Erlotinib combination with a mitochondria-targeted ubiquinone effectively suppresses pancreatic cancer cell survival

BACKGROUND Pancreatic cancer is a leading cause of cancer-related deaths.Increased activity of the epidermal growth factor receptor(EGFR)is often observed in pancreatic cancer,and the small molecule EGFR inhibitor erlotinib has been approved for pancreatic cancer therapy by the food and drug administration.Nevertheless,erlotinib alone is ineffective and should be combined with other drugs to improve therapeutic outcomes.We previously showed that certain receptor tyrosine kinase inhibitors can increase mitochondrial membrane potential(Δψm),facilitate tumor cell uptake ofΔψm-sensitive agents,disrupt mitochondrial homeostasis,and subsequently trigger tumor cell death.Erlotinib has not been tested for this effect.AIM To determine whether erlotinib can elevateΔψm and increase tumor cell uptake ofΔψm-sensitive agents,subsequently triggering tumor cell death.METHODSΔψm-sensitive fluorescent dye was used to determine how erlotinib affectsΔψm in pancreatic adenocarcinoma(PDAC)cell lines.The viability of conventional and patient-derived primary PDAC cell lines in 2D-and 3D cultures was measured after treating cells sequentially with erlotinib and mitochondria-targeted ubiquinone(MitoQ),aΔψm-sensitive MitoQ.The synergy between erlotinib and MitoQ was then analyzed using SynergyFinder 2.0.The preclinical efficacy of the twodrug combination was determined using immune-compromised nude mice bearing PDAC cell line xenografts.RESULTS Erlotinib elevatedΔψm in PDAC cells,facilitating tumor cell uptake and mitochondrial enrichment ofΔψm-sensitive agents.MitoQ triggered caspase-dependent apoptosis in PDAC cells in culture if used at high doses,while erlotinib pretreatment potentiated low doses of MitoQ.SynergyFinder suggested that these drugs synergistically induced tumor cell lethality.Consistent with in vitro data,erlotinib and MitoQ combination suppressed human PDAC cell line xenografts in mice more effectively than single treatments of each agent.CONCLUSION Our findings suggest that a combination of erlotinib and MitoQ has the potential to suppress pancreatic tumor cell viability effectively.

Clinical efficacy and safety of erlotinib combined with chemotherapy in the treatment of advanced pancreatic cancer:A meta-analysis

BACKGROUND Advanced pancreatic cancer is resistant to chemotherapeutic drugs,resulting in limited treatment efficacy and poor prognosis.Combined administration of the chemotherapeutic gemcitabine and erlotinib is considered a potential first-line treatment for advanced pancreatic cancer.However,their comparative benefits and potential risks remain unclear.AIM To assess the clinical efficacy and safety of erlotinib combined with other chemotherapy regimens for the treatment of advanced pancreatic cancer.METHODS Literature on the clinical efficacy and safety of erlotinib combined with chemotherapy for advanced pancreatic cancer was retrieved through an online search.The retrieved literature was subjected to a methodological qualitative assessment and was analyzed using the RevMan 5.3 software.Ten randomized controlled trials involving 2444 patients with advanced pancreatic cancer were included in the meta-analysis.RESULTS Compared with chemotherapeutic treatment,erlotinib combined with chemotherapy significantly prolonged the progression-free survival time of pancreatic cancer patients[hazard ratio(HR)=0.78,95%CI:0.66-0.92,P=0.003].Meanwhile,the overall survival(HR=0.99,95%CI:0.72-1.37,and P=0.95)and disease control rate(OR=0.93,95%CI:0.45-0.91,P=0.84)were not significantly favorable.In terms of safety,the erlotinib and chemotherapy combination was associated with a significantly higher risk of diarrhea(OR=3.59,95%CI:1.63-7.90,P<0.05)and rash(OR=3.63,95%CI:1.64-8.01,P<0.05)compared with single-agent chemotherapy.Moreover,the risk of vomiting(OR=1.27,95%CI:0.62-2.59,P=0.51),regurgitation/anorexia(OR=1.61,95%CI:0.25-10.31,P=0.62),and infection(OR=0.72,95%CI:0.28-1.87,P=0.50)were not significant in either group.CONCLUSION Compared with a single chemotherapeutic modality,erlotinib combined with gemcitabine can prolong progression-free survival in pancreatic cancer,but does not improve survival benefit or disease control rate,and can increase the risk of diarrhea and rash.

IRESSA（gefitinib）耐药患者应用TARCEVA（erlotinib）4例报告及文献复习

Iressa为治疗NSCLC的一种新型靶向治疗药物-EGFR酪氨酸激酶抑制剂，以疗效明显、副作用低及提高生活质量为特点。后又出现一作用类似的药物tarceva。给那些对iressa耐药的患者带来一线希望。我院自2004年2月至2006年4月共对4例患者服用iressa耐药后应用tarceva治疗，现报告如下。

分子靶向药物Erlotinib(Tarceva)可以延长晚期非小细胞肺癌患者的生存期

本期的快讯,选自刚刚结束的美国临床肿瘤学会(ASCO)第40届年会新设的一项特殊论坛:“late-breakingabstracts”,意即这些论文的结果是新鲜出炉且具有高影响力。详细的评价,将会在本刊后续的“循证评价”中陆续推出,敬请垂注。

抑制抗增殖蛋白2增强非小细胞肺癌细胞系A549对厄洛替尼敏感性

目的探讨抗增殖蛋白2(PHB2)在非小细胞肺癌细胞系A549对厄洛替尼(Erl)敏感性中的作用及其机制。方法在A549细胞中转染PHB2小干扰RNA(siPHB2),观察抑制PHB2表达对Erl诱导的细胞增殖和凋亡的影响。利用MitoTracker染色和感染绿色荧光蛋白-微管相关蛋白(GFP-LC3)观察微管相关蛋白(LC3)和线粒体共定位,EdU实验检测细胞增殖,平板集落检测细胞集落形成能力,TUNEL实验检测细胞凋亡,Western blot检测PHB2和LC3Ⅱ蛋白表达水平,用相应试剂盒检测线粒体膜电位、细胞色素c含量和呼吸链复合物Ⅰ/Ⅱ/Ⅴ活性。结果与siPHB2组和siCtrl+Erl组相比,siPHB2+Erl组EdU阳性的细胞数显著减少(P<0.05),集落形成数显著减少(P<0.05),TUNEL阳性的细胞数显著增加(P<0.05),线粒体膜电位显著降低(P<0.05),线粒体呼吸链复合物Ⅰ/Ⅱ/Ⅴ活性均显著降低(P<0.05),线粒体内细胞色素c减少(P<0.05),而细胞质内细胞色素c的增加(P<0.05)。结论抑制PHB2改善A549细胞对Erl的敏感性,其机制可能与抑制PHB2介导的线粒体自噬有关。

Erlotinib在肺癌应用中的相关分子和临床预后指标

1文献类型 治疗。 2证据水平 1a。 3文献来源 Tsao MS, Sakurada A, Cutz JC, et al, Erlotinib in lung cancer-molecular and clinical predictors of outcome [J]. N Engl J Med, 2005,353： 133-134,

Erlotinib对鼻咽癌细胞株放射敏感性的作用

目的:研究Erlotinib对人鼻咽癌细胞株CNE1及CNE2放射敏感性的影响。方法:人鼻咽癌细胞株CNE1、CNE2经Erlotinib、深部X线照射或两者联合处理,采用细胞克隆形成法检测Erlotinib对鼻咽癌细胞株放射敏感性的影响;流式细胞仪检测细胞凋亡及细胞周期的情况。结果:Erlotinib增强了鼻咽癌细胞株CNE1、CNE2的放射敏感性,放射增敏比分别为1.076、1.109;Erlotinib联合电离辐射可导致鼻咽癌细胞株CNE1、CNE2发生G2/M期阻滞;并促进鼻咽癌细胞株CNE2放射诱导的细胞凋亡。结论:Erlotinib联合电离辐射可致鼻咽癌细胞周期G2/M期阻滞,增强了鼻咽癌细胞株的放射敏感性。

国内首例厄洛替尼治疗TRPV3基因变异Olmsted综合征并文献复习

报道国内首例厄洛替尼成功治疗Olmsted综合征。患者,女53岁,左足底角质增厚、干燥皮疹伴疼痛40年,加重4年。组织病理学检查:角化亢进伴角化不全,角层内水肿,粒层减少,表皮角朊细胞部分变性,真皮乳头小血管增生扩张,管周稀疏炎性浸润。基因检测结果示:TRPV3基因变异。根据临床表现、组织病理学及基因检测结果,该患者诊断为Olmsted综合征。确诊后予口服厄洛替尼治疗,每日50 mg,后缓慢减量直至停药。治疗4个月后,双足底皮疹几乎完全清除,疼痛明显缓解。停药后随访2个月皮疹无复发。治疗期间无严重不良反应。

Inhibition of EGFR attenuates EGF-induced activation of retinal pigment epithelium cell via EGFR/AKT signaling pathway

AIM:To explore the effect of epidermal growth factor receptor(EGFR)inhibition by erlotinib and EGFR siRNA on epidermal growth factor(EGF)-induced activation of retinal pigment epithelium(RPE)cells.METHODS:Human RPE cell line(ARPE-19 cells)was activated by 100 ng/mL EGF.Erlotinib and EGFR siRNA were used to intervene EGF treatment.Cellular viability,proliferation,and migration were detected by methyl thiazolyl tetrazolium(MTT)assay,bromodeoxyuridine(BrdU)staining assay and wound healing assay,respectively.EGFR/protein kinase B(AKT)pathway proteins and N-cadherin,α-smooth muscle actin(α-SMA),and vimentin were tested by Western blot assay.EGFR was also determined by immunofluorescence staining.RESULTS:EGF treatment for 24h induced a significant increase of ARPE-19 cells’viability,proliferation and migration,phosphorylation of EGFR/AKT proteins,and decreased total EGFR expression.Erlotinib suppressed ARPE-19 cells’viability,proliferation and migration through down regulating total EGFR and AKT protein expressions.Erlotinib also inhibited EGF-induced an increase of proliferative and migrative ability in ARPE-19 cells and clearly suppressed EGF-induced EGFR/AKT proteins phosphorylation and decreased expression of N-cadherin,α-SMA,and vimentin proteins.Similarly,EGFR inhibition by EGFR siRNA significantly affected EGF-induced an increase of cell proliferation,viability,and migration,phosphorylation of EGFR/AKT proteins,and up-regulation of N-cadherin,α-SMA,and vimentin proteins.CONCLUSION:Erlotinib and EGFR-knockdown suppress EGF-induced cell viability,proliferation,and migration via EGFR/AKT pathway in RPE cells.EGFR inhibition may be a possible therapeutic approach for proliferative vitreoretinopathy(PVR).

FASN对Erlotinib耐药细胞株生长的影响及其机制

目的:探讨脂肪酸合酶(fatty acid synthase,FASN)在非小细胞肺癌(non-small-cell carcinoma,NSCLC)中,对厄洛替尼(Erlotinib)耐药细胞株生长的影响和其可能的机制。方法:应用实时定量PCR技术以及Western blot技术分别检测HCC827-EP细胞株与HCC827-ER细胞株中的FASN mRNA和蛋白水平变化。利用小干扰RNA技术阻抑FASN表达后,以SRB法检测干扰前后对HCC827-EP/ER细胞株生长作用的影响。以及阻抑FASN表达后,用实时定量PCR技术和Western blot检测叉头蛋白O1(forkhead box protein O1,FoxO1)水平的变化。用活性形式的FoxO1腺病毒感染细胞后,以SRB法检测细胞的存活率。结果:Erlotinib耐药细胞株的FASN表达水平高于亲代细胞株;阻抑FASN的表达,抑制了耐药细胞株的生长;下调FASN的表达,FoxO1mRNA及蛋白水平均有所升高。上调FoxO1的表达,抑制了耐药细胞株的生长。结论:FASN的高表达发生于Erlotinib耐药细胞株中,下调FASN表达可以抑制耐药细胞株的生长,其可能机制是抑制FASN表达上调了FoxO1,从而抑制了细胞的生长。

贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状NSCLC的成本-效用分析

目的 从我国卫生体系角度出发,评价贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状非小细胞肺癌(NSCLC)的经济性。方法 基于BEVERLY研究数据构建动态Markov模型,循环周期为3周,模拟至模型中99%的患者死亡,年贴现率为5%。模型产出为总成本与质量调整生命年(QALY)以及增量成本-效果比(ICER)。以3倍我国2023年人均国内生产总值(GDP)作为意愿支付(WTP)阈值,采用成本-效用分析法评价贝伐珠单抗联合厄洛替尼相对于厄洛替尼单药一线治疗晚期EGFR突变型非鳞状NSCLC的经济性,并采用单因素敏感性分析和概率敏感性分析验证基础分析结果的稳健性。结果 基础分析结果显示,与厄洛替尼单药方案相比,贝伐珠单抗联合厄洛替尼方案的ICER为1 452 243.01元/QALY,大于以3倍我国2023年人均GDP(268 074元/QALY)作为的WTP阈值,不具有经济性。单因素敏感性分析结果显示,贝伐珠单抗成本、无进展生存期和疾病进展期状态的效用值对结果的影响较大。概率敏感性分析结果显示,当WTP阈值为1 740 000元/QALY时,贝伐珠单抗联合厄洛替尼方案具有经济性的概率为50%。结论 在以3倍我国2023年人均GDP作为WTP阈值时,与厄洛替尼单药方案相比,贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状NSCLC不具有经济性。

杨梅素经β-catenin对厄洛替尼抗非小细胞肺癌的增敏作用与机制

目的探讨杨梅素经β-catenin对厄洛替尼抗非小细胞肺癌(NSCLC)的增敏作用及分子机制。方法将A549细胞分为对照组、厄洛替尼处理组、杨梅素处理组,采用Western blot方法检测β-catenin随时间和剂量的表达情况。构建siβ-catenin转染A549细胞敲降β-catenin的细胞株,应用集落形成实验,观察厄洛替尼处理后集落形成率。构建厄洛替尼和杨梅素单独处理组和联合处理组,Hoechst 33258实验检测细胞凋亡状况,Western blot检测凋亡相关蛋白的表达情况。结果厄洛替尼可显著诱导A549细胞中β-catenin的表达,并呈时间和剂量依赖效应,抑制β-catenin可增强A549细胞对厄洛替尼的敏感性。杨梅素可显著抑制β-catenin的表达。与厄洛替尼单独应用比较,杨梅素和厄洛替尼联合应用显著提高A549细胞凋亡率,增强凋亡相关蛋白的表达量。结论杨梅素通过下调β-catenin表达促进厄洛替尼抗NSCLC的敏感性,为杨梅素和厄洛替尼联合应用抵抗厄洛替尼的耐药性提供了实验依据和新的治疗思路。

Erlotinib治疗肝癌的临床研究进展

Erlotinib可以选择性抑制表皮生长因子受体,以发挥抗肿瘤活性。总结了Erlotinib治疗肝癌的Ⅱ-Ⅲ临床试验结果。两项Ⅱ期临床试验提示Erlotinib单药治疗肝癌的疗效适中,两项来自美国的Ⅱ期临床试验发现Erlotinib联合Bevacizumab治疗肝癌可以达到较好的疗效,但其潜在增加静脉曲张出血的风险,而两项来自亚洲的Ⅱ期临床试验显示Erlotinib联合Bevacizumab治疗肝癌的疗效欠佳。最近,一项随机对照Ⅲ期试验并未能证实Erlotinib可以显著改善索拉非尼治疗肝癌的总体生存时间。未来的研究应根据临床及分子预后标志物去选择适合接受Erlotinib的肝癌患者,以更有效地鉴定Erlotinib适用人群。

Erlotinib usage after prior treatment with gefitinib in advanced non-small cell lung cancer: A clinical perspective and review of published literature

Erlotinib and gefitinib are among the most widely researched, used and available molecularly targeted therapies for treatment of advanced non-small cell lung cancer(NSCLC). They are both tyrosine kinase inhibitors(TKIs) of the epidermal growth factor receptor(EGFR). In the past decade, there have been reports on clinical benefit from use of erlotinib after gefitinib failure in NSCLC patients. A review of published literature on this focussed topic is provided herein. Pooled analysis of published literature shows that majority of patients were female(60.6%), non-smokers(64.5%), had adenocarcinoma histology(88.3%) and were of East Asian ethnicity(92.3%). Presence of sensitizing EGFR mutation was detected in 48.4% of subjects. Disease control rates with prior gefitinib therapy and with subsequent erlotinib treatment were 79.4% and 45.4% respectively. Based upon our review, the most important predictive factor for clinical benefit from erlotinib identified was previous response to gefitinib. The exact explanations for the potential benefit from erlotinib use in this patient population is still not known and further studies are required to determine the role of molecular mechanismsespecially those related to resistance to initial EGFR TKI therapy.

Distinct antifibrogenic effects of erlotinib,sunitinib and sorafenib on rat pancreatic stellate cells

AIM:To study if three clinically available small molecule kinase inhibitors(SMI),erlotinib,sunitinib and sorafenib,exert antifibrogenic effects on pancreatic stellate cells(PSC)and analyze the basis of their action.METHODS:Cultured rat PSC were exposed to SMI.Cell proliferation and viability were assessed employing 5-bromo-2’-deoxyuridine incorporation assay and flow cytometry,respectively.2-Deoxy-2-[18F]fluoroglucose(18F-FDG)uptake was measured to study metabolic activity.Exhibition of the myofibroblastic PSC phenotype was monitored by immunofluorescence analysis ofα-smooth muscle actin(α-SMA)expression.Levels of mRNA were determined by real-time PCR,while protein expression and phosphorylation were analyzed by immunoblotting.Transforming growth factor-β1 (TGF-β1)levels in culture supernatants were quantified by ELISA.RESULTS:All three SMI inhibited cell proliferation and18F-FDG uptake in a dose-dependent manner and without significant cytotoxic effects.Furthermore,additive effects of the drugs were observed.Immunoblot analysis showed that sorafenib and sunitib,but not erlotinib,efficiently blocked activation of the AKT pathway,while all three drugs displayed little effect on phosphorylation of ERK1/2.Cells treated with sorafenib or sunitinib expressed less interleukin-6 mRNA as well as less collagen type 1 mRNA and protein.Sorafenib was the only drug that also upregulated the expression of matrix metalloproteinase-2 and reduced the secretion of TGF-β1 protein.All three drugs showed insignificant or discordant effects on the mRNA and protein levels ofα-SMA.CONCLUSION:The tested SMI,especially sorafenib,exert inhibitory effects on activated PSC,which should be further evaluated in preclinical studies.

Quantitative determination of erlotinib in human serum using competitive enzyme-linked immunosorbent assay

A selective and sensitive competitive enzyme-linked immunosorbent assay(ELISA) method was developed and validated for the quantification of erlotinib in 50 mL of samples of human serum. Anti-erlotinib serum was obtained by immunizing mice with an antigen conjugated with bovine serum albumin and 3,4-bis(2-methoxyethoxy)benzoic acid using the N-succinimidyl ester method. Enzyme labeling of erlotinib with horseradish peroxidase was similarly performed using 3,4-bis(2-methoxyethoxy)benzoic acid. A simple competitive ELISA for erlotinib was developed using the principle of direct competition between erlotinib and the enzyme marker for anti-erlotinib antibody, which had been immobilized on the plastic surface of a microtiter plate. Serum erlotinib concentrations lower than 40 ng/mL were reproducibly measurable using the ELISA. This ELISA was specific to erlotinib and showed very slight cross-reactivity(6.7%) with a major metabolite, O-desmethyl erlotinib. Using this assay, drug levels were easily measured in the blood of mice after oral administration of erlotinib at a single dose of 30 mg/kg. ELISA should be used as a valuable tool for therapeutic drug monitoring and in pharmacokinetic studies of erlotinib.

First-line erlotinib and fixed dose-rate gemcitabine for advanced pancreatic cancer

AIM: To investigate activity, toxicity, and prognostic factors for survival of erlotinib and fixed dose-rate gemcitabine (FDR-Gem) in advanced pancreatic cancer. METHODS: We designed a single-arm prospective, multicentre, open-label phase Ⅱ study to evaluate the combination of erlotinib (100 mg/d, orally) and weekly FDR-Gem (1000 mg/m 2 , infused at 10 mg/m 2 per minute) in a population of previously untreated patients with locally advanced, inoperable, or metastatic pancreatic cancer. Primary endpoint was the rate of progression-free survival at 6 mo (PFS-6); secondary endpoints were overall response rate (ORR), response duration, tolerability, overall survival (OS), and clinical benefit. Treatment was not considered to be of further interest if the PFS-6 was < 20% (p0 = 20%), while a PFS-6 > 40% would be of considerable interest (p1 = 40%); with a 5% rejection error (α = 5%) and a power of 80%, 35 fully evaluable patients with metastatic disease were required to be enrolled in order to complete the study. Analysis of prognostic factors for survival was also carried out. RESULTS: From May 2007 to September 2009, 46 patients were enrolled (male/female: 25/21; median age: 64 years; median baseline carbohydrate antigen 19-9 (CA 19-9): 897 U/mL; locally advanced/metastatic disease: 5/41). PFS-6 and median PFS were 30.4% and 14 wk (95%CI: 10-19), respectively; 1-year and median OS were 20.2% and 26 wk (95%CI: 8-43). Five patients achieved an objective response (ORR: 10.9%, 95%CI: 1.9-19.9); disease control rate was 56.5% (95%CI: 42.2-70.8); clinical benefit rate was 43.5% (95%CI: 29.1-57.8). CA 19-9 serum levels were decreased by > 25% as compared to baseline in 14/23 evaluable patients (63.6%). Treatment was well-tolerated, with skin rash being the most powerful predictor of both longer PFS (P < 0.0001) and OS (P = 0.01) at multivariate analysis (median OS for patients with or without rash: 42 wk vs 15 wk, respectively, Log-rank P = 0.03). Additional predictors of better outcome were: CA 19-9 reduction, female sex (for PFS), and good performance status (for OS). CONCLUSION: Primary study endpoint was not met. However, skin rash strongly predicted erlotinib efficacy, suggesting that a pharmacodynamic-based strategy for patient selection deserves further investigation.

Sustained complete response to erlotinib in squamous cell carcinoma of the head and neck:A case report

BACKGROUND Squamous cell carcinoma of head and neck(SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib.CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes(levels 2 and 3). Imaging studies including(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx,oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment.He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib.CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.