Current and emerging treatments for pancreatic cancer

Angiotensin II type 1 receptor mRNA and its protein expression in human pancreatic cancer cell lines

OBJECTIVE

The incidence of pancreatic cancer is increasing in China, and in many patients the surrounding lymphatics have already been invaded and there is blood-borne metastasis at the time of diagnosis. Additionally, pancreatic cancer is largely refractory to conventional therapies. Therefore, to improve its prognosis, it is important to resolve the problem of its growth. Angiotensin II type 1 receptor (AT1) stimulates the growth and angiogenesis of pancreatic cancer and a selective AT1 antagonist could inhibit these effects. The present study aimed to investigate the expression of AT1 in pancreatic cancer cell lines to provide the theoretical basis for its treatment.

METHODS

The pancreatic cancer cell lines were SW1990, PaTu8988s and PANC-1. RT-PCR was used to detect the AT1 mRNA expression, and ABC immunocytochemical staining and SDS-PAGE were used to detect the expression of AT1 protein.

RESULTS

Both AT1 mRNA and protein were expressed in all three cell lines. The AT1 protein was found on the cell membrane and in the cytoplasm of these cells. The AT1 protein (44 x 10(3)) was also demonstrated by SDS-PAGE.

CONCLUSION

The results suggest that AT1 plays an important role in the growth of pancreatic cancer and its inhibition may be a therapeutic strategy.

Antitumor activity of Virulizin, a novel biological response modifier (BRM) in a panel of human pancreatic cancer and melanoma xenografts

PURPOSE

To define the anticancer efficacy of Virulizin in vivo as a single agent or in combination with conventional drugs in human pancreatic tumor and melanoma xenografts.

METHODS

The therapeutic effect of Virulizin was evaluated in a series of human tumor xenografts in athymic nude mice.

RESULTS

Virulizin had a high level of antitumor activity against all the pancreatic tumors (BxPC-3, SU 86.86. and Mia-PaCa-2) and melanomas (C8161 and A2058), as indicated by suppression of tumor growth with an optimal T/C value of <or=40% when administered as a single agent. No significant changes in Virulizin antitumor activity were observed when different schedules (3 days/week vs 7 days/week) or routes of administration (i.p. vs i.m.) were used. In combination therapy, Virulizin significantly enhanced the antitumor activity of gemcitabine and 5-fluorouracil against pancreatic tumors and of dacarbazine against metastatic melanomas, as reflected by a further decrease in tumor growth as compared to tumors in animals treated with the conventional drugs alone.

CONCLUSION

These studies suggest that Virulizin effectively inhibits the growth of solid human pancreatic tumors and melanomas in the xenograft model.

Surgical management of hereditary pancreatic cancer

Pancreatic cancer continues to be a leading cause of cancer death in the United States. Seven genetic syndromes are now known to be associated with an increased incidence of pancreatic cancer. Other familial forms of pancreatic cancer exist although the genetic basis for this predisposition remains elusive. The similarities in the genetic and clinical manifestations of the sporadic and familial forms of pancreatic cancer suggest that pretreatment staging and management of patients with established pancreatic cancer should be similar. For carcinomas of the pancreatic head, pancreaticoduodenectomy should be performed according to current surgical practice, whereas the use of total pancreatectomy should be limited to cases in which margins are found to be positive or if the anatomy precludes a safe pancreaticojejunostomy. Total pancreatectomy may be considered in high-risk kindreds who strongly desire prophylactic surgery and in those with premalignant lesions. Identification of the precise genetic basis for inherited pancreatic cancer will someday make it possible to examine scientifically the effectiveness of specific management strategies.

Virulizin(R) - A review of its antineoplastic activity

Virulizin(R) (registered trademark of Lorus Therapeutics, Inc.) is a novel biological response modifier (BRM) that enhances cell-mediated immune response to tumour cells by direct macrophage activation. The agent, an aqueous solution containing a 5% (w/v) solid material mixture comprised of inorganic salts (95 - 99% of the dry weight) and organic compounds of molecular weight < 3000 Daltons (1 - 5% of the dry weight), is provided as a sterile, injectable formulation. Virtually all the organic compounds and ionic components in the mixture have been identified by chemical and spectroscopic methods. Virulizin(R) is obtained from bovine bile by a standardised process involving solvent extraction and heat hydrolysis. In vitro studies have shown that Virulizin(R) can stimulate blood monocytes, peritoneal macrophages and alveolar macrophages from patients with malignant and non-malignant diseases to mediate a level of tumour cell cytolysis that is equal to, or greater than, that elicited in the same cells by other, more conventional biological activators. Other studies have shown that the stimulation of cytotoxic function by Virulizin(R) is insensitive to the inhibitory effects of prostaglandins and, hence, is distinct from many other activators. Furthermore, the blood monocytes of patients currently receiving cytotoxic chemotherapy showed activation with Virulizin(R). In preclinical studies, Virulizin(R) showed modest inhibition of tumour growth in a human pancreatic cancer xenograft model (T/C, 0.60; p = 0.012) and increased survival time by 8% (p = 0.046) in a murine melanoma model. Toxicity studies in rats indicated that Virulizin(R) injected intramuscularly was well-tolerated by the animals. Except for a lower rate of body weight gain in the high dose group, no toxicological effect related to treatment was observed in a chronic 13-week study (three weekly im. injections of up to 1.1 ml/kg). Mutagenicity studies with Virulizin(R) were negative. Many Phase I/II and Phase II clinical trials were carried out with Virulizin(R) to evaluate the safety and efficacy of the agent to treat cancer patients. Three of those studies involved the treatment of patients with pancreatic adenocarcinoma. The majority of patients participating in these studies were those who had failed conventional treatment including surgery or chemotherapy. Disease stabilisation was observed in patients treated with Virulizin(R), and, based on a meta-analysis of the data from the three studies, the survival of the patients treated with Virulizin(R) was better than a similar patient population receiving standard chemotherapeutic agent for that disease indication. However, randomised studies may be required to confirm the effect of Virulizin(R) on disease stabilisation and survival. In the three studies on patients with malignant melanoma, at least 69% treated with Virulizin(R) showed no additional deterioration or had improved at four weeks with response being only slightly reduced after eight weeks. In the evaluation of safety, assessed overall from these clinical studies in 200 patients treated with Virulizin(R), the number and severity of adverse events were small. In conclusion, Virulizin(R) is a novel, clinically non-toxic biological response modifier that appears to have a clinical effect on disease stabilisation and survival in patients with pancreatic cancer and malignant melanoma. However, additional randomised studies may be required to confirm those effects. Future studies on Virulizin(R) will focus on the characterisation of the active components in the agent and the development of a synthetic formulation. Subsequently, the preclinical and clinical pharmacokinetics of Virulizin(R) will be determined and studies to optimise the human dose of the agent will be carried out.

The novel Trk receptor tyrosine kinase inhibitor CEP-701 (KT-5555) exhibits antitumor efficacy against human pancreatic carcinoma (Panc1) xenograft growth and in vivo invasiveness

The survival rate for patients with pancreatic ductal adenocarcinoma (PDAC) is among the poorest for all cancers. The factors that contribute to this poor prognosis are lack of effective early detection, high rate of metastases and a generally refractory response to available treatment modalities. The most commonly used treatment methods--chemotherapy and radiation therapy--are mainly used for symptom palliation, with surgery being the only "curative" treatment option. The use of combinations of treatment modalities is the only therapy available to patients with locally advanced disease or that which is surgically unresectable. These options are still not sufficient to increase patient survival time significantly. The aggressive behavior and poor prognosis of this cancer is associated with an increased expression of many growth factors and their cognate receptors. We have demonstrated previously the aberrant expression of the Trk receptors (Trks A, B, and C) in PDAC specimens and human PDAC-derived cell lines and a biphasic, dose-dependent response of specific neurotrophic agents on the in vitro invasiveness of PDAC cells. Based on these data we have evaluated the therapeutic potential of inhibiting neurotrophin-Trk interactions using a selective Trk tyrosine kinase inhibitor (CEP-701) on subcutaneous (s.c.) and tracheal xenografts derived from the poorly differentiated PDAC cell line, Panc1. We demonstrate that CEP-701 administration at 10 mg/kg s.c. BID for 21 days inhibited tumor growth of the Panc1 s.c. xenografts in a statistically-significant manner (p < 0.01) compared to vehicle controls, in the absence of morbidity and mortality. A T/C value of 25% was observed for CEP-701-treated s.c. xenografts. In addition, CEP-701 administration inhibited tumor cell invasion in the s.c. tracheal xenograft model of in vivo invasiveness. Taken together, these data suggest that further studies are warranted to evaluate CEP-701 as a potential therapeutic agent in the treatment of PDAC.