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Vandetanib (ZD6474), an Inhibitor of VEGFR and EGFR Signalling, As a Novel Molecular-Targeted Therapy Against Cholangiocarcinoma

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Vandetanib (ZD6474), an Inhibitor of VEGFR and EGFR Signalling, As a Novel Molecular-Targeted Therapy Against Cholangiocarcinoma British Journal of Cancer (2009) 100, 1257 – 1266 & 2009 Cancer Research UK All rights reserved 0007 – 0920/09 $32.00 www.bjcancer.com Vandetanib (ZD6474), an inhibitor of VEGFR and EGFR signalling, as a novel molecular-targeted therapy against cholangiocarcinoma 1,2 3 1 4 2 3 ,1,3 D Yoshikawa , H Ojima , A Kokubu , T Ochiya , S Kasai , S Hirohashi and T Shibata* 1 2 Cancer Genomics Project, National Cancer Center Research Institute, Tokyo, Japan; Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical College, Asahikawa, Japan; 3Pathology Division, National Cancer Center Research Institute, Tokyo, Japan; 4Section for Studies on Metastasis, National Cancer Center Research Institute, Tokyo, Japan Cholangiocarcinoma is an intractable cancer, with no effective therapy other than surgical resection. Elevated vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) expressions are associated with the progression of cholangiocarcinoma. We therefore examined whether inhibition of VEGFR and EGFR could be a potential therapeutic target for cholangiocarcinoma. Vandetanib (ZD6474, ZACTIMA), a VEGFR-2/EGFR inhibitor, was evaluated. Four human cholangiocarcinoma cell lines were molecularly characterised and investigated for their response to vandetanib. In vitro, two cell lines (OZ and HuCCT1), both of which harboured KRAS mutation, were refractory to vandetanib, one cell line (TGBC24TKB) was somewhat resistant, and another cell line (TKKK) was sensitive. The most sensitive cell line (TKKK) had EGFR amplification. Vandetanib significantly À1 À1 À1 À1 inhibited the growth of TKKK xenografts at doses X12.5 mg kg day (Po0.05), but higher doses (50 mg kg day , Po0.05) of À1 À1 vandetanib were required to inhibit the growth of OZ xenografts. Vandetanib (25 mg kg day ) also significantly (P ¼ 0.006) prolonged the time to metastasis in an intravenous model of TKKK metastasis. Inhibiting both VEGFR and EGFR signalling appears a promising therapeutic approach for cholangiocarcinoma. The absence of KRAS mutation and the presence of EGFR amplification may be potential predictive molecular marker of sensitivity to EGFR-targeted therapy in cholangiocarcinoma. British Journal of Cancer (2009) 100, 1257–1266. doi:10.1038/sj.bjc.6604988 www.bjcancer.com Published online 24 March 2009 & Translational Therapeutics 2009 Cancer Research UK Keywords: EGFR; VEGFR; cholangiocarcinoma; in vivo imaging; molecular-targeted therapy Cholangiocarcinoma (cancer of the bile duct epithelium) is one of study of erlotinib, an EGFR kinase inhibitor, for advanced the intractable cancers, whose incidence and mortality rates, cholangiocarcinoma suggests the clinical benefit for EGFR especially those of intrahepatic cholangiocarcinoma (IHCC), are inhibition in patients with cholangiocarcinoma (Philip et al, 2006). increasing worldwide (Khan et al, 2005). As cholangiocarcinoma is The EGFR signalling pathway is associated with the progression, difficult to diagnose at an early stage and no effective therapy other proliferation, migration, and survival of cancer cells (Yarden and than complete resection has been established, its prognosis is very Sliwkowski, 2001), and VEGF plays a key role in tumour-associated poor (5-year survival is 0–40% even in resected cases) (Khan et al, neo-angiogenesis, which provides a tumour with oxygen, nutrition, 2005; Sirica, 2005). Although gemcitabine-based chemotherapy and a route for metastasis (Tabernero, 2007). In addition, VEGF regimens have shown some potential in the treatment of upregulation in tumour cells is considered to be a mechanism of cholangiocarcinoma in recent years (Knox et al, 2005), novel resistance to EGFR inhibitors (Viloria Petit et al, 2001). Earlier, we therapeutic strategies are required. have also reported that EGFR and VEGF overexpressions are Recently, molecular-targeted therapies have become available frequent in cholangiocarcinoma (B20 and 50%, respectively), and have shown clinical benefit in some cancers (Gonzalez Angulo that EGFR overexpression is an independent prognostic factor in et al, 2006; Tabernero, 2007). Epidermal growth factor receptor IHCC, and that VEGF expression is associated with intrahepatic (EGFR) and vascular endothelial growth factor receptor (VEGFR) metastasis in IHCC (Yoshikawa et al, 2008). These observations have emerged as potential therapeutic targets in cholangiocarci- prompted us to hypothesise that dual inhibition of both EGFR and noma. Several studies have shown overexpression of EGFR, VEGFR may exert a synergistic anti-tumour effect in cholangio- amplification and mutation of EGFR genes (Gwak et al, 2005; carcinoma. Nakazawa et al, 2005; Leone et al, 2006), and overexpression of In vivo imaging using bioluminescence can monitor tumour VEGF protein (Tang et al, 2006) in cholangiocarcinoma. A phase II growth in animals, providing longitudinal and temporal informa- tion. Its value in the assessment of anti-cancer agents in vivo has been recently confirmed in some animal models of cancer (Jenkins *Correspondence: Dr T Shibata, Cancer Genomics Project, National et al, 2003; Nogawa et al, 2005). In this study, we established Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104- bioluminescent cholangiocarcinoma cells and mouse xenograft 0045, Japan; E-mail: [email protected] models of cholangiocarcinoma, and used these to assess the Revised 13 February 2009; accepted 18 February 2009; published online activity of vandetanib (ZD6474, ZACTIMA), a VEGFR-2 and an 24 March 2009 EGFR tyrosine kinase inhibitor, using an in vivo imaging system. VEGFR/EGFR inhibitor in cholangiocarcinoma D Yoshikawa et al 1258 MATERIALS AND METHODS Fluorescence in situ hybridisation for the EGFR gene locus Cholangiocarcinoma cell lines EGFR gene copy number per cell was investigated by fluorescence in situ hybridisation (FISH) using the LSI EGFR SpectrumOrange/ Four human cholangiocarcinoma cell lines derived from Japanese CEP7 SpectrumGreen probe (Vysis, Downers Grove, IL, USA), in patients (TKKK, OZ, TGBC24TKB, and HuCCT1) were purchased accordance with a published protocol (Ooi et al, 2004). Positivity from RIKEN Bio Resource Center (Tsukuba, Japan, http:// for gene amplification was defined as the presence of clustered www.brc.riken.jp/lab/cell/) or from the Japanese Collection of signals or X4 copies of orange signals. Research Bioresources (Osaka, Japan, http://cellbank.nibio.go.jp/). The TKKK cell line was derived from IHCC, and the OZ, TGBC24TKB, and HuCCT1 cell lines from extrahepatic cholangio- Drug and formulation carcinoma. Vandetanib was provided by AstraZeneca (Macclesfield, UK). For the in vitro study, vandetanib was formulated as a 10-mM stock in Subcutaneous xenograft model 100% dimethylsulphoxide and stored at À201C. Just before in vitro use, the stock solution was diluted in culture medium to the All animal experiment protocols were approved by the Committee required concentration. For the in vivo study, vandetanib was for Ethics in Animal Experimentation, and the experiments were administered as a homogeneous suspension with 1% polysorbate conducted in accordance with the Guideline for Animal Experi- (Tween 80; MP Biomedicals, Solon, OH, USA) and administered ments of the National Cancer Center (Tokyo, Japan). orally once a day at 0.1 ml/10 g body weight (b.w.). Eight-week-old female BALB/c-nu/nu athymic mice were Translational Therapeutics purchased from Japan SLC (Hamamatsu, Japan). A total of 8 Â 106 cells were suspended in 0.2 ml of culture medium without Cell proliferation assay foetal bovine serum and injected subcutaneously into the right Cell sensitivity to vandetanib was estimated using the 3-(4,5- flank of the mice. Tumour volume was calculated using the dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulpho- following formula: (short diameter)2 Â (long diameter)/2. phenyl)-2H-tetrazolium, inner salt (MTS) assay. The CellTiter 96 AQueous One Solution Reagent (Promega, Madison, WI, USA) was RT–PCR analysis for EGFR, VEGF, and VEGFR-2 used in accordance with manufacturer’s instructions. A total of Total RNA and genomic DNA were extracted from the four cell 5000 cells suspended in 100 ml of 10% foetal bovine serum- lines. Total RNA of 1 mg was converted into cDNA using a containing culture medium per well were placed on a 96-well Transcriptor First Strand cDNA Synthesis Kit (Roche, Basel, culture plate and treated with various concentrations of vandeta- Switzerland) in accordance with the manufacturer’s instructions. nib (0–100 mM). After 72 h, 20 ml of the reagent was added, and mRNA expression of EGFR, VEGF, and VEGFR-2 was assessed by the absorbance at 490 nm was recorded. The experiment was the RT–PCR method. Quantitative real-time PCR was conducted conducted in triplicate and repeated three times. All data were using LightCycler480 (Roche) in accordance with the manufac- calculated as a ratio to control, which means a ratio of absorbance turer’s instructions. TaqMan Probes (Applied Biosystems, Foster in each concentration of vandetanib treatment relative to that in ± City, CA, USA) for EGFR and VEGF were used. For standardisation the negative control, and presented as mean s.d. of the amount of RNA, expression of glyceraldehyde-3-phosphate dehydrogenase in each sample was quantified. Primers are shown Western blot analysis investigating molecular effects of in the Supplementary Table 1. vandetanib in vitro Each cell starved for 24 h was exposed to various concentrations of Mutation analysis
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