索拉非尼治疗转移性肾癌疗效与不良反应的关系

目的:探索索拉非尼在治疗转移性肾细胞癌（mRCC）患者中的不良反应与疗效之间的关系。方法:回顾性研究西京医院接受索拉非尼治疗的mRCC患者63例，利用卡方检验分析肿瘤控制率与不良反应的发生频率和严重程度的相关性，利用Kaplan-Meier方法分析16种不良反应，筛选出与患者PFS，OS相关的不良反应，将P＜0.05变量纳入多变量Cox比例风险回归模型进行进一步的多因素分析，确定独立预后因素。结果:63例接受索拉非尼治疗的患者中，完全缓解2例（3.2％），部分缓解16例（25.4％），疾病稳定37例（58.7％），疾病进展8例（12.7％）。中位PFS为12.0个月，中位OS为24.0个月。卡方检验结果示肿瘤控制率与不良反应的发生频率和严重程度相关（均P＜0.05）。多变量分析显示，更好的PFS的独立预后因素包括腹泻（OR 0.255,95％CI 0.130~0.500,P=0.000）和皮疹（OR 0.235,95％CI 0.114~0.482,P=0.000）。OS的独立预后因素包括腹泻（OR 0.454,95％CI 0.246~0.839,P=0.012），皮疹（OR 0.405,95％CI 0.211~0.776，P=0.006）和高血压（OR 0.373,95％CI 0.177~0.784,P=0.009）。结论:索拉非尼治疗mRCC患者的疗效与不良反应的发生频率和严重程度呈正相关。皮疹和腹泻是影响PFS的独立保护因素，皮疹，腹泻和高血压是影响OS的独立保护因素。这一结论仍需大量前瞻性研究证实。     

Treatment of generalized infantile myofibromatosis with sorafenib and imatinib: A case report

Infantile myofibromatosis (IM) is characterized by solitary musculoskeletal nodules presenting during infancy but can manifest as multiple lesions with visceral involvement. Multicentric IM with visceral involvement carries a high risk of mortality and there is no consensus on treatment. We present a case of a patient with multicentric IM and pulmonary involvement who progressed on several chemotherapeutic regimens and subsequently had a complete response to sorafenib and later imatinib. This report describes the novel use of sorafenib and imatinib to treat generalized IM and the role of continued tyrosine kinase inhibitor therapy to maintain remission.     

LY3214996 relieves acquired resistance to sorafenib in hepatocellular carcinoma cells

Background: Sorafenib, an oral multi-kinase inhibitor of rapidly accelerated fibrosarcoma; vascular endothelial growth factor receptor-2/3, platelet-derived growth factor receptor, c-Kit, and Flt-3 signaling, is approved for treatment of advanced hepatocellular carcinoma (HCC). However, the benefit of sorafenib is often diminished because of acquired resistance through the reactivation of ERK signaling in sorafenib-resistant HCC cells. In this work, we investigated whether adding LY3214996, a selective ERK1/2 inhibitor, to sorafenib would increase the anti-tumor effectiveness of sorafenib to HCC cells.Methods: The Huh7 cell line was used as a cell model for treatment with sorafenib, LY3214996, and their combination. Phosphorylation of the key kinases in the Ras/Raf/MAPK and PI3K/Akt pathways, protein expression of the cell cycle, and apoptosis migration were assessed with western blot. MTT and colony-formation assays were used to evaluate cell proliferation. Wound-healing assay was used to assess cell migration. Cell cycle and apoptosis analyses were conducted with flow cytometry.Results: LY3214996 decreased phosphorylation of the Ras/Raf/MAPK and PI3K/Akt pathways, including p-c-Raf, p-P90RSK, p-S6K and p-eIF4EBP1 activated by sorafenib, despite increased p-ERK1/2 levels. LY3214996 increased the anti-proliferation, anti-migration, cell-cycle progression, and pro-apoptotic effects of sorafenib on Huh7^R cells.Conclusions: Reactivation of ERK1/2 appears to be a molecular mechanism of acquired resistance of HCC to sorafenib. LY3214996 combined with sorafenib enhanced the anti-tumor effects of sorafenib in HCC. These findings form a theoretical basis for trial of LY3214996 combined with sorafenib as second-line treatment of sorafenib-resistant in advanced HCC.     

Multicenter retrospective analysis of systemic chemotherapy for unresectable combined hepatocellular and cholangiocarcinoma

We conducted a multicenter retrospective analysis to evaluate the efficacy of systemic chemotherapy for unresectable combined hepatocellular and cholangiocarcinoma. We enrolled 36 patients with pathologically proven, unresectable combined hepatocellular and cholangiocarcinoma treated with systemic chemotherapy. The log‐rank test determined the significance of each prognostic factor. Elevated alpha‐fetoprotein, carcinoembryonic antigen and carbohydrate antigen 19‐9 levels were observed in 58.3%, 16.7% and 38.9% of patients, respectively. First‐line chemotherapy included platinum‐containing regimens consisting of gemcitabine/cisplatin (n = 12) and fluorouracil/cisplatin (n = 11), sorafenib (n = 5) and others (n = 8). The median overall and progression‐free survival times were 8.9 and 2.8 months, respectively, with an overall response rate of 5.6%. Prognostic factors associated with negative outcomes included poor performance status, no prior primary tumor resection, a Child‐Pugh class of B, and elevated carcinoembryonic antigen levels with a hazard ratio of 2.25, 2.48, 3.25 and 2.84 by univariate analysis, respectively. The median overall survival times of the gemcitabine/cisplatin, fluorouracil/cisplatin, sorafenib and other groups were 11.9, 10.2, 3.5 and 8.1 months, respectively. Multivariate analysis revealed that the overall survival of patients within the sorafenib monotherapy group was poor compared with platinum‐containing regimens (HR: 15.83 [95% CI: 2.25‐111.43], P = .006). All 7 patients in the sorafenib group had progressive disease, including 2 patients with second‐line therapy. In conclusion, the platinum‐containing regimens such as gemcitabine/cisplatin were associated with more favorable outcomes than sorafenib monotherapy for unresectable combined hepatocellular and cholangiocarcinoma.     

索拉非尼联合5-氮杂-2′-脱氧胞苷对肝癌SMMC-7721细胞DNMT3B基因表达的影响

目的:探讨索拉非尼联合5-氮杂-2′-脱氧胞苷(5-Aza-CdR)对人肝癌细胞SMMC-7721的作用及其调控DNMT3B基因表达可能的分子 机制.方法:单独及联合给药后以MTT法测定SMMC-7721的增殖,Transwell检测其侵袭,流式细胞仪检测细胞凋亡,Western blot法观 察DNMT3B、p-Akt-Ser473及ERK蛋白的表达.结果:索拉非尼、5-Aza-CdR对肝癌SMMC-7721细胞半数抑制浓度(IC50)分别为11、6 μmol/L,联合用药选取(6+4)μmol/L作为后续用药浓 度.与对照组比较单药及联合用药均能抑制细胞侵袭、促进细胞凋亡、减少p-Akt-Ser473和DNMT3B蛋白的表达(P<0.05~P<0.01).结论:索拉非尼和5-Aza-CdR联合用药能有效降低索拉非尼用药浓度,降低肝癌SMMC-7721细胞DNMT3B蛋白表达水平.     

萝卜硫素联合索拉菲尼对肝癌HepG2细胞生长抑制和凋亡的影响

[目的] 探讨萝卜硫素与索拉菲尼联合对肝癌HepG2细胞生长抑制及凋亡的作用,并观察其可能的机制。[方法] 细胞计数试剂盒8（CCK8）法分析了萝卜硫素、索拉菲尼及两者联合给药对HepG2细胞增殖抑制率的影响,计算每种药物的半数抑制浓度（IC₅₀）及联合时的联合指数（CI）;流式细胞仪检测了HepG2细胞凋亡情况;免疫蛋白印记（Western Blot）检测了细胞周期蛋白D1（ClinD1）、C-myc、B淋巴细胞瘤-2（Bcl-2）、Bcl-2相关X蛋白（Bax）、磷酸化核因子-κB（p-NF-κB）及磷酸化核因子κB抑制蛋白α（p-IκBα）蛋白表达水平。[结果] 萝卜硫素与索拉菲尼联合对HepG2细胞增殖抑制作用和凋亡诱导作用显著高于各单独给药（P<0.05）,还表现出浓度依赖性,呈现出明显的协同作用（CI值<1）。Western Blot结果显示,相比于对照组及单独给药组,联合给药能显著抑制原癌基因[细胞周期蛋白D1（ClinD1）和C-myc]、抗凋亡蛋白Bcl-2、p-NF-κB及磷酸化IκBα蛋白的表达,诱导促凋亡蛋白Bax的表达（P<0.05）。[结论] 萝卜硫素与索拉菲尼联合对HepG2细胞具有协同抗肿瘤作用,机制可能与诱导细胞凋亡及抑制NF-κB信号通路活化有关。     

转基因斑马鱼模型应用于索拉非尼抗肝癌活性筛选的方法研究

目的 使用斑马鱼 (Danio rerio) 肝癌模型进行药物筛选,确定筛选方法和最适条件。方法 用不同浓度盐酸多西环素 (Dox) 处理转基因斑马鱼胚胎,诱导其肝脏异常增生,通过综合评价诱导效应与毒性效应,确定适合的诱导浓度;选择适宜的诱导浓度,对索拉非尼抑制肝部异常增生的能力进行评估。结果 确定了盐酸多西环素的最适诱导浓度为30~60mg/L,索拉非尼对斑马鱼模型的肝部异常增生有显著的抑制作用,同时也观察到药物的毒副作用。结论 该模型适用于索拉非尼及其类似物抗肝癌活性的评价与筛选,是评估化合物体内生物活性的快速筛选模型,同时也可以观测毒副作用,在其它抗肝癌药物及与Ras下游信号通路相关靶点的药物的筛选等方面具有广阔的应用前景。     

Metformin inhibits the prometastatic effect of sorafenib in hepatocellular carcinoma by upregulating the expression of TIP30

We previously found that a low dose of sorafenib had a prometastatic effect on hepatocellular carcinoma (HCC), which was caused by downregulation of TIP30 expression. More recently, metformin has been shown to have potential as a preventive and therapeutic agent for different cancers, including HCC. This study evaluated whether the combination of sorafenib and metformin is sufficient to revert the expression of TIP30, thereby simultaneously reducing lung metastasis and improving survival. Our data show that the combination of sorafenib and metformin inhibits proliferation and invasion in vitro, prolongs median survival, and reduces lung metastasis of HCC in vivo. This effect is closely associated with the upregulation of TIP30, partly through activating AMP‐activated protein kinase. Thioredoxin, a prometastasis factor, is negatively regulated by TIP30 and plays an essential role during the process of HCC metastasis. Overall, our results suggest that metformin might be a potent enhancer for the treatment of HCC by using sorafenib.     

Combination targeted therapy of VEGFR inhibitor,sorafenib, with an mTOR inhibitor,sirolimus induced a remakable response of rapid progressive Uterine PEComa

Perivascular epithelioid cell tumor is a rare tumor. To date, there is no consensus of therapy to be recommended for unresectable disease. For a low incidence and a rarely curable disease, the finding of new therapy is essential.

Here we report the first case of a patient with perivascular epithelioid cell tumor whose disease had a rapid progression after surgery and had a rapid remarkable response of combination therapy of a VEGFR inhibitor, sorafenib, with an mTOR inhibitor, sirolimus.

This result may have potential to deliver a new treatment option and inhibiting the mTOR pathway combined with inhibiting the VEGF pathways may be a useful strategy for malignant PEComas.