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Yang Y, Liu P, Zhou M, Yin L, Wang M, Liu T, Jiang X, Gao H. Small-molecule drugs of colorectal cancer: Current status and future directions. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166880. [PMID: 37696461 DOI: 10.1016/j.bbadis.2023.166880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the world's fourth most deadly cancer. CRC, as a genetic susceptible disease, faces significant challenges in optimizing prognosis through optimal drug treatment modalities. In recent decades, the development of innovative small-molecule drugs is expected to provide targeted interventions that accurately address the different molecular characteristics of CRC. Although the clinical application of single-target drugs is limited by the heterogeneity and high metastasis of CRC, novel small-molecule drug treatment strategies such as dual/multiple-target drugs, drug repurposing, and combination therapies can help overcome these challenges and provide new insights for improving CRC treatment. In this review, we focus on the current status of a range of small molecule drugs that are being considered for CRC therapy, including single-target drugs, dual/multiple-target drugs, drug repurposing and combination strategies, which will pave the way for targeting CRC vulnerabilities with small-molecule drugs in future personalized treatment.
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Affiliation(s)
- Yiren Yang
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People's Republic of China
| | - Pengyu Liu
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People's Republic of China
| | - Mingyang Zhou
- University of Pennsylvania, Philadelphia, PA 19104-6323, United States
| | - Linzhou Yin
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People's Republic of China
| | - Miao Wang
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People's Republic of China
| | - Ting Liu
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People's Republic of China
| | - Xiaowen Jiang
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People's Republic of China.
| | - Huiyuan Gao
- School of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People's Republic of China.
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Kasurinen J, Beilmann-Lehtonen I, Kaprio T, Hagström J, Haglund C, Böckelman C. Phenotypic subtypes predict outcomes in colorectal cancer. Acta Oncol 2023; 62:245-252. [PMID: 36867078 DOI: 10.1080/0284186x.2023.2183779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. The Colorectal Cancer Subtyping Consortium used the transcriptome-based method to classify CRC according to four molecular subtypes, each showing different genomic alterations and prognoses: CMS1 (microsatellite instable [MSI] immune), CMS2 (canonical), CMS3 (metabolic), and CMS4 (mesenchymal). To expedite the clinical implementation of such methods, easier and preferably tumor phenotype-based methods are needed. In this study, we describe a method to divide patients into four phenotypic subgroups using immunohistochemistry. Moreover, we analyze disease-specific survival (DSS) among different phenotypic subtypes and the associations between the phenotypic subtypes and clinicopathological variables. METHODS We categorized 480 surgically treated CRC patients into four phenotypic subtypes (immune, canonical, metabolic, and mesenchymal) using the immunohistochemically determined CD3-CD8 tumor-stroma index, proliferation index, and tumor-stroma percentage. We analyzed survival rates for the phenotypic subtypes in different clinical patient subgroups using the Kaplan-Meier method and Cox regression analysis. Associations between phenotypic subtypes and clinicopathological variables were examined using the chi-square test. RESULTS Patients with immune subtype tumors exhibited the best 5-year DSS, while mesenchymal subtype tumors accompanied the worst prognosis. The prognostic value of the canonical subtype showed wide variation among different clinical subgroups. Immune subtype tumors were associated with being female, stage I disease, and a right-side colon location. Metabolic tumors, however, were associated with pT3 and pT4 tumors, and being male. Finally, a mesenchymal subtype associated with stage IV disease, a mucinous histology, and a rectal tumor location. CONCLUSIONS Phenotypic subtype predicts patient outcome in CRC. Associations and prognostic values for subtypes resemble the transcriptome-based consensus molecular subtypes (CMS) classification. In our study, the immune subtype stood out with its exceptionally good prognosis. Moreover, the canonical subtype showed wide variability among clinical subgroups. Further studies are needed to investigate the concordance between transcriptome-based classification systems and the phenotypic subtypes.
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Affiliation(s)
- Jussi Kasurinen
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ines Beilmann-Lehtonen
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Kaprio
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
| | - Caj Haglund
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Camilla Böckelman
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Brunac AC, Fourquet J, Perot G, Jaffrelot M, Meilleroux J, Danjoux M, Filleron T, Nicolaï V, Guimbaud R, Icher S, Farés N, Selves J, Chibon F. CINSARC signature outperforms gold-standard TNM staging and consensus molecular subtypes for clinical outcome in stage II-III colorectal carcinoma. Mod Pathol 2022; 35:2002-2010. [PMID: 36202996 DOI: 10.1038/s41379-022-01166-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 12/24/2022]
Abstract
The outcome of stage II-III colorectal cancer (CRC) is highly variable and therapeutic choice is currently based on TNM staging with a few additional biomarkers. However, studies show that some stage III patients have a better prognosis than some stage II patients. A promising consensus molecular (CMS) classification with prognostic relevance has been developed, but it is not used in daily practice. Our team developed CINSARC, a 67-gene expression prognostic signature, whose prognostic value has been demonstrated in many cancer types. It is applicable to formalin-fixed, paraffin-embedded (FFPE) blocks using NanoString® technology. We investigated whether it could predict outcome in stage II-III CRC. We established the CINSARC classification on the TCGA retrospective cohort comprising 297 stage II-III CRC patients using RNA sequencing and on a second independent cohort comprising 169 cases using NanoString® technology. We compared its recurrence-free and overall survival prognostic value with TNM staging and CMS classification. In the TCGA cohort, we showed that CINSARC significantly splits the population of stage II-III CRC into two groups with different progression-free interval (P = 1.68 × 10-2; HR = 1.87 [1.11-3.16]) and overall survival (P = 3.73 × 10-3; HR = 2.45 [1.31-4.59]) and is a strong prognostic factor in multivariate analysis, outperforming TNM staging and CMS classification. We validated these results in the second cohort by applying CINSARC on FFPE samples with Nanostring® technology. CINSARC is a ready-to-use tool with a robust independent prognostic value in stage II-III CRC.
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Affiliation(s)
- Anne-Cécile Brunac
- Department of Pathology, Institut Universitaire du Cancer-Oncopole de Toulouse, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Joanna Fourquet
- Oncogenesis of Sarcomas, INSERM UMR1037, Cancer Research Centre of Toulouse, Toulouse, France
| | - Gaëlle Perot
- Oncogenesis of Sarcomas, INSERM UMR1037, Cancer Research Centre of Toulouse, Toulouse, France
| | - Marion Jaffrelot
- Department of Digestive Oncology, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Julie Meilleroux
- Department of Pathology, Institut Universitaire du Cancer-Oncopole de Toulouse, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Marie Danjoux
- Department of Pathology, Institut Universitaire du Cancer-Oncopole de Toulouse, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius-Regaud, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France
| | - Vincent Nicolaï
- Department of Medical Oncology, Institut Universitaire du Cancer-Oncopole de Toulouse, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Rosine Guimbaud
- Department of Digestive Oncology, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Samira Icher
- Department of Pathology, Institut Universitaire du Cancer-Oncopole de Toulouse, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Nadim Farés
- Department of Digestive Oncology, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Janick Selves
- Department of Pathology, Institut Universitaire du Cancer-Oncopole de Toulouse, Centre Hospitalier Universitaire (CHU), Toulouse, France
| | - Frédéric Chibon
- Oncogenesis of Sarcomas, INSERM UMR1037, Cancer Research Centre of Toulouse, Toulouse, France.
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Banias L, Jung I, Chiciudean R, Gurzu S. From Dukes-MAC Staging System to Molecular Classification: Evolving Concepts in Colorectal Cancer. Int J Mol Sci 2022; 23:ijms23169455. [PMID: 36012726 PMCID: PMC9409470 DOI: 10.3390/ijms23169455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
This historical review aimed to summarize the main changes that colorectal carcinoma (CRC) staging systems suffered over time, starting from the creation of the classical Duke’s classification, modified Astler–Coller staging, internationally used TNM (T—primary tumor, N—regional lymph nodes’ status, M—distant metastases) staging system, and ending with molecular classifications and epithelial–mesenchymal transition (EMT) concept. Besides currently used staging parameters, this paper briefly presents the author’s contribution in creating an immunohistochemical (IHC)-based molecular classification of CRC. It refers to the identification of three molecular groups of CRCs (epithelial, mesenchymal and hybrid) based on the IHC markers E-cadherin, β-catenin, maspin, and vimentin. Maspin is a novel IHC antibody helpful for tumor budding assessment, which role depends on its subcellular localization (cytoplasm vs. nuclei). The long road of updating the staging criteria for CRC has not come to an end. The newest prognostic biomarkers, aimed to be included in the molecular classifications, exert predictive roles, and become more and more important for targeted therapy decisions.
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Affiliation(s)
- Laura Banias
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
| | - Ioan Jung
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
| | - Rebeca Chiciudean
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
- Correspondence: ; Tel.: +40-745-673550; Fax: +40-265-210407
| | - Simona Gurzu
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
- Research Center of Oncopathology and Transdisciplinary Research (CCOMT), George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
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Ito Y, Osakabe M, Niinuma T, Uesugi N, Sugimoto R, Yanagawa N, Otsuka K, Sasaki A, Matsumoto T, Suzuki H, Sugai T. Genome-wide analysis of mRNA and microRNA expression in colorectal cancer and adjacent normal mucosa. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2022; 8:313-326. [PMID: 35285580 PMCID: PMC9161315 DOI: 10.1002/cjp2.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022]
Abstract
mRNA expression varies in human cancers. Such altered mRNA expression is negatively regulated by the expression of microRNAs (miRNAs), which play an important role in human tumorigenesis. According to this theory, inverse mRNA/miRNA expression may be a direct driver of cancer development, and certain genetic events may occur prior to the development of any discernible histological abnormalities. We examined the inverse expression between mRNAs and their corresponding miRNAs in colorectal cancer (CRC) and adjacent normal mucosa and performed pathway analysis to identify mRNA/miRNA networks. The cancer samples were divided into first (20 cases) and second (24 cases) cohorts, and 48 samples were obtained from two sections of the normal mucosa adjacent to the tumors from the second cohort. We investigated mRNAs with commonly altered expression in CRC and adjacent normal mucosa using isolated cancer glands and normal crypts from the first cohort, compared with that of distal normal crypts, using an array-based method. As a result, significant inverse correlations between CEACAM1 and miRNA-7114-5p and between AK1 and miRNA-6780-5p were found in CRC and adjacent normal mucosa. We validated these correlations in the second cohort using RT-PCR. To confirm these findings, transfection and immunohistochemical assays were also performed, which verified the inverse correlation between CEACAM1 and miRNA-7114-5p. Our findings suggest that the inverse correlations between the CEACAM1/miRNA-7114-5p and possibly AK1/miRNA-6780-5p pairs play an important role in early CRC development, and may help identify potential molecular targets for early detection of CRC.
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Affiliation(s)
- Yuma Ito
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Mitsumasa Osakabe
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Takeshi Niinuma
- Department of Molecular Biology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Ryo Sugimoto
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Naoki Yanagawa
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Koki Otsuka
- Department of Surgery, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Akira Sasaki
- Department of Surgery, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Hiromu Suzuki
- Department of Molecular Biology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Yahaba, Japan
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Valenzuela G, Canepa J, Simonetti C, Solo de Zaldívar L, Marcelain K, González-Montero J. Consensus molecular subtypes of colorectal cancer in clinical practice: A translational approach. World J Clin Oncol 2021; 12:1000-1008. [PMID: 34909395 PMCID: PMC8641009 DOI: 10.5306/wjco.v12.i11.1000] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/11/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
The identification of several genetic mutations in colorectal cancer (CRC) has allowed a better comprehension of the prognosis and response to different antineoplastic treatments. Recently, through a systematic process, consensus molecular subtypes (CMS) have been described to characterize genetic and molecular mutations in CRC patients. Through CMS, CRC patients can be categorized into four molecular subtypes of CRC by wide transcriptional genome analysis. CMS1 has microsatellite instability and mutations in CIMP and BRAF pathways. CMS2, distinguished by mutations in specific pathways linked to cellular metabolism, also has a better prognosis. CMS3 has a KRAS mutation as a hallmark. CMS4 presents mutations in fibrogenesis pathways and mesenchymal-epithelial transition, associated with a worse prognosis. CMS classification can be a meaningful step in providing possible answers to important issues in CRC, such as the use of adjuvant chemotherapy in stage II, personalized first-line chemotherapy for metastasic CRC, and possible new target treatments that address specific pathways in each molecular subtype. Understanding CMS is a crucial step in personalized medicine, although prospective clinical trials selecting patients by CMS are required to pass proof-of-concept before becoming a routine clinical tool in oncology routine care.
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Affiliation(s)
- Guillermo Valenzuela
- Basic and Clinical Oncology Department, University of Chile, Santiago 8380453, Chile
| | - Joaquín Canepa
- Basic and Clinical Oncology Department, University of Chile, Santiago 8380453, Chile
| | - Carolina Simonetti
- Basic and Clinical Oncology Department, University of Chile, Santiago 8380453, Chile
| | | | - Katherine Marcelain
- Basic and Clinical Oncology Department, University of Chile, Santiago 8380453, Chile
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