Phase II trial of external beam radiation with etanidazole (SR 2508) for the treatment of locally advanced prostate cancer

ZIF-Based Nanoparticles Combine X-Ray-Induced Nitrosative Stress with Autophagy Management for Hypoxic Prostate Cancer Therapy

Although reactive oxygen species (ROS)-mediated tumor treatments are predominant in clinical applications, ROS-induced protective autophagy promotes cell survival, especially in hypoxic tumors. Herein, X-ray triggered nitrite (NO₂ ^- ) is used for hypoxic prostate cancer therapy by inhibiting autophagy and inducing nitrosative stress based on an electrophilic zeolitic imidazole framework (ZIF-82-PVP). After internalization of pH-responsive ZIF-82-PVP nanoparticles, electrophilic ligands and Zn²⁺ are delivered into cancer cells. Electrophilic ligands can not only consume GSH under hypoxia but also capture low-energy electrons derived from X-rays to generate NO₂ ^- , which inhibits autophagy and further elevates lethal nitrosative stress levels. In addition, dissociated Zn²⁺ specifically limits the migration and invasion of prostate cancer cells through ion interference. In vitro and in vivo results indicate that ZIF-82-PVP nanoparticles under X-ray irradiation can effectively promote the apoptosis of hypoxic prostate cancer cells. Overall, this nitrosative stress-mediated tumor therapy strategy provides a novel approach targeting hypoxic tumors.

Perillyl alcohol mediated radiosensitization via augmentation of the Fas pathway in prostate cancer cells

BACKGROUND

The management of hormone-insensitive locally advanced prostate cancer is difficult and complex and there is an urgent need for the development of effective chemotherapeutic agents intended for combination with currently available treatment modalities.

METHODS

The present paper demonstrates the effectiveness of the monoterpene perillyl alcohol (POH) as potent radiosensitizer on DU145 and PC3 cell lines by performing clonogenic survival assays, cycle analysis, and assays to detect viability, apoptosis, and Fas receptor/ligand by flow cytometry.

RESULTS

POH pretreatment resulted in a dose dependent sensitization to kill cell by radiation. Furthermore, POH treatment induced a transient G(2)/M arrest, enhanced the expression of the membrane bound form of the Fas ligand and sensitized the cells to Fas mediated apoptosis.

CONCLUSIONS

The unique manner of radiosensitization in addition to its low toxicity profile makes POH a promising new agent for preclinical evaluation as a potential radiosensitizer in the treatment of prostate cancer.

Sustained release of etanidazole from spray dried microspheres prepared by non-halogenated solvents

Etanidazole, a kind of radiosensitizer, was encapsulated in the spray-dried microspheres using biodegradable polymer PLGA 65:35 as the carrier for controlled release applications. Two non-halogenated solvents, e.g., ethyl acetate (EA) and ethanol, were tested to modify the properties of microspheres prepared by the commonly used solvent dichloromethane (DCM) alone. Their effects on the release behavior, morphology, particle size, and encapsulation efficiency of etanidazole-loaded microspheres were determined, and results were compared with DCM. The particle formation process via spray drying technique was also analyzed in order to understand the results obtained. It was found that larger percentage of EA (in the solvent mixture consisting of DCM and EA) in the fabrication of PLGA 65:35 microspheres decreases the initial burst, release rate and prolongs the release duration of etanidazole. In contrast to the spherical and porous microspheres prepared by DCM, the microspheres prepared by the solvent EA are all nonporous with a doughnut like surface structure due to its comparatively rapid phase transition (phase inversion) but slow solvent evaporation rate (longer time required to solidify). Increasing the polymer concentration (e.g., 4%, w/v) can bring about much more spherical microspheres by spray drying. Although ethanol, as a co-solvent, can dissolve a higher amount of etanidazole and lead to a higher drug encapsulation efficiency, the addition of ethanol in the DCM solvent can significantly increase the initial burst and the release rate of the microspheres due to the inhomogeneous drug distribution and structure of microspheres caused by phase separation. This study shows that ethyl acetate is an excellent low-toxic solvent that can be used in the spray drying technique for decreasing the initial burst, prolonging the release duration of a highly water-soluble drug like etanidazole. The use of EA provides a promising way to develop a sustained release system for etanidazole and other highly water-soluble drugs.

Prodrug activation gene therapy and external beam irradiation in the treatment of prostate cancer

OBJECTIVES

Gene therapy may represent a new avenue for the development of multimodal treatment for men with locally advanced prostate cancer. This study explores the potential benefits of combining adenovirus-mediated (ADV) herpes simplex virus thymidine kinase gene (HSV-tk) transduction and ganciclovir (GCV) therapy with external beam radiation therapy (XRT) to enhance the therapeutic efficacy of each treatment alone.

METHODS

ADV/HSV-tk-transduced mouse prostate cancer cells, RM-1, were irradiated as single-cell suspensions at escalating doses in a cesium source (4.4 Gy/min). HSV-tk-expressing cells were randomized to receive varying doses and varying chronologies of GCV therapy in relation to XRT to fully evaluate potential cooperative activities. End points were determined in a clonogenic assay by counting colonies with greater than 50 cells 7 days after replating. The potential role of apoptosis as a mediator of enhanced cell killing was addressed by a TUNEL assay 12 and 24 hours after therapy.

RESULTS

Neither ADV infection nor GCV alone affected XRT killing. However, the combination of ADV/HSV-tk+GCV plus XRT maintained the 1 log of cell kill from gene therapy alone through escalating doses of radiation. Radiation sensitization was noted at higher doses of radiation (8.8 Gy or more). Although decreasing the GCV dose had a profound negative influence on HSV-tk+GCV-mediated killing, combination therapy continued to maintain the degree of HSV-tk+GCV killing through escalating doses of XRT in an additive fashion but did not result in radiosensitization. Changing the chronology of GCV exposure in relation to XRT did not significantly alter the additive activities of combination therapy. Studies of apoptosis noted a doubling of apoptotic activity with HSV-tk+GCV compared with HSV-tk+PBS with or without XRT. However, there was no significant change in apoptotic activity in combination therapy over HSV-tk+GCV alone within the 24-hour period after GCV exposure.

CONCLUSIONS

The combination of ADV/HSV-tk+GCV and XRT appears to result in at least additive, and with higher doses of radiation, synergistic killing activities, indicating a potential usefulness of this treatment strategy for patients with prostate cancer.

Results of a phase II trial of external beam radiation with etanidazole (SR 2508) for the treatment of locally advanced prostate cancer (RTOG Protocol 90-20)

PURPOSE

RTOG Protocol 90-20 was designed to evaluate the effect of the hypoxic cell sensitizer Etanidazole (SR-2508) on locally advanced adenocarcinoma of the prostate treated with concurrent external beam irradiation.

METHODS AND MATERIALS

Patients with biopsy-proven adenocarcinoma of the prostate with locally advanced T2b, T3, and T4 tumors were eligible for this study. No patients with disease beyond the pelvis were eligible. Serum prostate specific antigen (PSA) was mandatory. All patients received definitive external beam irradiation using standard four-field whole pelvis treatment to 45-50 Gy, followed by a cone down with a minimum total dose to the prostate of 66 Gy at 1.8-2.0 Gy/fraction over 6.5-7.5 weeks. Etanidazole was delivered 1.8 g/m2 given 3 times a week to a total of 34.2 g/m2 or 19 doses.

RESULTS

Thirty-nine patients were entered onto the study. Three patients refused treatment; therefore, 36 patients were eligible for further evaluation. Median follow-up was 36.9 months from treatment end. All patients had elevated initial PSA levels, and 18 patients had PSAs of > 20 ng/ml. Tumor classification was T2, 12 patients (33.3%); T3, 22 patients (61.1%); and T4, 2 patients (5.6%). Complete clinical response, defined as PSA < 4 ng/ml and complete clinical disappearance, was attained in 17.9% of (5/28 pts) with information at 90 days and 56% of patients by 12 months following treatment. Relapse-free survival was 13% at 3 years with PSA < 4 ng/ml. There were no Grade 4 or 5 toxicities, either acute (during treatment) or in follow-up.

CONCLUSIONS

Results of this trial regarding PSA response and clinical disappearance of disease are similar to historical controls and do not warrant further investigation of etanidazole as was done in this trial. Drug toxicity that, in the past, has been unacceptably high with other hypoxic cell sensitizers does not appear to be a significant problem with this drug.