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Jeon KH, Park S, Shin JH, Jung AR, Hwang SY, Seo SH, Jo H, Na Y, Kwon Y. Synthesis and evaluation of 7-(3-aminopropyloxy)-substituted flavone analogue as a topoisomerase IIα catalytic inhibitor and its sensitizing effect to enzalutamide in castration-resistant prostate cancer cells. Eur J Med Chem 2023; 246:114999. [PMID: 36493620 DOI: 10.1016/j.ejmech.2022.114999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
Prostate cancer patients primarily receive androgen receptor (AR)-targeted drugs as a primary treatment option because prostate cancer is associated with highly activated AR signaling. AR amplification made prostate cancer cells viable under treatment of AR-targeted therapy, leading to castration resistance. AR amplification was more common in enzalutamide-resistant patients. As a strategy to overcome castration resistance and to improve the efficacy of enzalutamide, second-generation nonsteroidal antiandrogen drugs for castration-resistant prostate cancer (CRPC) including topoisomerase II (topo II) poisons such as etoposide and mitoxantrone, have been administered in combination with enzalutamide. In the present study, it was confirmed that amplification of topo IIα, but not I and IIβ, was directly and proportionally associated with poor clinical outcome of Prostate cancer. Among a novel series of newly designed and synthesized 7-(3-aminopropyloxy)-substituted flavone analogues, compound 6, the most potent derivative, was further characterized and identified as a topo IIα catalytic inhibitor that intercalates into DNA and binds to the DNA minor groove with better efficacy and less genotoxicity than etoposide, a topo II poison. Compound 6 showed remarkable efficacy in inhibiting AR-negative CRPC cell growth and sensitizing activity to enzalutamide in AR-positive CRPC cells, thus confirming the potential of topo IIα catalytic inhibitor to overcome resistance to androgen deprivation therapy.
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Affiliation(s)
- Kyung-Hwa Jeon
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Seojeong Park
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Jae-Ho Shin
- College of Pharmacy, CHA University, 120 Haeryong-ro, Pochon-shi, Gyeongghi-do, 11160, Republic of Korea
| | - Ah-Reum Jung
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Soo-Yeon Hwang
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Seung Hee Seo
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Hyunji Jo
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Younghwa Na
- College of Pharmacy, CHA University, 120 Haeryong-ro, Pochon-shi, Gyeongghi-do, 11160, Republic of Korea
| | - Youngjoo Kwon
- College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea.
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Jeon KH, Park S, Jang HJ, Hwang SY, Shrestha A, Lee ES, Kwon Y. AK-I-190, a New Catalytic Inhibitor of Topoisomerase II with Anti-Proliferative and Pro-Apoptotic Activity on Androgen-Negative Prostate Cancer Cells. Int J Mol Sci 2021; 22:ijms222011246. [PMID: 34681904 PMCID: PMC8538266 DOI: 10.3390/ijms222011246] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022] Open
Abstract
Castration-resistant prostate cancer (CRPC) is a clinical challenge in treatment because of its aggressive nature and resistance to androgen deprivation therapy. Topoisomerase II catalytic inhibitors have been suggested as a strategy to overcome these issues. We previously reported AK-I-190 as a novel topoisomerase II inhibitor. In this study, the mechanism of AK-I-190 was clarified using various types of spectroscopic and biological evaluations. AK-I-190 showed potent topoisomerase II inhibitory activity through intercalating into DNA without stabilizing the DNA-enzyme cleavage complex, resulting in significantly less DNA toxicity than etoposide, a clinically used topoisomerase II poison. AK-I-190 induced G1 arrest and effectively inhibited cell proliferation and colony formation in combination with paclitaxel in an androgen receptor–negative CRPC cell line. Our results confirmed that topoisomerase II catalytic inhibition inhibited proliferation and induced apoptosis of AR-independently growing prostate cancer cells. These findings indicate the clinical relevance of topoisomerase II catalytic inhibitors in androgen receptor-negative prostate cancer.
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Affiliation(s)
- Kyung-Hwa Jeon
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea; (K.-H.J.); (S.P.); (H.J.J.); (S.-Y.H.)
| | - Seojeong Park
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea; (K.-H.J.); (S.P.); (H.J.J.); (S.-Y.H.)
| | - Hae Jin Jang
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea; (K.-H.J.); (S.P.); (H.J.J.); (S.-Y.H.)
| | - Soo-Yeon Hwang
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea; (K.-H.J.); (S.P.); (H.J.J.); (S.-Y.H.)
| | - Aarajana Shrestha
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Korea; (A.S.); (E.-S.L.)
| | - Eung-Seok Lee
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Korea; (A.S.); (E.-S.L.)
| | - Youngjoo Kwon
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea; (K.-H.J.); (S.P.); (H.J.J.); (S.-Y.H.)
- Correspondence:
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Pathmanandavel S, Crumbaker M, Yam AO, Nguyen A, Rofe C, Hovey E, Gedye C, Kwan EM, Hauser C, Azad AA, Eu P, Martin AJ, Joshua AM, Emmett L. 177Lutetium PSMA-617 and idronoxil (NOX66) in men with end-stage metastatic castrate-resistant prostate cancer (LuPIN): Patient outcomes and predictors of treatment response of a Phase I/II trial. J Nucl Med 2021; 63:560-566. [PMID: 34326127 PMCID: PMC8973290 DOI: 10.2967/jnumed.121.262552] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
177Lu-PSMA-617 is an effective therapy for metastatic castration-resistant prostate cancer (mCRPC). However, treatment resistance occurs frequently, and combination therapies may improve outcomes. We report the final safety and efficacy results of a phase I/II study combining 177Lu-PSMA-617 with idronoxil (NOX66), a radiosensitizer, and examine potential clinical, blood-based, and imaging biomarkers. Methods: Fifty-six men with progressive mCRPC previously treated with taxane chemotherapy and novel androgen signaling inhibitor (ASI) were enrolled. Patients received up to 6 doses of 177Lu-PSMA-617 (7.5 GBq) on day 1 in combination with a NOX66 suppository on days 1–10 of each 6-wk cycle. Cohort 1 (n = 8) received 400 mg of NOX66, cohort 2 (n = 24) received 800 mg, and cohort 3 (n = 24) received 1,200 mg. 68Ga-PSMA and 18F-FDG PET/CT were performed at study entry, and semiquantitative imaging analysis was undertaken. Blood samples were collected for analysis of blood-based biomarkers, including androgen receptor splice variant 7 expression. The primary outcomes were safety and tolerability; secondary outcomes included efficacy, pain scores, and xerostomia. Regression analyses were performed to explore the prognostic value of baseline clinical, blood-based, and imaging parameters. Results: Fifty-six of the 100 men screened were enrolled (56%), with a screening failure rate of 26% (26/100) for PET imaging criteria. All men had received prior treatment with ASI and docetaxel, and 95% (53/56) had received cabazitaxel. Ninety-six percent (54/56) of patients received at least 2 cycles of combination NOX66 and 177Lu-PSMA-617, and 46% (26/56) completed 6 cycles. Common adverse events were anemia, fatigue, and xerostomia. Anal irritation attributable to NOX66 occurred in 38%. Forty-eight of 56 had a reduction in prostate-specific antigen (PSA) level (86%; 95% CI, 74%–94%); 34 of 56 (61%; 95% CI, 47%–74%) had a PSA reduction of at least 50%. Median PSA progression-free survival was 7.5 mo (95% CI, 5.9–9 mo), and median overall survival was 19.7 mo (95% CI, 9.5–30 mo). A higher PSMA SUVmean correlated with treatment response, whereas a higher PSMA tumor volume and prior treatment with ASI for less than 12 mo were associated with worse overall survival. Conclusion: NOX66 with 177Lu-PSMA-617 is a safe and feasible strategy in men being treated with third-line therapy and beyond for mCRPC. PSMA SUVmean, PSMA-avid tumor volume, and duration of treatment with ASI were independently associated with outcome.
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Affiliation(s)
| | - Megan Crumbaker
- The Kinghorn Cancer Centre, St Vincent's Hospital, Australia
| | - Andrew O Yam
- The Kinghorn Cancer Centre, St Vincent's Hospital, Australia
| | - Andrew Nguyen
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney, Australia, Australia
| | | | - Elizabeth Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Australia
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Hospital, Australia
| | - Edmond M Kwan
- Department of Medicine, School of Clinical Sciences, Monash University, Australia
| | | | | | - Peter Eu
- Peter MacCallum Cancer Centre, Australia
| | - Andrew J Martin
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | | | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Australia
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Moritz J, Bauernhofer T, Mannweiler S, Langsenlehner T, Pummer K, Dandachi N, Pichler M. Evaluation of Blood-based Biomarkers for Prediction of Response in Carboplatin-treated Metastatic Castration-resistant Prostate Cancer Patients. In Vivo 2021; 34:3631-3638. [PMID: 33144478 DOI: 10.21873/invivo.12209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Carboplatin-containing treatment regimens demonstrate moderate efficacy in metastatic castration-resistant prostate cancer (mCRPC). In this study, we retrospectively analyzed the efficacy of carboplatin in relation to blood-based parameters. PATIENTS AND METHODS A retrospective chart review was performed for 20 patients with mCRPC who received carboplatin in a single center. RESULTS Median overall survival was 3.8 months (95%CI=1.5-7.1), median progression-free survival was 1.7 months. We observed two partial remissions (PR, 10%), four stable diseases (SD, 20%) and 14 disease progressions (PD, 70%), resulting in a clinical benefit rate of 30%. A doubling of NSE (neurone specific enolase) values was associated with a 19% absolute higher response rate (95%CI=14-23, p=0.027). All other laboratory parameters failed as predictive markers of response to carboplatin. In univariate Cox regression analysis, only NSE was significantly associated with impaired PFS (HR=0.7, 95%CI=0.56-0.96, p=0.030). CONCLUSION Carboplatin showed moderate efficacy against mCRPC in this unselected population of patients and NSE levels may help to predict the success of this treatment.
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Affiliation(s)
- Jennifer Moritz
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Thomas Bauernhofer
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | | | - Tanja Langsenlehner
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria
| | - Karl Pummer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Nadia Dandachi
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria .,Research Unit Epigenetic and Genetic Cancer Biomarkers, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
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Erkisa M, Ari F, Ulku I, Khodadust R, Yar Y, Yagci Acar H, Ulukaya E. Etoposide Loaded SPION-PNIPAM Nanoparticles Improve the in vitro Therapeutic Outcome on Metastatic Prostate Cancer Cells via Enhanced Apoptosis. Chem Biodivers 2020; 17:e2000607. [PMID: 32918383 DOI: 10.1002/cbdv.202000607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/11/2020] [Indexed: 01/02/2023]
Abstract
Prostate cancer is among the leading causes of death worldwide because its metastatic form is a deadly disease. Therefore, the development of new chemotherapeutics is of immense importance. Nanoparticle technology seems to provide diverse options in this regard. Therefore, poly(N-isopropylacrylamide) (PNIPAM) coated superparamagnetic iron oxide nanoparticles (SPION) loaded with Etoposide were prepared in small sizes (57 nm) and with 3.5 % drug content to improve the efficiency of Etoposide in prostate cancer therapy. Sustained release of the drug was achieved, which found to be sensitive to low pH and high temperature. The anti-growth activity of SPION-PNIPAM-Etoposide formulation against metastatic prostate cancer cells (PC-3, LNCaP) were investigated by SRB assay, then, confirmed by ATP assay. Mode of cell death was evaluated by using flow cytometry analyses. A significant improvement of nanoformulated drug was observed at 5-10 μg/ml doses of the drug in both cell lines. More importantly, this formulation enhanced the cytotoxic effect of Etoposide on PC-3 cells, which is considered more resistant to Etoposide than LNCaP and reduced the IC50 value by 55 % reaching to 4.5 μg drug/ml, which is a very significant improvement in the literature. It was clearly shown that nanoformulated drug provided about 3-fold increases in caspase-dependent early apoptotic cells in PC-3 cells. The novel formulation seems to successfully cause cell death of especially PC-3 metastatic prostate cancer cells. It should therefore be taken into consideration for further animal studies as a novel potent anticancer agent.
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Affiliation(s)
- Merve Erkisa
- Bursa Uludag University, Science and Art Faculty, Department of Biology, 16059, Bursa, Turkey.,Istinye University, Faculty of Medicine, Molecular Cancer Research Center, 34010, Istanbul, Turkey
| | - Ferda Ari
- Bursa Uludag University, Science and Art Faculty, Department of Biology, 16059, Bursa, Turkey
| | - Irem Ulku
- Koc University, Department of Chemistry, 34450, Istanbul, Turkey
| | | | - Yasemin Yar
- Koc University, Materials Science and Engineering, 34450, Istanbul, Turkey
| | - Havva Yagci Acar
- Koc University, Department of Chemistry, 34450, Istanbul, Turkey.,Koc University, Materials Science and Engineering, 34450, Istanbul, Turkey
| | - Engin Ulukaya
- Istinye University, School of Medicine, Department of Clinical Biochemistry, 34010, Istanbul, Turkey
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Crumbaker M, Pathmanandavel S, Yam AO, Nguyen A, Ho B, Chan L, Ende JA, Rofe C, Kongrak K, Kwan EM, Azad AA, Sharma S, Pugh TJ, Danesh A, Keane J, Eu P, Joshua AM, Emmett L. Phase I/II Trial of the Combination of 177Lutetium Prostate specific Membrane Antigen 617 and Idronoxil (NOX66) in Men with End-stage Metastatic Castration-resistant Prostate Cancer (LuPIN). Eur Urol Oncol 2020; 4:963-970. [PMID: 32758400 DOI: 10.1016/j.euo.2020.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/26/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Trials of lutetium prostate specific membrane antigen (PSMA) in men with metastatic castration-resistant prostate cancer (mCRPC) have demonstrated good safety and efficacy, but combination strategies may improve outcomes. Idronoxil is a synthetic flavonoid derivative with radiosensitising properties. OBJECTIVE To evaluate the safety and activity of 177Lu PSMA 617 (LuPSMA-617) in combination with idronoxil suppositories (NOX66) in patients with end-stage mCRPC. DESIGN, SETTING, AND PARTICIPANTS Thirty-two men with progressive mCRPC previously treated with taxane-based chemotherapy (91% treated with both docetaxel and cabazitaxel) and abiraterone and/or enzalutamide were enrolled in this phase I dose escalation study with phase II dose expansion. INTERVENTION Screening with 68Ga PSMA and 18F-fludeoxyglucose positron emission tomography (PET)/computed tomography (CT) was performed. Men received up to six cycles of LuPSMA-617 (7.5 GBq) on day 1, with escalating doses of NOX66 on days 1-10 of a 6-wk cycle. Cohort 1 (n = 8) received 400 mg and cohort 2 (n = 24) 800 mg of NOX66. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Adverse events (AEs), pain inventory scores, prostate-specific antigen (PSA) response, progression-free survival, and overall survival were evaluated. RESULTS AND LIMITATIONS Fifty-six men were screened and 32 (57%) were enrolled with a screen failure rate of 21% for PET imaging criteria. Dosing was as follows: 97% (31/32) received two or more doses and 47% (15/32) completed six doses. Common AEs included xerostomia, fatigue, and anaemia. Anal irritation attributable to NOX66 occurred in 28%. PSA responses were as follows: 91% (29/32) had any PSA response (median -74%; 95% confidence interval [CI] 76-97) and 62.5% (20/32) had a PSA fall of >50% (95% CI 45-77). The median PSA progression-free survival was 6.1 mo (95% CI 2.8-9.2) and median overall survival was 17.1 mo (95% CI 6.5-27.1). CONCLUSIONS NOX66 with LuPSMA-617 is a safe and feasible therapeutic strategy in men treated with third-line therapy and beyond for mCRPC. PATIENT SUMMARY Addition of NOX66 to 177Lu prostate-specific membrane antigen 617 is safe, and further studies are needed to assess its potential to augment the anticancer effects of LuPSMA-617.
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Affiliation(s)
- Megan Crumbaker
- The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, NSW, Australia; Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | | | - Andrew O Yam
- The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, NSW, Australia; Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Andrew Nguyen
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Bao Ho
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Lyn Chan
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Jesse A Ende
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Christopher Rofe
- The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Kamonwan Kongrak
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Edmond M Kwan
- Department of Medical Oncology, Monash Health, Clayton, VIC, Australia; Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Arun A Azad
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Shikha Sharma
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Arnavaz Danesh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Joanne Keane
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Peter Eu
- Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Anthony M Joshua
- The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia; St. Vincent's Clinical School, University of New South Wales, Kensington, NSW, Australia; Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Louise Emmett
- St. Vincent's Clinical School, University of New South Wales, Kensington, NSW, Australia; Department of Theranostics and Nuclear Medicine, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia.
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Dianhydrogalactitol synergizes with topoisomerase poisons to overcome DNA repair activity in tumor cells. Cell Death Dis 2020; 11:577. [PMID: 32709853 PMCID: PMC7381652 DOI: 10.1038/s41419-020-02780-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/27/2022]
Abstract
1,2:5,6-Dianhydrogalactitol (DAG) is a bi-functional DNA-targeting agent currently in phase II clinical trial for treatment of temozolomide-resistant glioblastoma (GBM). In the present study, we investigated the cytotoxic activity of DAG alone or in combination with common chemotherapy agents in GBM and prostate cancer (PCa) cells, and determined the impact of DNA repair pathways on DAG-induced cytotoxicity. We found that DAG produced replication-dependent DNA lesions decorated with RPA32, RAD51, and γH2AX foci. DAG-induced cytotoxicity was unaffected by MLH1, MSH2, and DNA-PK expression, but was enhanced by knockdown of BRCA1. Acting in S phase, DAG displayed selective synergy with topoisomerase I (camptothecin and irinotecan) and topoisomerase II (etoposide) poisons in GBM, PCa, and lung cancer cells with no synergy observed for docetaxel. Importantly, DAG combined with irinotecan treatment enhanced tumor responses and prolonged survival of tumor-bearing mice. This work provides mechanistic insight into DAG cytotoxicity in GBM and PCa cells and offers a rational for exploring combination regimens with topoisomerase I/II poisons in future clinical trials.
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Roviello G, Corona SP, Conca R, Petrioli R, Rosellini P, Bonetta A, Aieta M. Is there still a place for vinorelbine in advanced metastatic castration resistant prostate cancer? Medicine (Baltimore) 2019; 98:e16249. [PMID: 31261590 PMCID: PMC6616091 DOI: 10.1097/md.0000000000016249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this paper was to evaluate the activity and tolerability of oral vinorelbine in patients with advanced castration resistant prostate cancer (CRPC) who progressed after a minimum of three lines including: abiraterone acetate, docetaxel, cabazitaxel, and enzalutamide.Treatment consisted of weekly oral vinorelbine 60 mg/m. Chemotherapy was administered until disease progression or unacceptable toxicity.Twenty-six patients received vinorelbine: their median age was 74 years (range 58-84 years). Twenty-four (92.3%) patients had bone metastases. A decrease in PSA levels ≥50% was observed in 2 patients (7.7%). Among the subjects who were symptomatic at baseline, pain was reduced in 3 patients (13.6%) with a significant decrease in analgesic use. Median progression-free survival was 9 weeks (95% CI: 7 to 11) and median overall survival was 17 weeks (95% CI: 12 to 22). Treatment was well tolerated, and no grade 4 toxicities were observed.Our findings do not suggest the use of oral vinorelbine on a weekly schedule, in CRPC heavily pre-treated.
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Affiliation(s)
- Giandomenico Roviello
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
| | - Silvia Paola Corona
- Peter MacCallum Cancer Centre, Radiation Oncology Department, Moorabbin Campus, East Bentleigh Victoria, Australia
| | - Raffaele Conca
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
| | - Roberto Petrioli
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico “Le Scotte”, Siena
| | - Pietro Rosellini
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico “Le Scotte”, Siena
| | - Alberto Bonetta
- Radiotherapy department, ASST Cremona, Viale Concordia 1, Cremona, Italy
| | - Michele Aieta
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
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Effectiveness of Platinum-Based Chemotherapy in Patients With Metastatic Prostate Cancer: Systematic Review and Meta-analysis. Clin Genitourin Cancer 2019; 17:e627-e644. [PMID: 31023519 DOI: 10.1016/j.clgc.2019.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/15/2019] [Accepted: 03/17/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Taxanes are the only cytotoxic drugs that have demonstrated a survival benefit for patients with castration-resistant prostate cancer (CRPC), but there is some evidence that platinum compounds may also benefit such patients. METHODS We performed a systematic search on electronic databases. We sought prospective clinical studies testing platinum compounds for CRPC. Platinum compounds could be delivered alone or in combination with other drugs. Both randomized and nonrandomized studies were included for qualitative synthesis, only randomized studies were included for meta-analyses. Clinical overall response rate (cORR), prostate-specific antigen overall response rate (sORR), progression-free survival (PFS), overall survival (OS), and toxicity were the outcomes of interest. RESULTS We identified 53 studies delivering platinum agents for patients with CRPC. cORR varied from 0 to 82%, while sORR varied from 2% to 100%. Response rates were higher in patients who received combination treatments rather than platinum compounds alone. Pooled data from randomized trials demonstrated a statistically significant increase in both cORR (odds ratio = 5.3; 95% confidence interval, 1.89-14.92) and sORR (odds ratio = 2.07; 95% confidence interval, 1.33-3.22) when adding platinum compounds to chemotherapy. PFS varied from 2.1 to 12 months and OS 4.2 to 28 months with platinum-containing chemotherapy. Nausea and myelosuppression were the most common adverse effects. Toxicity was manageable in most studies. CONCLUSION Platinum compounds are a safe and active treatment for CRPC. Response rates are higher when cytotoxic chemotherapy containing platinum agents are compared to nonplatinum chemotherapy. Data on OS and PFS are inconclusive. More research is needed to evaluate whether platinum-based chemotherapy results in a survival benefit for patients with CRPC, as well as to establish predictive biomarkers.
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Ferro M, Di Lorenzo G, de Cobelli O, Bruzzese D, Pignataro P, Borghesi M, Musi G, Vartolomei MD, Cosimato V, Serino A, Ieluzzi V, Terracciano D, Damiano R, Cantiello F, Mistretta FA, Muto M, Lucarelli G, De Placido P, Buonerba C. Incidence of fatigue and low-dose corticosteroid use in prostate cancer patients receiving systemic treatment: a meta-analysis of randomized controlled trials. World J Urol 2018; 37:1049-1059. [PMID: 30519742 DOI: 10.1007/s00345-018-2579-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/26/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a complex condition that is reported in > 50% of cancer patients. In men with castration-resistant prostate cancer (CRPC), CRF was reported in 12-21% of patients. Approved systemic therapy against CRPC is commonly administered in combination with androgen-deprivation treatment (ADT) and, in some cases, with daily, low-dose corticosteroids. Importantly, the use of low-dose corticosteroids is associated with multiple negative effects, including reduced muscle mass. On these grounds, we hypothesized that the chronic use of corticosteroids may increase the incidence of fatigue in patients with prostate cancer. METHODS We reviewed all randomized trials published during the last 15 years conducted in patients with prostate cancer receiving systemic treatment and we performed a sub-group analysis to gather insights regarding the potential differences in the incidence of fatigue in patients receiving vs. not receiving daily corticosteroids as part of their systemic anti-neoplastic regimen. RESULTS Overall, 22,734 men enrolled in prospective randomized phase II and III trials were evaluable for fatigue. Estimated pooled incidence of grade 1-2 fatigue was 30.89% (95% CI = 25.34-36.74), while estimated pooled incidence of grade 3-4 fatigue was reported in 3.90% (95% CI = 2.91-5.02). Sub-group analysis showed that grade 3-4 fatigue was approximately double in patients who received daily corticosteroids as part of their anti-neoplastic treatment (5.58; 95% CI = 4.33-6.98) vs. those who did not (2.67%; 95% CI = 1.53-4.11). CONCLUSION Our findings highlight the need for ad hoc-designed prospective clinical trials to investigate whether the benefits associated with low-dose, daily corticosteroids outweigh the risks associated with corticosteroid-related adverse events such as fatigue.
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Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy.
| | - Giuseppe Di Lorenzo
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology, Milan, Italy.,University of Milan, Milan, Italy
| | - Dario Bruzzese
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Piero Pignataro
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy
| | - Marco Borghesi
- Department of Urology, University of Bologna, Bologna, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Mihai Dorin Vartolomei
- Division of Urology, European Institute of Oncology, Milan, Italy.,Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - Vincenzo Cosimato
- Division of Onco-hematology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | | | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | | | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.,Zooprophylactic Institute of Southern Italy, Portici, Italy
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11
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Roviello G, Petrioli R, Bonetta A, Conca R, Rodriquenz MG, Aieta M. Corticosteroid switch in heavily pre-treated castration-resistant prostate cancer patients progressed on abiraterone acetate plus prednisone. Invest New Drugs 2018; 36:1110-1115. [PMID: 30345466 DOI: 10.1007/s10637-018-0685-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023]
Abstract
The aim of this retrospective study is to evaluate the activity and safety of a steroidal switch from prednisone to dexamethasone in patients with advanced, heavily pre-treated, castration-resistant prostate cancer (CRPC) who progressed on abiraterone acetate. Treatment consisted of oral daily abiraterone plus dexamethasone (0.5 mg once daily) administered until disease progression or unacceptable toxicity. Thirty-six patients were evaluated: all men underwent a prior treatment with enzalutamide. A PSA decrease ≥50% was observed in 11% of patients; median progression-free survival was 10.8 weeks (95% CI: 9.2-16), and median survival was 17.6 weeks (95% CI: 15.8-28.8). Better efficacy and survival were observed in the subgroup of patients treated with abiraterone acetate prior for a period >3 months; treatment was well tolerated, and no grade 3-4 toxicities were observed. Our findings did not suggest the use of steroid switch in all CRPC who were heavily pre-treated. However, the switch could be an option for patients who responded well to prior abiraterone acetate treatment.
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Affiliation(s)
- Giandomenico Roviello
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture, PZ, Italy.
| | - Roberto Petrioli
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico "Le Scotte", 53100, Siena, Italy
| | - Alberto Bonetta
- Radiotherapy Department, ASST Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - Raffaele Conca
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture, PZ, Italy
| | - Maria Grazia Rodriquenz
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture, PZ, Italy
| | - Michele Aieta
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, 85028 Rionero, Vulture, PZ, Italy
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12
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Barata P, Emamekhoo H, Mendiratta P, Koshkin V, Tyler A, Ornstein M, Rini BI, Gilligan T, Kyriakopoulos C, Garcia JA. Treatment selection for men with metastatic prostate cancer who progress on upfront chemo-hormonal therapy. Prostate 2018; 78:1035-1041. [PMID: 29882332 DOI: 10.1002/pros.23663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 05/22/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Androgen deprivation therapy plus docetaxel (D-ADT) increases overall survival (OS) in men with high-volume, metastatic hormone-sensitive prostate cancer (mHSPC). Although the vast majority of men initially respond to D-ADT, most will progress and develop castration-resistant prostate cancer (CRPC). Little is known about the optimal treatment sequence for men with progressive disease on D-ADT. PATIENT AND METHODS Retrospective analysis of consecutive mHSPC patients treated with ≥3 cycles of D-ADT at Cleveland Clinic and University of Wisconsin-Madison was undertaken. The primary end-points included radiographic progression free survival (rPFS) and OS with first-line treatment for metastatic CRPC (mCRPC). RESULTS Final analysis included 136 patients, median age 65 (range 35-86), 77% GS ≥ 8, and 79% with high-volume disease who received ≥3 cycles of docetaxel. Undetectable PSA values at 12 and 24 months were observed in 32% and 25% of patients, respectively. Median time to CRPC (biochemical, clinical, or radiographic) was 19.6 months (16.6-22.6). Sixty patients (44%) received ≥1 treatment for CRPC: 48 patients (80%) received a second-generation hormonal therapy (sHT). Among these, 22 received abiraterone acetate, 20 enzalutamide, and six a novel CYP-17 inhibitor on trial (ASN-001). Five patients (8%) received sipuleucel-T; four (7%) radium-223, five (8%) chemotherapy (two carboplatin-based, two single agent cabazitaxel, one single agent docetaxel) and three other. Patients receiving sHT as the first treatment for mCRPC had a median rPFS of 9.0 months (95%CI, 6.9-11.2) compared with 3.0 months (95%CI, 1.5-4.5) for patients who received a non-sHT (P = 0.024). The choice of first therapy for mCRPC was independent of GS (P = 0.909), visceral disease (P = 0.690) and time to CRPC (P = 0.844). Longer OS correlated with time to CRPC (P = 0.010) and first treatment for CRPC with sHT (P = 0.005). CONCLUSIONS For patients with progressive disease on D-ADT, subsequent treatment with a sHT is associated with a longer rPFS and OS.
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Affiliation(s)
- Pedro Barata
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
| | - Hamid Emamekhoo
- Department of Medicine, Division of Hematology and Oncology Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Prateek Mendiratta
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
| | - Vadim Koshkin
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
| | - Allison Tyler
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
| | - Moshe Ornstein
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
| | - Brian I Rini
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
| | - Timothy Gilligan
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
| | - Christos Kyriakopoulos
- Department of Medicine, Division of Hematology and Oncology Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
| | - Jorge A Garcia
- Department of Hematology and Medical Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
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13
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Kornberg Z, Chou J, Feng FY, Ryan CJ. Prostate cancer in the era of "Omic" medicine: recognizing the importance of DNA damage repair pathways. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:161. [PMID: 29911109 PMCID: PMC5985268 DOI: 10.21037/atm.2018.05.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/02/2018] [Indexed: 02/01/2023]
Abstract
Data from recent high-throughput studies analyzing local and advanced prostate cancer have revealed an incredible amount of biological diversity, which has led to the classification of distinct molecular tumor subtypes. While integrating prostate cancer genomics with clinical medicine is still at its infancy, new approaches to treat prostate cancer are well underway and being studied. With the recognition that DNA damage repair (DDR) mutations play an important role in the pathogenesis of this disease, clinicians can begin to utilize genomic information in complex treatment decisions for prostate cancer patients. In this Review, we discuss the role of DDR mutations in prostate cancer, including deficiencies in homologous repair and mismatch repair (MMR), and how this information is revolutionizing the treatment landscape. In addition, we highlight the potential resistance mechanisms that may result as we begin to target these pathways in isolation and discuss potential combinatorial approaches that may delay or overcome resistance.
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Affiliation(s)
- Zachary Kornberg
- Department of Radiation Oncology, Division of Hematology and Oncology, Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Jonathan Chou
- Department of Medicine, Division of Hematology and Oncology, Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Felix Y. Feng
- Department of Radiation Oncology, Division of Hematology and Oncology, Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Charles J. Ryan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
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14
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Cattrini C, Zanardi E, Vallome G, Cavo A, Cerbone L, Di Meglio A, Fabbroni C, Latocca MM, Rizzo F, Messina C, Rubagotti A, Barboro P, Boccardo F. Targeting androgen-independent pathways: new chances for patients with prostate cancer? Crit Rev Oncol Hematol 2017; 118:42-53. [PMID: 28917268 DOI: 10.1016/j.critrevonc.2017.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023] Open
Abstract
Androgen deprivation therapy (ADT) is the mainstay treatment for advanced prostate cancer (PC). Most patients eventually progress to a condition known as castration-resistant prostate cancer (CRPC), characterized by lack of response to ADT. Although new androgen receptor signaling (ARS) inhibitors and chemotherapeutic agents have been introduced to overcome resistance to ADT, many patients progress because of primary or acquired resistance to these agents. This comprehensive review aims at exploring the mechanisms of resistance and progression of PC, with specific focus on alterations which lead to the activation of androgen receptor (AR)-independent pathways of survival. Our work integrates available clinical and preclinical data on agents which target these pathways, assessing their potential clinical implication in specific settings of patients. Given the rising interest of the scientific community in cancer immunotherapy strategies, further attention is dedicated to the role of immune evasion in PC.
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Affiliation(s)
- C Cattrini
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy.
| | - E Zanardi
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - G Vallome
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Cavo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - L Cerbone
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Di Meglio
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - C Fabbroni
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - M M Latocca
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - F Rizzo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - C Messina
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Rubagotti
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | - P Barboro
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy
| | - F Boccardo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
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15
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Hager S, Ackermann CJ, Joerger M, Gillessen S, Omlin A. Anti-tumour activity of platinum compounds in advanced prostate cancer-a systematic literature review. Ann Oncol 2016; 27:975-984. [PMID: 27052650 DOI: 10.1093/annonc/mdw156] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/25/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND For men with advanced castration-resistant prostate cancer (CRPC), several treatment options are available, including androgen receptor (AR) pathway inhibitors (abiraterone acetate, enzalutamide), taxanes (docetaxel, cabazitaxel) and the radionuclide (radium-223). However, cross-resistance is a clinically relevant problem. Platinum compounds have been tested in a number of clinical trials in molecularly unselected prostate cancer patients. Advances in CRPC molecular profiling have shown that a significant proportion of patients harbour DNA repair defects, which may serve as predictive markers for sensitivity to platinum agents. OBJECTIVE To systematically identify and analyse clinical trials that have evaluated platinum agents in advanced prostate cancer patients. METHODS PubMed was searched to identify published clinical trials of platinum agents in advanced prostate cancer. The PRIMSA statement was followed for the systematic review process. Identified trials are analysed for study design, statistical plan, assessments of anti-tumour activity and the potential value of predictive biomarkers. RESULTS A total of 163 references were identified by the literature search and 72 publications that met the selection criteria were included in this review; of these 33 used carboplatin, 27 cisplatin, 6 satraplatin, 4 oxaliplatin and 2 other platinum compounds. Overall, anti-tumour activity varies in the range of 10%-40% for objective response and 20%-70% for PSA decline ≥50%. Response seemed highest for the combinations of carboplatin with taxanes or oxaliplatin with gemcitabine. The interpretation of the clinical data is limited by differences in response criteria used and patient populations studied. CONCLUSION Platinum compounds have moderate anti-tumour activity in molecularly unselected patients with advanced prostate cancer. Translational evidence of DNA repair deficiency should be leveraged in future studies to select prostate cancer patients most likely to benefit from platinum-based therapy.
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Affiliation(s)
- S Hager
- Department of Oncology and Haematology, Cantonal Hospital, St Gallen, Switzerland
| | - C J Ackermann
- Department of Oncology and Haematology, Cantonal Hospital, St Gallen, Switzerland
| | - M Joerger
- Department of Oncology and Haematology, Cantonal Hospital, St Gallen, Switzerland
| | - S Gillessen
- Department of Oncology and Haematology, Cantonal Hospital, St Gallen, Switzerland
| | - A Omlin
- Department of Oncology and Haematology, Cantonal Hospital, St Gallen, Switzerland.
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16
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Di Lorenzo G, Pagliuca M, Perillo T, Benincasa A, Bosso D, De Placido S, Buonerba C. Docetaxel Rechallenge in a Heavily Pretreated Patient With Castration-Resistant Prostate Cancer: A Case Report and Review of Literature. Medicine (Baltimore) 2016; 95:e2754. [PMID: 27057826 PMCID: PMC4998742 DOI: 10.1097/md.0000000000002754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy agents for patients with metastatic castration-resistant prostate cancer (mCRPC) include docetaxel and cabazitaxel. Although docetaxel is approved in the first-line treatment setting, a few studies have shown that selected patients can benefit from docetaxel rechallenge.We, here, report the case of a heavily pretreated mCRPC patient who reported clinical benefit from receiving docetaxel after previous exposure to docetaxel, cabazitaxel, abiraterone, and enzalutamide.After 4 cycles of treatment, patient's performance status had improved to 1, the hemoglobin level was 12.9 g/dL and his serum prostate specific antigen levels were reduced by >70%, with no treatment-related adverse events.Although docetaxel rechallenge is a therapeutic option for selected patients, the risk of cumulative toxicity described in literature must be carefully considered.As the risk of cabazitaxel-related cumulative toxicity is probably lower, retreatment with cabazitaxel rather than docetaxel may also be an option in the setting of heavily pretreated mCRPC patients.
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Affiliation(s)
- Giuseppe Di Lorenzo
- From the Medical Oncology Unit, Department of Clinical Medicine, Federico II University, Naples, Italy
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17
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Top2a identifies and provides epigenetic rationale for novel combination therapeutic strategies for aggressive prostate cancer. Oncotarget 2016; 6:3136-46. [PMID: 25605014 PMCID: PMC4413643 DOI: 10.18632/oncotarget.3077] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/22/2014] [Indexed: 01/13/2023] Open
Abstract
Progression of aggressive prostate cancers (PCa) with androgen receptor splice variants or neuroendrocrine features is currently untreatable in the clinic. Therefore novel therapies are urgently required. We conducted RNA-seq using tumors from a unique murine transplant mouse model which spontaneously progresses to metastatic disease. Differential gene expression analysis revealed a significant increase of topoisomerase IIα, Top2a (Top2a) in metastatic tumors. Interrogation of human data revealed that increased Top2a expression in primary tumors selected patients with more aggressive disease. Further, significant positive correlation was observed between Top2a and the histone methyltransferase, Ezh2. Combination of the Top2 poison etoposide with the Ezh2 inhibitor GSK126 or DZNep significantly increased cell death in vitro in murine and human prostate cancer cell lines. Additionally, combination therapy extended time to progression and increased therapeutic efficacy in vivo. Overall, our studies demonstrate that patients screened for Top2a and Ezh2 expression would exhibit significant response to a combinational treatment involving low dose etoposide combined with Ezh2 inhibition. In addition, our data suggests that this combination therapeutic strategy is beneficial against aggressive PCa, and provides strong rationale for continued clinical development.
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18
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Hathaway AR, Baker MK, Sonpavde G. Emerging agents for the therapy of advanced prostate cancer. Future Oncol 2015; 11:2775-87. [DOI: 10.2217/fon.15.224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Since 2010, multiple advances have been made in the field of metastatic castration-resistant prostate cancer including regulatory approvals for five new agents including androgen pathway inhibitors (enzalutamide, abiraterone acetate), immunotherapy (sipuleucel-T), cytotoxic chemotherapy (cabazitaxel) and radiopharmaceuticals (radium-223) that have improved overall survival in this patient population. Despite these advances, each therapy has only extended median survival by 3–5 months and data suggest substantial cross-resistance among them. Given these modest increments, there is a major role for the vigorous investigation of new drugs and predictive biomarkers to select suitable patients who will benefit from them. This review describes emerging promising agents and their ongoing clinical development.
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Affiliation(s)
- Amanda R Hathaway
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL, USA
| | - Mary Katherine Baker
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL, USA
| | - Guru Sonpavde
- University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL, USA
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19
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Petrioli R, Roviello G, Fiaschi AI, Laera L, Bianco V, Ponchietti R, Barbanti G, Francini E. Low-Dose Estramustine Phosphate and Concomitant Low-Dose Acetylsalicylic Acid in Heavily Pretreated Patients With Advanced Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2015; 13:441-6. [DOI: 10.1016/j.clgc.2015.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 12/21/2022]
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20
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The third line of treatment for metastatic prostate cancer patients: Option or strategy? Crit Rev Oncol Hematol 2015; 95:265-71. [PMID: 26052050 DOI: 10.1016/j.critrevonc.2015.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/28/2014] [Accepted: 04/30/2015] [Indexed: 11/20/2022] Open
Abstract
New agents for metastatic castration-resistant prostate cancer (CRPC) developed in the past 3 years include cabaziataxel (Cbz), abiraterone acetate (AA) and enzalutamide (E). In this review, the results of clinical studies in which one of these drugs is included as the third line of treatment are discussed. Our review suggests that AA and E have limited activity, while Cbz seems to retain its efficacy. Prospective studies that further examine sequential treatments are warranted.
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21
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Petrioli R, Francini E, Fiaschi AI, Laera L, Roviello G. Targeted Therapies for Prostate Cancer. Cancer Invest 2015; 33:276-85. [DOI: 10.3109/07357907.2015.1033105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Rechallenge of docetaxel combined with epirubicin given on a weekly schedule in advanced castration-resistant prostate cancer patients previously exposed to docetaxel and abiraterone acetate: a single-institution experience. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2015. [PMID: 25636506 DOI: 10.1007/s12032-015-0485-232:485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of this paper was to evaluate the activity and tolerability of weekly docetaxel (D) combined with weekly epirubicin (EPI) in patients with advanced castrate-resistant prostate cancer (CRPC) previously exposed to D and abiraterone acetate (AA). Locally advanced or metastatic CRPC patients with 0-2 performance status, who had progressed after D and AA therapy, were included in the study. Previous treatment with chemotherapy agent cabazitaxel was also admitted. Treatment consisted of D 30 mg/m(2) intravenously (i.v.) and EPI 30 mg/m(2) i.v., every week (D/EPI). Chemotherapy was administered until disease progression or unacceptable toxicity. In our institution, twenty-six patients received D/EPI: their median age was 72 years (range 59-83 years). Twenty-three (88.5%) patients had bone metastases. A decrease in PSA levels ≥50% was observed in seven patients (26.9%, 95% CI: 0.11-0.47); of these, five had achieved a ≥50% PSA response during prior first-line D and six had achieved a PSA response during prior AA Among the subjects who were symptomatic at baseline, pain was reduced in nine patients (38.1%) with a significant decrease in analgesic use. Median progression-free survival was 4.4 months (95% CI, 3-5.2), and median overall survival was 10.7 months (95% CI, 8.9-18.4). Treatment was well tolerated and no grade 4 toxicities were observed. Our findings suggest that weekly D/EPI is feasible and active in heavily pretreated advanced CRPC patients and seem to support the hypothesis that the addition of EPI to D may lead to overcome the resistance to D in a subgroup of patients.
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Petrioli R, Roviello G, Fiaschi AI, Laera L, Miano ST, De Rubertis G, Barbanti G, Bianco V, Brozzetti S, Francini E. Rechallenge of docetaxel combined with epirubicin given on a weekly schedule in advanced castration-resistant prostate cancer patients previously exposed to docetaxel and abiraterone acetate: a single-institution experience. Med Oncol 2015; 32:52. [PMID: 25636506 DOI: 10.1007/s12032-015-0485-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/23/2015] [Indexed: 12/21/2022]
Abstract
The aim of this paper was to evaluate the activity and tolerability of weekly docetaxel (D) combined with weekly epirubicin (EPI) in patients with advanced castrate-resistant prostate cancer (CRPC) previously exposed to D and abiraterone acetate (AA). Locally advanced or metastatic CRPC patients with 0-2 performance status, who had progressed after D and AA therapy, were included in the study. Previous treatment with chemotherapy agent cabazitaxel was also admitted. Treatment consisted of D 30 mg/m(2) intravenously (i.v.) and EPI 30 mg/m(2) i.v., every week (D/EPI). Chemotherapy was administered until disease progression or unacceptable toxicity. In our institution, twenty-six patients received D/EPI: their median age was 72 years (range 59-83 years). Twenty-three (88.5%) patients had bone metastases. A decrease in PSA levels ≥50% was observed in seven patients (26.9%, 95% CI: 0.11-0.47); of these, five had achieved a ≥50% PSA response during prior first-line D and six had achieved a PSA response during prior AA Among the subjects who were symptomatic at baseline, pain was reduced in nine patients (38.1%) with a significant decrease in analgesic use. Median progression-free survival was 4.4 months (95% CI, 3-5.2), and median overall survival was 10.7 months (95% CI, 8.9-18.4). Treatment was well tolerated and no grade 4 toxicities were observed. Our findings suggest that weekly D/EPI is feasible and active in heavily pretreated advanced CRPC patients and seem to support the hypothesis that the addition of EPI to D may lead to overcome the resistance to D in a subgroup of patients.
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Affiliation(s)
- R Petrioli
- Medical Oncology Unit, University of Siena, Viale Bracci 11, 53100, Siena, Italy,
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Buonerba C, Di Lorenzo G. Is in vitro-acquired resistance to enzalutamide a useful model? Future Oncol 2014; 10:2551-3. [PMID: 25531044 DOI: 10.2217/fon.14.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Carlo Buonerba
- Medical Oncology Unit, Department of Clinical Medicine, Federico II University, Naples, Italy
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