靶向治疗在复发性卵巢癌治疗中的应用

复发与耐药是卵巢癌治疗失败的主要原因之一。近20年来,手术、化疗及放疗的发展在改善复发性卵巢癌预后方面发挥的作用有限。靶向治疗以肿瘤细胞在分子水平的特征性改变为作用靶点,发挥抗肿瘤的作用。近10年来,有大量临床研究对靶向药物治疗复发性卵巢癌的疗效与副反应进行了评价,并取得了一定的成果。     

PTTG: an important target gene for ovarian cancer therapy

Pituitary tumor transforming gene (PTTG), also known as securin is an important gene involved in many biological functions including inhibition of sister chromatid separation, DNA repair, organ development, and expression and secretion of angiogenic and metastatic factors. Proliferating cancer cells and most tumors express high levels of PTTG. Overexpression of PTTG in vitro induces cellular transformation and development of tumors in nude mice. The PTTG expression levels have been correlated with tumor progression, invasion, and metastasis. Recent studies show that down regulation of PTTG in tumor cell lines and tumors in vivo results in suppression of tumor growth, suggesting its important role in tumorigenesis. In this review, we focus on PTTG structure, sub-cellular distribution, cellular functions, and role in tumor progression with suggestions on possible exploration of this gene for cancer therapy.     

子宫内膜癌的靶向治疗

子宫内膜癌是常见的妇科恶性肿瘤,尽管手术、放化疗手段不断提高,但复发性或晚期子宫内膜癌患者的预后仍较差。对于标准治疗后出现进展的恶性肿瘤,靶向治疗可能是有希望的治疗方法之一。文章复习近年文献,对子宫内膜癌的靶向治疗进行阐述。     

Matrix metalloproteinase-1 gene promoter polymorphism and risk of ovarian cancer

OBJECTIVE: It has been suggested that the 2G allele of a guanine insertion-deletion promoter polymorphism in the promoter of the matrix metalloproteinase-1 (MMP1) gene may increase susceptibility to ovarian cancer. The 2G allele also has been associated with increased MMP1 expression. We investigated the relationship between the MMP1 polymorphism and ovarian cancer risk in a large population-based, case-control study. METHODS: The MMP1 promoter polymorphism was examined in white blood cell DNA from 311 cases and 387 age- and race-matched controls using a radiolabeled polymerase chain reaction assay. In addition, genotyping of the MMP1 polymorphism performed in 42 advanced-stage invasive serous ovarian cancers was compared to their mean relative MMP1 expression from Affymetrix microarrays. RESULTS: The 2G allele frequency did not differ significantly between cases (0.49) and controls (0.48), and the distribution of genotypes was in Hardy-Weinberg equilibrium. Using 1G homozygotes as the reference group, neither 2G homozygotes (odds ratio 1.1, 95% confidence interval 0.7-1.7) nor heterozygotes plus 2G homozygotes (odds ratio 0.9, 95% confidence interval 0.7-1.3) had an increased risk of ovarian cancer. There was also no relationship between MMP1 genotype and histologic grade, histologic type, stage, or tumor behavior (borderline versus invasive). The mean MMP1 expression was twice as high in 2G homozygotes relative to 1G homozygotes, but this difference was not statistically significant. CONCLUSION: The reported association between the MMP1 promoter polymorphism and ovarian cancer risk was not supported by our data. There was a suggestion that the 2G allele may be associated with higher MMP1 expression, and this finding is worthy of further investigation.     

Current strategies in gene therapy for ovarian cancer

The application of gene therapy strategies for ovarian cancer has employed various viral and nonviral vectors. Thus far, adenovirus has been the most promising vehicle for gene replacement but the use of non DNA-based viruses is also being explored. Recent novel advances in gene therapy approaches include refinement of vector targeting and the use of site-specific promoters and conditionally replicative adenoviral vectors. Although several clinical trials have documented the relative safety of gene therapy in ovarian cancer patients, few significant clinical responses have been effected. However, advances in the field are occurring rapidly and this strategy does appear promising for the treatment of ovarian cancer.     

From gene therapy to virotherapy for ovarian cancer

Ovarian cancer has the highest mortality of all cancers of the female reproductive system. Although progress in conventional therapies (surgery, chemotherapy and irradiation) has been achieved, the 5-year survival rate for patients with advanced stage ovarian cancer is still low. On this basis it is clear that there is a need for novel therapeutic paradigms. Targeted approaches are based on the increasing knowledge of the molecular basics of ovarian cancer. In this regard, gene therapy is a novel targeted approach for the treatment of ovarian cancer. However, current gene therapy delivery systems (viral and non-viral vectors) have to address the issues of inefficient transduction of target ovarian cancer cells and/or ectopic non-target delivery with attendant toxicity. Of note, the limited tumor transduction associated with current gene therapy interventions is due, in large part, to the fact that the employed vectors have been replication-incompetent. In this regard, human clinical trials have shown that the approach of replication-incompetent vectors has yet to succeed in ovarian cancer patients. In contrast, replication-competent viruses offer a method to achieve efficient tumor cell oncolysis (virotherapy) in ovarian cancer. Thus, in this very promising approach of virotherapy the replicating virus itself is the anti-cancer agent. This review discusses the concepts of gene therapy and virotherapy as novel targeted therapeutic approaches for the treatment of ovarian cancer.     

Icodextrin enhances survival in an intraperitoneal ovarian cancer murine model utilizing gene therapy

OBJECTIVE: Icodextrin, a novel glucose polymer solution utilized for peritoneal dialysis, has been demonstrated to have prolonged intraperitoneal (IP) instillation volumes in comparison to standard PBS solutions. In an animal model of ovarian cancer, we explored whether a survival advantage exists utilizing icodextrin rather than PBS as a delivery solution for an infectivity enhanced virotherapy approach. METHODS: Initial experiments evaluated whether icodextrin would adversely affect replication of a clinical grade infectivity enhanced conditionally replicative adenovirus (Delta24-RGD). Virus was added to prepared blinded solutions of PBS or icodextrin (20%) and then evaluated in vitro in various human ovarian cancer cell lines (SKOV3.ip1, PA-1, and Hey) and in vivo in a SKOV3.ip1 human ovarian cancer IP murine model. Viral replication was measured by detecting adenovirus E4 gene levels utilizing QRT-PCR. Survival was subsequently evaluated in a separate SKOV3.ip1 ovarian cancer IP murine model. Cohorts of mice were treated in blinded fashion with PBS alone, icodextrin alone, PBS+Delta24-RGD, or icodextrin+Delta24-RGD. Survival data were plotted on Kaplan-Meier curve and statistical calculations performed using the log-rank test. RESULTS: There was no adverse affect of icodextrin on vector replication in the ovarian cancer cell lines nor murine model tumor samples evaluated. Median survival in the IP treated animal cohorts was 23 days for the PBS group, 40 days for the icodextrin group, 65 days for the PBS+Delta24-RGD group, and 105 days for icodextrin+Delta24-RGD (p=0.023). Of note, 5 of the 10 mice in the icodextrin+Delta24-RGD group were alive at the end of the study period, all without evidence of tumor (120 days). CONCLUSIONS: These experiments suggest that the use of dialysates such as icodextrin may further enhance the therapeutic effects of novel IP virotherapy and other gene therapy strategies for ovarian cancer. Phase I studies utilizing icodextrin-based virotherapy for ovarian cancer are currently in development.     

GnRH analogues as an adjuvant therapy for ovarian cancer patients.

OBJECTIVES: Lowering gonadotropin levels with gonadotropin-releasing hormone (GnRH) analogues in patients with ovarian cancer remains open to debate. The aim of this study was to assess the results of treatment in stage III and stage IV ovarian cancer patients who had surgery supplemented with chemotherapy, radiotherapy, and GnRH analogues. Gonadotropin levels were monitored during treatment. METHODS: The study group comprised 69 patients aged 27-70 years, stratified according to the type of treatment. The overall disease-free, 5-year survival rates and the frequency of remissions were analyzed. Hormonal tests [follicle-stimulating hormone (FSH) and luteinizing hormone (LH)] were performed in 58 patients. Associations were checked between gonadotropin levels, clinical findings, and survival. The results were statistically compared. RESULTS: Statistically significant differences were noted when chemotherapy was supplemented with GnRH analogues and/or radiotherapy. Administration of GnRH analogues resulted in significantly lower levels of LH than of FSH. Levels of FSH were significantly lower in patients surviving at least 5 years or in complete remission at the time of this study. CONCLUSIONS: Combined therapy can produce favorable results in late-stage ovarian cancer, and GnRH analogues have an important role in treatment strategy.     

Gene therapy of epithelial ovarian cancer using adenoviral vectors

Ovarian cancer is the fourth most common cause of death in women. Gene therapy using the herpes simplex virus thymidine kinase (HSV-tk) gene followed by ganciclovir (GCV) treatment has been successfully applied in the treatment of different cancers in experimental animals and in humans. In a recent report, we have demonstrated that the HSV-tk/GCV system can be used efficiently to kill human epithelial ovarian cancer cells (Gynecol Obstet Invest 1997;43:268–75). In this work, we wanted to test the ability of the HSV-tk/GCV to treat ovarian cancer in an animal model.The immune-deficient nude mice model was employed, and mice were injected intraperitoneally with the human epithelial ovarian cancer cell line OVCAR3, 10⁸ cell/mouse. The mice were divided into three different groups, groups 1 and 2 were treated by intraperitoneal injection of adenovirus carrying the HSV-tk gene (ad-tk) on day 3 after cell implantation. Group 1 received 2 × 10⁸ pfu/mouse; group 2 received 20 × 10⁸ pfu/mouse. Group 3 did not receive any viral injection and served as our negative control. All mice received GCV 10 mg/kg IP bid for 6 days. All mice were hosted in the same facilities and had access to food and water ad libitum. Mice in group 3 started to show clinical manifestations of disease by day 10, and all mice were dead by day 21 (16 ± 1.5). At this point mice in groups 1 and 2 appeared perfectly healthy. Autopsy done on group 3 mice demonstrated multiple cancer implants in the abdominal cavity plus hemorrhagic ascitis. In contrast, autopsy on sample mice from groups 1 and 2 at the same time point failed to demonstrate any macroscopic or microscopic cancer.On further follow-up, mice in groups 1 and 2 started to show cancer-related signs, eg, weight loss, movement difficulty, poor reflex response, and finally death. Survival varied between 50 and 101 days with a mean of 66 ± 17 days for group 1 and 74 ± 13 days for group 2. Autopsy done on treated mice demonstrated multiple cancer implants and ascitis. In conclusion, a single injection of ad-tk/GCV was able to improve survival in an ovarian cancer mouse model from an average of 16 days to 74 days. Trials with multiple injection in a novel immune-competent mouse model of ovarian cancer are underway in our laboratory.     

An advanced generation of adenoviral vectors selectively enhances gene transfer for ovarian cancer gene therapy approaches.

OBJECTIVE: We hypothesized that incorporation of an integrin binding Arg-Gly-Asp (RGD)-containing peptide to the HI loop of the adenovirus fiber knob would allow enhanced, coxsackie-adenovirus receptor-independent gene transfer by modified Ad vector in the context of ovarian cancer. METHODS: Ovarian cancer cell lines, primary ovarian cancer cells, primary tumor explants, and mesothelial tissue were transfected with luciferase encoding adenovirus (AdCMVLuc) or a genetically modified adenovirus (Ad5lucRGD) which contained an RGD motif within the HI loop of the knob. The luciferase activity was measured and the transduction efficiencies of both viruses were compared. RESULTS: In all established ovarian cell lines and primary tumor cell samples there was dramatically augmented gene transfer observed with the Ad5lucRGD compared to AdCMVLuc. The enhanced gene transfer in ovarian cancer cell lines ranged from 2.5- to 471.6-fold, in ascites samples from 26.1- to 64.0-fold, and in tumor explants from 1.6- to 11.1-fold. Although gene transfer to normal mesothelial tissue was slightly augmented by RGD retargeting, the level of gene transfer was much lower than that seen in ovarian cancer cells. CONCLUSION: This study demonstrates that genetically altered adenoviruses with modified tropism are capable of more efficient gene transfer in the context of ovarian cancer. The higher level of transfer with respect to peritoneal mesothelium can be exploited to enhance the therapeutic index of interventions using adenoviral vectors. Studies are warranted, therefore, to determine the in vivo utility of this targeted vector approach in the context of gene therapeutic strategies for cancer of the ovary.     

人端粒酶逆转录酶启动子调控下胞嘧啶脱氨酶-胸苷激酶融合基因治疗卵巢癌的体外研究

目的　探讨人端粒酶逆转录酶 (hTERT)启动子调控下的融合双自杀基因———胞嘧啶脱氨酶 胸苷激酶 / 5 氟胞嘧啶 更昔洛韦 (CD TK/ 5 FC GCV)系统对人卵巢癌细胞及正常细胞的体外杀伤作用。方法　应用脂质体转染法将hTERT核心启动子报告质粒pBTdel 2 79转染人卵巢癌细胞系3AO、正常卵巢上皮细胞 (NOEC)和人胚肺成纤维细胞株HELF ,用荧光素酶分析检测hTERT启动子活性 ;应用RT PCR技术检测hTERTmRNA的表达水平。应用基因克隆技术分别构建hTERT启动子和巨细胞病毒 (CMV)启动子调控下的CD TK基因真核表达载体pBTdel 2 79 CD TK和pcDNA3 CD TK ,以及hTERT启动子调控下的TK基因表达载体pBTdel 2 79 TK。用四甲基偶氮唑蓝 (MTT)法和流式细胞术检测pBTdel 2 79 CD TK/ 5 FC GCV系统和pcDNA3 CD TK/ 5 FC GCV系统对上述 3种细胞不同的杀伤作用 ;应用RT PCR技术检测pBTdel 2 79 CD TK和pcDNA3 CD TK转染前后 3AO和NOEC细胞中CD和TK基因的表达情况。用扫描电子显微镜观察pBTdel 2 79 CD TK/ 5 FC GCV作用后 3AO细胞的形态变化。结果　卵巢癌细胞系 3AO中hTERT启动子活性增高 ,为 2 4 1% ,RT PCR检测hTERTmRNA为阳性 ,而在正常细胞NOEC和HELF中 ,hTERT启动子活性仅为 0 3%和 0 7% ,hTERTmRNA为阴性。与p     

Targeted composite value-based endpoints in platinum-sensitive recurrent ovarian cancer

ObjectivesFDA-approved treatments for platinum-sensitive recurrent ovarian cancer (PSROC) include bevacizumab and PARP inhibitors (PARPi); clinical decisions regarding therapy must be made prior to initiating chemotherapy. Using the American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO) value frameworks, we assessed relative values of concurrent/maintenance biologic therapies in PSROC.MethodsValue scores were calculated for key maintenance therapies based on randomized controlled trials: bevacizumab (OCEANS, GOG 213); olaparib (Study 19, SOLO2); niraparib (NOVA); rucaparib (ARIEL3). Personalized value scorecards were constructed for patients with germline/somatic-BRCA mutations, homologous recombination deficiency (HRD), and wild-type BRCA (wBRCA). ASCO value scores assess clinical benefit, toxicity, long-term survival, symptom palliation, treatment-free interval, and quality of life (QOL). ESMO value scores assess clinical benefit, toxicity, and QOL.ResultsASCO scores were highest for maintenance PARPi in germline/somatic-BRCA mutation cohorts: olaparib (SOLO2) = 47, (Study 19) = 62; niraparib = 50; rucaparib = 54. HRD cohorts had slightly lower scores: niraparib = 46; rucaparib = 37. wBRCA cohorts had the lowest scores: niraparib = 26; rucaparib = 26; and olaparib (Study 19) = 32, as did patients receiving bevacizumab (OCEANS) = 35, (GOG 213) = 26. ESMO scores demonstrated high-value for maintenance PARPi in germline/somatic-BRCA mutation cohorts and low-value for bevacizumab and PARPi in wBRCA cohorts.ConclusionsThe value of maintenance PARPi therapy depends heavily on BRCA status, with the highest value scores in germline/somatic-BRCA mutation cohorts. Personalized value scorecards provide a visual aid to assess the harm-benefit balance of maintenance PARPi for PSROC.     

Peritoneal osteosarcoma following irradiation therapy of ovarian cancer.

A peritoneal osteosarcoma occurring after irradiation therapy for cystadenocarcinoma of ovary is described. Only 6 cases of postradiation extraosseous osteosarcomas have been reported and none of them have arisen within the peritoneum. The clinical presentation and histopathology of this unusual tumor is presented with a review of the literature.     

Hormonal therapy in ovarian cancer

Ovarian carcinoma continues to be the leading cause of death due to gynecological malignancy. Epidemiologic studies indicate that steroid hormones play roles in ovarian carcinogenesis. Gonadotropins, estrogen, and androgen may be causative factors, while gonadotropin-releasing hormone and progesterone may be protective factors in ovarian cancer pathogenesis. Experimental studies have shown that hormonal receptors are expressed in ovarian cancer cells and mediate the growth-stimulatory or growth-inhibitory effects of the hormones on these cells. Hormonal therapeutic agents have been evaluated in several clinical trials. Most of these trials were conducted in patients with recurrent or refractory ovarian cancer, with modest efficacy and few side effects. Better understanding of the mechanisms through which hormones affect cell growth may improve the efficacy of hormonal therapy. Molecular markers that can reliably predict major clinical outcomes should be investigated further in well-designed trials.     

First-line therapy in ovarian cancer

Epithelial ovarian cancer is the gynecological tumor with the highest mortality rate. Recently, numerous new findings have emerged about status and extent of surgical therapy of this disease. Innovations regarding chemotherapy are also numerous. It is essential for the improvement of the patients' situation to transfer these new developments already implemented into national and international standards and guidelines to clinical practice.     

Tamoxifen therapy of epithelial ovarian cancer

The activity of the antiestrogen tamoxifen was evaluated in 23 patients with epithelial ovarian carcinoma. All patients had received cytotoxic chemotherapy. The patients were given daily doses of 20 or 40 mg tamoxifen orally for a minimum of eight weeks. No objective tumor regressions were noted. In 19 patients disease remained stable for a median duration of 17 weeks (range: eight to 47 weeks). Estrogen and/or progesterone levels available for six patients did not correlate with stability of disease. The authors conclude that tamoxifen does not induce objective response in patients with epithelial ovarian carcinoma who have been treated with cytotoxic chemotherapy. However, in the current study about 80% of such patients had short-lived objective stabilization of their disease.