology , Tisch Cancer Center, Mount Sinai Health System , New York, New York , USA
| | - Julie Steele
- Anatomic Pathology, Scripps Clinic Department of Pathology , Scripps Green Hospital , La Jolla, California , USA
| | - Cora N Sternberg
- Department of Medical Oncology , San Camillo Forlanini Hospital , Rome , Italy
| | - Friedrich Stiefel
- Psychiatric Liaison Service, Department of Psychiatry , University Hospital of Lausanne-CHUV , Lausanne , Switzerland
| | - Florian Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department Internal Medicine & Palliative Centre , Cantonal Hospital St.Gallen , St. Gallen , Switzerland
| | - Roger Stupp
- University Hospital Zürich , Zürich , Switzerland
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict & Health Research Program, London , UK
| | - Josep Tabernero
- Medical Oncology Department , Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Luzia Travado
- Psycho-Oncology Service, Clinical Centre of the Champalimaud Centre for the Unknown, Champalimaud Foundation , Lisbon , Portugal
| | - Marcel Verheij
- Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Emile Voest
- The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Everett Vokes
- Department of Medicine , University of Chicago Medical Center , Chicago, Illinois , USA
| | - Jamie Von Roenn
- Education, Science, and Professional Development, American Society of Clinical Oncology (ASCO) , Alexandria, Virginia , USA
| | - Jeffrey S Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center , New York, New York , USA
| | - Hans Wildiers
- Department of General Medical Oncology , University Hospitals Leuven , Leuven , Belgium
| | - Yosef Yarden
- Department of General Medical Oncology , University Hospitals Leuven , Leuven , Belgium
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Lacouture ME, Dréno B, Ascierto PA, Dummer R, Basset-Seguin N, Fife K, Ernst S, Licitra L, Neves RI, Peris K, Puig S, Sokolof J, Sekulic A, Hauschild A, Kunstfeld R. Characterization and Management of Hedgehog Pathway Inhibitor-Related Adverse Events in Patients With Advanced Basal Cell Carcinoma. Oncologist 2016; 21:1218-1229. [PMID: 27511905 PMCID: PMC5061532 DOI: 10.1634/theoncologist.2016-0186] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 06/09/2016] [Indexed: 12/14/2022] Open
Abstract
Abnormal activation of hedgehog pathway signaling is a key driver in the pathogenesis of basal cell carcinoma (BCC). Vismodegib, a first-in-class small-molecule inhibitor of hedgehog pathway signaling, is approved by regulatory authorities for the treatment of adults who have metastatic BCC or locally advanced BCC that has recurred after surgery, or who are not candidates for surgery and who are not candidates for radiation. A second inhibitor, sonidegib, was also recently approved for the same patient group with locally advanced BCC. Adverse events (AEs) commonly observed in hedgehog pathway inhibitor (HPI)-treated patients include muscle spasms, ageusia/dysgeusia, alopecia, weight loss, and asthenia (fatigue). These AEs are thought to be mechanistically related to inhibition of the hedgehog pathway in normal tissue. Although the severity of the majority of AEs associated with HPIs is grade 1-2, the long-term nature of these AEs can lead to decreased quality of life, treatment interruption, and in some cases discontinuation, all of which might affect clinical outcome. The incidence, clinical presentation, putative mechanisms, and management strategies for AEs related to HPIs in advanced BCC are described. These observations represent the first step toward the development of mechanism-based preventive and management strategies. Knowledge of these AEs will allow health care professionals to provide appropriate counseling and supportive care interventions, all of which will contribute to improved quality of life and optimal benefit from therapy. IMPLICATIONS FOR PRACTICE The hedgehog pathway inhibitors (HPIs) vismodegib and sonidegib represent a therapeutic breakthrough for patients with advanced basal cell carcinoma. However, the nature of the low-grade adverse events (AEs) commonly observed in HPI-treated patients, including muscle spasms, ageusia/dysgeusia, alopecia, weight loss, and fatigue, can impact clinical outcomes as a result of decreased quality of life and treatment discontinuation. The incidence, clinical presentation, putative mechanisms, and management strategies for AEs related to administration of HPIs are described, with the goal of enabling health care professionals to provide appropriate counseling and supportive care interventions to their patients.
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Affiliation(s)
| | - Brigitte Dréno
- Department of Dermatology, Hôtel Dieu University Hospital, Nantes, France
| | | | | | | | - Kate Fife
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Scott Ernst
- Western University London Regional Cancer Program, London, Ontario, Canada
| | | | - Rogerio I Neves
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | | | - Susana Puig
- Dermatology Department, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomédiques August Pi I Sunyer, Barcelona, Spain
| | - Jonas Sokolof
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
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Hansson J, Hauschild A, Kunstfeld R, Grob JJ, Dréno B, Mortier L, Ascierto PA, Licitra LF, Dutriaux C, Thomas L, Meyer N, Guillot B, Dummer R, Arenberger P, Fife K, Raimundo A, Dika E, Dimier N, Xynos I, Basset-Seguin N. Vismodegib (VISMO), a hedgehog pathway inhibitor (HPI), in advanced basal cell carcinoma (aBCC): STEVIE study primary analysis in 1215 patients (pts). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Johan Hansson
- Karolinska Institute and Karolinska University Hopsital, Stockholm, Sweden
| | | | | | | | | | - Laurent Mortier
- Universite Lille, Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | | | - Lisa F. Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Luc Thomas
- Lyon 1 University Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - Nicolas Meyer
- Institut Universitaire du Cancer de Toulouse, Paul Sabatier University, Toulouse, France
| | | | | | - Petr Arenberger
- University Hospital Kralovske Vinohrady Prague and Charles University Third Medical Faculty, Prague, Czech Republic
| | - Kate Fife
- NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Ana Raimundo
- Instituto Português de Oncologia Porto, Porto, Portugal
| | - Emi Dika
- University of Bologna, Bologna, Italy
| | | | - Ioannis Xynos
- Roche Products Ltd., Welwyn Garden City, United Kingdom
| | - Nicole Basset-Seguin
- Dermatology Department, Hôpital Saint-Louis, Assistance-Publique-Hôpitaux de Paris, Paris, France
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Rogers G, Kunstfeld R, Schadendorf D, Hauschild A, Maher I, Zloty D, Labeille B, Grob JJ, Puig S, Bergstrom D, Gilberg F, Dréno B. Mikie: A randomized, double-blinded, regimen-controlled, phase 2 study to assess the efficacy and safety of two different vismodegib (VISMO) regimens in patients (pts) with multiple basal cell carcinomas (BCCs). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Gary Rogers
- Tufts University School of Medicine, Beverly, MA
| | | | | | | | - Ian Maher
- Saint Louis University Medical School, St. Louis, MO
| | - David Zloty
- University of British Columbia, Vancouver, BC, Canada
| | - Bruno Labeille
- University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - Susana Puig
- Hospital Clinic de Barcelona, Barcelona, Spain
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Hauschild A, Hansson J, Grob J, Kunstfeld R, Dréno B, Mortier L, Ascierto P, Dummer R, Licitra L, Fife K, Ernst D, Dutriaux C, Jouary T, Meyer N, Guillot B, Williams S, Tandon M, Hou J, Basset-Seguin N. 3343 Exploratory analysis of vismodegib (VISMO) treatment discontinuation in the STEVIE study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Haymerle G, Fochtmann A, Kunstfeld R, Pammer J, Erovic BM. Merkel cell carcinoma: Overall survival after open biopsy versus wide local excision. Head Neck 2015; 38 Suppl 1:E1014-8. [DOI: 10.1002/hed.24148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 04/09/2015] [Accepted: 05/31/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Georg Haymerle
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Alexandra Fochtmann
- Department of Plastic and Reconstructive Surgery; Medical University of Vienna; Vienna Austria
| | - Rainer Kunstfeld
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - Johannes Pammer
- Department of Clinical Pathology; Medical University of Vienna; Vienna Austria
| | - Boban M. Erovic
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
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Dummer R, Basset-Seguin N, Hansson J, Grob JJ, Kunstfeld R, Dréno B, Mortier L, Ascierto PA, Licitra LF, Dutriaux C, Jouary T, Meyer N, Guillot B, Fife K, Ernst DS, Williams S, Fittipaldo AG, Xynos I, Hauschild A. Impact of treatment breaks on vismodegib patient outcomes: Exploratory analysis of the STEVIE study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Johan Hansson
- Karolinska University Hospital Solna, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | - Kate Fife
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Sarah Williams
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | - Ioannis Xynos
- Roche Products Limited, Welwyn Garden City, United Kingdom
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Basset-Seguin N, Hauschild A, Grob JJ, Kunstfeld R, Dréno B, Mortier L, Ascierto PA, Licitra L, Dutriaux C, Thomas L, Jouary T, Meyer N, Guillot B, Dummer R, Fife K, Ernst DS, Williams S, Fittipaldo A, Xynos I, Hansson J. Vismodegib in patients with advanced basal cell carcinoma (STEVIE): a pre-planned interim analysis of an international, open-label trial. Lancet Oncol 2015; 16:729-36. [PMID: 25981813 DOI: 10.1016/s1470-2045(15)70198-1] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Hedgehog pathway inhibitor vismodegib has shown clinical benefit in patients with advanced basal cell carcinoma and is approved for treatment of patients with advanced basal cell carcinoma for whom surgery is inappropriate. STEVIE was designed to assess the safety of vismodegib in a situation similar to routine practice, with a long follow-up. METHODS In this multicentre, open-label trial, adult patients with histologically confirmed locally advanced basal cell carcinoma or metastatic basal cell carcinoma were recruited from regional referral centres or specialist clinics. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, and adequate organ function. Patients with locally advanced basal cell carcinoma had to have been deemed ineligible for surgery. All patients received 150 mg oral vismodegib capsules once a day on a continuous basis in 28-day cycles. The primary objective was safety (incidence of adverse events until disease progression or unacceptable toxic effects), with assessments on day 1 of each treatment cycle (28 days) by principal investigator and coinvestigators at the site. Efficacy variables were assessed as secondary endpoints. The safety evaluable population included all patients who received at least one dose of study drug. Patients with histologically confirmed basal cell carcinoma who received at least one dose of study drug were included in the efficacy analysis. An interim analysis was pre-planned after 500 patients achieved 1 year of follow-up. This trial is registered with ClinicalTrials.gov, number NCT01367665. The study is still ongoing. FINDINGS Between June 30, 2011, and Nov 6, 2014, we enrolled 1227 patients. At clinical cutoff (Nov 6, 2013), 499 patients (468 with locally advanced basal cell carcinoma and 31 with metastatic basal cell carcinoma) had received study drug and had the potential to be followed up for 12 months or longer. Treatment was discontinued in 400 (80%) patients; 180 (36%) had adverse events, 70 (14%) had progressive disease, and 51 (10%) requested to stop treatment. Median duration of vismodegib exposure was 36·4 weeks (IQR 17·7-62·0). Adverse events happened in 491 (98%) patients; the most common were muscle spasms (317 [64%]), alopecia (307 [62%]), dysgeusia (269 [54%]), weight loss (162 [33%]), asthenia (141 [28%]), decreased appetite (126 [25%]), ageusia (112 [22%]), diarrhoea (83 [17%]), nausea (80 [16%]), and fatigue (80 [16%]). Most adverse events were grade 1 or 2. We recorded serious adverse events in 108 (22%) of 499 patients. Of the 31 patients who died, 21 were the result of adverse events. As assessed by investigators, 302 (66·7%, 62·1-71·0) of 453 patients with locally advanced basal cell carcinoma had an overall response (153 complete responses and 149 partial responses); 11 (37·9%; 20·7-57·7) of 29 patients with metastatic basal cell carcinoma had an overall response (two complete responses, nine partial responses). INTERPRETATION This study assessed the use of vismodegib in a setting representative of routine clinical practice for patients with advanced basal cell carcinoma. Our results show that treatment with vismodegib adds a novel therapeutic modality from which patients with advanced basal cell carcinoma can benefit substantially. FUNDING F Hoffmann-La Roche.
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Affiliation(s)
| | | | | | | | | | - Laurent Mortier
- University of Lille 2, Lille Regional University Hospital, Hopital Huriez, Lille, France
| | | | - Lisa Licitra
- Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
| | | | - Luc Thomas
- LYON 1 University-Centre Hospitalier Lyon Sud and Lyons Cancer Research Center (Pr Puisieux), Lyon, France
| | - Thomas Jouary
- Saint Andre Hospital CHU de Bordeaux, Bordeaux, France
| | - Nicolas Meyer
- Paul Sabatier University and Toulouse University Cancer Institute, Toulouse, France
| | | | | | - Kate Fife
- Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | - Johan Hansson
- Karolinska University Hospital, Solna, Stockholm, Sweden.
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Paulitschke V, Gerner C, Hofstätter E, Mohr T, Mayer RL, Pehamberger H, Kunstfeld R. Proteome profiling of keratinocytes transforming to malignancy. Electrophoresis 2015; 36:564-76. [PMID: 25395074 DOI: 10.1002/elps.201400309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/20/2014] [Accepted: 10/29/2014] [Indexed: 01/19/2023]
Abstract
To shed light on the multistep process of squamous cell carcinoma development and the underlying pathologic mechanisms, we performed comparative proteome analysis of keratinocytes, keratinocytes stimulated with Il-1beta, and A431 epidermoid carcinoma cells. Fractionation of the cells into supernatant, nucleus, and cytoplasm was followed by protein separation, proteolytic digest, and nano-LC separation, and fragmentation using an ion trap mass spectrometer. Specific bioinformatics tools were used to generate a list of keratinocyte-specific proteins. Ninety percent of these proteins were found to be upregulated in keratinocytes versus the A431 cells. Classification of the identified proteins by biologic function and gene set enrichment analysis revealed that keratinocytes produced more proteins involved in cell differentiation, cell adhesion, cell junction, calcium ion, calmodulin binding, cytoskeleton organization, and cytokinesis, whereas A431 produced more proteins involved in cell cycle checkpoint, cell cycle process, RNA processing and transport, DNA damage and repair, RNA and DNA binding, and chromatin remodeling. The protein signatures of A431 and normal keratinocytes treated with IL-1beta showed marked similarity, confirming that inflammation is an important step in malignant transformation in nonmelanoma skin cancer. Thus, proteome profiling and bioinformatic processing may support the understanding of the underlying mechanisms, with the potential to facilitate development of early biomarkers and patient-tailored therapy.
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Affiliation(s)
- Verena Paulitschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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22
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Paulitschke V, Berger W, Paulitschke P, Hofstätter E, Knapp B, Dingelmaier-Hovorka R, Födinger D, Jäger W, Szekeres T, Meshcheryakova A, Bileck A, Pirker C, Pehamberger H, Gerner C, Kunstfeld R. Vemurafenib Resistance Signature by Proteome Analysis Offers New Strategies and Rational Therapeutic Concepts. Mol Cancer Ther 2015; 14:757-68. [DOI: 10.1158/1535-7163.mct-14-0701] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
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Fochtmann A, Haymerle G, Kunstfeld R, Pammer J, Grasl MC, Erovic BM. Prognostic significance of lymph node ratio in patients with Merkel cell carcinoma. Eur Arch Otorhinolaryngol 2014; 272:1777-83. [DOI: 10.1007/s00405-014-3116-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/20/2014] [Indexed: 01/11/2023]
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Kunstfeld R, Hauschild A, Zloty D, Rogers G, Dreno B, Mitchell L, Starnawski M, Schadendorf D. MIKIE: A randomized, double-blind, regimen-controlled, phase II, multicenter study to assess the efficacy and safety of two different vismodegib regimens in patients with multiple basal cell carcinomas. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps9121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Axel Hauschild
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - David Zloty
- University of British Columbia, Vancouver, BC, Canada
| | - Gary Rogers
- Tufts University School of Medicine, Boston, MA
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Abstract
INTRODUCTION Basal cell carcinoma (BCC) is a malignancy that is driven by an activated Hedgehog (Hh) pathway. Smoothened inhibitors are a new promising treatment option for patients with locally advanced or metastatic BCC or basal cell nevus syndrome. But long-term data are still limited, the optimal treatment duration is not yet defined and there are already documented cases with acquired resistance. AREAS COVERED Treatment modalities with Hh inhibitors, side effects and potential pharmacological combination options are discussed. The current literature, including PubMed, Cochrane database and registered trials on ClinicalTrials.gov, was searched. EXPERT OPINION BCCs typically regress during therapy with Hh inhibitors. Muscle toxicity, dysgeusia and hair loss can be considered as on target adverse reactions. Muscle toxicity is the dose-limiting toxicity of sonidegib. It was not seen with vismodegib because of its high binding to plasma protein α-1-acid glycoprotein. Sonidegib is different and shows a clear dose-toxicity relationship, which allows to address the question of whether there is a dose dependency of regression rate, cure rate and progression-free survival. In addition, basic research has offered strategies to enhance efficacy by the combination with other molecules, such as EGFR inhibitors, MEK inhibitors or immunotherapy.
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Affiliation(s)
- Jil Dreier
- University Hospital Zurich, Department of Dermatology , Gloriastrasse 31, CH-8091 Zurich , Switzerland
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Haymerle G, Fochtmann A, Kunstfeld R, Pammer J, Erovic BM. Management of Merkel cell carcinoma of unknown primary origin: the Vienna Medical School experience. Eur Arch Otorhinolaryngol 2014; 272:425-9. [PMID: 24633244 DOI: 10.1007/s00405-014-2974-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
Merkel cell carcinoma is a rare, but highly aggressive skin tumor. We describe our single-institution experience with the diagnosis and treatment of Merkel cell carcinoma of unknown primary (MCCUP). We conducted a retrospective medical chart review of patients treated with MCCUP at the Vienna General Hospital between 2002 and 2011. Clinicopathologic variables and outcomes were analyzed. Of the entire cohort of 57 patients, 8 patients (14%) were diagnosed with MCCUP. Three patients presented with parotid gland involvement, four patients with positive inguinal lymph nodes and one with axillar lymph nodes. CK20 staining was positive in all tumor specimens, whereas MCPyV protein was positive in four out of six patients. The primary surgical modality in five cases was wide local excision. In one patient excisional biopsy was followed by re-resection. In one case only excisional biopsy was performed due to metastatic disease at first diagnosis. Two patients underwent concomitant parotidectomy and neck dissection, and four patients received adjuvant radiation therapy. Median recurrence-free survival was 20 months. Four patients died, three of disease and one of other cause. Recurrent disease was observed in two patients and treated with radiotherapy and chemotherapy. The 1- and 3-year overall survival rates were 87.5 and 37.5%, respectively. The 1- and 3-year disease-specific survival rates were 87.5 and 62.5%, respectively. Our study shows a poor outcome in patients with MCCUP, particularly in patients with node involvement of the trunk. We therefore suggest an aggressive and multimodal treatment approach for patients with MCCUP.
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Affiliation(s)
- Georg Haymerle
- Department of Otolaryngology Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria,
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Kunstfeld R, Hawighorst T, Streit M, Hong YK, Nguyen L, Brown LF, Detmar M. Thrombospondin-2 overexpression in the skin of transgenic mice reduces the susceptibility to chemically induced multistep skin carcinogenesis. J Dermatol Sci 2014; 74:106-15. [PMID: 24507936 DOI: 10.1016/j.jdermsci.2014.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/08/2013] [Accepted: 01/06/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND We have previously reported stromal upregulation of the endogenous angiogenesis inhibitor thrombospondin-2 (TSP-2) during multistep carcinogenesis, and we found accelerated and enhanced skin angiogenesis and carcinogenesis in TSP-2 deficient mice. GOALS To investigate whether enhanced levels of TSP-2 might protect from skin cancer development. METHODS We established transgenic mice with targeted overexpression of TSP-2 in the skin and subjected hemizygous TSP-2 transgenic mice and their wild-type littermates to a chemical skin carcinogenesis regimen. RESULTS TSP-2 transgenic mice showed a significantly delayed onset of tumor formation compared to wild-type mice, whereas the ratio of malignant conversion to squamous cell carcinomas was comparable in both genotypes. Computer-assisted morphometric analysis of blood vessels revealed pronounced tumor angiogenesis already in the early stages of carcinogenesis in wild type mice. TSP-2 overexpression significantly reduced tumor blood vessel density in transgenic mice but had no overt effect on LYVE-1 positive lymphatic vessels. The percentage of desmin surrounded, mature tumor-associated blood vessels and the degree of epithelial differentiation remained unaffected. The antiangiogenic effect of transgenic TSP-2 was accompanied by a significantly increased number of apoptotic tumor cells in transgenic mice. CONCLUSION Our results demonstrate that enhanced levels of TSP-2 in the skin result in reduced susceptibility to chemically-induced skin carcinogenesis and identify TSP-2 as a new target for the prevention of skin cancer.
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Affiliation(s)
- Rainer Kunstfeld
- Department of Dermatology, Division of General Dermatology, Medical University Vienna, Vienna, Austria; Cutaneous Biology Research Center and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Thomas Hawighorst
- Cutaneous Biology Research Center and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Department of Gynecology and Obstetrics, Georg-August University Goettingen, Goettingen, Germany
| | - Michael Streit
- Cutaneous Biology Research Center and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Young-Kwon Hong
- Cutaneous Biology Research Center and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Department of Surgery, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA; Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Lynh Nguyen
- Cutaneous Biology Research Center and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Lawrence F Brown
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Michael Detmar
- Cutaneous Biology Research Center and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA; Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland.
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Paulitschke V, Haudek-Prinz V, Griss J, Berger W, Mohr T, Pehamberger H, Kunstfeld R, Gerner C. Functional classification of cellular proteome profiles support the identification of drug resistance signatures in melanoma cells. J Proteome Res 2013; 12:3264-76. [PMID: 23713901 PMCID: PMC3733130 DOI: 10.1021/pr400124w] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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Drug
resistance is a major obstacle in melanoma treatment. Recognition
of specific resistance patterns, the understanding of the patho-physiology
of drug resistance, and identification of remaining options for individual
melanoma treatment would greatly improve therapeutic success. We performed
mass spectrometry-based proteome profiling of A375 melanoma cells
and HeLa cells characterized as sensitive to cisplatin in comparison
to cisplatin resistant M24met and TMFI melanoma cells. Cells were
fractionated into cytoplasm, nuclei and secretome and the proteome
profiles classified according to Gene Ontology. The cisplatin resistant
cells displayed increased expression of lysosomal as well as Ca2+ ion binding and cell adherence proteins. These findings
were confirmed using Lysotracker Red staining and cell adhesion assays
with a panel of extracellular matrix proteins. To discriminate specific
survival proteins, we selected constitutively expressed proteins of
resistant M24met cells which were found expressed upon challenging
the sensitive A375 cells. Using the CPL/MUW proteome database, the
selected lysosomal, cell adherence and survival proteins apparently
specifying resistant cells were narrowed down to 47 proteins representing
a potential resistance signature. These were tested against our proteomics
database comprising more than 200 different cell types/cell states
for its predictive power. We provide evidence that this signature
enables the automated assignment of resistance features as readout
from proteome profiles of any human cell type. Proteome profiling
and bioinformatic processing may thus support the understanding of
drug resistance mechanism, eventually guiding patient tailored therapy.
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Affiliation(s)
- Verena Paulitschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Grob JJ, Kunstfeld R, Dreno B, Jouary T, Mortier L, Basset-Seguin N, Ascierto PA, Hansson J, Mitchell L, Starnawski M, Hauschild A. Vismodegib, a Hedgehog pathway inhibitor (HPI), in advanced basal cell carcinoma (aBCC): STEVIE study interim analysis in 300 patients. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9036 Background: Therapy options are limited for locally advanced (la) and metastatic (m) BCC. Aberrant Hedgehog (Hh) signaling is the key driver in BCC pathogenesis. Vismodegib, a first-in-class HPI, is approved in the US for use in adults with aBCC. STEVIE is an ongoing study focusing on safety of vismodegib therapy in patients with aBCC. We present data from the third interim analysis (data cutoff: 19 October 2012), which also permits a preliminary assessment of efficacy of vismodegib in the largest study ever conducted in patients with aBCC. Methods: Adult patients with laBCC or mBCC received oral vismodegib 150 mg QD until progressive disease, unacceptable toxicity, or withdrawal. Safety is the primary objective of STEVIE (Common Terminology Criteria for Adverse Events 4.0). Secondary endpoints include efficacy variables. Recruitment is ongoing. Results: This analysis included 300 patients with locally advanced (n=278) or metastatic (n=22) BCC from 11 countries with potential for ≥3-month follow-up. Median treatment duration, including vismodegib interruption, was 176.5 days (range 1-455 days). Common treatment-emergent AEs (TEAEs), typically ≤ grade 2, included muscle spasm (59.3%), alopecia (49.3%), and dysgeusia (41.0%) and were comparable to prior analysis. Serious TEAEs occurred in 53 patients (17.7%). 131 (43.7%) discontinued from the study, mainly due to patient or investigator request (n=41), AEs (n=35), disease progression (n=18) or death (n=13; 7 due to AEs assessed by the investigator as unrelated to study drug, 3 due to AEs not possible to be assessed, 3 due to disease progression). Preliminary best overall response in patients with available tumor assessments (n=251) included complete response (17.5%), partial response (39.8%), stable disease (39.0%) and progressive disease (2.8%). Patient recruitment and monitoring is ongoing. Conclusions: This third interim analysis of STEVIE confirms the previously observed vismodegib safety profile but can also provide further information about the high rate of tumor control with vismodegib in a large series of patients with aBCC. Clinical trial information: 2011-000195-34.
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Affiliation(s)
- Jean Jacques Grob
- Department of Dermatology and Skin Cancer, Timone Hospital, Marseille, France
| | - Rainer Kunstfeld
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Dreno
- Centre Hospitalier Régional Universitaire Hotel Dieu, Nantes, France
| | - Thomas Jouary
- Saint André Hospital CHU de Bordeaux, Dermatology, Bordeaux, France
| | - Laurent Mortier
- Department of Dermatology, Faculty of Medicine, University of Lille 2, Lille Regional University Hospital, Lille, France
| | | | | | - Johan Hansson
- Karolinska University Hospital Solna, Stockholm, Sweden
| | | | | | - Axel Hauschild
- University Medical Center Schleswig-Holstein, Kiel, Germany
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Schindler K, Schicher N, Kunstfeld R, Pehamberger H, Toepker M, Haitel A, Hoeller C, Harmankaya K. A rare case of primary rhabdoid melanoma of the urinary bladder treated with ipilimumab, an anti-CTLA 4 monoclonal antibody. Melanoma Res 2012; 22:320-5. [PMID: 22713795 DOI: 10.1097/cmr.0b013e32835566c0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Primary melanoma of the urinary bladder is a rare subentity of melanoma. The same applies for melanoma of the rhabdoid histopathologic phenotype. A female patient was initially diagnosed with melanoma of unknown origin caused by macroscopic lymph node metastasis in the left inguinal and parailiacal regions. Because of the extent of the disease, radical surgery could not be performed. The patient underwent systemic chemotherapy with dacarbazine, followed by the experimental compound tasisulam. Upon sudden macrohematuria, cystoscopy showed a large infiltrating tumorous structure located on the left side of the urinary bladder. Clinically, the amelanotic tumor showed endophytic growth into the lumen; on the histopathological specimen, the growth pattern was partially undermining the urothelium, which is commonly observed in primary melanoma of the urinary bladder. Cytologically, the tumor cells were classified as rhabdoid melanoma, a very rare variant of melanoma, which is commonly amelanotic and expresses S100, vimentin and Ncam. Mutational analysis showed positive results for BRAF V600E. After detecting the primary melanoma, the patient received anti-CTLA4 antibody treatment with 3 mg/kg ipilimumab, through which a partial response was achieved. Past computed tomography scans should be re-evaluated for suspicious lesions, and cystoscopy should be included in the clinical workup if the pattern of metastasis is congruent with the drainage sites of the urinary bladder.
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Affiliation(s)
- Katja Schindler
- Department of Dermatology, Division of General Dermatology, Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
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Paulitschke V, Gruber S, Hofstätter E, Haudek-Prinz V, Klepeisz P, Schicher N, Jonak C, Petzelbauer P, Pehamberger H, Gerner C, Kunstfeld R. Proteome analysis identified the PPARγ ligand 15d-PGJ2 as a novel drug inhibiting melanoma progression and interfering with tumor-stroma interaction. PLoS One 2012; 7:e46103. [PMID: 23049949 PMCID: PMC3458105 DOI: 10.1371/journal.pone.0046103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/28/2012] [Indexed: 12/12/2022] Open
Abstract
Peroxisome proliferator-activated receptors (PPARs) have been originally thought to be restricted to lipid metabolism or glucose homeostasis. Recently, evidence is growing that PPARγ ligands have inhibitory effects on tumor growth. To shed light on the potential therapeutic effects on melanoma we tested a panel of PPAR agonists on their ability to block tumor proliferation in vitro. Whereas ciglitazone, troglitazone and WY14643 showed moderate effects on proliferation, 15d-PGJ2 displayed profound anti-tumor activity on four different melanoma cell lines tested. Additionally, 15d-PGJ2 inhibited proliferation of tumor-associated fibroblasts and tube formation of endothelial cells. 15d-PGJ2 induced the tumor suppressor gene p21, a G2/M arrest and inhibited tumor cell migration. Shot gun proteome analysis in addition to 2D-gel electrophoresis and immunoprecipitation of A375 melanoma cells suggested that 15d-PGJ2 might exert its effects via modification and/or downregulation of Hsp-90 (heat shock protein 90) and several chaperones. Applying the recently established CPL/MUW database with a panel of defined classification signatures, we demonstrated a regulation of proteins involved in metastasis, transport or protein synthesis including paxillin, angio-associated migratory cell protein or matrix metalloproteinase-2 as confirmed by zymography. Our data revealed for the first time a profound effect of the single compound 15d-PGJ2 on melanoma cells in addition to the tumor-associated microenvironment suggesting synergistic therapeutic efficiency.
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Affiliation(s)
- Verena Paulitschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Silke Gruber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | | | - Philipp Klepeisz
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Schicher
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Peter Petzelbauer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Hubert Pehamberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Rainer Kunstfeld
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Jonak C, Mildner M, Klosner G, Paulitschke V, Kunstfeld R, Pehamberger H, Tschachler E, Trautinger F. The hsp27kD heat shock protein and p38-MAPK signaling are required for regular epidermal differentiation. J Dermatol Sci 2010; 61:32-7. [PMID: 21081267 DOI: 10.1016/j.jdermsci.2010.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/12/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND In human epidermal keratinocytes the expression of hsp27 is closely related to differentiation in vitro and in situ. OBJECTIVE We aimed to gain further insight into the role of hsp27 in epidermal differentiation by specific inhibition through siRNA and inhibition of p38-MAPK, the key enzyme of hsp27 phosphorylation. METHODS Normal human keratinocytes (KC) and organotypic skin cultures (SE-skin equivalents) were used. Expression and phosphorylation of hsp27 was inhibited in these models by siRNA and SB203580, a specific inhibitor of p38-MAPK, respectively. Modification of morphology and expression of hsp27 and other differentiation associated proteins was investigated by immunofluorescence, western blot, and RT-PCR. RESULTS Inhibition of p38-MAPK resulted in a downregulation of hsp27 in KC and SE. Additionally, in the presence of SB203580 Ca(2+) induced expression of pro-filaggrin and loricrin was inhibited at the protein level and expression of filaggrin, keratin 10, and transglutaminase 1 at the mRNA level. Addition of SB203580 to SE, as well as hsp27 knockdown in this model resulted in identical patterns of irregular differentiation, disturbance of epidermal layers, and delayed expression of K10. CONCLUSION These results provide evidence that the expression of hsp27 and its phosphorylation by p38-MAPK are required for keratinocyte differentiation and for the formation of a regularly stratified epidermis.
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Affiliation(s)
- Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Cueni LN, Hegyi I, Shin JW, Albinger-Hegyi A, Gruber S, Kunstfeld R, Moch H, Detmar M. Tumor lymphangiogenesis and metastasis to lymph nodes induced by cancer cell expression of podoplanin. Am J Pathol 2010; 177:1004-16. [PMID: 20616339 DOI: 10.2353/ajpath.2010.090703] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The membrane glycoprotein podoplanin is expressed by several types of human cancers and might be associated with their malignant progression. Its exact biological function and molecular targets are unclear, however. Here, we assessed the relevance of tumor cell expression of podoplanin in cancer metastasis to lymph nodes, using a human MCF7 breast carcinoma xenograft model. We found that podoplanin expression promoted tumor cell motility in vitro and, unexpectedly, increased tumor lymphangiogenesis and metastasis to regional lymph nodes in vivo, without promoting primary tumor growth. Importantly, high cancer cell expression levels of podoplanin correlated with lymph node metastasis and reduced survival times in a large cohort of 252 oral squamous cell carcinoma patients. Based on comparative transcriptional profiling of tumor xenografts, we identified endothelin-1, villin-1, and tenascin-C as potential mediators of podoplanin-induced tumor lymphangiogenesis and metastasis. These unexpected findings identify a novel mechanism of tumor lymphangiogenesis and metastasis induced by cancer cell expression of podoplanin, suggesting that reagents designed to interfere with podoplanin function might be developed as therapeutics for patients with advanced cancer.
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Affiliation(s)
- Leah N Cueni
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland
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Paulitschke V, Schicher N, Szekeres T, Jäger W, Elbling L, Riemer AB, Scheiner O, Trimurtulu G, Venkateswarlu S, Mikula M, Swoboda A, Fiebiger E, Gerner C, Pehamberger H, Kunstfeld R. 3,3',4,4',5,5'-hexahydroxystilbene impairs melanoma progression in a metastatic mouse model. J Invest Dermatol 2009; 130:1668-79. [PMID: 19956188 DOI: 10.1038/jid.2009.376] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Stilbenes comprise a group of polyphenolic compounds, which exert inhibitory effects on various malignancies. The aim of this study was to evaluate the antitumor effects of a previously unreported stilbene derivative-3,3',4,4',5,5'-hexahydroxystilbene, termed M8-on human melanoma cells. Cell-cycle analysis of the metastatic melanoma cell line M24met showed that M8 treatment induces G(2)/M arrest accompanied with a dose- and time-dependent upregulation of p21 and downregulation of CDK-2 and leads to apoptosis. M8 induces the expression of phosphorylated p53, proteins involved in the mismatch repair machinery (MSH6, MSH2, and MLH1) and a robust tail moment in a comet assay. In addition, M8 inhibited cell migration in Matrigel assays. Shotgun proteomics and western analysis showed the regulation among others of paxillin, integrin-linked protein kinase, p21-activated kinase, and ROCK-1 indicating that M8 inhibits mesenchymal and amoeboid cell migration. These in vitro data were confirmed in vivo in a metastatic human melanoma severe combined immunodeficient (SCID) mouse model. We showed that M8 significantly impairs tumor growth. M8 also interfered with the metastatic process, as M8 treatment prevented the metastatic spread of melanoma cells to distant lymph nodes in vivo. In summary, M8 exerts strong antitumor effects with the potential to become a new drug for the treatment of metastatic melanoma.
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Affiliation(s)
- Verena Paulitschke
- Department of Dermatology, Medical University of Vienna, Währingergürtel 18-20, Vienna, Austria
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Schicher N, Paulitschke V, Swoboda A, Kunstfeld R, Loewe R, Pilarski P, Pehamberger H, Hoeller C. Erlotinib and bevacizumab have synergistic activity against melanoma. Clin Cancer Res 2009; 15:3495-502. [PMID: 19447871 DOI: 10.1158/1078-0432.ccr-08-2407] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Melanoma is one of the most aggressive types of cancer with currently no chance of cure once the disease has spread to distant sites. Therapeutic options for advanced stage III and IV are very limited, mainly palliative, and show response in only approximately 20% of all cases. The presented preclinical study was done to investigate the influence of a combined treatment of the epidermal growth factor receptor inhibitor erlotinib and the vascular endothelial growth factor monoclonal antibody bevacizumab in melanoma. EXPERIMENTAL DESIGN AND RESULTS The epidermal growth factor receptor was expressed in all cell lines tested, and treatment with erlotinib did inhibit the activation of the MEK/extracellular signal-regulated kinase and AKT signaling pathways. Whereas in vitro no influence on tumor cell proliferation was seen with erlotinib or bevacizumab monotherapy, a decreased invasive potential on erlotinib treatment in a three-dimensional Matrigel assay was observed. Furthermore, both drugs inhibited proliferation and sprouting of endothelial cells. In vivo, in a severe combined immunodeficient mouse xenotransplantation model, reduction in tumor volume under combined treatment with erlotinib and bevacizumab was superior to the additive effect of both single agents. This was associated with reduced cell proliferation, increased apoptosis, and a reduction in tumor angiogenesis compared with control or single treatment groups. Likewise, the reduction in the extent of lymph node and lung metastasis was most pronounced in animals treated with both drugs. CONCLUSION The presented data strongly support the use of a combination of erlotinib and bevacizumab as a novel treatment regimen for metastatic melanoma.
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Affiliation(s)
- Nikolaus Schicher
- Department of Dermatology, Medical University Vienna, Vienna, Austria
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Paulitschke V, Kunstfeld R, Mohr T, Slany A, Micksche M, Drach J, Zielinski C, Pehamberger H, Gerner C. Entering a New Era of Rational Biomarker Discovery for Early Detection of Melanoma Metastases: Secretome Analysis of Associated Stroma Cells. J Proteome Res 2009; 8:2501-10. [DOI: 10.1021/pr8010827] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Verena Paulitschke
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
| | - Rainer Kunstfeld
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
| | - Thomas Mohr
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
| | - Astrid Slany
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
| | - Michael Micksche
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
| | - Johannes Drach
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
| | - Christoph Zielinski
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
| | - Hubert Pehamberger
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
| | - Christopher Gerner
- Department of Dermatology and Department of Medicine I, Medical University of Vienna, Vienna, A-1090, Austria
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Kajiya K, Kunstfeld R, Chung JH, Detmar M. Reduction of lymphatic vessels in photodamaged human skin. J Dermatol Sci 2007; 47:241-3. [PMID: 17572071 PMCID: PMC3398153 DOI: 10.1016/j.jdermsci.2007.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 04/24/2007] [Accepted: 05/01/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Kentaro Kajiya
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rainer Kunstfeld
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Chung
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Michael Detmar
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
Dimethylfumarate (DMF) inhibits signals transmitted by Rel proteins and is used for the treatment of inflammatory skin diseases such as psoriasis, but potential effects of DMF on tumor progression have yet not been analyzed. We show that DMF reduced melanoma growth and metastasis in severe combined immunodeficient mouse models. To identify targets of DMF action, we analyzed mRNA expression in DMF-treated melanomas by gene chip arrays. Using BiblioSphere software for data analysis, significantly regulated genes were mapped to Gene Ontology terms cell death, cell growth, and cell cycle. Indeed, we found that DMF inhibited proliferation of human melanoma cells A375 and M24met in vitro. The cell cycle was arrested at the G(2)-M boundary. Moreover, DMF was proapoptotic, as shown by cell cycle analysis and by Annexin V and Apo2.7 staining. These results were confirmed in vivo. DMF reduced proliferation rates of tumor cells as assessed by Ki-67 immunostaining and increased apoptosis as assessed by terminal deoxyribonucleotidyl transferase-mediated dUTP nick end labeling staining. In conclusion, DMF is antiproliferative and proapoptotic and reduces melanoma growth and metastasis in animal models.
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Affiliation(s)
- Robert Loewe
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
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Kunstfeld R. Osterreichische Gesellschaft fur Dermatologie und Venerologie OGDV. J Dtsch Dermatol Ges 2006; 4:610. [PMID: 16883661 DOI: 10.1111/j.1610-0387.2006.06773.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Shin JW, Min M, Larrieu-Lahargue F, Canron X, Kunstfeld R, Nguyen L, Henderson JE, Bikfalvi A, Detmar M, Hong YK. Prox1 promotes lineage-specific expression of fibroblast growth factor (FGF) receptor-3 in lymphatic endothelium: a role for FGF signaling in lymphangiogenesis. Mol Biol Cell 2005; 17:576-84. [PMID: 16291864 PMCID: PMC1356570 DOI: 10.1091/mbc.e05-04-0368] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Fibroblast growth factors play important roles in angiogenesis, but their functions in lymphangiogenesis remain poorly understood. The homeodomain transcription factor Prox1 is essential for development of the lymphatic system by specifying lymphatic endothelial cell (LEC) fate. Here, we identify fibroblast growth factor (FGF) receptor (FGFR)-3 as a novel Prox1 target gene. Ectopic overexpression of Prox1 in blood vascular endothelial cells up-regulates FGFR-3. Prox1 induces the expression of the IIIc isoform, which we also found to be the major isoform of FGFR-3 expressed in LECs. This transcriptional activation is mediated by a direct binding of Prox1 to newly identified Prox1-response elements in the FGFR-3 promoter. Consistently, FGFR-3 is up-regulated in Prox1-positive newly formed lymphatic vessels during embryogenesis and its lymphatic-specific expression is maintained throughout development. We also found that FGF-1 and FGF-2 promote proliferation, migration, and survival of cultured LECs without involvement of vascular endothelial cell growth factor receptor-3. We show that FGF-2 binds to low- and high-affinity receptors on LECs and is efficiently internalized and processed. Moreover, functional inhibition of FGFR-3 using small interfering RNA represses LEC proliferation. Together, these results indicate that FGFR-3 is an initial target of Prox1 during the lymphatic cell fate specification and that FGF signaling may play an important role in lymphatic vessel development.
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MESH Headings
- Animals
- Apoptosis
- Base Sequence
- Cell Proliferation
- Cells, Cultured
- Endothelium, Lymphatic/cytology
- Endothelium, Lymphatic/embryology
- Endothelium, Lymphatic/metabolism
- Fibroblast Growth Factor 1/physiology
- Fibroblast Growth Factor 2/physiology
- Gene Expression Regulation, Developmental
- Homeodomain Proteins/genetics
- Homeodomain Proteins/metabolism
- Homeodomain Proteins/physiology
- Humans
- Lymphangiogenesis/genetics
- Mice
- Molecular Sequence Data
- Rats
- Receptor, Fibroblast Growth Factor, Type 3/genetics
- Receptor, Fibroblast Growth Factor, Type 3/metabolism
- Receptor, Fibroblast Growth Factor, Type 3/physiology
- Signal Transduction/physiology
- Tumor Suppressor Proteins
- Up-Regulation
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Affiliation(s)
- Jay W Shin
- Cutaneous Biology Research Center and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
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Hirakawa S, Kodama S, Kunstfeld R, Kajiya K, Brown LF, Detmar M. VEGF-A induces tumor and sentinel lymph node lymphangiogenesis and promotes lymphatic metastasis. ACTA ACUST UNITED AC 2005; 201:1089-99. [PMID: 15809353 PMCID: PMC2213132 DOI: 10.1084/jem.20041896] [Citation(s) in RCA: 530] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The mechanisms of tumor metastasis to the sentinel lymph nodes are poorly understood. Vascular endothelial growth factor (VEGF)-A plays a principle role in tumor progression and angiogenesis; however, its role in tumor-associated lymphangiogenesis and lymphatic metastasis has remained unclear. We created transgenic mice that overexpress VEGF-A and green fluorescent protein specifically in the skin, and subjected them to a standard chemically-induced skin carcinogenesis regimen. We found that VEGF-A not only strongly promotes multistep skin carcinogenesis, but also induces active proliferation of VEGF receptor-2-expressing tumor-associated lymphatic vessels as well as tumor metastasis to the sentinel and distant lymph nodes. The lymphangiogenic activity of VEGF-A-expressing tumor cells was maintained within metastasis-containing lymph nodes. The most surprising finding of our study was that even before metastasizing, VEGF-A-overexpressing primary tumors induced sentinel lymph node lymphangiogenesis. This suggests that primary tumors might begin preparing their future metastatic site by producing lymphangiogenic factors that mediate their efficient transport to sentinel lymph nodes. This newly identified mechanism of inducing lymph node lymphangiogenesis likely contributes to tumor metastasis, and therefore, represents a new therapeutic target for advanced cancer and/or for the prevention of metastasis.
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Affiliation(s)
- Satoshi Hirakawa
- Cutaneous Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
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Kunstfeld R, Hirakawa S, Hong YK, Schacht V, Lange-Asschenfeldt B, Velasco P, Lin C, Fiebiger E, Wei X, Wu Y, Hicklin D, Bohlen P, Detmar M. Induction of cutaneous delayed-type hypersensitivity reactions in VEGF-A transgenic mice results in chronic skin inflammation associated with persistent lymphatic hyperplasia. Blood 2004; 104:1048-57. [PMID: 15100155 DOI: 10.1182/blood-2003-08-2964] [Citation(s) in RCA: 241] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Vascular endothelial growth factor-A (VEGF-A) expression is up-regulated in several inflammatory diseases including psoriasis, delayed-type hypersensitivity (DTH) reactions, and rheumatoid arthritis. To directly characterize the biologic function of VEGF-A in inflammation, we evaluated experimental DTH reactions induced in the ear skin of transgenic mice that overexpress VEGF-A specifically in the epidermis. VEGF-A transgenic mice underwent a significantly increased inflammatory response that persisted for more than 1 month, whereas inflammation returned to baseline levels within 7 days in wild-type mice. Inflammatory lesions in VEGF-A transgenic mice closely resembled human psoriasis and were characterized by epidermal hyperplasia, impaired epidermal differentiation, and accumulation of dermal CD4+ T-lymphocytes and epidermal CD8+ lymphocytes. Surprisingly, VEGF-A also promoted lymphatic vessel proliferation and enlargement, which might contribute to the increased inflammatory response, as lymphatic vessel enlargement was also detected in human psoriatic skin lesions. Combined systemic treatment with blocking antibodies against VEGF receptor-1 (VEGFR-1) and VEGFR-2 potently inhibited inflammation and also decreased lymphatic vessel size. Together, these findings reveal a central role of VEGF-A in promoting lymphatic enlargement, vascular hyperpermeability, and leukocyte recruitment, thereby leading to persistent chronic inflammation. They also indicate that inhibition of VEGF-A bioactivity might be a new approach to anti-inflammatory therapy.
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Affiliation(s)
- Rainer Kunstfeld
- Cutaneous Biology Research Center, Massachusetts General Hospital, Bldg 149, 13th St, Charlestown, MA 02129, USA
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Funovics MA, Kapeller B, Hoeller C, Su HS, Kunstfeld R, Puig S, Macfelda K. MR imaging of the her2/neu and 9.2.27 tumor antigens using immunospecific contrast agents. Magn Reson Imaging 2004; 22:843-50. [PMID: 15234453 DOI: 10.1016/j.mri.2004.01.050] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Accepted: 01/27/2004] [Indexed: 12/11/2022]
Abstract
Molecular imaging of tumor antigens using immunospecific magnetic resonance (MR) contrast agents is a rapidly evolving field, which can potentially aid in early disease detection, monitoring of treatment efficacy, and drug development. In this study, we designed, synthetized, and tested in vitro two novel monocrystalline iron oxide nanoparticles (MION) conjugated to antibodies against the her2/neu tyrosine kinase receptor and the 9.2.27 proteoglycane sulfate. MION was synthetized by coprecipitation of iron II and iron III salts in 12-kD dextran solution; antibody coupling was performed by reductive amination. The relaxivity of the conjugates was 24.1-29.1 mM(-1) s(-1), with 1.8 to 2.1 antibody molecules per nanoparticle. A panel of cultured melanoma and mammary cell lines was used for testing. The cells were incubated with the particles at 16-32 microg Fe/ml in culture medium for 3 h at 37 degrees C, and investigated with immune fluorescence, transmission electron microscopy (TEM), MRI of cell suspensions in gelatine, and spectrophotometric iron determination. All receptor-positive cell lines, but not the controls, showed receptor-specific immune fluorescence, and strong changes in T(2) signal intensity at 1.5 T. The changes in 1/T(2) were between 1.5 and 4.6 s(-1) and correlated with the amount of cell-bound iron (R = 0.92). The relaxivity of cell-bound MION increased to 55.9 +/- 10.4 mM(-1) s(-1). TEM showed anti-9.2.27 conjugates binding to the plasma membrane, while the anti-her2/neu conjugates underwent receptor-mediated endocytosis. In conclusion, we obtained receptor-specific T(2) MR contrast with novel covalently bound, multivalent MION conjugates with anti-9.2.27 and anti-her2/neu to image tumor surface antigens. This concept can potentially be expanded to a large number of targets and to in vivo applications.
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Affiliation(s)
- Martin A Funovics
- Department of Radiology, Medical University Vienna, Vienna, Austria.
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Hong YK, Lange-Asschenfeldt B, Velasco P, Hirakawa S, Kunstfeld R, Brown LF, Bohlen P, Senger DR, Detmar M. VEGF-A promotes tissue repair-associated lymphatic vessel formation via VEGFR-2 and the alpha1beta1 and alpha2beta1 integrins. FASEB J 2004; 18:1111-3. [PMID: 15132990 DOI: 10.1096/fj.03-1179fje] [Citation(s) in RCA: 242] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular endothelial growth factor-A (VEGF-A) is strongly up-regulated in wounded cutaneous tissue and promotes repair-associated angiogenesis. However, little is known about its role in lymphatic regeneration of the healing skin. We studied wound healing in transgenic mice that overexpress VEGF-A specifically in the epidermis and in wild-type mice in the absence or presence of inhibitors of VEGF-A signaling. Surprisingly, transgenic overexpression of VEGF-A in the skin promoted lymphangiogenesis at the wound healing site, whereas systemic blockade of VEGFR-2 prevented lymphatic vessel formation. Studies in cultured lymphatic endothelial cells revealed that VEGF-A induced expression of the alpha1 and alpha2 integrins, which promoted their in vitro tube formation and their haptotactic migration toward type I collagen. VEGF-A-induced lymphatic endothelial cord formation and haptotactic migration were suppressed by anti-alpha1 and anti-alpha2 integrin blocking antibodies, and systemic blockade of the alpha1 and alpha2 integrins inhibited VEGF-A-driven lymphangiogenesis in vivo. We propose that VEGF-A promotes lymphatic vasculature formation via activation of VEGFR-2 and that lineage-specific differences of integrin receptor expression contribute to the distinct dynamics of wound-associated angiogenesis and lymphangiogenesis.
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Affiliation(s)
- Young-Kwon Hong
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts 02129, USA
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Affiliation(s)
- Julia Valencak
- Department of Dermatology, Division of General Dermatology, University of Vienna, Vienna, Austria.
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Noh YH, Matsuda K, Hong YK, Kunstfeld R, Riccardi L, Koch M, Oura H, Dadras SS, Streit M, Detmar M. An N-Terminal 80 kDa Recombinant Fragment of Human Thrombospondin-2 Inhibits Vascular Endothelial Growth Factor Induced Endothelial Cell Migration In Vitro and Tumor Growth and Angiogenesis In Vivo. J Invest Dermatol 2003; 121:1536-43. [PMID: 14675207 DOI: 10.1046/j.1523-1747.2003.12643.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have previously shown that stable overexpression of the thrombospondin-2 (TSP-2) gene inhibited the tumor growth and angiogenesis of human squamous cell carcinoma xenotransplants. To investigate the potential antitumoral efficacy of systemic TSP-2 therapy, we expressed a recombinant 80 kDa fragment of human TSP-2 (TSP-2/NTF), encompassing the N-terminal globular region through the three type 1 repeats, in human kidney 293 EBNA cells, using a modified pCEP4 expression vector. Daily intraperitoneal injections of TSP-2/NTF resulted in a significant inhibition of the growth of human A431 squamous cell carcinomas in vivo and in reduced tumor vascularization. To further investigate possible mechanisms of the antiangiogenic activity of TSP-2/NTF, several in vitro angiogenesis assays were performed in human dermal microvascular endothelial cells. TSP-2/NTF inhibited vascular endothelial growth factor induced migration of human dermal microvascular endothelial cells and inhibited tube formation on Matrigel in vitro. TSP-2/NTF also inhibited vascular endothelial growth factor induced angiogenesis in an in vivo Matrigel assay. Moreover, TSP-2/NTF potently induced human dermal microvascular endothelial cell apoptosis in vitro but did not affect A431 tumor cell proliferation or apoptosis. These findings identify TSP-2/NTF as a potent systemic inhibitor of tumor growth and angiogenesis, acting by direct inhibition of several endothelial cell functions involved in neovascularization.
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Affiliation(s)
- Yun-Hee Noh
- Cutaneous Biology Research Center and Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts 02129, USA
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Kunstfeld R, Wickenhauser G, Michaelis U, Teifel M, Umek W, Naujoks K, Wolff K, Petzelbauer P. Paclitaxel encapsulated in cationic liposomes diminishes tumor angiogenesis and melanoma growth in a "humanized" SCID mouse model. J Invest Dermatol 2003; 120:476-82. [PMID: 12603862 DOI: 10.1046/j.1523-1747.2003.12057.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Paclitaxel is an alkaloid that inhibits endothelial cell proliferation, motility, and tube formation at nanomolar concentrations. Cationic liposome preparations have been shown to target blood vessels. We wished to explore the possibility that paclitaxel encapsulated in cationic liposomes carries paclitaxel to blood vessels and thereby provides an antiangiogenic effect. We used a humanized SCID mouse melanoma model, which allowed us to analyze tumor growth and tumor angiogenesis in an orthotopic tumor model. Here, human melanoma cells grow on human dermis and are in part nourished by human vessels. We show that paclitaxel encapsulated in liposomes prevents melanoma growth and invasiveness and improves survival of mice. Moreover, liposome-encapsulated paclitaxel reduces vessel density at the interface between the tumor and the human dermis and reduces endothelial cell mitosis to background levels. In contrast, equimolar concentrations of paclitaxel solubilized in Cremophor EL(R) had only insignificant effects on tumor growth and did not reduce the mitotic index of endothelium in vivo, although the antiproliferative effect of solubilized paclitaxel in Cremophor EL(R)in vitro was identical to that seen with liposome-coupled paclitaxel. In conclusion, we present a model of how to exploit cytotoxic effects of compounds to prevent tumor growth by using cationic liposomes for targeting an antiproliferative drug to blood vessels.
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Affiliation(s)
- Rainer Kunstfeld
- Department of Dermatology, Division of General Dermatology, University of Vienna Medical School, Vienna, Austria
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Kunstfeld R, Wickenhauser G, Michaelis U, Teifel M, Umek W, Naujoks K, Wolff K, Petzelbauer P. Paclitaxel encapsulated in cationic liposomes diminishes tumor angiogenesis and melanoma growth in a "humanized" SCID mouse model. J Invest Dermatol 2003. [PMID: 12603862 DOI: 10.1046/u523-1747.2003.12057x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Paclitaxel is an alkaloid that inhibits endothelial cell proliferation, motility, and tube formation at nanomolar concentrations. Cationic liposome preparations have been shown to target blood vessels. We wished to explore the possibility that paclitaxel encapsulated in cationic liposomes carries paclitaxel to blood vessels and thereby provides an antiangiogenic effect. We used a humanized SCID mouse melanoma model, which allowed us to analyze tumor growth and tumor angiogenesis in an orthotopic tumor model. Here, human melanoma cells grow on human dermis and are in part nourished by human vessels. We show that paclitaxel encapsulated in liposomes prevents melanoma growth and invasiveness and improves survival of mice. Moreover, liposome-encapsulated paclitaxel reduces vessel density at the interface between the tumor and the human dermis and reduces endothelial cell mitosis to background levels. In contrast, equimolar concentrations of paclitaxel solubilized in Cremophor EL(R) had only insignificant effects on tumor growth and did not reduce the mitotic index of endothelium in vivo, although the antiproliferative effect of solubilized paclitaxel in Cremophor EL(R)in vitro was identical to that seen with liposome-coupled paclitaxel. In conclusion, we present a model of how to exploit cytotoxic effects of compounds to prevent tumor growth by using cationic liposomes for targeting an antiproliferative drug to blood vessels.
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Affiliation(s)
- Rainer Kunstfeld
- Department of Dermatology, Division of General Dermatology, University of Vienna Medical School, Vienna, Austria
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