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Lin Z, Wu Z, Luo W. Bulk and single-cell sequencing identified a prognostic model based on the macrophage and lipid metabolism related signatures for osteosarcoma patients. Heliyon 2024; 10:e26091. [PMID: 38404899 PMCID: PMC10884844 DOI: 10.1016/j.heliyon.2024.e26091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
The introduction of multidrug combination chemotherapy has significantly advanced the long-term survival prospects for osteosarcoma (OS) patients over the past decades. However, the escalating prevalence of chemoresistance has emerged as a substantial impediment to further advancements, necessitating the formulation of innovative strategies. Our present study leveraged sophisticated bulk and single-cell sequencing techniques to scrutinize the OS immune microenvironment, unveiling a potential association between the differentiation state of macrophages and the efficacy of OS chemotherapy. Notably, we observed that a heightened presence of lipid metabolism genes and pathways in predifferentiated macrophages, constituting the major cluster of OS patients exhibiting a less favorable response to chemotherapy. Subsequently, we developed a robust Macrophage and Lipid Metabolism (MLMR) risk model and a nomogram, both of which demonstrated commendable prognostic predictive performance. Furthermore, a comprehensive investigation into the underlying mechanisms of the risk model revealed intricate associations with variations in the immune response among OS patients. Finally, our meticulous drug sensitivity analysis identified a spectrum of potential therapeutic agents for OS, including AZD2014, Sapitinib, Buparlisib, Afuresertib, MIRA-1, and BIBR-1532. These findings significantly augment the therapeutic arsenal available to clinicians managing OS, presenting a promising avenue for elevating treatment outcomes.
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Affiliation(s)
- Zili Lin
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China
| | - Ziyi Wu
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, PR China
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China
- National Clinical Research Center for Geriatric Disorders,Xiangya Hospital, Changsha, Hunan, 410008, PR China
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2
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Chen C, Wang S, Wang J, Yao F, Tang X, Guo W. Nanosized drug delivery strategies in osteosarcoma chemotherapy. APL Bioeng 2023; 7:011501. [PMID: 36845905 PMCID: PMC9957606 DOI: 10.1063/5.0137026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Despite recent developments worldwide in the therapeutic care of osteosarcoma (OS), the ongoing challenges in overcoming limitations and side effects of chemotherapy drugs warrant new strategies to improve overall patient survival. Spurred by rapid progress in biomedicine, nanobiotechnology, and materials chemistry, chemotherapeutic drug delivery in treatment of OS has become possible in recent years. Here, we review recent advances in the design of drug delivery system, especially for chemotherapeutic drugs in OS, and discuss the relative merits in trials along with future therapeutic options. These advances may pave the way for novel therapies requisite for patients with OS.
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Affiliation(s)
| | - Shidong Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing 100044, People's Republic of China
| | - Juan Wang
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Fangzhou Yao
- Wuzhen Laboratory, Jiaxing, People's Republic of China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing 100044, People's Republic of China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing 100044, People's Republic of China,Author to whom correspondence should be addressed:. Tel.: ±86 18406559069
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Barnes DJ, Dutton P, Bruland Ø, Gelderblom H, Faleti A, Bühnemann C, van Maldegem A, Johnson H, Poulton L, Love S, Tiemeier G, van Beelen E, Herbschleb K, Haddon C, Billingham L, Bradley K, Ferrari S, Palmerini E, Picci P, Dirksen U, Strauss SJ, Hogendoorn PCW, Buddingh E, Blay JY, Cleton-Jansen AM, Hassan AB. Outcomes from a mechanistic biomarker multi-arm and randomised study of liposomal MTP-PE (Mifamurtide) in metastatic and/or recurrent osteosarcoma (EuroSarc-Memos trial). BMC Cancer 2022; 22:629. [PMID: 35672690 PMCID: PMC9175372 DOI: 10.1186/s12885-022-09697-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
The phase III clinical study of adjuvant liposomal muramyl tripeptide (MTP-PE) in resected high-grade osteosarcoma (OS) documented positive results that have been translated into regulatory approval, supporting initial promise for innate immune therapies in OS. There remains, however, no new approved treatment such as MTP-PE for either metastatic or recurrent OS. Whilst the addition of different agents, including liposomal MTP-PE, to surgery for metastatic or recurrent high-grade osteosarcoma has tried to improve response rates, a mechanistic hiatus exists in terms of a detailed understanding the therapeutic strategies required in advanced disease. Here we report a Bayesian designed multi-arm, multi-centre, open-label phase II study with randomisation in patients with metastatic and/or recurrent OS, designed to investigate how patients with OS might respond to liposomal MTP-PE, either given alone or in combination with ifosfamide. Despite the trial closing because of poor recruitment within the allocated funding period, with no objective responses in eight patients, we report the design and feasibility outcomes for patients registered into the trial. We demonstrate the feasibility of the Bayesian design, European collaboration, tissue collection with genomic analysis and serum cytokine characterisation. Further mechanistic investigation of liposomal MTP-PE alone and in combination with other agents remains warranted in metastatic OS.
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Affiliation(s)
- David J Barnes
- Oxford Molecular Pathology Institute, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, and Oxford University Hospital NHS Trust, Oxford, OX1 3RE, UK
| | - Peter Dutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and Centre for Statistics in Medicine (CSM), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Øyvind Bruland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo and Department of Oncology-Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Hans Gelderblom
- Leiden University Medical Center, P.O. Box 9600, Postzone K1-P, 2300RC, Leiden, The Netherlands
| | - Ade Faleti
- Department of Oncology Early Phase trials unit and Oncology Clinical Trials Office (OCTO), University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Claudia Bühnemann
- Oxford Molecular Pathology Institute, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, and Oxford University Hospital NHS Trust, Oxford, OX1 3RE, UK
| | - Annemiek van Maldegem
- Oxford Molecular Pathology Institute, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, and Oxford University Hospital NHS Trust, Oxford, OX1 3RE, UK
- Leiden University Medical Center, P.O. Box 9600, Postzone K1-P, 2300RC, Leiden, The Netherlands
| | - Hannah Johnson
- Department of Oncology Early Phase trials unit and Oncology Clinical Trials Office (OCTO), University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Lisa Poulton
- Department of Oncology Early Phase trials unit and Oncology Clinical Trials Office (OCTO), University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Sharon Love
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and Centre for Statistics in Medicine (CSM), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Gesa Tiemeier
- Oxford Molecular Pathology Institute, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, and Oxford University Hospital NHS Trust, Oxford, OX1 3RE, UK
- Leiden University Medical Center, P.O. Box 9600, Postzone K1-P, 2300RC, Leiden, The Netherlands
| | - Els van Beelen
- Leiden University Medical Center, P.O. Box 9600, Postzone K1-P, 2300RC, Leiden, The Netherlands
| | - Karin Herbschleb
- Department of Oncology Early Phase trials unit and Oncology Clinical Trials Office (OCTO), University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Caroline Haddon
- Department of Oncology Early Phase trials unit and Oncology Clinical Trials Office (OCTO), University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK
| | - Lucinda Billingham
- Cancer Research Clinical Trials Unit (Cancer Sciences), Institute of Cancer and Genomic Sciences, Robert Aitken Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Kevin Bradley
- Department of Radiology, Churchill Hospital, Oxford University Hospitals Foundation Trust, Oxford, OX3 7LJ, UK
| | - Stefano Ferrari
- Istituti Ortopedici Rizzoli, Via C. Pupilli 1, 40136, Bologna, Italy
| | | | - Piero Picci
- Istituti Ortopedici Rizzoli, Via C. Pupilli 1, 40136, Bologna, Italy
| | - Uta Dirksen
- Pediatrics III, West German Cancer Centre Network Essen-Muenster, University Hospital Essen, Hufelanstr 55, Essen, 45147, Germany
| | - Sandra J Strauss
- Department of Oncology, UCLH NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Pancras C W Hogendoorn
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and Centre for Statistics in Medicine (CSM), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
- Leiden University Medical Center, P.O. Box 9600, Postzone K1-P, 2300RC, Leiden, The Netherlands
| | - Emmeline Buddingh
- Leiden University Medical Center, P.O. Box 9600, Postzone K1-P, 2300RC, Leiden, The Netherlands
| | | | | | - Andrew Bassim Hassan
- Oxford Molecular Pathology Institute, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, and Oxford University Hospital NHS Trust, Oxford, OX1 3RE, UK.
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and Centre for Statistics in Medicine (CSM), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.
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Luo ZW, Liu PP, Wang ZX, Chen CY, Xie H. Macrophages in Osteosarcoma Immune Microenvironment: Implications for Immunotherapy. Front Oncol 2020; 10:586580. [PMID: 33363016 PMCID: PMC7758531 DOI: 10.3389/fonc.2020.586580] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022] Open
Abstract
Osteosarcoma is a malignant primary bone tumor commonly occurring in children and adolescents. The treatment of local osteosarcoma is mainly based on surgical resection and chemotherapy, whereas the improvement of overall survival remains stagnant, especially in recurrent or metastatic cases. Tumor microenvironment (TME) is closely related to the occurrence and development of tumors, and macrophages are among the most abundant immune cells in the TME. Due to their vital roles in tumor progression, macrophages have gained increasing attention as the new target of tumor immunotherapy. In this review, we present a brief overview of macrophages in the TME and highlight the clinical significance of macrophages and their roles in the initiation and progression of osteosarcoma. Finally, we summarize the therapeutic approaches targeting macrophage, which represent a promising strategy in osteosarcoma therapies.
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Affiliation(s)
- Zhong-Wei Luo
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, China
| | - Pan-Pan Liu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhen-Xing Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, China
| | - Chun-Yuan Chen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Xie
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Movement System Injury and Repair Research Center, Xiangya Hospital, Central South University, Changsha, China
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Organ Injury, Aging and Regenerative Medicine, Changsha, China
- Hunan Key Laboratory of Bone Joint Degeneration and Injury, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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5
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Meyers PA. Muramyl Tripeptide-Phosphatidyl Ethanolamine Encapsulated in Liposomes (L-MTP-PE) in the Treatment of Osteosarcoma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1257:133-139. [PMID: 32483736 DOI: 10.1007/978-3-030-43032-0_11] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The recruitment of autologous macrophages to attack osteosarcoma represents a novel immunotherapy approach to the treatment of osteosarcoma. Muramyl tripeptide-phosphatidyl ethanolamine encapsulated in liposomes (L-MTP-PE) was derived as a compound with the ability to stimulate macrophages to destroy autologous osteosarcoma tumor cells. Preclinical studies including studies in dogs with spontaneously arising osteosarcoma showed the ability of L-MTP-PE to control microscopic metastatic disease in osteosarcoma. A pivotal clinical trial led to the approval of L-MTP-PE for the treatment of newly diagnosed osteosarcoma in over 40 countries.
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Affiliation(s)
- Paul A Meyers
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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6
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Brard C, Piperno-Neumann S, Delaye J, Brugières L, Hampson LV, Le Teuff G, Le Deley MC, Gaspar N. Sarcome-13/OS2016 trial protocol: a multicentre, randomised, open-label, phase II trial of mifamurtide combined with postoperative chemotherapy for patients with newly diagnosed high-risk osteosarcoma. BMJ Open 2019; 9:e025877. [PMID: 31110092 PMCID: PMC6530327 DOI: 10.1136/bmjopen-2018-025877] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The controversial results on the mifamurtide efficacy associated with chemotherapy, issued from the American INT-0133-study, in localised osteosarcomas, and the underpowered analysis performed separately in metastatic patients, should be clarified to homogenise international use of this promising drug. The European Commission has granted a marketing authorisation to mifamurtide combined with postoperative chemotherapy in localised osteosarcomas but not in metastatic patients, while the Food and Drug Administration (FDA) has denied this authorisation. METHODS AND ANALYSIS Sarcome-13/OS2016 trial is a multicentre randomised open-label phase II trial evaluating the survival benefit of mifamurtide administered during 36 weeks in combination with postoperative chemotherapy versus chemotherapy alone, in patients >2 and ≤50 years with newly diagnosed high-risk localised or metastatic osteosarcoma. The main objective is to evaluate the impact on event-free survival (EFS) of mifamurtide on intention-to-treat population. The secondary objectives are to evaluate the impact of mifamurtide on overall survival, to evaluate the feasibility and toxicity of the planned treatment, to correlate biology/immunology with the mifamurtide efficacy/toxicity. With a total of 126 enrolled patients and 51 events, the power is 80% if mifamurtide is associated with an 18% improvement of the 3-year EFS (52%vs70%, equivalent to an HR=0.55), with a one-sided logrank test alpha=10%. As relevant historical data are available (aggregate treatment effect from the INT-0133 trial and individual data from the control group of the Sarcome-09/OS2006 trial), a Bayesian analysis is also planned. ETHICS AND DISSEMINATION This study was approved by the 'Comité de Protection des Personnes Ile de France I' (12/06/2018), complies with the Declaration of Helsinki and French laws and regulations, and follows the International Conference on Harmonisation E6 Guideline for Good Clinical Practice. The trial results, even if they are inconclusive, as well as biological ancillary studies will be presented at appropriate international congresses and published in international peer-review journals. TRIAL REGISTRATION NUMBER EudraCT 2017-001165-24, NCT03643133.
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Affiliation(s)
- Caroline Brard
- CESP, INSERM, Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
| | | | | | - Laurence Brugières
- Department of Childhood and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | - Lisa V Hampson
- Medicaland Pharmaceutical Statistics Research Unit, Departmentof Mathematics and Statistics, FyldeCollege, Lancaster University, Lancaster, United Kingdom
- Statistical Methodology Department, Novartis Pharma AG, Basel, Switzerland
| | - Gwénaël Le Teuff
- CESP, INSERM, Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
| | - Marie-Cécile Le Deley
- CESP, INSERM, Faculté de médecine, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Methodology and Biostatistic Unit, Centre Oscar Lambret, Lille, France
| | - Nathalie Gaspar
- Department of Childhood and Adolescent Oncology, Gustave Roussy, Villejuif, France
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Current and Emerging Targets in Immunotherapy for Osteosarcoma. JOURNAL OF ONCOLOGY 2019; 2019:7035045. [PMID: 30693030 PMCID: PMC6332920 DOI: 10.1155/2019/7035045] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/04/2018] [Indexed: 01/06/2023]
Abstract
Osteosarcoma is the most common primary malignancy of bone. Although outcomes of patients with osteosarcoma have improved since the introduction of chemotherapy, outcomes of metastatic or unresectable osteosarcomas are still unsatisfactory. To improve osteosarcoma outcomes, the development of novel systemic therapies for osteosarcoma is needed. Since the 1880s, various immunotherapies have been utilized in patients with osteosarcoma and some patients have shown response to the treatment. Based on recent studies about the role of the immune system in malignancies, immunotherapies including immune modulators such as interleukin-2 and muramyl tripeptide, dendritic cells, immune checkpoint inhibitors, and engineered T cells have been utilized in patients with malignancies. Although there are limited reports of immunotherapies for osteosarcoma, immunotherapy is thought to be a promising treatment option for treating osteosarcomas. In this review, an overview of various immunotherapies for osteosarcoma is provided and their potential as adjuvant therapies is discussed.
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Nabergoj S, Mlinarič-Raščan I, Jakopin Ž. Harnessing the untapped potential of nucleotide-binding oligomerization domain ligands for cancer immunotherapy. Med Res Rev 2018; 39:1447-1484. [PMID: 30548868 PMCID: PMC6767550 DOI: 10.1002/med.21557] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
In the last decade, cancer immunotherapy has emerged as an effective alternative to traditional therapies such as chemotherapy and radiation. In contrast to the latter, cancer immunotherapy has the potential to distinguish between cancer and healthy cells, and thus to avoid severe and intolerable side‐effects, since the cancer cells are effectively eliminated by stimulated immune cells. The cytosolic nucleotide‐binding oligomerization domains 1 and 2 receptors (NOD1 and NOD2) are important components of the innate immune system and constitute interesting targets in terms of strengthening the immune response against cancer cells. Many NOD ligands have been synthesized, in particular NOD2 agonists that exhibit favorable immunostimulatory and anticancer activity. Among them, mifamurtide has already been approved in Europe by the European Medicine Agency for treating patients with osteosarcoma in combination with chemotherapy after complete surgical removal of the primary tumor. This review is focused on NOD receptors as promising targets in cancer immunotherapy as well as summarizing current knowledge of the various NOD ligands exhibiting antitumor and even antimetastatic activity in vitro and in vivo.
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Affiliation(s)
- Sanja Nabergoj
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | | | - Žiga Jakopin
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
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9
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Galligioni E, Santarosa M, Favaro D, Spada A, Talamini R, Quaia M. In Vitro Synergic Effect of Interferon Gamma Combined with Liposomes Containing Muramyl Tripeptide on Human Monocyte Cytotoxicity Against Fresh Allogeneic and Autologous Tumor Cells. TUMORI JOURNAL 2018; 80:385-91. [PMID: 7839471 DOI: 10.1177/030089169408000514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims The purpose of the present study was to investigate whether human recombinant interferon- γ (hrIFN - γ) can act synergically with various activators in increasing the cytotoxicity of cancer patient monocytes against fresh autologous and allogeneic tumor cells. Methods Fresh target cells were obtained by means on the mechanical and enzymatic dissociation of human renal carcinomas. A 375 and SW 626 cell lines were used as positive controls. Monocytes from renal cancer patients and normal volunteers were activated in vitro with lipopolysaccharide, muramyl tripeptide (MTP-PE) or liposomes containing MTP-PE (MTP-PE liposomes), with or without a pre-incubation with hrIFN- γ and were tested for cytotoxicity by means of a 72-hr 111indium-release assay. All of the patients were tumor free at the time of the study. Results Cancer patient peripheral blood monocytes were activated in vitro by different immunomodulators and became cytotoxic to freshly dissociated autologous or allogeneic tumor cells. A synergic effect producing maximal cytotoxicity was obtained with an appropriately scheduled combination of hrIFN- γ (10 U/ml) and MTP-PE liposomes (50 nm/ml), free lipopolysaccharide (10 μg/ml) or MTP-PE (100 μg/ml). The synergic cytotoxicity was observed against fresh allogeneic and autologous tumor cells, as well as against cultured cells. Conclusions All of these data support the possibility of a combined treatment using hrIFN- γ and MTP-PE liposomes in human studies, particularly when it is borne in mind that liposomes can prevent the direct toxicity of many immunomodulators and that the low levels of hrIFN- γ required for the synergic activation are not toxic in vivo.
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Affiliation(s)
- E Galligioni
- Divisione di Oncologia Medica, Centro di Riferimento Oncologico, Aviano (PN), Italy
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10
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Jimmy R, Stern C, Lisy K, White S. Effectiveness of mifamurtide in addition to standard chemotherapy for high-grade osteosarcoma: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2113-2152. [PMID: 28800058 DOI: 10.11124/jbisrir-2016-003105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Osteosarcoma mostly occurs during the period of rapid bone growth in children and adolescents as high-grade osteosarcomas. Current treatment recommended for high-grade non-metastatic and metastatic and/or relapsed osteosarcoma involves neoadjuvant multiagent conventional chemotherapy, followed by surgical resection of macroscopically detected tumor and postoperative adjuvant chemotherapy. However, residual micrometastatic deposits that develop following surgery have shown resistance to postoperative/adjuvant chemotherapy. Therefore, there is a critical need for more effective and innovative therapeutic approaches such as immune stimulatory agents. The most extensively studied immune stimulatory agent in the treatment of osteosarcoma is mifamurtide. The aim of this systematic review was to identify and synthesize the evidence on the effectiveness of mifamurtide in addition to standard chemotherapy on survival outcomes. OBJECTIVES To present the best available evidence on the treatment of high-grade non-metastatic and metastatic osteosarcoma with mifamurtide in addition to standard chemotherapy. INCLUSION CRITERIA TYPES OF PARTICIPANTS All populations of patients regardless of age, gender or ethnicity with high-grade, resectable, non-metastatic and metastatic osteosarcoma based on histological diagnosis. TYPES OF INTERVENTIONS AND COMPARATORS This review focused on intravenous infusion of either of the pharmaceutical formulations of mifamurtide (MTP-PE or L-MTP-PE) in addition to standard chemotherapy, and the comparator was chemotherapy alone. TYPES OF STUDIES This review considered any experimental study design including randomized controlled trials, non-randomized trials and quasi-experimental studies. OUTCOMES The primary outcomes of interest were event-free survival, overall survival and recurrence of osteosarcoma. Secondary outcomes that were considered included health-related quality of life and any mifamurtide-related adverse events. SEARCH STRATEGY A search for published and unpublished literature in English was undertaken (seven published literature databases, four unpublished literature databases, and three government agency and organizational websites were searched). Studies published between 1990 to June 2016 were considered. A three-step strategy was developed using MeSH terminology and keywords to ensure that all relevant studies were included related to this review. METHODOLOGICAL QUALITY The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using a standardized Joanna Briggs Institute (JBI) critical appraisal tool. DATA EXTRACTION Data was extracted from the studies that were identified as meeting the criteria for methodological quality using the standard JBI data extraction tool. DATA SYNTHESIS Due to the heterogeneity of populations and interventions in available studies, meta-analysis was not possible and results are presented in narrative form. RESULTS Three papers outlining two studies involving 802 patients evaluated the effectiveness of mifamurtide in addition of chemotherapy. Results indicated no significant difference in event-free survival between the addition of mifamurtide to standard chemotherapy regimen and chemotherapy alone, both in non-metastatic and metastatic osteosarcoma patients. There was a significant difference in progression-free survival favoring the addition of mifamurtide in pulmonary metastatic and/or relapsed osteosarcoma. There was no significant difference in overall survival between the addition of mifamurtide and chemotherapy alone in metastatic osteosarcoma; however there was a significant difference favoring the addition of mifamurtide in non-metastatic osteosarcoma patients. The addition of mifamurtide resulted in a significant difference in survival after relapse in pulmonary metastatic and/or relapsed osteosarcoma patients. Both studies reported on mifamurtide-related adverse events - the first was reported as toxicity which included haematological, hepatic, renal, gastrointestinal disorders, cardiac, rhythm and nervous system disorders, ear disorders and others (infection, fever; and performance status) in metastatic osteosarcoma patients. Results were similar across all combined treatment regimens. Although no statistical analysis was undertaken, the figures suggest there were no significant differences between the treatment regimens. In the other study, mifamurtide-related adverse events were reported as clinical toxic effects of mifamurtide in relapsed osteosarcoma, which included chills, fever and headache for the initial dose of mifamurtide, while for the subsequent doses of mifamurtide all patients reported toxicity as delayed fatigue. CONCLUSIONS The available evidence on the effectiveness of mifamurtide in addition to a standard chemotherapy regimen for the treatment of high-grade osteosarcoma is limited and therefore no definitive conclusions can be made.
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Affiliation(s)
- Rincy Jimmy
- 1Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 2Speech Pathology, School of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
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11
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Affiliation(s)
- Yukihiro Namba
- Lipid Project Nippon Fine Chemical Co. Ltd. Takasago, Hyogo 676, Japan
| | - Naoto Oku
- Department of Radiobiochemistry University of Shizuoka Yada, Shizuoka 422, Japan
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Muramyl tripeptide-phosphatidyl ethanolamine encapsulated in liposomes (L-MTP-PE) in the treatment of osteosarcoma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 804:307-21. [PMID: 24924182 DOI: 10.1007/978-3-319-04843-7_17] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bacille Calmette-Guerin (BCG) has been used for decades as an immune stimulant to treat cancer. Early work by Fidler and Kleinerman identified muramyl dipeptide (MDP) as a critical component of the BCG cell wall which retained most of the immunostimulatory properties of the native BCG. Addition of a peptide to MDP resulted in muramyl tripeptide (MTP) which allowed incorporation into liposomal membranes. The resulting pharmaceutical, liposomal muramyl tripeptide phosphatidyl ethanolamine (L-MTP-PE or mifamurtide) showed activity in preclinical models of human cancers. Phase I studies documented the safety of the compound for human administration. These trials did not reach a maximally tolerated dose (MTD), and the dose chosen for phase II trials was a biologically optimized dose, not an MTD. Phase II studies showed decreased risk of further recurrence in patients who received mifamurtide after surgical ablation of metastatic osteosarcoma. A phase III prospective randomized trial demonstrated a statistically significant reduction in the risk of death from osteosarcoma when MTP was added to systemic chemotherapy for the treatment of localized osteosarcoma. The same trial allowed treatment of patients who presented with initially metastatic disease. While the overall and event-free survival was improved in patients with metastatic osteosarcoma who received L-MTP-PE, the sample size was small and the improvement did not achieve conventional statistical significance. From 2008 to 2012, patients with metastatic and recurrent osteosarcoma were given L-MTP-PE in an expanded access trial, and the results suggest a decreased risk of subsequent recurrence and death with the inclusion of L-MTP-PE in the treatment strategy for these high-risk patients.
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Jimmy R, White S, Lisy K. Effectiveness of mifamurtide in addition to standard chemotherapy for high-grade osteosarcoma: a systematic review protocol. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Constantinidou A, Pollack S, Loggers E, Rodler E, Jones RL. The evolution of systemic therapy in sarcoma. Expert Rev Anticancer Ther 2013; 13:211-23. [PMID: 23406562 DOI: 10.1586/era.12.161] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Approximately 50% of patients with localized soft tissue sarcomas will develop recurrent disease after complete surgical resection, requiring alternative means of treatment. Conventional chemotherapy comprising of doxorubicin and ifosfamide has shown benefit in advanced disease, however, there remains a clear need for more effective, less toxic, therapies for the treatment of this heterogeneous group of mesenchymal malignancies. Recently, greater emphasis has been placed on the underlying biology of individual sarcoma subtypes, with the development and evaluation of novel therapies both in common and in rare subtypes. In addition, there is a greater specificity in the selection of chemotherapy agents based on activity in individual histological subtypes. Despite these advances the management of sarcoma, and in particular of rare subtypes, remains a major challenge. Some histological subtypes are resistant to conventional chemotherapy and patients with these diseases should be offered participation in early phase clinical trials of novel drugs.
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Ando K, Mori K, Corradini N, Redini F, Heymann D. Mifamurtide for the treatment of nonmetastatic osteosarcoma. Expert Opin Pharmacother 2011; 12:285-92. [PMID: 21226638 DOI: 10.1517/14656566.2011.543129] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The standard treatment for osteosarcoma requires both macroscopic surgical wide resection and postoperative multi-drug chemotherapy in neoadjuvant and adjuvant settings. However, the 5-year event-free survival has remained at a plateau of 60-70% of patients with nonmetastatic osteosarcoma for more than 30 years. AREAS COVERED Mifamurtide (liposomal muramyl tripeptide phosphatidylethanolamine; L-MTP-PE) is a new agent. L-MTP-PE is a nonspecific immunomodulator, which is a synthetic analog of a component of bacterial cell walls. L-MTP-PE activates macrophages and monocytes as a potent activator of immune response in addition to standard chemotherapy. It also improves the overall survival from 70 to 78% and results in a one-third reduction in the risk of death from osteosarcoma. This review summarizes the most recent findings about L-MTP-PE and its therapeutic application for nonmetastatic osteosarcoma. EXPERT OPINION Recently, L-MTP-PE has been approved in Europe for the treatment of nonmetastatic osteosarcoma with chemotherapy. L-MTP-PE in combination with traditional treatment is expected to go mainstream and to be beneficial for patients with osteosarcoma. Information about potential benefit regarding mifamurtide use in the neoadjuvant setting (i.e., before surgery) and/or usefulness of L-MTP-PE in metastatic in relapsed and metastatic osteosarcoma requires analysis of expanded access and/or future clinical trials of L-MTP-PE in high-burden and low-burden situations.
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Affiliation(s)
- Kosei Ando
- Shiga University of Medical Science, Department of Orthopaedic Surgery, Otsu, Shiga, Japan.
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Abstract
Purpose. Original articles and abstracts published between January 1991 and January 1997
were selected according to specified criteria and reviewed to provide answers to five interesting questions about the
systemic treatment of metastatic osteosarcoma. Results. (1) In patients with metastatic disease at presentation, what is the outcome after intensive multi-agent chemotherapy? Historically, survival has been poor, but may be improving with the use of ifosfamide-containing regimens. (2) Can response to new agents be evaluated better in patients who have received no previous chemotherapy? Based on limited data, this is probably true. (3) Is the response to neo-adjuvant chemotherapy, as determined by histopathology, similar for the primary tumor and
synchronous pulmonary metastases? With intensive multi-agent chemotherapy, good histological response rates are in the range 70–90% for both groups. (4) What is the outcome, after intensive combined modality treatment with chemotherapy and surgery, in patients
relapsing with metastases after previous adjuvant chemotherapy, and what are the important prognostic factors? Outcome is highly variable, but 5-year survival ranges between 25 and 50% and a good outcome is more likely if
recurrent disease is limited to resectable lung metastases. (5) Can a biological agent (L-MTP-PE) prolong the time to relapse in patients with resected metastatic osteosarcoma? Preliminary data suggest that this is possible, but more studies are required.
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Affiliation(s)
- V Bramwell
- London Regional Cancer Centre University of Western Ontario 790 Commissioners Road, East Ontario London N6A 4L6 Canada
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Abstract
Mifamurtide (liposomal muramyl tripeptide phosphatidyl ethanolamine; Mepact) is an immunomodulator with antitumor effects that appear to be mediated via activation of monocytes and macrophages. In the EU, mifamurtide is indicated in children, adolescents, and young adults for the treatment of high-grade, resectable, non-metastatic osteosarcoma after macroscopically complete surgical resection; it is administered by intravenous infusion in conjunction with postoperative multiagent chemotherapy. In the US, mifamurtide is currently an investigational agent that holds orphan drug status for the treatment of osteosarcoma. In a large, randomized, open-label, multicenter, phase III trial, the addition of adjuvant (postoperative) mifamurtide to three- or four-drug combination chemotherapy (doxorubicin, cisplatin, and high-dose methotrexate with, or without, ifosfamide) was associated with a statistically significant improvement in overall survival in patients with newly diagnosed, high-grade, non-metastatic, resectable osteosarcoma. The pattern of outcome was generally similar in a small cohort of patients with metastatic disease who were enrolled in this trial. Mifamurtide is generally well tolerated; adverse events attributed to administration of the drug include chills, fever, headache, nausea, and myalgias. Based on the available data, mifamurtide can be considered for inclusion in treatment protocols for localized osteosarcoma.
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Affiliation(s)
- James E Frampton
- Adis, a Wolters Kluwer Business, Mairangi Bay, North Shore, Auckland, New Zealand.
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Meyers PA. Muramyl tripeptide (mifamurtide) for the treatment of osteosarcoma. Expert Rev Anticancer Ther 2009; 9:1035-49. [PMID: 19671023 DOI: 10.1586/era.09.69] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteosarcoma is an ultraorphan disease. There are approximately 1000 new patients diagnosed with osteosarcoma each year in the USA and Europe. Current treatment for osteosarcoma utilizes multiagent chemotherapy and surgical resection of all clinically detectable disease. Current treatments for osteosarcoma achieve 60-70% event-free survival (EFS) for patients with localized disease and approximately 20% EFS for patients who present with metastasis. These results have been stable for two decades. The addition of muramyl tripeptide (mifamurtide) to chemotherapy resulted in a trend towards improved EFS and a one-third reduction in the risk of death from osteosarcoma. Mifamurtide has been approved in Europe for the treatment of newly diagnosed osteosarcoma in combination with chemotherapy.
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Affiliation(s)
- Paul A Meyers
- Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Siegel HJ, Pressey JG. Current concepts on the surgical and medical management of osteosarcoma. Expert Rev Anticancer Ther 2008; 8:1257-69. [PMID: 18699764 DOI: 10.1586/14737140.8.8.1257] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although advances have been made in both surgical and medical management of patients with osteosarcoma, the overall survival of patients with osteosarcoma has remained constant, with no substantial improvement in the past 15 years. Advances in imaging have had a substantial impact on surgical planning and staging. These advances have, in turn, had a major impact on the surgeon's ability to perform limb-sparing surgery. Surgical techniques have improved in terms of instrumentation, modularity of implants and availability. Limb salvage has proven to be an acceptable method of treatment both with respect to oncologic and functional outcome in those patients where a wide resection may be achieved. The use of massive allografts has been largely replaced with the use of modern oncologic endoprostheses. Biologic targets that will enable new therapies to have maximum effect on tumor cells while minimizing toxicity to the host tissues need to be identified.
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Affiliation(s)
- Herrick J Siegel
- University of Alabama at Birmingham, Orthopedic Specialties Building, 1313 13th St South, Suite 211, Birmingham, AL 35205, USA.
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Mifamurtide: CGP 19835, CGP 19835A, L-MTP-PE, liposomal MTP-PE, MLV 19835A, MTP-PE, muramyltripeptide phosphatidylethanolamine. Drugs R D 2008; 9:131-5. [PMID: 18298131 DOI: 10.2165/00126839-200809020-00007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Mifamurtide is a conjugate of muramyl tripeptide linked to dipalmitoyl phosphatidyl ethanolamine; the phospholipid facilitates incorporation of the peptide into liposomes. The agent stimulates macrophages to seek out and destroy cancer cells. The compound was originated by Novartis (formerly CIBA-Geigy), and is being developed by IDM Pharma for osteosarcoma. Mifamurtide is being reviewed by regulatory authorities in the US and EU for this indication.CIBA-Geigy originally developed mifamurtide in the early 1980s and the agent was subsequently outlicensed to Jenner Biotherapies in the 1990s. IDM Pharma acquired the rights to the drug from Jenner in April 2003.IDM and Genesis Pharma have entered into an exclusive licensing and marketing agreement for mifamurtide in South East Europe. Under the agreement terms, IDM will receive an upfront fee from Genesis, as well as milestone payments on reaching certain sales levels in the territory. Medison Pharma signed an agreement with IDM Pharma for the sales and marketing of mifamurtide in Israel. IDM will receive an upfront license fee from Medison and will be entitled to receive a milestone payment upon regulatory approval of the agent in Israel, as well as royalties on net sales.IDM outlicensed exclusive marketing rights for mifamurtide in the UK and Ireland to Cambridge Laboratories in June 2005. In exchange, IDM is entitled to an upfront license fee and milestone payments prior to launch, as well as royalties calculated on product sales.Previously, Chiron Vaccines (a joint venture between Novartis and Chiron formed in 1995) investigated mifamurtide as an adjuvant in HIV gp120 vaccine; however, development has been discontinued.IDM Pharma will purchase approximately 7.1 million shares of its common stock to raise approximately $US23.5 million in net proceeds. The company intends to use the funds for working capital and corporate purposes, including the company's activities related to gaining marketing approval of mifamurtide in the US and Europe. Following the announcement by ODAC in May 2007, IDM Pharma decided to amend the NDA for mifamurtide with additional vital status data from the completed phase III trial. This data was not available at the time the original filing was made, and the company believes that capturing this supplemental data will overcome the need for additional trials, further confirm the overall survival benefit of mifamurtide in osteosarcoma, and provide evidence for approvability. IDM Pharma intends to analyse the additional follow-up data and submit an amendment to the agency by the first quarter of 2008; the company is also working on addressing other concerns raised by the US FDA in the non-approvable letter. The US regulatory submission included safety and efficacy data from NCI-funded phase III trials in 678 patients with osteosarcoma conducted by the Pediatric Oncology Group and the Children's Cancer Group in over 147 US centres. The NDA also included safety and biological effects data of mifamurtide from 17 phase I and II studies in 248 patients conducted by Ciba-Geigy. In the EU, IDM Pharma filed a MAA with the EMEA in November 2006 for approval of mifamurtide (Mepacttrade mark) in combination with postoperative chemotherapy for the treatment of patients with newly diagnosed osteosarcoma following complete surgical resection. The company expects that the EMEA will make a decision regarding marketing approval for mifamurtide by the end of 2007. Mifamurtide has orphan drug status for the treatment of osteosarcoma in the US and EU.
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Mori K, Ando K, Heymann D. Liposomal muramyl tripeptide phosphatidyl ethanolamine: a safe and effective agent against osteosarcoma pulmonary metastases. Expert Rev Anticancer Ther 2008; 8:151-9. [PMID: 18279055 DOI: 10.1586/14737140.8.2.151] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteosarcoma is the most common form of primary malignant bone tumor. The use of chemotherapy drugs with many side effects, including high-dose methotrexate, doxorubicin, cisplatin and ifosfamide, has greatly improved osteosarcoma survival compared with surgery alone. However, for 20 years, overall survival remained at a plateau of 60-70% in nonmetastatic disease and 20-30% in metastatic osteosarcoma owing to lung metastases. Liposomal muramyl tripeptide phosphatidyl ethanolamine (L-MTP-PE) is a new agent that improves overall osteosarcoma survival (chemotherapy without L-MTP-PE 70% versus with L-MTP-PE 78%; p = 0.03). L-MTP-PE offers additional benefit for osteosarcoma treatment in combination with chemotherapy, particularly ifosfamide-containing regimens. Clinical experience indicates that side effects such as fever are temporary and controlled or prevented with ibuprofen and/or acetoaminophen premedication; severe side effects are rare. Although surgery will remain the main approach for osteosarcoma treatment of lung metastases, L-MTP-PE combined with other modalities, including chemotherapy, appears to be of benefit in these patients as well.
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Affiliation(s)
- Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Otsu, Shiga, 520-2192 Japan.
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Meyers PA, Schwartz CL, Krailo MD, Healey JH, Bernstein ML, Betcher D, Ferguson WS, Gebhardt MC, Goorin AM, Harris M, Kleinerman E, Link MP, Nadel H, Nieder M, Siegal GP, Weiner MA, Wells RJ, Womer RB, Grier HE. Osteosarcoma: the addition of muramyl tripeptide to chemotherapy improves overall survival--a report from the Children's Oncology Group. J Clin Oncol 2008; 26:633-8. [PMID: 18235123 DOI: 10.1200/jco.2008.14.0095] [Citation(s) in RCA: 490] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare three-drug chemotherapy with cisplatin, doxorubicin, and methotrexate with four-drug chemotherapy with cisplatin, doxorubicin, methotrexate, and ifosfamide for the treatment of osteosarcoma. To determine whether the addition of muramyl tripeptide (MTP) to chemotherapy enhances event-free survival (EFS) and overall survival in newly diagnosed patients with osteosarcoma. PATIENTS AND METHODS Six hundred sixty-two patients with osteosarcoma without clinically detectable metastatic disease and whose disease was considered resectable received one of four prospectively randomized treatments. All patients received identical cumulative doses of cisplatin, doxorubicin, and methotrexate and underwent definitive surgical resection of primary tumor. Patients were randomly assigned to receive or not to receive ifosfamide and/or MTP in a 2 x 2 factorial design. The primary end points for analysis were EFS and overall survival. RESULTS In the current analysis, there was no evidence of interaction, and we were able to examine each intervention separately. The chemotherapy regimens resulted in similar EFS and overall survival. There was a trend toward better EFS with the addition of MTP (P = .08). The addition of MTP to chemotherapy improved 6-year overall survival from 70% to 78% (P = .03). The hazard ratio for overall survival with the addition of MTP was 0.71 (95% CI, 0.52 to 0.96). CONCLUSION The addition of ifosfamide to cisplatin, doxorubicin, and methotrexate did not enhance EFS or overall survival for patients with osteosarcoma. The addition of MTP to chemotherapy resulted in a statistically significant improvement in overall survival and a trend toward better EFS.
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Meyers PA, Schwartz CL, Krailo M, Kleinerman ES, Betcher D, Bernstein ML, Conrad E, Ferguson W, Gebhardt M, Goorin AM, Harris MB, Healey J, Huvos A, Link M, Montebello J, Nadel H, Nieder M, Sato J, Siegal G, Weiner M, Wells R, Wold L, Womer R, Grier H. Osteosarcoma: A Randomized, Prospective Trial of the Addition of Ifosfamide and/or Muramyl Tripeptide to Cisplatin, Doxorubicin, and High-Dose Methotrexate. J Clin Oncol 2005; 23:2004-11. [PMID: 15774791 DOI: 10.1200/jco.2005.06.031] [Citation(s) in RCA: 506] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine whether the addition of ifosfamide and/or muramyl tripeptide (MTP) encapsulated in liposomes to cisplatin, doxorubicin, and high-dose methotrexate (HDMTX) could improve the probability for event-free survival (EFS) in newly diagnosed patients with osteosarcoma (OS). Patients and Methods Six hundred seventy-seven patients with OS without clinically detectable metastatic disease were treated with one of four prospectively randomized treatments. All patients received identical cumulative doses of cisplatin, doxorubicin, and HDMTX and underwent definitive surgical resection of the primary tumor. Patients were randomly assigned to receive or not to receive ifosfamide and/or MTP in a 2 × 2 factorial design. The primary end point for analysis was EFS. Results Patients treated with the standard arm of therapy had a 3-year EFS of 71%. We could not analyze the results by factorial design because we observed an interaction between the addition of ifosfamide and the addition of MTP. The addition of MTP to standard chemotherapy achieved a 3-year EFS rate of 68%. The addition of ifosfamide to standard chemotherapy achieved a 3-year EFS rate of 61%. The addition of both ifosfamide and MTP resulted in a 3-year EFS rate of 78%. Conclusion The addition of ifosfamide in this dose schedule to standard chemotherapy did not enhance EFS. The addition of MTP to chemotherapy might improve EFS, but additional clinical and laboratory investigation will be necessary to explain the interaction between ifosfamide and MTP.
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Affiliation(s)
- Paul A Meyers
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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Marina N, Gebhardt M, Teot L, Gorlick R. Biology and therapeutic advances for pediatric osteosarcoma. Oncologist 2004; 9:422-41. [PMID: 15266096 DOI: 10.1634/theoncologist.9-4-422] [Citation(s) in RCA: 483] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Osteosarcoma is the most common malignant bone tumor in children and adolescents. Survival for these patients was poor with the use of surgery and/or radiotherapy. The introduction of multi-agent chemotherapy dramatically improved the outcome for these patients and the majority of modern series report 3-year disease-free survival of 60%-70%. This paper describes current strategies for treating patients with osteosarcoma as well as review of the clinical features, radiologic and diagnostic work-up, and pathology. The authors review the state of the art management for patients with osteosarcoma in North America and Europe including the use of limb-salvage procedures and reconstruction as well as discuss the etiologic and biologic factors associated with tumor development. Therapy-related sequelae and future directions in the biology and therapy for these patients are also discussed.
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Affiliation(s)
- Neyssa Marina
- Department of Pediatrics, Division of Hematology-Oncology, Stanford University Medical Center, Stanford, California 94305-5208, USA.
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Chun R, de Lorimier LP. Update on the biology and management of canine osteosarcoma. Vet Clin North Am Small Anim Pract 2003; 33:491-516, vi. [PMID: 12852233 DOI: 10.1016/s0195-5616(03)00021-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Osteosarcoma (OSA) is the most common primary bone tumor diagnosed in dogs. Our understanding of the risk factors and genetic changes in canine OSA patients is growing, but specific, innovative therapeutic strategies are slow in coming. Appendicular skeletal osteosarcoma, the most frequent form of this disease, is typically seen in large to giant breeds, with males being overrepresented in most reports. Axial skeletal OSA is less common than appendicular OSA, but the biologic behavior of the disease is equally aggressive in all skeletal sites except for the mandible. Though the current standard of care for dogs with osteosarcoma remains surgical resection of the affected site, followed by chemotherapy with either a platinum- (cisplatin or carboplatin) or doxorubicin-based protocol, novel therapies are being actively investigated.
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Affiliation(s)
- Ruthanne Chun
- Kansas State University College of Veterinary Medicine, Mosier Hall, 1800 Denison Avenue, Manhattan, KS 66506-5606, USA.
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Cytotoxicity of antiosteosarcoma recombinant immunotoxins composed of TP-3 Fv fragments and a truncated Pseudomonas exotoxin A. J Immunother 2001. [PMID: 11265772 DOI: 10.1097/00002371-200103000-00009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Regrowth of drug-resistant tumor cells is responsible for approximately half of an unselected osteosarcoma population still dying of the disease despite aggressive combination therapy. Two monoclonal antibodies, TP-1 (immunoglobulin 2a) and TP-3 (immunoglobulin 2b) are available, which specifically recognize an antigen on osteosarcoma cells. In this work, we have fused the variable (V) genes of TP-3 to a truncated fragment of Pseudomonas exotoxin A, referred to as PE38. Two immunotoxins were made that differed in the Fv portion: TP-3(scFv)-PE38, which contains a peptide linker, and TP-3(dsFv)-PE38, which contains a disulfide bond for stabilization of the association between the V domains. Recombinant TP-3 immunotoxins were expressed in Escherichia coli and purified from inclusion bodies. We describe the design and expression of these immunotoxins, and their properties with regard to antigen binding, stability, and cytotoxicity. Toxicity studies were done in mice. We found that the immunotoxins exhibited very similar in vitro properties, whereas in vivo TP-3(dsFv)-PE38 was much better tolerated than TP-3(scFv)-PE38.
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Abstract
A comprehensive multidisciplinary approach has transformed osteosarcoma from a disease with a modest long-term survival to one in which at least two-thirds of patients will be cured. Surgery remains the vital modality for treating the primary tumor, whereas adjuvant chemotherapy plays an essential role in the control of subclinical metastatic disease. Complete surgical excision of the primary tumor remains an essential element of treatment. For many patients, a combination of advances in surgical technique, improved imaging modalities to accurately document tumor extent, and the effect of neoadjuvant chemotherapy has made limb salvage procedures a safe alternative to amputation. In some patients for whom complete surgical excision is impossible, the addition of radiation therapy may allow local tumor control. The most effective chemotherapy agents currently in use include high-dose methotrexate, doxorubicin, cisplatin, and ifosfamide/etoposide. The optimal schedule of therapy is still being investigated, as is the role of dose intensification. Unfortunately, some groups of patients remain at high risk of eventual relapse. Those whose tumors show relatively low degrees of necrosis after administration of chemotherapy have poorer survival than patients with more chemotherapy-responsive tumors. Similarly, patients who present with overt metastatic disease (particularly bone metastases), as well as patients with tumors that recur after treatment, continue to have an unsatisfactory outcome. These groups, in particular, may benefit from future investigations into novel agents, such as biological response modifiers, antiangiogenesis factors, and growth receptor modulation.
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Affiliation(s)
- W S Ferguson
- Division of Pediatric Hematology-Oncology, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
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Ham SJ, Schraffordt Koops H, van der Graaf WT, van Horn JR, Postma L, Hoekstra HJ. Historical, current and future aspects of osteosarcoma treatment. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1998; 24:584-600. [PMID: 9870738 DOI: 10.1016/s0748-7983(98)93896-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- S J Ham
- Department of Orthopaedic Surgery, Groningen University Hospital, The Netherlands
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Affiliation(s)
- J S Dome
- Johns Hopkins Oncology Center, Division of Pediatric Oncology, Baltimore, MD 21287, USA
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Abstract
Over the last several decades, significant advances have been made in our ability to understand and treat osteosarcoma. In this article we describe the diagnosis, evaluation, and treatment of patients with this disease. The surgical issues are discussed. We review the major clinical trials that have led to our current level of understanding. The current studies for the treatment of osteosarcoma are described.
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Affiliation(s)
- P A Meyers
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Killion JJ, Bucana CD, Radinsky R, Dong Z, O'Reilly T, Bilbe G, Tarcsay L, Fidler IJ. Maintenance of intestinal epithelium structural integrity and mucosal leukocytes during chemotherapy by oral administration of muramyl tripeptide phosphatidylethanolamine. Cancer Biother Radiopharm 1996; 11:363-71. [PMID: 10851497 DOI: 10.1089/cbr.1996.11.363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The systemic administration of doxorubicin (DXR) decreases the number of epithelial cells and leukocytes in the small intestine of mice. Oral administration of muramyl tripeptide phosphatidylethanolamine (MTP-PE) prevented both disruption of intestinal architecture, and a decrease in the number of macrophages, and it induced the expression of IL-6, G-CSF, GM-CSF, and TNF-alpha in the intestinal tissue. The data suggest that the oral administration of MTP-PE can prevent chemotherapy-induced toxicity to the intestinal mucosa and hence infections due to translocation of aerobic bacteria from the intestine to the blood.
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Affiliation(s)
- J J Killion
- Department of Cell Biology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA
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MacEwen EG, Kurzman ID. Canine osteosarcoma: amputation and chemoimmunotherapy. Vet Clin North Am Small Anim Pract 1996; 26:123-33. [PMID: 8825571 DOI: 10.1016/s0195-5616(96)50011-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Canine osteosarcoma is a highly metastatic cancer commonly seen in large breed dogs. At the time of diagnosis, approximately 90% to 95% of the dogs have established micrometastases. Dogs undergoing amputation alone have a median survival time of 3 to 4 months. Amputation followed by cisplatin chemotherapy increases median survival times to 9 to 11 months. When dogs are treated with amputation and cisplatin, followed by immunotherapy (with liposome-encapsulated muramyl tripeptide phosphatidylethanolamine), median survival times increase to 14.4 months, the longest reported median survival time for dogs with osteosarcoma treated by amputation and any form of adjuvant therapy.
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Affiliation(s)
- E G MacEwen
- Department of Medical Sciences, University of Wisconsin, Madison 53706, USA
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Daemen T, Hoedemakers R, Storm G, Scherphof GL. Opportunities in targeted drug delivery to Kupffer cells: delivery of immunomodulators to Kupffer cells-activation of tumoricidal properties. Adv Drug Deliv Rev 1995. [DOI: 10.1016/0169-409x(95)00038-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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34
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Kleinerman ES. Biologic Therapy for Osteosarcoma Using Liposome-Encapsulated Muramyl Tripeptide. Hematol Oncol Clin North Am 1995. [DOI: 10.1016/s0889-8588(18)30079-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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35
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36
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Fidler IJ. Therapy of cancer metastasis by systemic activation of macrophages. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 1994; 30:271-326. [PMID: 7833294 DOI: 10.1016/s1054-3589(08)60177-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- I J Fidler
- Department of Cell Biology, University of Texas M. D. Anderson Cancer Center, Houston 77030
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37
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Barna BP, Thomassen MJ, Maier M, Medendorp SV, Tubbs RR, Chiang T, Zhou P, Yen-Lieberman B, Singh-Burgess S, Deodhar SD. Combination therapy with a synthetic peptide of C-reactive protein and interleukin 2: augmented survival and eradication of pulmonary metastases. Cancer Immunol Immunother 1994; 38:38-42. [PMID: 8299117 PMCID: PMC11038352 DOI: 10.1007/bf01517168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/1993] [Accepted: 08/24/1993] [Indexed: 01/29/2023]
Abstract
A synthetic peptide (RS-83277) derived from the structure of human C-reactive protein (CRP) was previously shown to have antitumor activity in three different murine tumor models when administered in multilamellar vesicles (MLV). The therapeutic effects were comparable to those seen with MLV-encapsulated native CRP. The present study evaluated the therapeutic and immunomodulatory effects of administering CRP peptide RS-83277 MLV simultaneously with low-dose recombinant interleukin-2 (IL-2) to C57Bl/6 mice bearing established pulmonary metastases of fibrosarcoma T241. Results demonstrated that the capacity of RS-83277 MLV to inhibit tumor metastases and prolong survival was significantly augmented by combination with 10,000 U/day IL-2 i.p. Treated animals showed no evidence of toxicity. By immunohistochemistry, increased Thy 1.2+ cells were detectable in lungs of RS-83277 MLV/IL-2-treated animals compared to those receiving RS-83277 MLV alone. Circulating tumor necrosis factor alpha (TNF) and interferon (IFN) were not detectable in animals receiving RS-83277 MLV alone, but TNF was significantly elevated in animals receiving IL-2. In the presence of combination therapy, however, circulating TNF was not detectable. Results suggest that the combination of synthetic CRP peptide RS-83277 MLV and low-dose IL-2 offers a therapeutic advantage over either agent alone.
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Affiliation(s)
- B P Barna
- Division of Pathology and Laboratory Medicine, Cleveland Clinic Foundation, OH 41195
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38
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Galligioni E, Quaia M, Spada A, Favaro D, Santarosa M, Talamini R, Monfardini S. Activation of cytolytic activity in peripheral blood monocytes of renal cancer patients against non-cultured autologous tumor cells. Int J Cancer 1993; 55:380-5. [PMID: 8375921 DOI: 10.1002/ijc.2910550307] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Our purpose was to evaluate the ability of blood monocytes of renal cancer patients to become cytotoxic against fresh, autologous tumor cells. Fresh target cells were obtained by mechanical enzymatic dissociation of tumor and normal renal tissue. The A375 cell line, derived from a human melanoma, and the SW626 cell line, derived from a human ovarian carcinoma, were used as positive target cell controls. Monocytes from renal cancer patients and normal volunteers were activated in vitro with lipopolysaccharide (LPS), or muramyl tripeptide (MTP-PE), or multilamellar vesicle liposomes containing MTP-PE (MLV-MTP-PE), with or without a pre-incubation with r-IFN-gamma, and tested for cytotoxicity in a 72-hr 111Indium-release assay. All patients were tumor-free at the time of the monocyte study. No difference in cytotoxic activity was observed between monocytes from healthy volunteers and those from cancer patients. Freshly dissociated tumor cells were as susceptible to tumoricidal monocytes as the 2 cell lines. Moreover, no cell population appeared to be resistant to activated monocytes, which were cytotoxic to both allogeneic and autologous fresh tumor cells. Activated monocytes maintained their ability to discriminate between normal and neoplastic cells and were not cytotoxic against autologous or allogeneic normal non-neoplastic cells. Our data indicate that MLV MTP-PE liposomes activate peripheral blood monocytes from cancer patients to a tumoricidal status against fresh, dissociated non-cultured autologous tumor cells.
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39
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Fidler IJ, Kleinerman ES. Therapy of cancer metastasis by systemic activation of macrophages: from the bench to the clinic. RESEARCH IN IMMUNOLOGY 1993; 144:284-7; discussion 294-8. [PMID: 8378598 DOI: 10.1016/0923-2494(93)80109-c] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- I J Fidler
- Department of Cell Biology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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40
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Fujimaki W, Itoh K, An T, Gano JB, Ross MI, Mansfield PF, Balch CM, Augustus LB, Karkevitch DD, Johnston D. Cytokine production and immune cell activation in melanoma patients treated with liposomal muramyl tripeptide (CGP 19835A lipid). CANCER BIOTHERAPY 1993; 8:307-18. [PMID: 7804372 DOI: 10.1089/cbr.1993.8.307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We conducted a pilot study using liposome-encapsulated muramyl tripeptide phosphatidylethanolamine (L-MTP-PE) preoperatively in patients with stage III or IV resectable melanoma who were at high risk for recurrence. Patients received L-MTP-PE for 1 month before surgery and then 5 months postoperatively. Several immune parameters were monitored during preoperative therapy to search for correlations with clinical (tumor) response. The 18 patients were classified into three groups according to their responses and disease-free intervals: no evidence of disease (NED) at week 24 of therapy, relapse during therapy and progressive disease on therapy noted at the time of surgery. Six of nine patients in the NED group demonstrated increased monocyte tumoricidal activity (MTA) during week 1 of therapy. MTA increased in three of the six patients in the relapse group. MTA did not increase in the three patients who had progressive disease on therapy. Plasma neopterin levels were elevated by 72 h following the first L-MTP-PE dose in all 18 patients. Circulating levels of tumor necrosis factor were elevated in 15 of 16 patients tested, and IL-6 levels were elevated in all 18 patients. Melanoma cells from all three patients with progressive disease at the time of surgery proliferated well in vitro, whereas tumor cells from 10 of the 15 patients in the other two groups did not proliferate. There were no discernible differences among the three groups in the magnitude of IL-2-induced proliferation of tumor infiltrating lymphocytes. However, IL-2-activated TILs from the NED group exhibited cytotoxicity against autologous tumor cells in vitro. In summary, whereas L-MTP-PE stimulated several immunologic responses in all patients, the only two parameters that correlated with clinical status were MTA and the tumor proliferation assay. These two biologic assays could serve to distinguish potential responders from nonresponders early in the course of treatment.
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Affiliation(s)
- W Fujimaki
- Department of Cell Biology, University of Texas M. D. Anderson Cancer Center, Houston 77030
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41
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Kleinerman ES, Maeda M, Jaffe N. Liposome-encapsulated muramyl tripeptide: a new biologic response modifier for the treatment of osteosarcoma. Cancer Treat Res 1993; 62:101-107. [PMID: 8096724 DOI: 10.1007/978-1-4615-3518-8_14] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We have demonstrated that monocytes from osteosarcoma patients can be rendered tumor cytotoxic by both in vitro incubation with liposomal MTP-PE and i.v. administration of this agent. Chemotherapy did not interfere with this activation process. We have further demonstrated in phase I and phase II trials that liposomal MTP-PE can be given safely i.v. to both adults and children with minimal side effects. The findings of peripheral fibrosis with neovascularization and infiltration of the tumor with chronic inflammatory cells after liposomal MTP-PE therapy are unlike any observed following chemotherapy or surgery. Subsequent to chemotherapy, osteosarcoma lung metastases usually exhibit a zone of central necrosis, with viable tumor cells growing at the periphery of the lesion. However, in our patients following liposomal MTP-PE viable tumor cells were observed in the center of the lesion, with necrosis and fibrosis at the periphery. These changes were thus interpreted as a specific response to liposomal MTP-PE. The peripheral fibrosis observed in these tumors is reminiscent of the appearance of pulmonary tuberculosis lesions. Initially, the lesion is walled off and slow necrosis proceeds from the outside so that the lesion is replaced by fibrous tissue. Eradication of tuberculosis by chronic inflammation is a slow process. Viable bacilli can persist for months. Thus, our choice of a 3-month treatment course may have been insufficient. We have now extended our protocol to allow 6 months of therapy. Osteosarcoma appears to be an ideal disease in which to employ liposomal MTP-PE as an additional adjuvant to present chemotherapy regimens.(ABSTRACT TRUNCATED AT 250 WORDS)
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Utsugi T, Brown D, Nii A, Fidler IJ. Frozen-thawed human blood monocytes respond reproducibly to activation stimuli: implications for screening of BRMs. BIOTHERAPY (DORDRECHT, NETHERLANDS) 1992; 5:301-8. [PMID: 1290726 DOI: 10.1007/bf02179048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of this study was to identify the optimal freezing conditions for human blood monocytes to allow their recovery and use for in vitro screening of activation stimuli. Human monocytes separated from buffy coats of healthy blood donors were suspended at a density of 1 x 10(7) cells/ml in freezing medium consisting of 70% medium: 20% fetal bovine serum: 10% DMSO frozen in a stepdown freezer, and stored at -180 degrees C. Monocytes were thawed at different times up to 4 months later. Viability was > 90%. Fresh monocytes from different donors and frozen monocytes thawed at different times were incubated with different concentrations of lipopolysaccharide, muramyl tripeptide, muramyl dipeptide, or lipopeptide. Tumoricidal activity and IL-1 production of fresh monocytes varied greatly among the 5 different preparations. In contrast, the frozen monocytes (thawed at different times) produced uniform levels of antitumor activity and IL-1 production. These results show that monocytes recovered from frozen storage maintain their ability to respond to activation stimuli in a uniform and reproducible manner. Thus, the use of frozen-thawed monocytes is recommended for screening of macrophage-activating agents.
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Affiliation(s)
- T Utsugi
- Department of Cell Biology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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Sugarman SM, Perez-Soler R. Liposomes in the treatment of malignancy: a clinical perspective. Crit Rev Oncol Hematol 1992; 12:231-42. [PMID: 1497823 DOI: 10.1016/1040-8428(92)90056-v] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Technological advances in liposomal preparation and efficient drug entrapment, along with supportive preclinical studies, have led to a number of recent clinical trials utilizing liposomes as drug carriers in the treatment of human malignancy. Although the results of these trials must be considered preliminary, it is clear that liposomal delivery of chemotherapeutic agents is safe at the doses administered. Aside from minor constitutional symptoms, virtually all toxicity could be attributed to release of the incorporated drug. Myelosuppression tends to be the dose-limiting toxicity with free drug, whereas constitutional symptoms are more likely to occur with encapsulated biologic therapy. Prior to human trials, there was fear that intravenous injection of liposomes could result in pulmonary emboli. No cases of pulmonary embolism secondary to liposome therapy have been recorded. The objective response rate in the patients studied appears to be minimal. This is not surprising, since the overwhelming majority of patients studied had disease that was advanced and previously shown to be refractory to therapy. Subgroups of patients that appear to benefit most include those with breast cancer who were treated with liposomal doxorubicin and those with advanced melanoma treated with liposomal tumor vaccines. Additional phase II and III clinical trials will better define the effectiveness of treatment modalities incorporating liposomes. VI-A. Future directions One of the earliest applications of liposomes may be in the amelioration of drug toxicity. Although not yet proven, the clinical studies reviewed suggest that liposomal delivery of doxorubicin reduces cardiotoxicity without sacrificing antitumor effect. Although similar claims have been made in support of continuous infusion doxorubicin [11], one can avoid unnecessary hospitalization or the bulk and expense of portable infusion devices by a single administration of the liposomal preparation. Liposome encapsulation can markedly alter the biodistribution and pharmacokinetics of well-known chemotherapeutic agents. The effectiveness of liposomal drug delivery in human trials thus far has probably been more closely related to altered pharmacokinetics rather than enhanced drug delivery to tumor or increased tumor responsiveness. As demonstrated by Gabizon [19], increased liposome circulating time in the murine model can be achieved by using small unilamellar vesicles containing a phosphatidylcholine of high phase-transition temperature and a small molar fraction of monosialoganglioside or hydrogenated phosphatidylinositol.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- S M Sugarman
- Department of Medicine, University of Texas, M.D., Anderson Cancer Center, Houston 77030
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Kleinerman ES, Raymond AK, Bucana CD, Jaffe N, Harris MB, Krakoff IH, Benjamin R, Fidler IJ. Unique histological changes in lung metastases of osteosarcoma patients following therapy with liposomal muramyl tripeptide (CGP 19835A lipid). Cancer Immunol Immunother 1992; 34:211-20. [PMID: 1537053 PMCID: PMC11038889 DOI: 10.1007/bf01741788] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/1991] [Accepted: 10/01/1991] [Indexed: 12/27/2022]
Abstract
We have recently begun a phase II trial in patients with osteosarcoma who developed pulmonary metastases during adjuvant chemotherapy or who presented with pulmonary metastases that persisted despite chemotherapy. Eligible patients were rendered free of visible disease by surgery. Liposome-encapsulated muramyl tripeptide phosphatidylethanolamine (MTP-PE, CGP 19835A lipid) (2 mg/m2) was infused twice weekly for 3 months. In five patients, a single tumor nodule recurred within 6 weeks after completion of therapy. These lesions were resected and submitted for pathological examination. Tissue specimens obtained after therapy were compared to those obtained before therapy. All the patients showed a histological change in the characteristics of the pulmonary tumors. In three patients, peripheral fibrosis surrounded the tumor and inflammatory cell infiltration and neovascularization were present. This is in contrast to central necrosis, with viable peripheral tumor cells and no inflammatory response observed in lesions resected following chemotherapy. In a fourth case, evidence of early fibrotic changes was found. This and the fifth case showed a change in malignant characteristics, from high grade before liposomal therapy to low grade after therapy. The present study provides evidence for a biological effect of liposomal MTP-PE.
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Affiliation(s)
- E S Kleinerman
- Department of Cell Biology, University of Texas M. D. Anderson Cancer Center, Houston 77030
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