Circulating biomarkers of sorafenib efficacy in advanced HCC

302

Background: Sorafenib represents the only drug with proven efficacy as first-line treatment of hepatocellular carcinoma (HCC). We analyzed 12 cytokines and growth factors related to angiogenesis, inflammation and cell proliferation and evaluated their possible utility as biomarkers of sorafenib efficacy in HCC. Methods: Our study population consisted of 62 HCC patients who received first-line sorafenib and 20 healthy controls. Material was collected at 3 different snapshots: (A) at baseline, (B) after 4 weeks on treatment, (C) at disease progression. Using commercially available ELISA kits we measured the serum levels of: VEGF-A, b FGF, sVEGFR2, Ang2, SDF1, VEGF-C, IL-6, IL-8, AFP, HGF, TSP1, BMP9 (bone morphogenetic protein 9). BMP9, a vascular quiescence factor, was explored for first time in HCC. Results: Patients had significant: (a) higher levels of Ang2, IL-6, IL-8, AFP, HGF, VEGF-A, FGFb , (b) lower levels of SDF1 than controls. At snapshot (B) we found a significant decrease of BMP9 and sVEGFR2 while a trend for significant increase was observed for VEGF-A, bFGF and IL-6. All statistically significant correlations for baseline levels of examined cytokines and their median change at week 4 with overall survival (OS) and progression free survival (PFS) are listed (Table). At disease progression (snapshot C) in comparison with baseline we found statistical significant: (a) increase for AFP, VEGF-A, bFGF, IL-6, (b) decrease for BMP9 and sVEGFR2. Conclusions: The values of circulating cytokines and growth factors examined in the present study showed frequent and statistically significant alterations during the disease course. Whether these factors could serve as potential biomarkers of sorafenib efficacy in HCC is something warranting further exploration and confirmation in bigger studies. [Table: see text]

Bevacizumab plus temsirolimus as second-line treatment for advanced hepatocellular carcinoma (HCC)

e14567

Background: The mTOR pathway has a central role in HCC not only in the tumor growth but also in the insulin driven hepatocarcinogenesis and is reported activated in 40-50% of HCC patients. Temsirolimus is an mTOR inhibitor with proven efficacy in renal cell carcinoma. The angiogenesis inhibitor bevacizumab has shown promising activity in HCC. Sorafenib represents the only drug with proven efficacy in HCC but currently there is no standard 2nd line treatment for patients who progress on sorafenib. Therefore, we performed a phase II study to determine the activity of a bevacizumab plus temsirolimus combination in second-line HCC. Methods: Patients who had progressed on sorafenib were eligible. Other eligibility criteria included ECOG PS 0-2 and Child- Pugh score A. The combination consisted of bevacizumab 10 mg/Kg plus temsirolimus 25 mg (total dose) given i.v. biweekly. After the enrolment of the 1/3 of the preplanned 40 patients (n=13) an interim analysis had to be performed to evaluate biologic activity. Biologic activity was defined either as a partial response by RECIST criteria or a > 50% decline in AFP in at least 2 of 13 patients. An expanded panel of possible biomarkers of response including VEGF, HGF, FGFb, TSP-1 and others, were measured at baseline. Results: The median age of the first 13 patients was 67 years (53-79 years) . The patients performace status was 0 (n=3), 1 (n=4) and 2 (n=6) and 11 of 13 patients had extrahepatic disease. Four patients had radiographic partial responses and five patients had > 50% reduction in AFP. Seven patients (53,8%) showed bioactivity. It is of note that two of them experiencing durable and long lasting partial remissions of 20 and 16 months respectively are still on treatment. One patient developed reversible posterior leycoencephalopathy syndrome (Grade 4 ) and one grade 4 hypertension. Grade 3 non-hematologic toxicities included hyperglycemia (n=3), hyperlipidemia (n=2), diarrhea (n=2) and infection (n=2). Conclusions: The combination of bevacizumab plus temsirolimus is well tolerated with encouraging activity. The study's preplanned criteria for activity have been met and the study continues accrual.

Erythropoietin receptors in endometrial carcinoma as related to HIF1{alpha} and VEGF expression

Erythropoietin receptors (EpoRs) are expressed in a large percentage of cells in many human malignancies, including endometrial adenocarcinoma. In such tumors, administration of recombinant human erythropoietin (rhEpo) during radiotherapy and chemotherapy may oppose tumor progression by interfering with growth and invasion pathways. In the present study, a strong EpoR expression was demonstrated in 58.8% of 72 stage I endometrial adenocarcinomas, and this pattern was linked with a high degree of tumor differentiation (p=0.01), deep myometrial invasion (p=0.04) and, marginally, with poor prognosis (p=0.06). In addition, a strong association with the immunohistochemical expression of hypoxia-inducible factor 1alpha (HIF1alpha) and the downstream angiogenic protein vascular endothelial growth factor (VEGF) was noted. In multivariate analysis, HIF1alpha, but not EpoR, was associated with the depth of myometrial invasion (p=0.04) and marginally with prognosis (p=0.07). It is concluded that EpoR are common constituents of endometrial adenocarcinomas and are related to tumor aggressiveness, although this is probably a result of their involvement in an active HIF pathway.

Serum C-reactive protein (CRP) levels in cancer patients are linked with tumor burden and are reduced by anti-hypertensive medication

High levels of CRP relate with advanced disease and poor prognosis of cancer patients. CRP serum levels were measured in 684 cancer patients who had undergone complete surgery or inoperable patients. Patients with inoperable tumors had significantly higher CRP levels (1.21 +/- 2.2 vs. 0.40 +/- 0.4 mg/dL; p < 0.0001). No association with gender, diabetes, autoimmune disease, thyroid disease or allergy was noted. Significantly higher CRP levels were noted in operated patients with hypertension (0.55 +/- 0.5 vs. 0.35 +/- 0.4; p = 0.001), coronary disease (0.73 +/- 0.8 vs. 0.39 +/- 0.4; p = 0.01) and obesity (0.51 +/- 0.5 vs. 0.37 +/- 0.4; p = 0.04). On the contrary, analysis in the group of inoperable patients showed that hypertensive patients had significantly lower CRP levels (0.64 +/- 1.0 vs. 1.36 +/- 2.4; p = 0.008). Although the tumor itself is the main factor defining increased CRP levels in cancer patients, hypertension, coronary disease and obesity are also linked with high CRP levels. Anti-hypertensive drugs appear as potent suppressors of the tumor-induced CRP production.