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Xu W, Gaborieau V, Niman SM, Mukeria A, Liu X, Maremanda KP, Takakura A, Zaridze D, Freedman ML, Xie W, McDermott DF, Choueiri TK, Catalano PJ, Sabbisetti V, Bonventre JV, Pierorazio PM, Singla N, Brennan P, Bhatt RS. Plasma Kidney Injury Molecule-1 for Preoperative Prediction of Renal Cell Carcinoma Versus Benign Renal Masses, and Association With Clinical Outcomes. J Clin Oncol 2024:JCO2300699. [PMID: 38701382 DOI: 10.1200/jco.23.00699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/17/2023] [Accepted: 02/20/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE Both clear cell and papillary renal cell carcinomas (RCCs) overexpress kidney injury molecule-1 (KIM-1). We investigated whether plasma KIM-1 (pKIM-1) may be a useful risk stratification tool among patients with suspicious renal masses. METHODS Prenephrectomy pKIM-1 was measured in two independent cohorts of patients with renal masses. Cohort 1, from the prospective K2 trial, included 162 patients found to have clear cell RCC (cases) and 162 patients with benign renal masses (controls). Cohort 2 included 247 patients with small (cT1a) renal masses from an academic biorepository, of whom 184 had RCC. We assessed the relationship between pKIM-1, surgical pathology, and clinical outcomes. RESULTS In Cohort 1, pKIM-1 distinguished RCC versus benign masses with area under the receiver operating curve (AUC-ROC, 0.81 [95% CI, 0.76 to 0.86]). In Cohort 2 (cT1a only), pKIM-1 distinguished RCC versus benign masses (AUC-ROC, 0.74 [95% CI, 0.67 to 0.80]) and the addition of pKIM-1 to an established nomogram for predicting malignancy improved the model AUC-ROC (0.65 [95% CI, 0.57 to 0.74] v 0.78 [95% CI, 0.72 to 0.85]). A pKIM-1 cutpoint identified using Cohort 2 demonstrated sensitivity of 92.5% and specificity of 60% for identifying RCC in Cohort 1. In long-term follow-up of RCC cases (Cohort 1), higher prenephrectomy pKIM-1 was associated with worse metastasis-free survival (multivariable MFS hazard ratio [HR] 1.29 per unit increase in log pKIM-1, 95% CI, 1.10 to 1.53) and overall survival (multivariable OS HR 1.31 per unit increase in log pKIM-1, 95% CI, 1.10 to 1.54). In long-term follow-up of Cohort 2, no metastatic events occurred, consistent with the favorable prognosis of resected cT1a RCC. CONCLUSION Among patients with renal masses, pKIM-1 is associated with malignant pathology, worse MFS, and risk of death. pKIM-1 may be useful for selecting patients with renal masses for intervention versus surveillance.
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Affiliation(s)
- Wenxin Xu
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Anush Mukeria
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Xiaowen Liu
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - David Zaridze
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | | | | | | | | | | | | | | | | | - Nirmish Singla
- Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
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2
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Shigemura T, Perrot N, Huang Z, Bhatt RS, Sheshdeh AB, Ahmar NE, Ghandour F, Signoretti S, McDermott DF, Freeman GJ, Mahoney KM. Regulation of HHLA2 expression in kidney cancer and myeloid cells. BMC Cancer 2023; 23:1039. [PMID: 37891555 PMCID: PMC10605970 DOI: 10.1186/s12885-023-11496-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The immune checkpoint HERV-H LTR-associating 2 (HHLA2) is expressed in kidney cancer and various other tumor types. Therapeutics targeting HHLA2 or its inhibitory receptor KIR3DL3 are being developed for solid tumors, including renal cell carcinoma (RCC). However, the regulation of HHLA2 expression remains poorly understood. A better understanding of HHLA2 regulation in tumor cells and the tumor microenvironment is crucial for the successful translation of these therapeutic agents into clinical applications. METHODS Flow cytometry and quantitative real-time PCR were used to analyze HHLA2 expression in primary kidney tumors ex vivo and during in vitro culture. HHLA2 expression in A498 and 786-O ccRCC cell lines was examined in vitro and in subcutaneous tumor xenografts in NSG mice. Monocytes and dendritic cells were analyzed for HHLA2 expression. We tested a range of cytokines and culture conditions, including hypoxia, to induce HHLA2 expression. RESULTS Analysis of HHLA2 expression revealed that HHLA2 is expressed on tumor cells in primary kidney tumors ex vivo; however, its expression gradually diminishes during a 4-week in vitro culture period. A498 and 786-O ccRCC tumor cell lines do not express HHLA2 in vitro, but HHLA2 expression was observed when grown as subcutaneous xenografts in NSG immunodeficient mice. Induction experiments using various cytokines and culture conditions failed to induce HHLA2 expression in A498 and 786-O tumor cell lines in vitro. Analysis of HHLA2 expression in monocytes and dendritic cells demonstrated that only IL-10 and BMP4, along with IL-1β and IL-6 to a lesser extent, modestly enhanced HHLA2 protein and mRNA expression. CONCLUSIONS HHLA2 expression is induced on kidney cancer cells in vivo by a tumor microenvironmental signal that is not present in vitro. HHLA2 expression is differentially regulated in kidney cancer epithelial cells and monocytes. Cytokines, particularly IL10, that induce HHLA2 expression in monocytes fail to upregulate HHLA2 expression in tumor cell lines in vitro. These findings underscore the importance of the interplay between tumor cell and tumor microenvironmental signals in the regulation of HHLA2. Further investigation is warranted to elucidate the mechanisms involved in HHLA2 regulation and its implications for therapeutic development.
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Affiliation(s)
- Tomonari Shigemura
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Nahuel Perrot
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Zimo Huang
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Rupal S Bhatt
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Aseman Bagheri Sheshdeh
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Nourhan El Ahmar
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Fatme Ghandour
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - David F McDermott
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA, 02215, USA.
| | - Kathleen M Mahoney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA, 02215, USA.
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
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3
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Sarkar S, Bhatt RS, Mahla AS, Kumar A. Supplementation of Moringa oleifera leaf concentrate pellets on nutrient utilization, antioxidant status, and reproductive performance of prolific ewes during extreme summer months in semi-arid tropical conditions. Trop Anim Health Prod 2023; 55:241. [PMID: 37328676 DOI: 10.1007/s11250-023-03659-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
A feeding trial was conducted for a period of 60 days during extreme summer months to observe the effect of supplementation of Moringa oleifera leaves containing concentrate pellets on nutrient utilization, antioxidant status, and reproductive performance in Avishaan ewes reared under semi-arid condition. Forty adult non-pregnant cyclic ewes (2-3 years, 31.8 ± 0.81 kg body weight) were selected and randomly allocated into 2 groups of 20 animals each, viz., G-I (control) and G-II (treatment). The ewes were grazed on natural pasture for 8 h, offered ad libitum Cenchrus ciliaris hay after grazing and concentrate pellets @ 300 g/animal/day. The ewes in G-I were offered conventional concentrate pellets, whereas G-II ewes were offered concentrate pellets containing 15% Moringa leaves. The mean temperature humidity index during the period of study was 27.5 ± 0.3 and 34.6 ± 0.4 at 0700 h and 1400 h, respectively, indicating severe heat stress. Nutrient intake and utilization were comparable between the two groups. The antioxidant status was higher in G-II ewes as the values of catalase, superoxide dismutase, and total antioxidant capacity were higher (P < 0.05) in G-II ewes compared to G-I. The conception rate was higher (100%) in G-II ewes than G-I ewes (70%). Multiple birth percentage was 77.8% in G-II ewes, and it was comparable with the herd average of Avishaan (74.7%). However, ewes in G-I group exhibited a marked decline in multiple birth percentage (28.6%) than the normal herd average. Hence, it can be concluded that inclusion of Moringa oleifera leaves in feeding of prolific Avishaan ewes improved their antioxidant status resulting in optimum reproductive performance during stressful summer months.
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Affiliation(s)
- Srobana Sarkar
- ICAR-Central Sheep and Wool Research Institute, Avikanagar, Rajasthan, 304501, India.
| | - R S Bhatt
- ICAR-Central Sheep and Wool Research Institute, Avikanagar, Rajasthan, 304501, India
| | - Ajit Singh Mahla
- ICAR-Central Sheep and Wool Research Institute, Avikanagar, Rajasthan, 304501, India
| | - Arun Kumar
- ICAR-Central Sheep and Wool Research Institute, Avikanagar, Rajasthan, 304501, India
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Abstract
Resistance to tyrosine kinase inhibitors of the vascular endothelial growth factor receptor inevitably develops in most patients with metastatic kidney cancer. Our recent findings demonstrate that addition of angiotensin-(1-7) peptide can be a potential therapy that delays such resistance.
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Affiliation(s)
- Thomas Walther
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork, Ireland.,Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald, Germany
| | - Prateek Khanna
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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5
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Francini E, Ou FS, Rhoades J, Wolfe EG, O’Connor EP, Ha G, Gydush G, Kelleher KM, Bhatt RS, Balk SP, Sweeney CJ, Adalsteinsson VA, Taplin ME, Choudhury AD. Circulating Cell-Free DNA as Biomarker of Taxane Resistance in Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2021; 13:4055. [PMID: 34439209 PMCID: PMC8391478 DOI: 10.3390/cancers13164055] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
There are no biomarkers predictive of resistance to docetaxel or cabazitaxel validated for patients with metastatic castration-resistant prostate cancer (mCRPC). We assessed the association between ABCB1 amplification and primary resistance to docetaxel or cabazitaxel for patients with mCRPC, using circulating cell-free DNA (cfDNA). Patients with ≥1 plasma sample drawn within 12 months before starting docetaxel (cohort A) or cabazitaxel (cohort B) for mCRPC were identified from the Dana-Farber Cancer Institute IRB approved database. Sparse whole genome sequencing was performed on the selected cfDNA samples and tumor fractions were estimated using the computational tool ichorCNA. We evaluated the association between ABCB1 amplification or other copy number alterations and primary resistance to docetaxel or cabazitaxel. Of the selected 176 patients, 45 samples in cohort A and 21 samples in cohort B had sufficient tumor content. No significant association was found between ABCB1 amplification and primary resistance to docetaxel (p = 0.58; odds ratio (OR) = 1.49) or cabazitaxel (p = 0.97; OR = 1.06). No significant association was found between exploratory biomarkers and primary resistance to docetaxel or cabazitaxel. In this study, ABCB1 amplification did not predict primary resistance to docetaxel or cabazitaxel for mCRPC. Future studies including ABCB1 amplification in a suite of putative biomarkers and a larger cohort may aid in drawing definitive conclusions.
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Affiliation(s)
- Edoardo Francini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA; (E.P.O.); (G.H.); (K.M.K.); (C.J.S.); (M.-E.T.); (A.D.C.)
| | - Fang-Shu Ou
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (F.-S.O.); (E.G.W.)
| | - Justin Rhoades
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (J.R.); (G.G.); (V.A.A.)
| | - Eric G. Wolfe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA; (F.-S.O.); (E.G.W.)
| | - Edward P. O’Connor
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA; (E.P.O.); (G.H.); (K.M.K.); (C.J.S.); (M.-E.T.); (A.D.C.)
| | - Gavin Ha
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA; (E.P.O.); (G.H.); (K.M.K.); (C.J.S.); (M.-E.T.); (A.D.C.)
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (J.R.); (G.G.); (V.A.A.)
| | - Gregory Gydush
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (J.R.); (G.G.); (V.A.A.)
| | - Kaitlin M. Kelleher
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA; (E.P.O.); (G.H.); (K.M.K.); (C.J.S.); (M.-E.T.); (A.D.C.)
| | - Rupal S. Bhatt
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; (R.S.B.); (S.P.B.)
| | - Steven P. Balk
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; (R.S.B.); (S.P.B.)
| | - Christopher J. Sweeney
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA; (E.P.O.); (G.H.); (K.M.K.); (C.J.S.); (M.-E.T.); (A.D.C.)
| | - Viktor A. Adalsteinsson
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (J.R.); (G.G.); (V.A.A.)
| | - Mary-Ellen Taplin
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA; (E.P.O.); (G.H.); (K.M.K.); (C.J.S.); (M.-E.T.); (A.D.C.)
| | - Atish D. Choudhury
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA; (E.P.O.); (G.H.); (K.M.K.); (C.J.S.); (M.-E.T.); (A.D.C.)
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (J.R.); (G.G.); (V.A.A.)
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6
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Kaplan I, Bubley GJ, Bhatt RS, Taplin ME, Dowling S, Mahoney K, Werner E, Nguyen P. Enzalutamide With Radiation Therapy for Intermediate-Risk Prostate Cancer: A Phase 2 Study. Int J Radiat Oncol Biol Phys 2021; 110:1416-1422. [PMID: 33636278 DOI: 10.1016/j.ijrobp.2021.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Androgen deprivation therapy (ADT) is often used as adjuvant treatment with radiation therapy (RT) for intermediate-risk prostate cancer. ADT is associated with multiple side effects, including weight gain, loss of libido, and hot flashes. In contrast, antiandrogen monotherapy has been generally better tolerated. This study aimed to assess the effectiveness of enzalutamide (an antiandrogen) monotherapy with RT for the treatment of intermediate-risk prostate cancer. METHODS AND MATERIALS This trial was an open-label, phase 2 study of 6 months of enzalutamide monotherapy with external beam RT for intermediate-risk prostate cancer. Enzalutamide was initiated 2 months before external beam RT. The primary endpoint was prostate-specific antigen (PSA) response measured at the end of enzalutamide administration at the 6-month timepoint. Secondary endpoints included assessment of toxicity and changes in anthropomorphic body measurement, sexual function, and metabolism. The sample size was 64 patients. The hypothesis was that if ≥60% of the patients did not achieve a PSA nadir of ≤0.2 ng/mL, the study results would be deemed negative. RESULTS The results met the prespecified endpoint for efficacy in that PSA values ≤0.2 ng/mL were observed in 49 of 64 patients (77%), and 60 of 64 patients (94%) had PSA values ≤0.5ng/mL. The most frequent adverse events were hypertension and gynecomastia. There were no changes in anthropomorphic body measurements and only modest erectile dysfunction. CONCLUSIONS Using PSA response as an endpoint, enzalutamide monotherapy may be as effective as ADT in combination with external beam RT for patients with intermediate-risk prostate cancer, and it is associated with fewer side effects. Randomized trials comparing enzalutamide with ADT are justified.
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Affiliation(s)
- Irving Kaplan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Glenn J Bubley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Shanna Dowling
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kathleen Mahoney
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - E Werner
- Department of Biostatics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Paul Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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7
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Khanna P, Soh HJ, Chen CH, Saxena R, Amin S, Naughton M, Joslin PN, Moore A, Bakouny Z, O'Callaghan C, Catalano P, Signoretti S, McKay R, Choueiri TK, Bhasin M, Walther T, Bhatt RS. ACE2 abrogates tumor resistance to VEGFR inhibitors suggesting angiotensin-(1-7) as a therapy for clear cell renal cell carcinoma. Sci Transl Med 2021; 13:13/577/eabc0170. [PMID: 33472951 DOI: 10.1126/scitranslmed.abc0170] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
Abstract
Angiotensin converting enzyme 2 (ACE2) is an enzyme that belongs to the renin-angiotensin system (RAS) and antagonizes the classical angiotensin (Ang) II/angiotensin II receptor type 1 (AT1) receptor pathway. Here, we report that higher ACE2 expression correlates with better overall survival in patients with clear cell renal cell carcinoma (ccRCC). Moreover, ACE2 has inhibitory effects on tumor proliferation in ccRCC in vitro and in preclinical animal models of ccRCC. We further show that Ang-(1-7), a heptapeptide generated by ACE2, is the likely mediator of this effect. Vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) treatment of ccRCC xenografts decreased ACE2 expression, and combination treatment with VEGFR-TKI and Ang-(1-7) generated additive suppression of tumor growth and improved survival outcomes. Last, the addition of Ang-(1-7) to programmed death-ligand 1 (PD-L1) pathway inhibitor and VEGFR-TKI showed further growth suppression in an immunocompetent RCC model. Together, these results suggest that targeting the ACE2/Ang-(1-7) axis is a promising therapeutic strategy against ccRCC.
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Affiliation(s)
- Prateek Khanna
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.,Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA 02138, USA
| | - Hong Jie Soh
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland
| | - Chun-Hau Chen
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ruchi Saxena
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Seema Amin
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Maura Naughton
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland
| | - Patrick Neset Joslin
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Andrew Moore
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland
| | - Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Carol O'Callaghan
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland
| | - Paul Catalano
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Rana McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Manoj Bhasin
- Division of Interdisciplinary Medicine and Biotechnology and Genomics, Proteomics, Bioinformatics and Systems Biology Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Thomas Walther
- Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork T12 K8AF, Ireland. .,Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald 17489, Germany
| | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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8
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McKay RR, Kwak L, Crowdis JP, Sperger JM, Zhao SG, Xie W, Werner L, Lis RT, Zhang Z, Wei XX, Lang JM, Van Allen EM, Bhatt RS, Yu EY, Nelson PS, Bubley GJ, Montgomery RB, Taplin ME. Phase II Multicenter Study of Enzalutamide in Metastatic Castration-Resistant Prostate Cancer to Identify Mechanisms Driving Resistance. Clin Cancer Res 2021; 27:3610-3619. [PMID: 33849963 PMCID: PMC8254786 DOI: 10.1158/1078-0432.ccr-20-4616] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/23/2021] [Accepted: 04/09/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Enzalutamide is a second-generation androgen receptor (AR) inhibitor that has improved overall survival (OS) in metastatic castration-resistant prostate cancer (CRPC). However, nearly all patients develop resistance. We designed a phase II multicenter study of enzalutamide in metastatic CRPC incorporating tissue and blood biomarkers to dissect mechanisms driving resistance. PATIENTS AND METHODS Eligible patients with metastatic CRPC underwent a baseline metastasis biopsy and then initiated enzalutamide 160 mg daily. A repeat metastasis biopsy was obtained at radiographic progression from the same site when possible. Blood for circulating tumor cell (CTC) analysis was collected at baseline and progression. The primary objective was to analyze mechanisms of resistance in serial biopsies. Whole-exome sequencing was performed on tissue biopsies. CTC samples underwent RNA sequencing. RESULTS A total of 65 patients initiated treatment, of whom 22 (33.8%) had received prior abiraterone. Baseline biopsies were enriched for alterations in AR (mutations, amplifications) and tumor suppression genes (PTEN, RB1, and TP53), which were observed in 73.1% and 92.3% of baseline biopsies, respectively. Progression biopsies revealed increased AR amplifications (64.7% at progression vs. 53.9% at baseline) and BRCA2 alterations (64.7% at progression vs. 38.5% at baseline). Genomic analysis of baseline and progression CTC samples demonstrated increased AR splice variants, AR-regulated genes, and neuroendocrine markers at progression. CONCLUSIONS Our results demonstrate that a large proportion of enzalutamide-treated patients have baseline and progression alterations in the AR pathway and tumor suppressor genes. We demonstrate an increased number of BRCA2 alterations post-enzalutamide, highlighting the importance of serial tumor sampling in CRPC.
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Affiliation(s)
- Rana R McKay
- University of California San Diego, San Diego, California
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lucia Kwak
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Jamie M Sperger
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Shuang G Zhao
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Wanling Xie
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Rosina T Lis
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Xiao X Wei
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joshua M Lang
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Evan Y Yu
- University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Peter S Nelson
- University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Glenn J Bubley
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - R Bruce Montgomery
- University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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Xu W, Puligandla M, Halbert B, Haas NB, Flaherty KT, Uzzo RG, Dutcher JP, DiPaola RS, Sabbisetti V, Bhatt RS. Plasma KIM-1 Is Associated with Recurrence Risk after Nephrectomy for Localized Renal Cell Carcinoma: A Trial of the ECOG-ACRIN Research Group (E2805). Clin Cancer Res 2021; 27:3397-3403. [PMID: 33832947 DOI: 10.1158/1078-0432.ccr-21-0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/26/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE No circulating biomarkers are currently available to identify patients at highest risk of recurrence after nephrectomy for renal cell carcinoma (RCC). Kidney injury molecule-1 (KIM-1) is overexpressed in RCC and its ectodomain circulates in plasma. We investigated whether plasma KIM-1 is a prognostic biomarker in patients with localized RCC after nephrectomy. EXPERIMENTAL DESIGN The ECOG-ACRIN E2805 (ASSURE) trial evaluated adjuvant sunitinib, sorafenib, or placebo in resected high-risk RCC. KIM-1 levels were measured from banked plasma at trial enrollment 4-12 weeks after nephrectomy. Lognormal accelerated failure time models were used to test for association between KIM-1 and disease-free survival (DFS) as well as overall survival (OS). RESULTS Plasma from 418 patients was analyzed. Higher post-nephrectomy KIM-1 was associated with worse DFS across all study arms after adjustment for Fuhrman grade, T stage, N stage, and tumor histology [survival time ratio 0.56 for 75th vs. 25th percentile of KIM-1; 95% confidence interval (CI), 0.42-0.73; P < 0.001]. The association between KIM-1 and DFS was stronger among patients with pathologic nodal involvement (P interaction = 0.0086). The addition of post-nephrectomy KIM-1 improved the concordance of clinical prognostic models [Stage, Size, Grade, and Necrosis (SSIGN) concordance 0.57 vs. 0.43, P = 0.05; UCLA International Staging System (UISS) concordance 0.60 vs. 0.40, P = 0.0005]. Higher post-nephrectomy KIM-1 was also associated with worse OS after multivariable adjustment (survival time ratio 0.71 for 75th vs. 25th percentile of KIM-1; 95% CI, 0.56-0.91; P < 0.001). CONCLUSIONS Post-nephrectomy plasma KIM-1 is associated with DFS and OS in RCC, and may be a biomarker for microscopic residual disease.
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Affiliation(s)
- Wenxin Xu
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Brian Halbert
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Naomi B Haas
- University of Pennsylvania/Abramson Cancer Center, Philadelphia, Philadelphia
| | | | | | | | | | | | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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10
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Gjyrezi A, Xie F, Voznesensky O, Khanna P, Calagua C, Bai Y, Kung J, Wu J, Corey E, Montgomery B, Mace S, Gianolio DA, Bubley GJ, Balk SP, Giannakakou P, Bhatt RS. Taxane resistance in prostate cancer is mediated by decreased drug-target engagement. J Clin Invest 2021; 130:3287-3298. [PMID: 32478682 DOI: 10.1172/jci132184] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/11/2020] [Indexed: 01/03/2023] Open
Abstract
Despite widespread use of taxanes, mechanisms of action and resistance in vivo remain to be established, and there is no way of predicting who will respond to therapy. This study examined prostate cancer (PCa) xenografts and patient samples to identify in vivo mechanisms of taxane action and resistance. Docetaxel drug-target engagement was assessed by confocal anti-tubulin immunofluorescence to quantify microtubule bundling in interphase cells and aberrant mitoses. Tumor biopsies from metastatic PCa patients obtained 2 to 5 days after their first dose of docetaxel or cabazitaxel were processed to assess microtubule bundling, which correlated with clinical response. Microtubule bundling was evident in PCa xenografts 2 to 3 days after docetaxel treatment but was decreased or lost with acquired resistance. Biopsies after treatment with leuprolide plus docetaxel showed extensive microtubule bundling as did biopsies obtained 2 to 3 days after initiation of docetaxel or cabazitaxel in 2 patients with castration-resistant PCa with clinical responses. In contrast, microtubule bundling in biopsies 2 to 3 days after the first dose of docetaxel was markedly lower in 4 nonresponding patients. These findings indicate that taxanes target both mitotic and interphase cells in vivo and that resistance is through mechanisms that impair drug-target engagement. Moreover, the findings suggest that microtubule bundling after initial taxane treatment may be a predictive biomarker for clinical response.
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Affiliation(s)
- Ada Gjyrezi
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical Center, New York, New York, USA
| | - Fang Xie
- Division of Hematology and Oncology, Department of Medicine, and
| | - Olga Voznesensky
- Division of Hematology and Oncology, Department of Medicine, and
| | - Prateek Khanna
- Division of Hematology and Oncology, Department of Medicine, and
| | - Carla Calagua
- Division of Hematology and Oncology, Department of Medicine, and
| | - Yang Bai
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical Center, New York, New York, USA
| | - Justin Kung
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jim Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Eva Corey
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Bruce Montgomery
- Department of Medicine and Oncology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Sandrine Mace
- Research and Development, Sanofi, Vitry-sur-Seine, France
| | | | - Glenn J Bubley
- Division of Hematology and Oncology, Department of Medicine, and
| | - Steven P Balk
- Division of Hematology and Oncology, Department of Medicine, and
| | - Paraskevi Giannakakou
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical Center, New York, New York, USA.,Sandra and Edward Meyer Cancer Center, Weill Cornell Medical Center, New York, New York, USA
| | - Rupal S Bhatt
- Division of Hematology and Oncology, Department of Medicine, and
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11
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Tsai LL, Bhatt RS, Strob MF, Jegede OA, Sun MRM, Alsop DC, Catalano P, McDermott D, Robson PM, Atkins MB, Pedrosa I. Arterial Spin Labeled Perfusion MRI for the Evaluation of Response to Tyrosine Kinase Inhibition Therapy in Metastatic Renal Cell Carcinoma. Radiology 2020; 298:332-340. [PMID: 33258745 DOI: 10.1148/radiol.2020201763] [Citation(s) in RCA: 3] [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: 01/21/2023]
Abstract
Background Tumor perfusion may inform therapeutic response and resistance in metastatic renal cell carcinoma (RCC) treated with antiangiogenic therapy. Purpose To determine if arterial spin labeled (ASL) MRI perfusion changes are associated with tumor response and disease progression in metastatic RCC treated with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs). Materials and Methods In this prospective study (ClinicalTrials.gov identifier: NCT00749320), metastatic RCC perfusion was measured with ASL MRI before and during sunitinib or pazopanib therapy between October 2008 and March 2014. Objective response rate (ORR) and progression-free survival (PFS) were calculated. Perfusion was compared between responders and nonresponders at baseline, at week 2, after cycle 2 (12 weeks), after cycle 4 (24 weeks), and at disease progression and compared with the ORR by using the Wilcoxon rank sum test and with PFS by using the log-rank test. Results Seventeen participants received sunitinib (mean age, 59 years ± 7.0 [standard deviation]; 11 men); 11 participants received pazopanib (mean age, 63 years ± 6.6; eight men). Responders had higher baseline tumor perfusion than nonresponders (mean, 404 mL/100 g/min ± 213 vs 199 mL/100 g/min ± 136; P = .02). Perfusion decreased from baseline to week 2 (-53 mL/100 g/min ± 31; P < .001), after cycle 2 (-65 mL/100 g/min ± 25; P < .001), and after cycle 4 (-79 mL/100 g/min ± 15; P = .008). Interval reduction in perfusion at those three time points was not associated with ORR (P = .63, .29, and .27, respectively) or PFS (P = .28, .27, and .32). Perfusion increased from cycle 4 to disease progression (51% ± 11; P < .001). Conclusion Arterial spin labeled perfusion MRI may assist in identifying responders to vascular endothelial growth factor receptor tyrosine kinase inhibitors and may help detect early evidence of disease progression in patients with metastatic renal cell carcinoma. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Goh and De Vita in this issue.
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Affiliation(s)
- Leo L Tsai
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - Rupal S Bhatt
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - Meaghan F Strob
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - Opeyemi A Jegede
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - Maryellen R M Sun
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - David C Alsop
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - Paul Catalano
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - David McDermott
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - Philip M Robson
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - Michael B Atkins
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
| | - Ivan Pedrosa
- From the Department of Radiology (L.L.T., M.F.S., D.C.A.) and Division of Hematology/Oncology (R.S.B., D.M.), Beth Israel Deaconess Medical Center, Boston, Mass; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Mass (O.A.J., P.C.); Department of Radiology, Lowell General Hospital, Lowell, Mass (M.R.M.S.); Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (P.M.R.); Division of Hematology/Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (M.B.A.); and Department of Radiology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390 (I.P.)
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12
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Bhatt RS, Berjis A, Konge JC, Mahoney KM, Klee AN, Freeman SS, Chen CH, Jegede OA, Catalano PJ, Pignon JC, Sticco-Ivins M, Zhu B, Hua P, Soden J, Zhu J, McDermott DF, Arulanandam AR, Signoretti S, Freeman GJ. KIR3DL3 Is an Inhibitory Receptor for HHLA2 that Mediates an Alternative Immunoinhibitory Pathway to PD1. Cancer Immunol Res 2020; 9:156-169. [PMID: 33229411 DOI: 10.1158/2326-6066.cir-20-0315] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/16/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022]
Abstract
Blockade of the PD1 pathway is a broadly effective cancer therapy, but additional immune-inhibitory pathways contribute to tumor immune evasion. HERV-H LTR-associating 2 (HHLA2; also known as B7H5 and B7H7) is a member of the B7 family of immunoregulatory ligands that mediates costimulatory effects through its interaction with the CD28 family member transmembrane and immunoglobulin domain containing 2 (TMIGD2). However, HHLA2 has also been known to have inhibitory effects on T cells. Here, we report that we have identified killer cell immunoglobulin-like receptor, three immunoglobulin domains and long cytoplasmic tail 3 (KIR3DL3) as an inhibitory receptor for HHLA2 in T cells and natural killer (NK) cells and have generated HHLA2 and KIR3DL3 antibodies that block the immune-inhibitory activity of HHLA2, preserving the costimulatory signal. It is known that HHLA2 is frequently expressed in several tumor types, including clear cell renal cell carcinoma (ccRCC). We found that HHLA2 expression was nonoverlapping with PDL1 expression in ccRCC, suggesting that HHLA2 mediates a mechanism of tumor immune evasion that is independent from PDL1. Blockade of both the PD1 and KIR3DL3 pathways may be a more effective way to reverse tumor immune evasion.See related Spotlight on p. 128.
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Affiliation(s)
- Rupal S Bhatt
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Abdulla Berjis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Julie C Konge
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kathleen M Mahoney
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Alyssa N Klee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Samuel S Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Chun-Hau Chen
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Opeyemi A Jegede
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paul J Catalano
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jean-Christophe Pignon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maura Sticco-Ivins
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Baogong Zhu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ping Hua
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jo Soden
- Retrogenix, Chinley, High Peak, United Kingdom
| | - Jie Zhu
- BPS Bioscience, San Diego, California
| | - David F McDermott
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Antonio R Arulanandam
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
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13
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Xu W, Puligandla M, Manola J, Bullock AJ, Tamasauskas D, McDermott DF, Atkins MB, Haas NB, Flaherty K, Uzzo RG, Dutcher JP, DiPaola RS, Bhatt RS. Angiogenic Factor and Cytokine Analysis among Patients Treated with Adjuvant VEGFR TKIs in Resected Renal Cell Carcinoma. Clin Cancer Res 2019; 25:6098-6106. [PMID: 31471309 DOI: 10.1158/1078-0432.ccr-19-0818] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/06/2019] [Accepted: 07/09/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The use of VEGFR TKIs for the adjuvant treatment of renal cell carcinoma (RCC) remains controversial. We investigated the effects of adjuvant VEGFR TKIs on circulating cytokines in the ECOG-ACRIN 2805 (ASSURE) trial. EXPERIMENTAL DESIGN Patients with resected high-risk RCC were randomized to sunitinib, sorafenib, or placebo. Plasma from 413 patients was analyzed from post-nephrectomy baseline, 4 weeks, and 6 weeks after treatment initiation. Mixed effects and Cox proportional hazards models were used to test for changes in circulating cytokines and associations between disease-free survival (DFS) and cytokine levels. RESULTS VEGF and PlGF increased after 4 weeks on sunitinib or sorafenib (P < 0.0001 for both) and returned to baseline at 6 weeks on sunitinib (corresponding to the break in the sunitinib schedule) but not sorafenib (which was administered continuously). sFLT-1 decreased after 4 weeks on sunitinib and 6 weeks on sorafenib (P < 0.0001). sVEGFR-2 decreased after both 4 and 6 weeks of treatment on sunitinib or sorafenib (P < 0.0001). Patients receiving placebo had no significant changes in cytokine levels. CXCL10 was elevated at 4 and 6 weeks on sunitinib and sorafenib but not on placebo. Higher baseline CXCL10 was associated with worse DFS (HR 1.41 per log increase in CXCL10, Bonferroni-adjusted P = 0.003). This remained significant after adjustment for T-stage, Fuhrman grade, and ECOG performance status. CONCLUSIONS Among patients treated with adjuvant VEGFR TKIs for RCC, drug-host interactions mediate changes in circulating cytokines. Elevated baseline CXCL10 was associated with worse DFS. Studies to understand functional consequences of these changes are under way.
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Affiliation(s)
- Wenxin Xu
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Maneka Puligandla
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Judith Manola
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | | | | | | | - Michael B Atkins
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Naomi B Haas
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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14
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Voss MH, Bhatt RS, Vogelzang NJ, Fishman M, Alter RS, Rini BI, Beck JT, Joshi M, Hauke R, Atkins MB, Burgess E, Logan TF, Shaffer D, Parikh R, Moazzam N, Zhang X, Glasser C, Sherman ML, Plimack ER. A phase 2, randomized trial evaluating the combination of dalantercept plus axitinib in patients with advanced clear cell renal cell carcinoma. Cancer 2019; 125:2400-2408. [PMID: 30951193 DOI: 10.1002/cncr.32061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/30/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In a prior open-label study, the combination of dalantercept, a novel antiangiogenic targeting activin receptor-like kinase 1 (ALK1), plus axitinib was deemed safe and tolerable with a promising efficacy signal in patients with advanced renal cell carcinoma (RCC). METHODS In the current phase 2, randomized, double-blind, placebo-controlled study, patients with clear cell RCC previously treated with 1 prior angiogenesis inhibitor were randomized 1:1 to receive axitinib plus dalantercept versus axitinib plus placebo. Randomization was stratified by the type of prior therapy. The primary endpoint was progression-free survival (PFS). Secondary endpoints were PFS in patients with ≥2 prior lines of anticancer therapy, overall survival, and the objective response rate. RESULTS Between June 10, 2014, and February 23, 2017, a total of 124 patients were randomly assigned to receive axitinib plus dalantercept (59 patients) or placebo (65 patients). The median PFS was not found to be significantly different between the treatment groups (median, 6.8 months vs 5.6 months; hazard ratio, 1.11 [95% CI, 0.71-1.73; P = .670]). Neither group reached the median overall survival (hazard ratio, 1.39 [95% CI, 0.70-2.77; P = .349]). The objective response rate was 19.0% (11 of 58 patients; 95% CI, 9.9%-31.4%) in the dalantercept plus axitinib group and 24.6% (15 of 61 patients; 95% CI, 14.5%-37.3%) in the placebo plus axitinib group. At least 1 treatment-emergent adverse event of ≥grade 3 was observed in 59% of patients (34 of 58 patients) in the dalantercept group and 64% of patients (39 of 61 patients) in the placebo group. One treatment-related death occurred in the placebo plus axitinib group. CONCLUSIONS Although well tolerated, the addition of dalantercept to axitinib did not appear to improve treatment-related outcomes in previously treated patients with advanced RCC.
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Affiliation(s)
- Martin H Voss
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Robert S Alter
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Brian I Rini
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Ralph Hauke
- Nebraska Methodist Hospital, Omaha, Nebraska
| | | | - Earle Burgess
- Levine Cancer Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Theodore F Logan
- Indiana University Health Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | | | - Rahul Parikh
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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15
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Fischl AS, Wang X, Falcon BL, Almonte-Baldonado R, Bodenmiller D, Evans G, Stewart J, Wilson T, Hipskind P, Manro J, Uhlik MT, Chintharlapalli S, Gerald D, Alsop DC, Benjamin LE, Bhatt RS. Inhibition of Sphingosine Phosphate Receptor 1 Signaling Enhances the Efficacy of VEGF Receptor Inhibition. Mol Cancer Ther 2019; 18:856-867. [PMID: 30787172 DOI: 10.1158/1535-7163.mct-18-0548] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/25/2018] [Revised: 10/04/2018] [Accepted: 02/04/2019] [Indexed: 01/15/2023]
Abstract
Inhibition of VEGFR signaling is an effective treatment for renal cell carcinoma, but resistance continues to be a major problem. Recently, the sphingosine phosphate (S1P) signaling pathway has been implicated in tumor growth, angiogenesis, and resistance to antiangiogenic therapy. S1P is a bioactive lipid that serves an essential role in developmental and pathologic angiogenesis via activation of the S1P receptor 1 (S1P1). S1P1 signaling counteracts VEGF signaling and is required for vascular stabilization. We used in vivo and in vitro angiogenesis models including a postnatal retinal angiogenesis model and a renal cell carcinoma murine tumor model to test whether simultaneous inhibition of S1P1 and VEGF leads to improved angiogenic inhibition. Here, we show that inhibition of S1P signaling reduces the endothelial cell barrier and leads to excessive angiogenic sprouting. Simultaneous inhibition of S1P and VEGF signaling further disrupts the tumor vascular beds, decreases tumor volume, and increases tumor cell death compared with monotherapies. These studies suggest that inhibition of angiogenesis at two stages of the multistep process may maximize the effects of antiangiogenic therapy. Together, these data suggest that combination of S1P1 and VEGFR-targeted therapy may be a useful therapeutic strategy for the treatment of renal cell carcinoma and other tumor types.
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MESH Headings
- Angiogenesis Inhibitors/pharmacology
- Animals
- Antibodies, Monoclonal/pharmacology
- Carcinoma, Renal Cell/blood supply
- Carcinoma, Renal Cell/drug therapy
- Carcinoma, Renal Cell/metabolism
- Carcinoma, Renal Cell/pathology
- Cell Line, Tumor
- Drug Therapy, Combination
- Endothelial Cells/drug effects
- Endothelial Cells/metabolism
- Female
- Humans
- Kidney Neoplasms/blood supply
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/metabolism
- Kidney Neoplasms/pathology
- Lysophospholipids/antagonists & inhibitors
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Nude
- Neovascularization, Pathologic/drug therapy
- Sphingosine/analogs & derivatives
- Sphingosine/antagonists & inhibitors
- Sphingosine-1-Phosphate Receptors/antagonists & inhibitors
- Sunitinib/pharmacology
- Treatment Outcome
- Tumor Burden/drug effects
- Vascular Endothelial Growth Factor A/pharmacology
- Vascular Endothelial Growth Factor Receptor-2/antagonists & inhibitors
- Xenograft Model Antitumor Assays
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Affiliation(s)
| | - Xiaoen Wang
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Rupal S Bhatt
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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16
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Grossman JE, Wu Y, Ye H, Bhatt RS. Case of Basal Cell Carcinoma of the Prostate Successfully Treated Before and After a BRCA2 Reversion Mutation. JCO Precis Oncol 2018; 2:PO.18.00193. [PMID: 32914001 PMCID: PMC7446519 DOI: 10.1200/po.18.00193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Yubo Wu
- All authors: Harvard Medical School, Boston, MA
| | - Huihui Ye
- All authors: Harvard Medical School, Boston, MA
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17
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Scelo G, Muller DC, Riboli E, Johansson M, Cross AJ, Vineis P, Tsilidis KK, Brennan P, Boeing H, Peeters PHM, Vermeulen RCH, Overvad K, Bueno-de-Mesquita HB, Severi G, Perduca V, Kvaskoff M, Trichopoulou A, La Vecchia C, Karakatsani A, Palli D, Sieri S, Panico S, Weiderpass E, Sandanger TM, Nøst TH, Agudo A, Quirós JR, Rodríguez-Barranco M, Chirlaque MD, Key TJ, Khanna P, Bonventre JV, Sabbisetti VS, Bhatt RS. KIM-1 as a Blood-Based Marker for Early Detection of Kidney Cancer: A Prospective Nested Case-Control Study. Clin Cancer Res 2018; 24:5594-5601. [PMID: 30037816 PMCID: PMC6239904 DOI: 10.1158/1078-0432.ccr-18-1496] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 05/14/2018] [Revised: 06/19/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
Purpose: Renal cell carcinoma (RCC) has the potential for cure with surgery when diagnosed at an early stage. Kidney injury molecule-1 (KIM-1) has been shown to be elevated in the plasma of RCC patients. We aimed to test whether plasma KIM-1 could represent a means of detecting RCC prior to clinical diagnosis.Experimental Design: KIM-1 concentrations were measured in prediagnostic plasma from 190 RCC cases and 190 controls nested within a population-based prospective cohort study. Cases had entered the cohort up to 5 years before diagnosis, and controls were matched on cases for date of birth, date at blood donation, sex, and country. We applied conditional logistic regression and flexible parametric survival models to evaluate the association between plasma KIM-1 concentrations and RCC risk and survival.Results: The incidence rate ratio (IRR) of RCC for a doubling in KIM-1 concentration was 1.71 [95% confidence interval (CI), 1.44-2.03, P = 4.1 × 10-23], corresponding to an IRR of 63.3 (95% CI, 16.2-246.9) comparing the 80th to the 20th percentiles of the KIM-1 distribution in this sample. Compared with a risk model including known risk factors of RCC (age, sex, country, body mass index, and tobacco smoking status), a risk model additionally including KIM-1 substantially improved discrimination between cases and controls (area under the receiver-operating characteristic curve of 0.8 compared with 0.7). High plasma KIM-1 concentrations were also associated with poorer survival (P = 0.0053).Conclusions: Plasma KIM-1 concentrations could predict RCC incidence up to 5 years prior to diagnosis and were associated with poorer survival. Clin Cancer Res; 24(22); 5594-601. ©2018 AACR.
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Affiliation(s)
- Ghislaine Scelo
- International Agency for Research on Cancer (IARC), Lyon, France
| | - David C Muller
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | | | - Amanda J Cross
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Paul Brennan
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Denmark
| | - H Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gianluca Severi
- CESP, Faculté de Médecine, Université Paris-Sud, Faculté de médecine, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Vittorio Perduca
- CESP, Faculté de Médecine, Université Paris-Sud, Faculté de médecine, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
- Laboratoire de Mathématiques Appliquées MAP5 (UMR CNRS 8145), Université Paris Descartes, Paris, France
| | - Marina Kvaskoff
- CESP, Faculté de Médecine, Université Paris-Sud, Faculté de médecine, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | | | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milan, Italy
| | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Greece
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute, ISPO, Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Torkjel M Sandanger
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Therese H Nøst
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Institut Catatlà d'Oncologia, L'Hospitalet de Llobregat, Spain
| | | | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maria-Dolores Chirlaque
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford
| | - Prateek Khanna
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joseph V Bonventre
- Brigham and Women's Hospital, Harvard Institutes of Medicine, Boston, Massachusetts
| | - Venkata S Sabbisetti
- Brigham and Women's Hospital, Harvard Institutes of Medicine, Boston, Massachusetts
| | - Rupal S Bhatt
- Department of Medicine, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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18
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Aderao GN, Sahoo A, Bhatt RS, Kumawat PK, Soni L. In vitro rumen fermentation kinetics, metabolite production, methane and substrate degradability of polyphenol rich plant leaves and their component complete feed blocks. J Anim Sci Technol 2018; 60:26. [PMID: 30455972 PMCID: PMC6225722 DOI: 10.1186/s40781-018-0184-6] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022]
Abstract
Background This experiment aimed at assessing polyphenol-rich plant biomass to use in complete feed making for the feeding of ruminants. Methods An in vitro ruminal evaluation of complete blocks (CFB) with (Acacia nilotica, Ziziphus nummularia leaves) and without (Vigna sinensis hay) polyphenol rich plant leaves was conducted by applying Menke’s in vitro gas production (IVGP) technique. A total of six substrates, viz. three forages and three CFBs were subjected to in vitro ruminal fermentation in glass syringes to assess gas and methane production, substrate degradability, and rumen fermentation metabolites. Results Total polyphenol content (g/Kg) was 163 in A. nilotica compared to 52.5 in Z. nummularia with a contrasting difference in tannin fractions, higher hydrolysable tannins (HT) in the former (140.1 vs 2.8) and higher condensed (CT) tannins in the later (28.3 vs 7.9). The potential gas production was lower with a higher lag phase (L) in CT containing Z. nummularia and the component feed block. A. nilotica alone and as a constituent of CFB produced higher total gas but with lower methane while the partitioning factor (PF) was higher in Z. nummularia and its CFB. Substrate digestibility (both DM and OM) was lower (P < 0.001) in Z. nummularia compared to other forages and CFBs. The fermentation metabolites showed a different pattern for forages and their CFBs. The forages showed higher TCA precipitable N and lower acetate: propionate ratio in Z. nummularia while the related trend was found in CFB with V. sinensis. Total volatile fatty acid concentration was higher (P < 0.001) in A. nilotica leaves than V. sinensis hay and Z. nummularia leaves. It has implication on widening the forage resources and providing opportunity to use forage biomass rich in polyphenolic constituents in judicious proportion for reducing methane and enhancing green livestock production. Conclusion Above all, higher substrate degradability, propionate production, lower methanogenesis in CFB with A. nilotica leaves may be considered useful. Nevertheless, CFB with Z. nummularia also proved its usefulness with higher TCA precipitable N and PF. It has implication on widening the forage resources and providing opportunity to use polyphenol-rich forage biomass for reducing methane and enhancing green livestock production.
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Affiliation(s)
- Ganesh N Aderao
- 2Division of Animal Nutrition Division, ICAR- Central Sheep and Wool Research Institute, Avikanagar, Rajasthan 304501 India
| | - A Sahoo
- 1Animal Nutrition Division, ICAR- Indian Veterinary Research Institute, 243122, Izatnagar, UP India
| | - R S Bhatt
- 2Division of Animal Nutrition Division, ICAR- Central Sheep and Wool Research Institute, Avikanagar, Rajasthan 304501 India
| | - P K Kumawat
- 2Division of Animal Nutrition Division, ICAR- Central Sheep and Wool Research Institute, Avikanagar, Rajasthan 304501 India
| | - Lalit Soni
- 2Division of Animal Nutrition Division, ICAR- Central Sheep and Wool Research Institute, Avikanagar, Rajasthan 304501 India
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19
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Melms JC, Thummalapalli R, Shaw K, Ye H, Tsai L, Bhatt RS, Izar B. Alpha-fetoprotein (AFP) as tumor marker in a patient with urothelial cancer with exceptional response to anti-PD-1 therapy and an escape lesion mimic. J Immunother Cancer 2018; 6:89. [PMID: 30208947 PMCID: PMC6134551 DOI: 10.1186/s40425-018-0394-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 04/17/2018] [Accepted: 08/10/2018] [Indexed: 12/25/2022] Open
Abstract
The development of a new lesion in a patient with a complete remission to anti-PD-1 therapy is highly concerning for a drug resistant escape lesion. Here, we present a case of a 62-year-old patient with chemotherapy-resistant metastatic urothelial cancer who had a complete remission to pembrolizumab. The patient’s disease burden tracked closely to serum levels of alpha-fetoprotein (AFP) expressed by the tumor and served as an accurate tumor marker. Surveillance imaging revealed a solitary growing pulmonary nodule mimicking an escape lesion in the absence of an increase in AFP levels. Biopsy of this lesion revealed a benign intraparenchymal lymph node with no evidence of metastatic carcinoma. This case indicates that in some patients, biomarkers aberrantly expressed by their tumors, such as AFP in this patient, may be used as a tumor marker for response to anti-PD-1 therapy and emphasizes the importance of confirming potential escape lesions by pathologic examination.
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Affiliation(s)
- Johannes C Melms
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Rohit Thummalapalli
- Department of Medical Oncology, Dana-Farber Cancer Institute, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Kristin Shaw
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Huihui Ye
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Leo Tsai
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rupal S Bhatt
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin Izar
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Medical Oncology, Dana-Farber Cancer Institute, 330 Brookline Avenue, Boston, MA, 02215, USA. .,Broad Institute of MIT and Harvard, Cambridge, MA, USA. .,Ludwig Center for Cancer Research at Harvard, Boston, MA, USA.
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20
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Gao X, Jegede O, Gray C, Catalano PJ, Novak J, Kwiatkowski DJ, McKay RR, George DJ, Choueiri TK, McDermott DF, Signoretti S, Bhatt RS. Comprehensive Genomic Profiling of Metastatic Tumors in a Phase 2 Biomarker Study of Everolimus in Advanced Renal Cell Carcinoma. Clin Genitourin Cancer 2018; 16:341-348. [PMID: 29754934 DOI: 10.1016/j.clgc.2018.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 03/08/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Genomic events leading to activation of mechanistic target of rapamycin (mTOR) are common in renal cell carcinoma (RCC). Everolimus is an allosteric mTOR inhibitor with efficacy in metastatic RCC. We characterized the genomic profile of RCC tumors from metastatic sites and assessed whether particular alterations correlate with clinical response to everolimus. PATIENTS AND METHODS An open-label, single-arm phase 2 biomarker study of everolimus 10 mg daily was conducted in metastatic RCC patients. Needle biopsy or metastasectomy was performed on metastatic tumors before everolimus initiation. Next-generation sequencing was performed using a targeted hybrid capture panel detecting alterations within exons and key introns of ≥ 300 cancer-associated genes. Disease assessments were obtained every 8 weeks using standard radiographic modalities and evaluated by Response Evaluation Criteria in Solid Tumors criteria. RESULTS Objective response was seen in 1 (4.2%) of 24 patients. Two patients (8.3%) had stable disease lasting > 6 months. Median (90% confidence interval) overall and progression-free survival were 20.1 (8.6, NA) and 3.8 (2.4, 5.4) months, respectively. Next-generation sequencing was successful on 18 pretreatment specimens and 3 on-treatment specimens. Alterations in the phosphatidylinositol 3-kinase-protein kinase B-mammalian target of rapamycin (PI3K-AKT-mTOR) pathway were identified in 8 (44%) of 18 pretreatment samples. An mTOR E2419D mutation was identified in the patient who experienced partial response. Alterations in VHL, PBRM1, SETD2, KDM5C, and ATM were common in the RCC metastases before initiation of everolimus. CONCLUSION Nearly half of heavily pretreated RCC metastases may harbor mutations in components of the PI3K-AKT-mTOR pathway. Commonly mutated genes in primary RCC were also altered at a high frequency in RCC metastases.
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Affiliation(s)
- Xin Gao
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Opeyemi Jegede
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Connor Gray
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jesse Novak
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David J Kwiatkowski
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rana R McKay
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Daniel J George
- Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University School of Medicine, Durham, NC
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - David F McDermott
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rupal S Bhatt
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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21
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Hu J, Schokrpur S, Archang M, Hermann K, Sharrow AC, Khanna P, Novak J, Signoretti S, Bhatt RS, Knudsen BS, Xu H, Wu L. A Non-integrating Lentiviral Approach Overcomes Cas9-Induced Immune Rejection to Establish an Immunocompetent Metastatic Renal Cancer Model. Mol Ther Methods Clin Dev 2018; 9:203-210. [PMID: 29766028 PMCID: PMC5948229 DOI: 10.1016/j.omtm.2018.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/20/2018] [Indexed: 12/13/2022]
Abstract
The CRISPR-based technology has revolutionized genome editing in recent years. This technique allows for gene knockout and evaluation of function in cell lines in a manner that is far easier and more accessible than anything previously available. Unfortunately, the ability to extend these studies to in vivo syngeneic murine cell line implantation is limited by an immune response against cells transduced to stably express Cas9. In this study, we demonstrate that a non-integrating lentiviral vector approach can overcome this immune rejection and allow for the growth of transduced cells in an immunocompetent host. This technique enables the establishment of a von Hippel-Lindau (VHL) gene knockout RENCA cell line in BALB/c mice, generating an improved model of immunocompetent, metastatic renal cell carcinoma (RCC).
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Affiliation(s)
- Junhui Hu
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Urology and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Department of Paediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shiruyeh Schokrpur
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Maani Archang
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Kip Hermann
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Allison C. Sharrow
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Prateek Khanna
- Department of Medicine, Beth Israel Deacones Medical Center, Boston, MA 02215, USA
- Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, MA 02215, USA
| | - Jesse Novak
- Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, MA 02215, USA
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Sabina Signoretti
- Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, MA 02215, USA
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Rupal S. Bhatt
- Department of Medicine, Beth Israel Deacones Medical Center, Boston, MA 02215, USA
- Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, MA 02215, USA
| | - Beatrice S. Knudsen
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Hua Xu
- Department of Urology and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lily Wu
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Urology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Corresponding author Lily Wu, MD, PhD, Departments of Molecular & Medical Pharmacology and Urology, 33-118 CHS, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1735, USA.
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22
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Wang X, Solban N, Khanna P, Callea M, Song J, Alsop DC, Pearsall RS, Atkins MB, Mier JW, Signoretti S, Alimzhanov M, Kumar R, Bhasin MK, Bhatt RS. Inhibition of ALK1 signaling with dalantercept combined with VEGFR TKI leads to tumor stasis in renal cell carcinoma. Oncotarget 2018; 7:41857-41869. [PMID: 27248821 PMCID: PMC5173101 DOI: 10.18632/oncotarget.9621] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/05/2016] [Indexed: 12/21/2022] Open
Abstract
Treatment of metastatic renal cell carcinoma (mRCC) with agents that block signaling through vascular endothelial growth factor receptor 2 (VEGFR2) induces disease regression or stabilization in some patients; however, these responses tend to be short-lived. Therefore, development of combination therapies that can extend the efficacy of VEGFR antagonists in mRCC remains a priority. We studied murine xenograft models of RCC that become refractory to treatment with the VEGFR tyrosine kinase inhibitor (TKI) sunitinib. Dalantercept is a novel antagonist of Activin receptor-like kinase 1 (ALK1)/Bone morphogenetic protein (BMP) 9 signaling. Dalantercept inhibited growth in the murine A498 xenograft model which correlated with hyperdilation of the tumor vasculature and an increase in tumor hypoxia. When combined with sunitinib, dalantercept induced tumor necrosis and prevented tumor regrowth and revascularization typically seen with sunitinib monotherapy in two RCC models. Combination therapy led to significant downregulation of angiogenic genes as well as downregulation of endothelial specific gene expression particularly of the Notch signaling pathway. We demonstrate that simultaneous targeting of molecules that control distinct phases of angiogenesis, such as ALK1 and VEGFR, is a valid strategy for treatment of mRCC. At the molecular level, combination therapy leads to downregulation of Notch signaling.
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Affiliation(s)
- Xiaoen Wang
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Prateek Khanna
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marcella Callea
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jiaxi Song
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Michael B Atkins
- Departments of Oncology and Medicine, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - James W Mier
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Ravi Kumar
- Acceleron Pharma, Inc., Cambridge, MA, USA
| | - Manoj K Bhasin
- Division of Interdisciplinary Medicine & Biotechnology, and Genomics, Proteomics, Bioinformatics and Systems Biology Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Lalani AKA, Gray KP, Albiges L, Callea M, Pignon JC, Pal S, Gupta M, Bhatt RS, McDermott DF, Atkins MB, Woude GFV, Harshman LC, Choueiri TK, Signoretti S. Differential expression of c-Met between primary and metastatic sites in clear-cell renal cell carcinoma and its association with PD-L1 expression. Oncotarget 2017; 8:103428-103436. [PMID: 29262573 PMCID: PMC5732739 DOI: 10.18632/oncotarget.21952] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/29/2017] [Indexed: 12/12/2022] Open
Abstract
In preclinical models, c-Met promotes survival of renal cancer cells through the regulation of programmed death-ligand 1 (PD-L1). However, this relationship in human clear cell renal cell carcinoma (ccRCC) is not well characterized. We evaluated c-Met expression in ccRCC patients using paired primary and metastatic samples and assessed the association with PD-L1 expression and other clinical features. Areas with predominant and highest Fuhrman nuclear grade (FNG) were selected. c-Met expression was evaluated by IHC using an anti-Met monoclonal antibody (MET4 Ab) and calculated by a combined score (CS, 0-300): intensity of c-Met staining (0-3) x % of positive cells (0-100). PD-L1 expression in tumor cells was previously assessed by IHC and PD-L1+ was defined as PD-L1 > 0% positive cells. Our cohort consisted of 45 pairs of primary and metastatic ccRCC samples. Overall, c-Met expression was higher in metastatic sites compared to primary sites (average c-Met CS: 55 vs. 28, p = 0.0003). Higher c-Met expression was associated with higher FNG (4 vs. 3) in primary tumors (average c-Met CS: 52 vs. 20, p = 0.04). c-Met expression was numerically greater in PD-L1+ vs. PD-L1- tumors. Higher c-Met expression in metastatic sites compared to primary tumors suggests that testing for biomarkers of response to c-Met inhibitors should be conducted in metastases. While higher c-Met expression in PD-L1+ tumors requires further investigation, it supports exploring these targets in combination clinical trials.
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Affiliation(s)
- Aly-Khan A Lalani
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kathryn P Gray
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Marcella Callea
- Department of Pathology, Ospedale San Raffaele, Milan, Italy
| | | | - Soumitro Pal
- Division of Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Mamta Gupta
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rupal S Bhatt
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David F McDermott
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Washington D.C., USA
| | | | - Lauren C Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
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Voss MH, Bhatt RS, Plimack ER, Rini BI, Alter RS, Beck JT, Wilson D, Zhang X, Mutyaba M, Glasser C, Attie KM, Sherman ML, Pandya SS, Atkins MB. The DART Study: Results from the Dose-Escalation and Expansion Cohorts Evaluating the Combination of Dalantercept plus Axitinib in Advanced Renal Cell Carcinoma. Clin Cancer Res 2016; 23:3557-3565. [PMID: 28031424 DOI: 10.1158/1078-0432.ccr-16-2395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 09/27/2016] [Revised: 11/30/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022]
Abstract
Purpose: Activin receptor-like kinase 1 (ALK1) is a novel target in angiogenesis. Concurrent targeting of ALK1 and VEGF signaling results in augmented inhibition of tumor growth in renal cell carcinoma (RCC) xenograft models. Dalantercept is an ALK1-receptor fusion protein that acts as a ligand trap for bone morphogenetic proteins 9 and 10. The DART Study evaluated the safety, tolerability, pharmacokinetics, pharmacodynamics, and antitumor activity of dalantercept plus axitinib in patients with advanced RCC and determined the optimal dose for further testing.Experimental Design: Patients received dalantercept 0.6, 0.9, or 1.2 mg/kg subcutaneously every 3 weeks plus axitinib 5 mg by mouth twice daily until disease progression or intolerance.Results: Twenty-nine patients were enrolled in the dose escalation (n = 15) and expansion (n = 14) cohorts. There were no dose-limiting toxicities or grade 4/5 treatment-related adverse events. In addition to common VEGFR tyrosine kinase inhibitor effects, such as fatigue and diarrhea, commonly seen treatment-related adverse events were peripheral edema, epistaxis, pericardial effusion, and telangiectasia. The objective response rate by RECIST v1.1 was 25% with responses seen at all dose levels. The overall median progression-free survival was 8.3 months.Conclusions: The combination of dalantercept plus axitinib is well tolerated and associated with clinical activity. On the basis of safety and efficacy results, the 0.9 mg/kg dose level was chosen for further study in a randomized phase II trial of dalantercept plus axitinib versus placebo plus axitinib. Clin Cancer Res; 23(14); 3557-65. ©2016 AACR.
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Affiliation(s)
- Martin H Voss
- Memorial Sloan Kettering Cancer Center, New York, New York.
- Department of Medicine, Weill Medical College of Cornell University, New York, New York
| | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Brian I Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Robert S Alter
- John Theurer Cancer Center Hackensack UMC, Hackensack, New Jersey
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25
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Pal SK, Drabkin HA, Reeves JA, Hainsworth JD, Hazel SE, Paggiarino DA, Wojciak J, Woodnutt G, Bhatt RS. A phase 2 study of the sphingosine-1-phosphate antibody sonepcizumab in patients with metastatic renal cell carcinoma. Cancer 2016; 123:576-582. [PMID: 27727447 DOI: 10.1002/cncr.30393] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 08/30/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Upregulation of sphingosine-1-phosphate (S1P) may mediate resistance to vascular endothelial growth factor (VEGF)-directed therapies and inhibit antitumor immunity. Antagonism of S1P in preclinical models appears to overcome this resistance. In this phase 2 study, the authors assessed the activity of sonepcizumab, a first-in-class inhibitor of S1P, in patients with metastatic renal cell carcinoma (mRCC) with a history of prior VEGF-directed therapy. METHODS Patients were required to have clear cell mRCC and to have received treatment with at least 1 prior VEGF-directed agent. Prior treatment with immunotherapeutic agents and ≤1 mammalian target of rapamycin inhibitors was permitted. The primary endpoint of the study was progression-free survival. Additional endpoints included response rate and safety, and overall survival (OS) performed post hoc. RESULTS A total of 40 patients were enrolled with a median of 3 prior therapies (range, 1-5 prior therapies), 78% of whom had intermediate-risk disease by second-line International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria. Although the current study did not achieve its primary endpoint based on the 2-month progression-free survival, a median OS of 21.7 months was observed. Four patients (10%) demonstrated a partial response, with a median duration of response of 5.9 months. No grade 3/4 treatment-related adverse events were observed in >5% of patients (adverse events were graded and recorded for each patient using Common Terminology Criteria for Adverse Events [version 4.0]); the most frequent grade 1/2 treatment-related adverse events were fatigue (30%), weight gain (18%), constipation (15%), and nausea (15%). Biomarker studies demonstrated an increase in S1P concentrations with therapy. Comprehensive genomic profiling of 3 patients with a clinical benefit of >24 months indicated von Hippel-Lindau (VHL) and polybromo-1 (PBRM1) alterations. CONCLUSIONS The encouraging OS and favorable safety profile observed with sonepcizumab should prompt further investigation of the agent in combination with VEGF-directed agents or checkpoint inhibitors. Cancer 2017;123:576-582. © 2016 American Cancer Society.
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Affiliation(s)
- Sumanta K Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Harry A Drabkin
- Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | | | | | | | - Rupal S Bhatt
- Department of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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26
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Scelo G, Hofmann JN, Banks RE, Bigot P, Bhatt RS, Cancel-Tassin G, Chew SK, Creighton CJ, Cussenot O, Davis IJ, Escudier B, Frayling TM, Häggström C, Hildebrandt MAT, Holcatova I, Johansson M, Linehan WM, McDermott DF, Nathanson KL, Ogawa S, Perlman EJ, Purdue MP, Stattin P, Swanton C, Vasudev NS, Wu X, Znaor A, Brennan P, Chanock SJ. International cancer seminars: a focus on kidney cancer. Ann Oncol 2016; 27:1382-5. [PMID: 27130845 PMCID: PMC4959923 DOI: 10.1093/annonc/mdw186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 01/05/2023] Open
Abstract
Recent years have seen important advances in our understanding of the etiology, biology and genetics of kidney cancer. To summarize important achievements and identify prominent research questions that remain, a workshop was organized by IARC and the US NCI. A series of 'difficult questions' were formulated, which should be given future priority in the areas of population, genomic and clinical research.
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Affiliation(s)
- G Scelo
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - J N Hofmann
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Service, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - R E Banks
- Clinical and Biomedical Proteomics Group, Cancer Research UK Centre, Leeds Institute for Cancer Studies and Pathology, St James' University Hospital, Leeds, UK
| | - P Bigot
- Department of Urology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - R S Bhatt
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Kidney Cancer Program, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - G Cancel-Tassin
- Groupe de Recherche GRC-UPMC n°5, Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP), Paris, France
| | - S K Chew
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, University College London, London, UK
| | - C J Creighton
- Duncan Cancer Center-Biostatistics, Baylor College of Medicine, Houston
| | - O Cussenot
- Groupe de Recherche GRC-UPMC n°5, Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP), Paris, France
| | - I J Davis
- Department of Genetics, UNC School of Medicine, Chapel Hill, USA
| | - B Escudier
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - C Häggström
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå Department of Biobank Research, Umeå University, Umeå, Sweden
| | - M A T Hildebrandt
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - I Holcatova
- Institute of Public Health and Preventive Medicine, Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - M Johansson
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - W M Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda
| | - D F McDermott
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Kidney Cancer Program, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - K L Nathanson
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - S Ogawa
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - E J Perlman
- Department of Pathology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, USA
| | - M P Purdue
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Service, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - P Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå
| | - C Swanton
- University College London Hospitals and Cancer Institute, London, UK
| | - N S Vasudev
- Clinical and Biomedical Proteomics Group, Cancer Research UK Centre, Leeds Institute for Cancer Studies and Pathology, St James' University Hospital, Leeds, UK
| | - X Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Znaor
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - P Brennan
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - S J Chanock
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Service, National Cancer Institute, National Institutes of Health, Bethesda, USA
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Mahoney KM, Jacobus S, Bhatt RS, Song J, Carvo I, Cheng SC, Simpson M, Fay AP, Puzanov I, Michaelson MD, Atkins MB, McDermott DF, Signoretti S, Choueiri TK. Phase 2 Study of Bevacizumab and Temsirolimus After VEGFR TKI in Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer 2016; 14:304-313.e6. [PMID: 27036973 DOI: 10.1016/j.clgc.2016.02.007] [Citation(s) in RCA: 10] [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: 12/03/2015] [Revised: 02/08/2016] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inhibiting VEGF and mammalian target of rapamycin (mTOR) pathways are standard treatment approaches for patients with metastatic renal cell carcinoma (mRCC). Here we report the activity and safety of the VEGF ligand inhibitor bevacizumab and the mTOR inhibitor temsirolimus combination in patients with clear cell (CC) and non-clear cell (NCC) mRCC whose disease had failed to respond to prior VEGF blockade. PATIENTS AND METHODS In this phase 2 investigator-initiated multicenter study, patients received bevacizumab and temsirolimus. The primary end point was 4-month progression-free survival (PFS) rate. Secondary end points included overall response rate, median overall survival (OS), toxicity, and correlative studies of biomarkers downstream of mTOR. RESULTS Forty patients received at least 1 dose of therapy. Thirty-three (82.5%) had favorable/intermediate risk disease according to International Metastatic Renal Cell Carcinoma Database Consortium criteria, 13 (32.5%) with nccRCC histology. Nineteen (48.7%) had primary vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI)-refractory disease. The 4-month PFS rate was 65%. Overall median PFS and OS were 5.6 and 12.2 months. Median PFS and OS were 6.5 and 9.6 months in patients with primary VEGFR TKI-refractory disease, and 5.6 months and 13.1 months in patients with nccRCC. Dose reductions were needed in 80% of patients. Most frequent toxicities included fatigue, hypertension, dyslipidemia, and proteinuria. Dose discontinuation due to adverse events occurred in 27.5% of patients. Baseline tumor immunohistochemistry for phospho-S6 protein was not associated with clinical benefit. CONCLUSION Combining bevacizumab and temsirolimus in patients previously treated with VEGFR TKI was possible but with dose reductions and treatment discontinuations. This combination resulted in modest activity, including in patients with primary VEGF-refractory disease and NCC histology.
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Affiliation(s)
- Kathleen M Mahoney
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Susanna Jacobus
- Department of Statistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Rupal S Bhatt
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jiaxi Song
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ingrid Carvo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Su-Chun Cheng
- Department of Statistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mekailah Simpson
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - André P Fay
- PUCRS School of Medicine, Porto Alegre, Brazil
| | - Igor Puzanov
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - M Dror Michaelson
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael B Atkins
- Department of Medical Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC
| | - David F McDermott
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sabina Signoretti
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
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McKay RR, Lin X, Albiges L, Fay AP, Kaymakcalan MD, Mickey SS, Ghoroghchian PP, Bhatt RS, Kaffenberger SD, Simantov R, Choueiri TK, Heng DY. Statins and survival outcomes in patients with metastatic renal cell carcinoma. Eur J Cancer 2016; 52:155-62. [DOI: 10.1016/j.ejca.2015.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/02/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
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Varma G, Wang X, Vinogradov E, Bhatt RS, Sukhatme VP, Seth P, Lenkinski RE, Alsop DC, Grant AK. Selective spectroscopic imaging of hyperpolarized pyruvate and its metabolites using a single-echo variable phase advance method in balanced SSFP. Magn Reson Med 2015; 76:1102-15. [PMID: 26507361 DOI: 10.1002/mrm.26004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 02/10/2015] [Revised: 08/15/2015] [Accepted: 09/11/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE In balanced steady state free precession (bSSFP), the signal intensity has a well-known dependence on the off-resonance frequency, or, equivalently, the phase advance between successive radiofrequency (RF) pulses. The signal profile can be used to resolve the contributions from the spectrally separated metabolites. This work describes a method based on use of a variable RF phase advance to acquire spatial and spectral data in a time-efficient manner for hyperpolarized 13C MRI. THEORY AND METHODS The technique relies on the frequency response from a bSSFP acquisition to acquire relatively rapid, high-resolution images that may be reconstructed to separate contributions from different metabolites. The ability to produce images from spectrally separated metabolites was demonstrated in vitro, as well as in vivo following administration of hyperpolarized 1-13C pyruvate in mice with xenograft tumors. RESULTS In vivo images of pyruvate, alanine, pyruvate hydrate, and lactate were reconstructed from four images acquired in 2 s with an in-plane resolution of 1.25 × 1.25 mm(2) and 5 mm slice thickness. CONCLUSION The phase advance method allowed acquisition of spectroscopically selective images with high spatial and temporal resolution. This method provides an alternative approach to hyperpolarized 13C spectroscopic MRI that can be combined with other techniques such as multiecho or fluctuating equilibrium bSSFP. Magn Reson Med 76:1102-1115, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Gopal Varma
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Xiaoen Wang
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elena Vinogradov
- Advanced Imaging Research Center, Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rupal S Bhatt
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Vikas P Sukhatme
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pankaj Seth
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert E Lenkinski
- Advanced Imaging Research Center, Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - David C Alsop
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron K Grant
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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30
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Bhatt RS, Sahoo A, Karim SA, Agrawal AR. Effects of calcium soap of rice bran oil fatty acids supplementation alone and with DL-α-tocopherol acetate in lamb diets on performance, digestibility, ruminal parameters and meat quality. J Anim Physiol Anim Nutr (Berl) 2015. [PMID: 26211674 DOI: 10.1111/jpn.12370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Thirty-six Malpura lambs (28 day old and 6.7 ± 0.25 kg BW) were distributed equally in three groups having six males and six female. They were ad libitum fed individually three different experimental diets containing calcium soap of fatty acids (CA-FA) at 0 (T1 ) and 40 (T2 and T3 ) g/kg concentrate up to six months of age. Animals in T3 were supplemented additionally with 40 mg DL-α-tocopherol acetate/kg of concentrate. The roughage moiety included ad libitum dry Prosopis cineraria and fresh Azadirachata indica leaves. All the lambs were allowed to suckle from their dam up to weaning (90 day of age). Supplementation of Ca-FA improved weight gain and feed conversion ratio during both pre- (28-90 days) and post-weaning (91-180 days) phases; however, no effect of DL-α-tocopherol was observed. Metabolic parameters during post-weaning phase revealed non-significant effect on digestibility but improved nitrogen balance in the test groups. The effect on biochemical attributes did not show any significant alteration in ruminal parameters, blood biochemicals and urinary purine derivatives. Carcass traits revealed higher (p < 0.05) dressing yield and loin eye area with Ca-FA supplementation. The value of thiobarbituric reactive substances for nuggets prepared from frozen carcasses revealed significant (p < 0.05) reduction in T3 compared to the other dietary groups. Fatty acid profile of adipose tissue revealed higher (p < 0.001) 9-octadecanoic, 9-12-octadecadienoic, polyunsaturated fatty acids (PUFA), higher ratio of PUFA/saturated fatty acids (SFA), ω-6/ω-3 and lower SFA in Ca-FA-supplemented groups. It is concluded that supplementation of 40 g/kg calcium soap prepared from industrial grade rice bran oil in lamb ration provided additional energy intake, improved N utilization, gain and feed conversion ratio besides improving dressing yield and meat quality with CLA enriched fatty acid profile. DL-α-tocopherol acetate when supplemented at 40 mg/kg feed reduced lipid oxidation of meat products thus improving its keeping quality.
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Affiliation(s)
- R S Bhatt
- Division of Animal Nutrition, Central Sheep and Wool Research Insitute Avikanagar, Rajasthan, India
| | - A Sahoo
- Division of Animal Nutrition, Central Sheep and Wool Research Insitute Avikanagar, Rajasthan, India
| | - S A Karim
- Division of Animal Nutrition, Central Sheep and Wool Research Insitute Avikanagar, Rajasthan, India
| | - A R Agrawal
- Division of Animal Nutrition, Central Sheep and Wool Research Insitute Avikanagar, Rajasthan, India
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McKay RR, Rodriguez GE, Lin X, Kaymakcalan MD, Hamnvik OPR, Sabbisetti VS, Bhatt RS, Simantov R, Choueiri TK. Angiotensin system inhibitors and survival outcomes in patients with metastatic renal cell carcinoma. Clin Cancer Res 2015; 21:2471-9. [PMID: 25724518 PMCID: PMC4566854 DOI: 10.1158/1078-0432.ccr-14-2332] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/07/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE The renin-angiotensin system may play a role in carcinogenesis. The purpose of this study was to evaluate the impact of angiotensin system inhibitors (ASI) on outcomes in metastatic renal cell carcinoma (mRCC) patients treated in the targeted therapy era. EXPERIMENTAL DESIGN We conducted a pooled analysis of mRCC patients treated on phase II and III clinical trials. Statistical analyses were performed using Cox regression adjusted for several risk factors and the Kaplan-Meier method. RESULTS A total of 4,736 patients were included, of whom 1,487 received ASIs and 783 received other antihypertensive agents. Overall, ASI users demonstrated improved overall survival (OS) compared with users of other antihypertensive agents (adjusted HR, 0.838, P = 0.0105, 26.68 vs. 18.07 months) and individuals receiving no antihypertensive therapy (adjusted HR, 0.810, P = 0.0026, 26.68 vs. 16.72 months). When stratified by therapy type, a benefit in OS was demonstrated in ASI users compared with nonusers in individuals receiving VEGF therapy (adjusted HR, 0.737, P < 0.0001, 31.12 vs. 21.94 months) but not temsirolimus or IFNα. An in vitro cell viability assay demonstrated that sunitinib in combination with an ASI significantly decreased RCC cell viability compared with control at physiologically relevant doses. This effect was not observed with either agent alone or with other non-ASI antihypertensives or temsirolimus. CONCLUSIONS In the largest analysis to date, we demonstrate that ASI use improved survival in mRCC patients treated in the targeted therapy era. Further studies are warranted to investigate the mechanism underlying this interaction and verify our observations to inform clinical practice.
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Affiliation(s)
- Rana R McKay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Xun Lin
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Woman's Hospital, Boston, Massachusetts
| | - Marina D Kaymakcalan
- Department of Pharmacy and Clinical Support, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ole-Petter R Hamnvik
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Woman's Hospital, Boston, Massachusetts
| | | | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Callea M, Albiges L, Gupta M, Cheng SC, Genega EM, Fay AP, Song J, Carvo I, Bhatt RS, Atkins MB, Hodi FS, Choueiri TK, McDermott DF, Freeman GJ, Signoretti S. Differential Expression of PD-L1 between Primary and Metastatic Sites in Clear-Cell Renal Cell Carcinoma. Cancer Immunol Res 2015; 3:1158-64. [PMID: 26014095 DOI: 10.1158/2326-6066.cir-15-0043] [Citation(s) in RCA: 222] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/11/2015] [Indexed: 12/23/2022]
Abstract
PD-L1 expression in primary clear-cell renal cell carcinoma (ccRCC) increases the likelihood of response to anti-PD-1 inhibition, but fails to identify all responders. We hypothesized that PD-L1 levels assessed in randomly selected areas of the primary tumors may not accurately reflect expression levels in metastatic lesions, which are the target of systemic therapy. Therefore, we compared PD-L1 expression in a series of primary ccRCC and their metastases. Tissue blocks from 53 primary ccRCCs and 76 corresponding metastases were retrieved. Areas with predominant and highest nuclear grade were selected. Slides were immunostained with a validated anti-PD-L1 antibody (405.9A11). Membranous expression in tumor cells was quantified using H-score. Expression in tumor-infiltrating mononuclear cells (TIMC) was quantified using a combined score. Discordant tumor cell PD-L1 staining between primary tumors and metastases was observed in 11 of 53 cases (20.8%). Overall, tumor cell PD-L1 levels were not different in primary tumors and metastases (P = 0.51). Tumor cell PD-L1 positivity was associated with higher T stage (P = 0.03) and higher Fuhrman nuclear grade (P < 0.01). Within individual lesions, PD-L1 positivity was heterogeneous and almost exclusively detected in high nuclear grade areas (P < 0.001). No difference was found in PD-L1 levels in TIMCs between primary tumors and metastases (P = 0.82). The heterogeneity of PD-L1 expression in ccRCC suggests that its assessment as a predictive biomarker for PD-1 blockade may require analysis of metastatic lesions. Notably, because PD-L1 expression was mostly detected in high nuclear grade areas, to avoid false-negative results, these areas should be specifically selected for assessment.
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Affiliation(s)
- Marcella Callea
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurence Albiges
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Mamta Gupta
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, Massachusetts
| | - Su-Chun Cheng
- Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, Massachusetts. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - André P Fay
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jiaxi Song
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ingrid Carvo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rupal S Bhatt
- Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, Massachusetts. Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael B Atkins
- Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, Massachusetts
| | - David F McDermott
- Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, Massachusetts. Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. Kidney Cancer Program, Dana-Farber Harvard Cancer Center, Boston, Massachusetts.
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Abstract
GATA2 has been well-characterized as a critical pioneer transcription factor for androgen receptor (AR) in prostate cancer. In this issue of Cancer Cell, Vidal and colleagues identify increased GATA2 and its AR-independent transactivation of IGF2 as a mechanism that can mediate taxane resistance through activation of IGF1/insulin receptor signaling.
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Affiliation(s)
- Stephen R Plymate
- Department of Medicine, University of Washington and GRECC-VAPSHCS, Seattle, WA 98104, USA
| | - Rupal S Bhatt
- Division of Hematology-Oncology, Department of Medicine, Beth Israel Deaconess Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Steven P Balk
- Division of Hematology-Oncology, Department of Medicine, Beth Israel Deaconess Cancer Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Zhang L, Wang X, Bullock AJ, Callea M, Shah H, Song J, Moreno K, Visentin B, Deutschman D, Alsop DC, Atkins MB, Mier JW, Signoretti S, Bhasin M, Sabbadini RA, Bhatt RS. Anti-S1P Antibody as a Novel Therapeutic Strategy for VEGFR TKI-Resistant Renal Cancer. Clin Cancer Res 2015; 21:1925-1934. [PMID: 25589614 DOI: 10.1158/1078-0432.ccr-14-2031] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/13/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE VEGFR2 tyrosine kinase inhibition (TKI) is a valuable treatment approach for patients with metastatic renal cell carcinoma (RCC). However, resistance to treatment is inevitable. Identification of novel targets could lead to better treatment for patients with TKI-naïve or -resistant RCC. EXPERIMENTAL DESIGN In this study, we performed transcriptome analysis of VEGFR TKI-resistant tumors in a murine model and discovered that the SPHK-S1P pathway is upregulated at the time of resistance. We tested sphingosine-1-phosphate (S1P) pathway inhibition using an anti-S1P mAb (sphingomab), in two mouse xenograft models of RCC, and assessed tumor SPHK expression and S1P plasma levels in patients with metastatic RCC. RESULTS Resistant tumors expressed several hypoxia-regulated genes. The SPHK1 pathway was among the most highly upregulated pathways that accompanied resistance to VEGFR TKI therapy. SPHK1 was expressed in human RCC, and the product of SPHK1 activity, S1P, was elevated in patients with metastatic RCC, suggesting that human RCC behavior could, in part, be due to overproduction of S1P. Sphingomab neutralization of extracellular S1P slowed tumor growth in both mouse models. Mice bearing tumors that had developed resistance to sunitinib treatment also exhibited tumor growth suppression with sphingomab. Sphingomab treatment led to a reduction in tumor blood flow as measured by MRI. CONCLUSIONS Our findings suggest that S1P inhibition may be a novel therapeutic strategy in patients with treatment-naïve RCC and also in the setting of resistance to VEGFR TKI therapy.
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Affiliation(s)
- Liang Zhang
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America
| | - Xiaoen Wang
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America.,Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America
| | - Andrea J Bullock
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America
| | - Marcella Callea
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115, United States of America
| | - Harleen Shah
- Division of Interdisciplinary Medicine and Biotechnology, and Genomics and Proteomics Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America
| | - Jiaxi Song
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115, United States of America
| | - Kelli Moreno
- Lpath Inc., 4025 Sorrento Valley Blvd. San Diego, CA, 92121, United States of America
| | - Barbara Visentin
- Lpath Inc., 4025 Sorrento Valley Blvd. San Diego, CA, 92121, United States of America
| | - Douglas Deutschman
- Department of Biology, San Diego State University, 5500 Campanile Dr. San Diego, CA. 92182-4614, United States of America
| | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America
| | - Michael B Atkins
- Departments of Oncology and Medicine, Georgetown-Lombardi Comprehensive Cancer Center, 3970 Reservoir Road, NW, Washington, DC. United States of America
| | - James W Mier
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115, United States of America
| | - Manoj Bhasin
- Division of Interdisciplinary Medicine and Biotechnology, and Genomics and Proteomics Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America
| | - Roger A Sabbadini
- Lpath Inc., 4025 Sorrento Valley Blvd. San Diego, CA, 92121, United States of America
| | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215, United States of America
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McDermott DF, Cheng SC, Signoretti S, Margolin KA, Clark JI, Sosman JA, Dutcher JP, Logan TF, Curti BD, Ernstoff MS, Appleman L, Wong MKK, Khushalani NI, Oleksowicz L, Vaishampayan UN, Mier JW, Panka DJ, Bhatt RS, Bailey AS, Leibovich BC, Kwon ED, Kabbinavar FF, Belldegrun AS, Figlin RA, Pantuck AJ, Regan MM, Atkins MB. The high-dose aldesleukin "select" trial: a trial to prospectively validate predictive models of response to treatment in patients with metastatic renal cell carcinoma. Clin Cancer Res 2014; 21:561-8. [PMID: 25424850 DOI: 10.1158/1078-0432.ccr-14-1520] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [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] [Indexed: 01/17/2023]
Abstract
PURPOSE High-dose aldesleukin (HD IL2) received FDA approval for the treatment of metastatic renal cell carcinoma (MRCC) in 1992, producing a 14% objective response rate (ORR) and durable remissions. Retrospective studies suggested that clinical and pathologic features could predict for benefit. The Cytokine Working Group conducted this prospective trial to validate proposed predictive markers of response to HD IL2. EXPERIMENTAL DESIGN Standard HD IL2 was administered to prospectively evaluate whether the ORR of patients with mRCC with "good" predictive pathologic features based on an "integrated selection" model [ISM (e.g., clear-cell histology subclassification and carbonic anhydrase-9 (CA-9) IHC staining] was significantly higher than the ORR of a historical, unselected population. Archived tumor was collected for pathologic analysis including tumor programmed death-ligand 1 (PD-L1) expression. RESULTS One hundred and twenty eligible patients were enrolled between June 11 and September 7; 70% were Memorial Sloan Kettering Cancer Center (New York, NY) intermediate risk, 96% had clear cell RCC, and 99% had prior nephrectomy. The independently assessed ORR was 25% (30/120, 95% CI, 17.5%-33.7%, P = 0.0014; 3 complete responses, 27 partial responses) and was higher than a historical ORR. Thirteen patients (11%) remained progression free at 3 years and the median overall survival was 42.8 months. ORR was not statistically different by ISM classification ("good-risk" 23% vs. "poor-risk" 30%; P = 0.39). ORR was positively associated with tumor PD-L1 expression (P = 0.01) by IHC. CONCLUSIONS In this prospective, biomarker validation study, HD IL2 produced durable remissions and prolonged survival in both "good" and "poor-risk" patients. The proposed ISM was unable to improve the selection criteria. Novel markers (e.g., tumor PD L1 expression) appeared useful, but require independent validation.
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Affiliation(s)
- David F McDermott
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.
| | | | - Sabina Signoretti
- Brigham and Women's Hospital, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | | | - Joseph I Clark
- Loyola University, Stritch School of Medicine, Chicago, Illinois
| | - Jeffrey A Sosman
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | | | | | - Brendan D Curti
- Providence Cancer Center, Earle A. Chiles Research Institute, Portland, Oregon
| | - Marc S Ernstoff
- Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Dartmouth, New Hampshire
| | - Leonard Appleman
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | | | - James W Mier
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - David J Panka
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Rupal S Bhatt
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Alexandra S Bailey
- Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | | | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Arie S Belldegrun
- University of California Los Angeles Medical Center, Santa Monica, California
| | - Robert A Figlin
- Cedars-Sinai's Samuel Oschin Comprehensive Cancer Institute, West Hollywood, California
| | - Allan J Pantuck
- University of California Los Angeles Medical Center, Santa Monica, California
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Bhatt RS, Zhang L, Bullock A, Wang X, Moreno K, Signoretti S, Atkins MB, Sabbadini R, Mier JW. Abstract LB-369: Sphingosine-1-phosphate (S1P) as a novel target in renal cancer (RCC). Tumour Biol 2014. [DOI: 10.1158/1538-7445.am10-lb-369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bhatt RS, Karim SA, Sahoo A, Shinde AK. Growth performance of lambs fed diet supplemented with rice bran oil as such or as calcium soap. Asian-Australas J Anim Sci 2014; 26:812-9. [PMID: 25049854 PMCID: PMC4093241 DOI: 10.5713/ajas.2012.12624] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/29/2012] [Accepted: 12/20/2012] [Indexed: 11/30/2022]
Abstract
Forty two Malpura lambs (21 d old) were divided into three groups of 14 each consisting of 8 females and 6 males. Lambs were allowed to suckle their respective dams twice daily up to weaning (13 wks) and offered free choice concentrate and roughage in a cafeteria system. The lambs in control group were fed conventional concentrate mixture, in RBO group concentrate mixture fortified with 4% industrial grade rice bran oil and in Ca-soap rice bran oil (as in RBO group) was supplemented in the form of calcium soap. The concentrate intake decreased(p≤0.05) in RBO group as a result total dry matter, crude protein and metabolizable energy intake decreased compared to control whereas Ca-soap prepared from the same rice bran oil stimulated the concentrate intake leading to higher total dry matter, crude protein and energy intakes. The digestibility of dry matter (p≤0.05), organic matter (p≤0.05) and crude protein (p≤0.05) was higher in RBO group followed by Ca-soap and control whereas no effect was observed for ether extract digestibility. Higher cholesterol (p≤0.05) content was recorded in serum of oil supplemented groups (RBO and Ca-soap) while no effect was recorded for other blood parameters. Rice bran oil as such adversely affected and reduced the body weight gain (p≤0.001) of lambs in comparison to control whereas the Ca-soap of rice bran oil improved body weight gain and feed conversion efficiency in lambs. Fat supplementation decreased total volatile fatty acids (p≤0.05) and individual volatile fatty acid concentration which increased at 4 h post feeding. Fat supplementation also reduced (p≤0.05) total protozoa count. Ca-soap of rice bran oil improved pre slaughter weight (p≤0.05) and hot carcass weight (p≤0.05). It is concluded from the study that rice bran oil in the form of calcium soap at 40 g/kg of concentrate improved growth, feed conversion efficiency and carcass quality as compared to rice bran oil as such and control groups.
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Affiliation(s)
- R S Bhatt
- Central Sheep and Wool Research Institute, Avikanagar-304 501, Rajasthan, India
| | - S A Karim
- Central Sheep and Wool Research Institute, Avikanagar-304 501, Rajasthan, India
| | - A Sahoo
- Central Sheep and Wool Research Institute, Avikanagar-304 501, Rajasthan, India
| | - A K Shinde
- Central Sheep and Wool Research Institute, Avikanagar-304 501, Rajasthan, India
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Abstract
The vascular endothelial growth factor (VEGF) pathway is critical for tumor angiogenesis. However, VEGF pathway inhibition has been limited by intrinsic and acquired resistance. Simultaneously targeting multiple steps involved in tumor angiogenesis is a potential means of overcoming this resistance. Activin like kinase 1 (ALK1) and endoglin (ENG) have effects on angiogenesis that are distinct from those of VEGF. Whereas VEGF is important for vessel initiation, ALK1 and endoglin are involved in vessel network formation. Thus, ALK1 and endoglin pathway inhibitors are attractive partners for VEGF-based combination antiangiogenic therapy. Genetic evidence supports a role for this receptor family and its ligands, bone morphogenetic proteins (BMP) 9 and 10, in vascular development. Patients with genetic alterations in ALK1 or endoglin develop hereditary hemorrhagic telangiectasia, a disorder characterized by abnormal vessel development. There are several inhibitors of the ALK1 pathway advancing in clinical development for treatment of various tumor types, including renal cell and ovarian carcinomas. Targeting of alternate angiogenic pathways, particularly in combination with VEGF pathway blockade, holds the promise of optimally inhibiting angiogenically driven tumor progression. Clin Cancer Res; 20(11); 2838-45. ©2014 AACR.
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Affiliation(s)
- Rupal S Bhatt
- Authors' Affiliations: Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and Departments of Oncology and Medicine, Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Michael B Atkins
- Authors' Affiliations: Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and Departments of Oncology and Medicine, Georgetown-Lombardi Comprehensive Cancer Center, Washington, District of Columbia
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Wang X, Bullock AJ, Zhang L, Wei L, Yu D, Mahagaokar K, Alsop DC, Mier JW, Atkins MB, Coxon A, Oliner J, Bhatt RS. The role of angiopoietins as potential therapeutic targets in renal cell carcinoma. Transl Oncol 2014; 7:188-95. [PMID: 24704536 PMCID: PMC4101387 DOI: 10.1016/j.tranon.2014.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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] [Received: 09/19/2013] [Revised: 12/10/2013] [Accepted: 01/02/2014] [Indexed: 12/12/2022] Open
Abstract
Angiopoietin 2 (Ang2) is a secreted glycoprotein upregulated at sites of angiogenesis and has been implicated in cancer neovascularization. Recent studies have suggested efficacy of combined Ang and vascular endothelial growth factor receptor (VEGFR) inhibition for patients with metastatic renal cell carcinoma (mRCC). We measured Ang2 expression in human tissue and plasma, and tested the effect of dual Ang1/2 (trebananib; AMG386) or Ang2 alone (L1-7) inhibition with VEGFR inhibition on murine RCC growth and blood flow. Ang2 levels were higher in human tumors than normal tissues with RCC ranking highest for Ang2 expression across all tumor types tested. Plasma Ang2 was significantly higher in patients with mRCC compared to controls or patients with stage I disease. Plasma Ang2 decreased with sunitinib treatment and increased at time of disease progression. In the RCC mouse, dual Ang1/2 and Ang2 inhibition improved the activity of sunitinib. Combined Ang1/2 and VEGFR inhibition prevented the resumption of blood flow associated with sunitinib resistance. Thus, Ang2 inhibition, independent of Ang1 inhibition, improves the activity of sunitinib and plasma Ang2 increases in the setting of progression on sunitinib possibly contributing to resistance. Further, arterial spin-labeled perfusion magnetic resonance imaging might be a non-invasive marker of the antiangiogenic activity of Ang inhibitors.
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Affiliation(s)
- Xiaoen Wang
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andrea J Bullock
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Liang Zhang
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Lin Wei
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Dongyin Yu
- Oncology Research, Amgen Inc, Thousand Oaks, CA
| | - Kedar Mahagaokar
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - James W Mier
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael B Atkins
- Departments of Oncology and Medicine, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | | | - Jon Oliner
- Oncology Research, Amgen Inc, Thousand Oaks, CA
| | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Beddy P, Genega EM, Ngo L, Hindman N, Wei J, Bullock A, Bhatt RS, Atkins MB, Pedrosa I. Tumor necrosis on magnetic resonance imaging correlates with aggressive histology and disease progression in clear cell renal cell carcinoma. Clin Genitourin Cancer 2013; 12:55-62. [PMID: 24145001 DOI: 10.1016/j.clgc.2013.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 05/19/2012] [Revised: 07/20/2013] [Accepted: 07/31/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The study objective was to correlate the magnetic resonance imaging (MRI) features of clear cell renal cell carcinoma (ccRCC) with the histopathologic features and disease progression. METHODS Institutional review board approval for this retrospective study was obtained; patient consent was not required. The initial staging MRI scans of 75 patients with histologically confirmed ccRCC were retrospectively reviewed. The imaging was assessed by 2 radiologists for the presence of tumor necrosis, cystic degeneration, intracellular fat, hemorrhage, retroperitoneal collaterals, and renal vein thrombosis. Quantitative analysis for the MRI presence of intracellular lipid within tumors was performed. MRI findings were correlated with histopathologic findings of clear cell percentage, alveolar and tubular growth pattern, and disease progression. Statistical associations were evaluated with nonparametric univariable analyses and multivariable logistic regression models. RESULTS Correlation between MRI and histopathologic features was performed in 75 patients, whereas follow-up data were available for progression analysis in 68 patients. The presence of tumor necrosis, retroperitoneal collaterals, and renal vein thrombosis on MRI was significantly associated with a low percentage of tumor cells with clear cytoplasm (P < .01) and metastatic disease at presentation or disease progression (P < .01). At multivariable analysis, necrosis remained the only feature statistically associated with disease progression (P = .03; adjusted odds ratio, 27.7; 95% confidence interval, 1.4-554.7 for reader 1 and P = .02; adjusted odds ratio, 29.3; 95% confidence interval, 1.7-520.8 for reader 2). CONCLUSIONS Necrosis in ccRCC on MRI correlates with the histopathologic finding of lower percentage of tumor cells with clear cytoplasm and is a poor prognostic indicator irrespective of tumor size.
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Affiliation(s)
- Peter Beddy
- Department of Radiology, St. James Hospital and Trinity College, Dublin, Ireland
| | - Elizabeth M Genega
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nicole Hindman
- Department of Radiology, New York University Langone Medical Center, New York, NY
| | - Jesse Wei
- Department of Radiology, St. James Hospital and Trinity College, Dublin, Ireland
| | - Andrea Bullock
- Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Rupal S Bhatt
- Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michael B Atkins
- Department of Medicine, Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ivan Pedrosa
- Department of Radiology, St. James Hospital and Trinity College, Dublin, Ireland.
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Wang X, Bullock A, Zhang L, Yu D, Wei L, Song J, Bhasin M, Signoretti S, Alsop DC, Mier JW, Atkins MB, Coxon A, Oliner J, Bhatt RS. Abstract 1608: Angiopoietin 2 is elevated in patients with RCC, and Ang2 inhibition improves antiantiogenic activity of sunitinib in a mouse model of RCC. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Several small molecules targeting angiogenic receptor tyrosine kinases (TKIs) are approved for treatment of advanced RCC. While many patients (pts) respond to TKIs, resistance develops in all. Ang2 is a secreted glycoprotein that is upregulated at sites of angiogenesis and has been implicated in cancer neovascularization. Ang2 is elevated in many cancer states, and higher levels are associated with poor prognosis. Recent studies have also suggested efficacy of combined Ang and VEGFR inhibition as therapy in RCC.
Mehtods: A panel of angiogenic genes was analyzed by RT-PCR in several tumor vs normal tissues. Plasma Ang2 levels in pts with RCC were measured in duplicate at baseline, on treatment with sunitinib (median 34.5 days after starting sunitinib), and at resistance to sunitinib. Finally, dual Ang1/2 (AMG 386) or Ang2 (L1-7) inhibition was also tested in a murine RCC xenograft model of resistance to VEGFR inhibition. Tumors were assessed for blood flow by arterial spin labeled (ASL) MRI.
Results: Among the genes studied, Ang2 levels were 6.7 fold higher in human tumors vs normal (nl) tissues, and 12.6 fold higher in RCC vs nl. RCC ranked highest for Ang2 expression across all the tumor types tested, with Ang2 levels in RCC being 2.8 fold higher than in all other tumor types. VEGF and KDR showed similar results, with both exhibiting higher levels in tumors vs nl tissues (7.5 fold for VEGF and 2 fold for KDR). VEGF was 25.5 fold higher in RCC vs nl, and KDR was 6 fold higher in RCC vs nl. VEGF and KDR were also higher in RCC than all other tumor types (7.0 fold for VEGF and 6.5 fold for KDR).
Plasma Ang2 was significantly higher in pts with metastatic RCC (n=50) compared to controls (n=26) and pts with stage I disease (n=39) (P<0.001). Ang2 was also measured in pts at baseline, day 28 and at time of progression on sunitinib. Plasma Ang2 decreased at day 28 (n=39 pairs) and increased at the time of disease progression (n=28 pairs) (P<0.001). In our mouse model of RCC, dual Ang1/2 (AMG 386) or Ang2 (L1-7) inhibition improved the activity of sunitinib (su) (time to progression on su, su+AMG 386, su+L1-7 = 25.6±12.4, 48.2±13.5, or 51.9±17.2 days, respectively (P<0.05). Treatment with these agents exhibited a trend towards reduction in residual viable tissue after combination treatment and prevented the resumption of blood flow as measured with ASL MRI with sunitinib alone (tumor perfusion on day 50 post-treatment with su, su+AMG 386, su+L1-7 = 36.7±15.0, 18.4±11.1, or 16.0±7.3 ml/100g/min, respectively, P<0.01).
Conclusion: Ang2 inhibition is elevated in pts with RCC, and Ang2 inhibition improves the activity of sunitinib in our mouse model of resistance. Plasma Ang2 levels increase in pts treated with sunitinib and may contribute to resistance to therapy. It is possible that the subset of pts with the highest Ang2 at resistance may be the optimal candidates for combination of these antiangiogenic agents.
Citation Format: Xiaoen Wang, Andrea Bullock, Liang Zhang, Dongyin Yu, Lin Wei, Jiaxi Song, Manoj Bhasin, Sabina Signoretti, David C. Alsop, James W. Mier, Michael B. Atkins, Angela Coxon, Jon Oliner, Rupal S. Bhatt. Angiopoietin 2 is elevated in patients with RCC, and Ang2 inhibition improves antiantiogenic activity of sunitinib in a mouse model of RCC. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1608. doi:10.1158/1538-7445.AM2013-1608
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Affiliation(s)
- Xiaoen Wang
- 1Beth Israel Deaconess Medical Ctr., Boston, MA
| | | | | | | | - Lin Wei
- 1Beth Israel Deaconess Medical Ctr., Boston, MA
| | - Jiaxi Song
- 4Brigham and Women's Hospital, Boston, MA
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Alimzhanov M, Solban N, Lee M, Philbrook P, Wang X, Wei L, Song J, Signoretti S, Pearsall RS, Sherman ML, Kumar R, Bhatt RS. Abstract 5080: Inhibiting the ALK1/BMP9 signaling pathway with dalantercept as an antiangiogenic therapy. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-5080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Activin receptor-like kinase 1 (ALK1) is an endothelial cell-specific receptor for bone morphogenetic proteins (BMP) 9 and 10, and is a key regulator of angiogenesis and vascular morphogenesis. Preclinical data suggest that the BMP9/ALK1 pathway is operating in the resolution and maturation stage of angiogenesis, which is distinct from the VEGF/VEGFR pathway which drives the initiation stage of angiogenesis. Dalantercept is an ALK1 extracellular domain-Fc fusion protein that inhibits the BMP9/ALK1 pathway. Thus, dalantercept may prove useful either as a monotherapy to inhibit tumor angiogenesis or in combination with VEGFR inhibitors to target different phases of vascular network formation and potentially to overcome acquired resistance to anti-VEGF therapy.
To test this hypothesis, the A498 renal cell carcinoma xenograft model was used to test dalantercept efficacy either alone or in combination with sunitinib. In this model, tumor progression was defined as a 2 mm increase in tumor length. In the placebo group, mean (± SD) tumor progression was 5.8 ±0.6 days. Treatment with dalantercept delayed tumor progression to 10.8 ± 1.7 days (p<0.01 vs placebo) and sunitinib delayed tumor progression to 13.8 ± 2.5 days (p<0.01 vs placebo). The combination treatment of dalantercept plus sunitinib had a greater beneficial effect with a delay in tumor progression to 35 ± 12.6 days (p=0.01 vs sunitinib).
We used immunohistochemistry (IHC) analysis to evaluate effects of dalantercept on tumor vasculature and to look for potential biomarkers of response to treatment in A498 tumors. Id1 is a transcription factor expressed in endothelial cells and is known to be regulated via the BMP9/ALK1/SMAD pathway. We observed a decrease in Id1 protein expression in endothelial cells of A498 xenografts treated with dalantercept, consistent with our previous experiments. Because BMP9 is one of the main target ligands of dalantercept, IHC analysis of archived human tumor samples was performed to determine BMP9 expression levels in various tumor types. In squamous cell carcinoma of the head and neck it was shown that out of 28 tumor samples 79% had high or medium levels of BMP9 staining, with little to no staining in normal tissues. Data from BMP9 expression in renal cell carcinoma and hepatocellular carcinoma will also be presented.
In a Phase 1 study in patients with advanced, refractory solid tumors, dalantercept was generally well tolerated and exhibited signs of clinical activity including patients with objective response and prolonged stable disease. Dalantercept is currently being tested in several Phase 2 oncology studies, including a study of dalantercept in combination with the anti-VEGFR TKI axitinib in second-line advanced renal cell carcinoma.
Citation Format: Marat Alimzhanov, Nicolas Solban, Michael Lee, Phaethon Philbrook, Xiaoen Wang, Lin Wei, Jiaxi Song, Sabina Signoretti, R. Scott Pearsall, Matthew L. Sherman, Ravindra Kumar, Rupal S. Bhatt. Inhibiting the ALK1/BMP9 signaling pathway with dalantercept as an antiangiogenic therapy. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5080. doi:10.1158/1538-7445.AM2013-5080
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Affiliation(s)
| | | | | | | | - Xiaoen Wang
- 2Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, MA
| | - Lin Wei
- 2Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jiaxi Song
- 2Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sabina Signoretti
- 2Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | - Rupal S. Bhatt
- 2Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, MA
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Wang X, Zhang L, O'Neill A, Bahamon B, Alsop DC, Mier JW, Goldberg SN, Signoretti S, Atkins MB, Wood CG, Bhatt RS. Cox-2 inhibition enhances the activity of sunitinib in human renal cell carcinoma xenografts. Br J Cancer 2013; 108:319-26. [PMID: 23322198 PMCID: PMC3566808 DOI: 10.1038/bjc.2012.591] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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] [Revised: 12/07/2012] [Accepted: 12/07/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sunitinib (Su), a tyrosine kinase inhibitor of VEGFR, is effective at producing tumour response in clear cell renal cell carcinoma (cRCC), but resistance to therapy is inevitable. As COX-2 is a known mediator of tumour growth, we explored the potential benefit of COX-2 inhibition in combination with VEGFR inhibition in attempts at delaying tumour progression on Su. METHODS COX-2 expression was compared with areas of hypoxia in tumours that progressed on Su vs untreated tumours. Mice bearing human cRCC xenografts were treated with Su and the COX-2 inhibitor, celecoxib, and the effects on tumour growth were assessed. Sequential vs concurrent regimens were compared. RESULTS COX-2 expression was increased in cRCC xenografts in areas of tumour hypoxia. The combination of Su and celecoxib achieved longer times to tumour progression compared to treatment with either agent alone or to untreated control animals in four models. This effect was seen with concurrent but not with sequential therapy. CONCLUSION COX-2 inhibition can extend the effectiveness of VEGFR inhibition. This effect is dependent on the timing of therapy. Clinical trials combining Su and COX-2 inhibitors should be considered as a means delaying time to progression on sunitinib in patients with metastatic cRCC.
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Affiliation(s)
- X Wang
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - L Zhang
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - A O'Neill
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - B Bahamon
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - D C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - J W Mier
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - S N Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
- Department of Radiology, Hadassah Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
| | - S Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - M B Atkins
- Georgetown-Lombardi Comprehensive Cancer Center, 3970 Reservoir Road, NW, Washington, DC 20057, USA
| | - C G Wood
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe-Unit1373, Houston, TX 77030, USA
| | - R S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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Wang X, Solban N, Bhasin MK, Bahamon B, Zhang L, Signoretti S, Alsop DC, Atkins MB, Pearsall RS, Mier JW, Kumar R, Bhatt RS. Abstract LB-313: ALK1-Fc inhibits tumor growth in a VEGF pathway resistance model of renal cell carcinoma. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-lb-313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Treatment of metastatic RCC with agents that block signaling through VEGFR2 induces disease stabilization or regression in a substantial fraction of patients (pts); however, these responses tend to be short-lived. Mice bearing 786-O and A498 human RCC xenografts treated with sunitinib or sorafenib also exhibit a period of tumor stabilization followed by the resumption of growth and restoration of angiogenesis despite continued drug administration. Thus, alternate angiogenic pathways are of interest in the treatment of RCC. Activin receptor-like kinase 1 (ALK1) is one of 7 type I TGFβ receptors which is predominantly expressed on activated vascular endothelial cells. ALK1-Fc is a soluble receptor fusion protein containing the extracellular domain of ALK1 linked to a human Ig Fc region. ALK1-Fc binds to and neutralizes the activity of bone morphogenetic protein 9 and 10 (BMP9, 10) and has demonstrated antiangiogenic activity in vivo. Currently, ALK1-Fc (ACE-041) is undergoing clinical development. We have found evidence of TGFβ pathway upregulation in tumors that have developed resistance to sunitinib. Thus, to explore the role of ALK signaling in the treatment of RCC we administered ALK1-Fc to mice bearing RCC xenografts. In the treatment naïve A498 model, administration of ALK1-Fc alone delayed tumor growth relative to vehicle: days to grow by 2 mm vehicle- 5.8 +/−0.96 days (n=5) vs ALK1-Fc- 10.8 +/− 1.7 days (n=4, p<0.01). Single agent ALK1-Fc did not show activity in the 786-O model; however combination ALK1-Fc + sunitinib slowed tumor growth to a greater extent than either agent alone or vehicle tumors in both the A498 and the 786-O tumor models. A498 tumors treated with sunitinib took 13.8+/−2.5 days (n=4) to increase by 2 mm vs the ALK1-Fc + sunitinib combination (35 +/− 12.6 days (n=4) (p=0.01)). 786-O derived tumors, treated with sunitinib took 24.7+/−8.3 days (n=3), while tumors treated with combination of ALK1-Fc + sunitinib took 43.7+/−4.2 days (n=3, p<0.03) to grow by 2 mm. Perfusion imaging of these tumors revealed that sunitinib + ALK-Fc lowers perfusion more than sunitinib treated tumors. Our data indicate that ALK1-Fc treatment can act as a single agent to delay tumor growth in at least 1 RCC xenograft model. In addition, combination therapy with ALK1-Fc and sunitinib further delays tumor growth vs either agent administered alone. The effect of the combination therapy on vessel formation and tumor perfusion are currently being investigated. The differential response to ALK1-Fc treatment in the A498 compared to the 786-O cell lines provides an opportunity to explore the molecular and pathological differences between the two models, which may allow for better insight into mechanisms of action and future pt selection. The data demonstrate that blocking ligand signaling through the endogenous ALK1 receptor, either alone or in combination with other antiangiogenic therapies, is a valid strategy for treatment of RCC.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-313. doi:1538-7445.AM2012-LB-313
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Affiliation(s)
- Xiaoen Wang
- 1Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | - Liang Zhang
- 1Beth Israel Deaconess Medical Center, Boston, MA
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Ross RW, Galsky MD, Febbo P, Barry M, Richie JP, Xie W, Fennessy FM, Bhatt RS, Hayes J, Choueiri TK, Tempany CM, Kantoff PW, Taplin ME, Oh WK. Phase 2 study of neoadjuvant docetaxel plus bevacizumab in patients with high-risk localized prostate cancer: a Prostate Cancer Clinical Trials Consortium trial. Cancer 2012; 118:4777-84. [PMID: 22282219 DOI: 10.1002/cncr.27416] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/17/2011] [Accepted: 11/29/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Treatment of high-risk localized prostate cancer remains inadequate. The authors performed a phase 2 multicenter trial of neoadjuvant docetaxel plus bevacizumab before radical prostatectomy. METHODS Eligibility included any of the following: prostate-specific antigen (PSA) >20 ng/mL or PSA velocity >2 ng/mL/y, cT3 disease, any biopsy Gleason score 8 to 10, and Gleason score 7 with T3 disease by endorectal magnetic resonance imaging (MRI) at 1.5 T. Also, those with ≥50% biopsy cores involved and either Gleason score 7, PSA >10, or cT2 disease were eligible. Patients were treated with docetaxel 70 mg/m(2) every 3 weeks for 6 cycles and bevacizumab 15 mg/m(2) every 3 weeks for 5 cycles. The primary endpoint was partial response by endorectal MRI. RESULTS Forty-one patients were treated. Median age was 55 years (range, 40-66 years). Baseline characteristics included: median PSA, 10.1 ng/mL; cT2, 49%, cT3, 32%; and Gleason score 8 to 10, 73%. Thirty-eight of 41 (93%) patients completed all 6 cycles. Grade ≥3 adverse events were rare, although 3 of 41 (7%) experienced febrile neutropenia. Twelve patients (29%; 95% confidence interval [CI], 16%-45%) achieved a >50% reduction in tumor volume, and 9 patients (22%; 95% CI, 11%-38%) achieved a >50% post-treatment decline in PSA. Thirty-seven of the 41 patients underwent radical prostatectomy; there were no complete pathologic responses. CONCLUSIONS Neoadjuvant docetaxel and bevacizumab is safe, and results in reductions in both tumor volume and serum PSA, in men with high-risk localized prostate cancer. The role of neoadjuvant chemotherapy in prostate cancer, and perioperative antiangiogenic therapy in general, requires further elucidation through ongoing and planned trials.
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Affiliation(s)
- Robert W Ross
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
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Wang X, Zhang L, Goldberg SN, Bhasin M, Brown V, Alsop DC, Signoretti S, Mier JW, Atkins MB, Bhatt RS. High dose intermittent sorafenib shows improved efficacy over conventional continuous dose in renal cell carcinoma. J Transl Med 2011; 9:220. [PMID: 22188900 PMCID: PMC3258225 DOI: 10.1186/1479-5876-9-220] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [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: 09/19/2011] [Accepted: 12/21/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) responds to agents that inhibit vascular endothelial growth factor (VEGF) pathway. Sorafenib, a multikinase inhibitor of VEGF receptor, is effective at producing tumor responses and delaying median progression free survival in patients with cytokine refractory RCC. However, resistance to therapy develops at a median of 5 months. In an effort to increase efficacy, we studied the effects of increased sorafenib dose and intermittent scheduling in a murine RCC xenograft model. METHODS Mice bearing xenografts derived from the 786-O RCC cell line were treated with sorafenib according to multiple doses and schedules: 1) Conventional dose (CD) continuous therapy; 2) high dose (HD) intermittent therapy, 3) CD intermittent therapy and 4) HD continuous therapy. Tumor diameter was measured daily. Microvessel density was assessed after 3 days to determine the early effects of therapy, and tumor perfusion was assessed serially by arterial spin labeled (ASL) MRI at day 0, 3, 7 and 10. RESULTS Tumors that were treated with HD sorafenib exhibited slowed tumor growth as compared to CD using either schedule. HD intermittent therapy was superior to CD continous therapy, even though the total dose of sorafenib was essentially equivalent, and not significantly different than HD continuous therapy. The tumors exposed to HD sorafenib had lower microvessel density than the untreated or the CD groups. ASL MRI showed that tumor perfusion was reduced to a greater extent with the HD sorafenib at day 3 and at all time points thereafter relative to CD therapy. Further the intermittent schedule appeared to maintain RCC sensitivity to sorafenib as determined by changes in tumor perfusion. CONCLUSIONS A modification of the sorafenib dosing schedule involving higher dose intermittent treatment appeared to improve its efficacy in this xenograft model relative to conventional dosing. MRI perfusion imaging and histologic analysis suggest that this benefit is related to enhanced and protracted antiangiogenic activity. Thus, better understanding of dosing and schedule issues may lead to improved therapeutic effectiveness of VEGF directed therapy in RCC and possibly other tumors.
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Affiliation(s)
- Xiaoen Wang
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Liang Zhang
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - S Nahum Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Manoj Bhasin
- Division of Interdisciplinary Medicine and Biostatistics, Beth Israel Deaconess Medical Center, Harvard Medical School, Massachusetts, USA
| | - Victoria Brown
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David C Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James W Mier
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael B Atkins
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rupal S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Bhatt RS, Zurita AJ, O'Neill A, Norden-Zfoni A, Zhang L, Wu HK, Wen PY, George D, Sukhatme VP, Atkins MB, Heymach JV. Increased mobilisation of circulating endothelial progenitors in von Hippel-Lindau disease and renal cell carcinoma. Br J Cancer 2011; 105:112-7. [PMID: 21673679 PMCID: PMC3137404 DOI: 10.1038/bjc.2011.186] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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: 12/19/2022] Open
Abstract
Background: Circulating endothelial cells (CECs) are a candidate biomarker for monitoring angiogenesis in cancer. Circulating endothelial cell subsets are mobilised by angiogenic mediators. Because of the highly angiogenic phenotype of renal cell carcinoma (RCC), we sought to assess the potential of CECs as a marker of RCC in patients with von Hippel-Lindau (VHL) disease and those with sporadic RCC. Methods: We performed multicolour flow cytometry to enumerate CECs in patients with RCC, patients with VHL disease with and without RCC, and normal subjects. Two subsets of CECs were evaluated: mature CECs (mCECs) and circulating endothelial progenitors (CEPs). Results: In patients with VHL disease and RCC and those with sporadic RCC (N=10), CEPs and the CEP:mCEC ratio were higher than in normal subjects (N=17) (median CEPs: 0.97 vs 0.19 cells μl−1, respectively, P<0.01; median CEP:mCEC: 0.92 vs 0.58, respectively, P=0.04). However, in patients with VHL without RCC, CECs were not increased. In paired pre- and post-nephrectomy RCC patient samples (N=20), CEPs decreased after surgery (median difference 0.02 cells μl−1, −0.06 to 1.2; P=0.05). Conclusion: Circulating endothelial progenitors were elevated in RCC, but not in patients with VHL without RCC. Circulating endothelial progenitor enumeration merits further investigation as a monitoring strategy for patients with VHL.
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Affiliation(s)
- R S Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, MASCO 426, Boston, MA 02215, USA.
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Zhang L, Bhasin M, Schor-Bardach R, Wang X, Collins MP, Panka D, Putheti P, Signoretti S, Alsop DC, Libermann T, Atkins MB, Mier JW, Goldberg SN, Bhatt RS. Resistance of renal cell carcinoma to sorafenib is mediated by potentially reversible gene expression. PLoS One 2011; 6:e19144. [PMID: 21559452 PMCID: PMC3084751 DOI: 10.1371/journal.pone.0019144] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 03/27/2011] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Resistance to antiangiogenic therapy is an important clinical problem. We examined whether resistance occurs at least in part via reversible, physiologic changes in the tumor, or results solely from stable genetic changes in resistant tumor cells. EXPERIMENTAL DESIGN Mice bearing two human RCC xenografts were treated with sorafenib until they acquired resistance. Resistant 786-O cells were harvested and reimplanted into naïve mice. Mice bearing resistant A498 cells were subjected to a 1 week treatment break. Sorafenib was then again administered to both sets of mice. Tumor growth patterns, gene expression, viability, blood vessel density, and perfusion were serially assessed in treated vs control mice. RESULTS Despite prior resistance, reimplanted 786-O tumors maintained their ability to stabilize on sorafenib in sequential reimplantation steps. A transcriptome profile of the tumors revealed that the gene expression profile of tumors upon reimplantation reapproximated that of the untreated tumors and was distinct from tumors exhibiting resistance to sorafenib. In A498 tumors, revascularization was noted with resistance and cessation of sorafenib therapy and tumor perfusion was reduced and tumor cell necrosis enhanced with re-exposure to sorafenib. CONCLUSIONS In two RCC cell lines, resistance to sorafenib appears to be reversible. These results support the hypothesis that resistance to VEGF pathway therapy is not solely the result of a permanent genetic change in the tumor or selection of resistant clones, but rather is due to a great extent to reversible changes that likely occur in the tumor and/or its microenvironment.
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Affiliation(s)
- Liang Zhang
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Manoj Bhasin
- Division of Interdisciplinary Medicine and Biotechnology, and Genomics and Proteomics Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Rachel Schor-Bardach
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Xiaoen Wang
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Michael P. Collins
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - David Panka
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Prabhakar Putheti
- Departments of Surgery and Medicine, The Transplant Institute at Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - David C. Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Towia Libermann
- Division of Interdisciplinary Medicine and Biotechnology, and Genomics and Proteomics Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Michael B. Atkins
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - James W. Mier
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - S. Nahum Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Rupal S. Bhatt
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Kidney Cancer Program of the Dana Farber/Harvard Cancer Center, Boston, Massachusetts, United States of America
- * E-mail:
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Bhatt RS, Wang X, Zhang L, Collins MP, Signoretti S, Alsop DC, Goldberg SN, Atkins MB, Mier JW. Renal cancer resistance to antiangiogenic therapy is delayed by restoration of angiostatic signaling. Mol Cancer Ther 2010; 9:2793-802. [PMID: 20699227 DOI: 10.1158/1535-7163.mct-10-0477] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [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: 12/30/2022]
Abstract
Treatment of metastatic renal cell cancer (RCC) with antiangiogenic agents that block vascular endothelial growth factor (VEGF) receptor 2 signaling produces tumor regression in a substantial fraction of patients; however, resistance typically develops within 6 to 12 months. The purpose of this study was to identify molecular pathways involved in resistance. Treatment of mice bearing either 786-0 or A498 human RCC xenografts with sorafenib or sunitinib produced tumor growth stabilization followed by regrowth despite continued drug administration analogous to the clinical experience. Tumors and plasma were harvested at day 3 of therapy and at the time of resistance to assess pathways that may be involved in resistance. Serial perfusion imaging, and plasma and tumor collections were obtained in mice treated with either placebo or sunitinib alone or in combination with intratumoral injections of the angiostatic chemokine CXCL9. Sunitinib administration led to an early downmodulation of IFNγ levels as well as reduction of IFNγ receptor and downstream angiostatic chemokines CXCL9 to 11 within the tumor. Intratumoral injection of CXCL9, although producing minimal effects by itself, when combined with sunitinib resulted in delayed resistance in vivo accompanied by a prolonged reduction of microvascular density and tumor perfusion as measured by perfusion imaging relative to sunitinib alone. These results provide evidence that resistance to VEGF receptor therapy is due at least in part to resumption of angiogenesis in association with reduction of IFNγ-related angiostatic chemokines, and that this resistance can be delayed by concomitant administration of CXCL9.
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Affiliation(s)
- Rupal S Bhatt
- Division of Hematology Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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Abstract
In Experiment 1, one group of pigeons learned to classify a set of stimuli into the human language classes cat, flower, car, and chair (categorization); another group learned to classify the same set into arbitrary classes (pseudocategorization). Then, both groups were trained on a new categorization task and their performance compared to that of a control group that had no initial classification training. Hull's (1943) notion of secondary generalization (generalization that is not based on physical similarity but on mediating associations) predicts that categorization experience will facilitate the learning of a new categorization task, whereas pseudocategorization experience will impair it. However, in Experiment 1, performance on the new categorization task was not differently affected by prior experience. In Experiment 2, pigeons initially trained to classify a set of 48 stimuli (original training) were later trained to classify a subset of four of these stimuli using new responses (reassignment training). Then, they were tested on the 44 remaining stimuli. Performance better accorded with original than with reassignment training, indicating that categorization training did not lead to the formation of equivalence classes of stimuli, in which the equivalence relationship is mediated by secondary generalization. The lack of evidence of secondary generalization implies that our pigeons failed to meet Lea's (1984) criterion for conceptual behavior.
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