Doxorubicin In Sarcoma Research Articles

Best Overall Response-Associated Signature to Doxorubicin in Soft Tissue Sarcomas: A Transcriptomic Analysis from ANNOUNCE.

This exploratory analysis evaluated the tumor samples of the patients treated with doxorubicin (with or without olaratumab) in a negative phase III ANNOUNCE trial to better understand the complexity of advanced soft tissue sarcomas (STS) and to potentially identify its predictive markers. RNA sequencing was performed on pretreatment tumor samples (n = 273) from the ANNOUNCE trial to evaluate response patterns and identify potential predictive treatment markers for doxorubicin. A BOR-associated signature to doxorubicin (REDSARC) was created by evaluating tumors with radiographic response versus progression. An external cohort of doxorubicin-treated patients from the Spanish Group for Research on Sarcomas (GEIS) was used for refinement and validation. A total of 259 samples from the trial were considered for analysis. Comparative analyses by the treatment arm did not explain the negative trial. However, there was an association between the BOR signature and histologic subtype (χ2P = 2.0e-7) and grade (P = 0.002). There were no associations between the BOR signature and gender, age, ethnicity, or stage. Applied to survival outcomes, REDSARC was also predictive for progression-free survival (PFS) and overall survival (OS). Using the GEIS cohort, a refined 25-gene signature was identified and applied to the ANNOUNCE cohort, where it was predictive of PFS and OS in leiomyosarcoma, liposarcoma, and other sarcoma subtypes, but not in undifferentiated pleomorphic sarcoma. The refined REDSARC signature provides a potential tool to direct the application of doxorubicin in sarcomas and other malignancies. Validation and further refinement of the signature in other potentially subtype specific prospective cohorts is recommended.

The multikinase inhibitor EC-70124 synergistically increased the antitumor activity of doxorubicin in sarcomas.

Cytotoxic drugs like doxorubicin remain as the most utilized agents in sarcoma treatment. However, advanced sarcomas are often resistant, thus stressing the need for new therapies aimed to overcome this resistance. Multikinase inhibitors provide an efficient way to target several pro-tumorigenic pathways using a single agent and may constitute a valuable strategy in the treatment of sarcomas, which frequently show an aberrant activation of pro-tumoral kinases. Therefore, we studied the antitumor activity of EC-70124, an indolocarbazole analog that have demonstrated a robust ability to inhibit a wide range of pro-survival kinases. Evaluation of the phospho-kinase profile in cell-of-origin sarcoma models and/or sarcoma primary cell lines evidenced that PI3K/AKT/mTOR, JAK/STAT or SRC were among the most highly activated pathways. In striking contrast with the structurally related drug midostaurin, EC-70124 efficiently prevented the phosphorylation of these targets and robustly inhibited proliferation through a mechanism associated to the induction of DNA damage, cell cycle arrest and apoptosis. In addition, EC-70124 was able to partially reduce tumor growth in vivo. Importantly, this compound inhibited the expression and activity of ABC efflux pumps involved in drug resistance. In line with this ability, we found that the combined treatment of EC-70124 with doxorubicin resulted in a synergistic cytotoxic effect in vitro and an increased antitumor activity of this cytotoxic drug in vivo. Altogether, these results uncover the capability of the novel multikinase inhibitor EC-70124 to counteract drug resistance in sarcoma and highlight its therapeutic potential when combined with current treatments.

Nilotinib as co-adjuvant treatment with doxorubicin in sarcomas: Phase I trial results—A Spanish Group for Research on Sarcoma (GEIS) study.

10573 Background: Our group has recently published several relevant aspects of MDR proteins as potential targets in sarcomas: MRP1 expression was significantly correlated with poor prognosis in sar...

Clinical applications of palifermin: amelioration of oral mucositis and other potential indications.

Mucositis is one of the most significant toxicities in cancer patients undergoing cytotoxic treatment. It can have a negative impact on both quality of life and health economics. Severe oral mucositis can contribute to hospitalization, need for narcotic analgesics, total parentral nutrition, suboptimal delivery of anti-neoplastic treatment, and morbidity and mortality. Palifermin, a recombinant derivative of human keratinocyte growth factor, is the first active agent approved by the FDA for the prevention of severe oral mucositis in patients undergoing haematopoietic stem cell transplantation (HSCT). Several studies have also shown significant reduction in the incidence, severity and/or duration of oral mucositis in other high-risk settings such as concurrent chemoradiotherapy (CT/RT) for patients with head and neck cancer, and use of mucotoxic chemotherapeutic agents such as doxorubicin in sarcoma and fluorouracil for the treatment of colorectal cancer. The reduction in mucositis has translated into amelioration of symptoms and improvement in daily functioning as measured by patient-reported outcome in multiple studies. The clinical response to palifermin appears to be related in part to epithelial proliferation and mucosal thickening. Palifermin also has other potential clinical applications including the acceleration of immune reconstitution and inhibition of graft-versus-host disease in patients undergoing HSCT, and mitigation of dysphagia in lung cancer patients treated with concurrent CT/RT. Palifermin is generally well tolerated with mild-to-moderate skin and oral adverse events. Future studies may expand the use of palifermin into other areas that would benefit from its cytoprotective and regenerative effects.

Rational for targeted polytherapy in sarcoma: Get the genie out of the bottle.

e13519 Background: While a change of paradigm occurred in the last decade from chemotherapy to targeted therapy for cancer treatment, this work investigates the optimal combination of targeted agents with doxorubicin in sarcoma. Methods: Three sarcoma cell lines were studied RD18 (rhabdomyosarcoma), A204 (undifferentiated sarcoma) and TC 71 (Ewing's sarcoma) and exposed to increasing concentrations of vorinostat (HDAC inhibitor), 17-DMAG (Hsp90 inhibitor), abacavir (anti-telomerase) and sorafenib (tyrosine kinase inhibitor) alone, combined 2 by 2, then with doxorubicin. Viability was assessed by MTS assay. The Chou and Talalay combination index (CI) was used to determine additive (CI=1), synergistic (CI<1) or antagonistic effect (CI>1). Cell cycle analysis, measure of apoptosis by Annexin V and caspase 3/7 activity were studied using flow cytometry analysis and luminescent assay. Results: In monotherapy, the agents showed 30% to 90% decrease in viability but abacavir, which remained less active. Combination therapies with vorinostat, sorafenib and 17-DMAG showed strong synergism. Abacavir was found antagonistic with each drug. Either vorinostat or 17DMAG synergized with doxorubicin, achieving 60% cell killing compared to doxorubicin alone 12% (p=0.007). However, no synergy was observed for sorafenib with doxorubicin. The triple therapy vorinostat, 17DMAG and Doxorubicin did not show synergism but transiently increased the subG1 population at 24H, 70% compared to 30% in monotherapy with an increase in early caspase-independent apoptosis (11% to 36%, p= 0.0008). Conclusions: This work provides evidence of synergism of dual combinations of vorinostat, 17DMAG and sorafenib. In adjunction to doxorubicin, these combinations enhance doxorubicin cytotoxicity at therapeutically relevant concentrations. [Table: see text]