Abstract
Autophagy, a process of cellular self-degradation and cell survival whereby the cell generates energy and metabolic intermediates under conditions of stress (i.e., nutrient deprivation), is also commonly induced in tumor cells in response to chemotherapy and radiation. While chemotherapy-induced autophagy and radiation-induced autophagy are generally considered to have cytoprotective functions, thereby reducing tumor cell sensitivity (and potentially conferring resistance) to various treatment modalities, autophagy can also be nonprotective; furthermore, the nature of the autophagy can be altered via the “autophagic switch” depending on such factors as the p53 status of the tumor cells. Defective or compromised autophagy has also been associated with neurodegenerative diseases, raising concerns as to the impact of autophagy inhibition on normal tissue function. Furthermore, the impact of autophagy inhibition on the immune system response to therapy as well as the influence of autophagy inhibition in combination with chemotherapy or radiation on critical tissue sites such as the bone marrow remain uncertain. These are factors requiring serious consideration within the context of current clinical efforts to exploit autophagy inhibition as a therapeutic strategy in cancer.
Highlights
Pharmacologic Autophagy Inhibitors in Clinical TrialsOver the course of the last decade, one strategy that has been considered to have the potential to both enhance the response to cancer therapeutics and to overcome drug and radiation resistance is that of autophagy inhibition
Autophagy, a process of cellular self-degradation and cell survival whereby the cell generates energy and metabolic intermediates under conditions of stress, is commonly induced in tumor cells in response to chemotherapy and radiation
Over the course of the last decade, one strategy that has been considered to have the potential to both enhance the response to cancer therapeutics and to overcome drug and radiation resistance is that of autophagy inhibition
Summary
Over the course of the last decade, one strategy that has been considered to have the potential to both enhance the response to cancer therapeutics and to overcome drug and radiation resistance is that of autophagy inhibition. In order for the current clinical trials combining both conventional and targeted therapies with pharmacological autophagy inhibition (i.e., using hydroxychloroquine), to have a likelihood of demonstrating efficacy, therapy-induced autophagy would have to be exclusively cytoprotective in function; alternatively, patients would have to be stratified based on which patients’ tumors were undergoing protective autophagy and in response to which therapeutic agents, which is currently neither practical nor feasible. Another possibility is that the pharmacologic autophagy inhibitors would have to be capable of sensitizing tumor cells to cancer therapeutics through autophagy-independent pathways
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