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1678P PREDICTIVE VALUE OF TWO PHENOTYPING PROBES FOR<br />

THE PHARMACOKINETICS OF SUNITINIB IN CANCER<br />

PATIENTS<br />

J.S.L. Kloth 1 , H.J. Klumpen 2 , C.F. Samer 3 , K. Eechoute 1 , N.A.G. Lankheet 4 ,<br />

B.L. Kam 5 , M. Wong 6 , J.H.M. Schellens 7 , R.H.J. Mathijssen 8 , H. Gurney 9<br />

1 Medical Oncology, Erasmus Medical Center, Rotterdam, NETHERLANDS,<br />

2 Medical Oncology, Academic Medical Center (AMC), Amsterdam,<br />

NETHERLANDS, 3 Swiss Center for Applied Human Toxicities (SCAHT), Geneva<br />

University, Geneve, SWITZERLAND, 4 Department of Pharmacy and<br />

Pharmacology, Slotervaart Hospital/The Ne<strong>the</strong>rlands Cancer Institute,<br />

Amsterdam, NETHERLANDS, 5 Department of Nuclear Medicine, Erasmus<br />

Medical Center, Rotterdam, NETHERLANDS, 6 Department of Nuclear Medicine,<br />

Westmead institute for Cancer Research, Sydney, NSW, AUSTRALIA,<br />

7 Department of Clinical Pharmacology, The Ne<strong>the</strong>rlands Cancer Institute,<br />

Amsterdam, NETHERLANDS, 8 Department of Medical Oncology, Erasmus<br />

University Medical Center, Rotterdam, NETHERLANDS, 9 Medical Oncology,<br />

Westmead Hospital, Sydney, NSW, AUSTRALIA<br />

Background: Cancer patients treated with sunitinib show a wide inter-patient<br />

variability in drug exposure. This may at least partly explain <strong>the</strong> variation in toxicity<br />

and efficacy related to sunitinib treatment. The primary aim of this study was to<br />

investigate whe<strong>the</strong>r <strong>the</strong> clearance of 2 phenotyping probes are related to <strong>the</strong><br />

pharmacokinetics (PK) of sunitinib.<br />

Patients and methods: A prospective multi-center study was performed in cancer<br />

patients treated with single agent sunitinib. PK of sunitinib and its active metabolite<br />

N-desethyl-sunitinib were measured at start of sunitinib intake and within 4 weeks of<br />

continuous daily dosing. A correlation analysis was performed between <strong>the</strong>se PK data<br />

and midazolam clearance (as a CYP3A phenotyping probe) and hepatic 99m Tc-MIBI<br />

scans (as a probe for ABCB1 [P-glycoprotein] activity).<br />

Results: A total of 52 GIST and renal cell cancer patients were included in this study,<br />

of whom 46 were evaluable for analysis of sunitinib PK. Mean trough level of<br />

sunitinib, adjusted for dose, at day 1 of a new course was 14.7 ng/mL (range 7.2-28.9<br />

ng/mL), and 56.2 ng/mL (range 19.1-151.1 ng/mL) in <strong>the</strong> 4 th week of a treatment<br />

cycle. A significant correlation between N-desethyl-sunitinib trough levels and<br />

plasma clearance of midazolam (r = 0.58, P = 0.006) within 24 hours after <strong>the</strong> first<br />

intake of sunitinib was found. In addition, a trend was seen for <strong>the</strong> correlation<br />

between midazolam clearance and sunitinib trough levels at steady state (r = 0.26, P<br />

= 0.09). No correlation between sunitinib trough levels and hepatic 99m Tc-MIBI<br />

clearance was seen in an interim analysis after 27 patients.<br />

Conclusions: These observations show a correlation between <strong>the</strong> midazolam<br />

clearance test that serves as a probe for CYP3A and <strong>the</strong> exposure to sunitinib.<br />

Meanwhile, a lack of correlation was seen between sunitinib PK and <strong>the</strong> studied<br />

ABCB1 probe. These data could ultimately lead to a fur<strong>the</strong>r personalization of<br />

sunitinib dosing. Additional investigations are in progress, including population PK<br />

modeling of sunitinib, and incorporation of pharmacogenetic parameters to fur<strong>the</strong>r<br />

unravel <strong>the</strong> mechanisms behind <strong>the</strong>se findings.<br />

Disclosure: All authors have declared no conflicts of interest.<br />

1679P HEAT SHOCK PROTEIN 90 INHIBITION DOWNREGULATES<br />

C-KIT EXPRESSION IN GIST CELLS THROUGH DIMINISHING<br />

TRANSCRIPTION AND ENHANCING PROTEIN DEGRADATION<br />

VIA BOTH AUTOPHAGY AND PROTEASOME PATHWAYS<br />

Y. Hsueh 1 ,C.Yen 2 , N. Shih 1 , N. Chiang 1 ,C.Li 3 , L. Chen 1<br />

1 National Institute of Cancer Research, National Health Research Institutes,<br />

Tainan, TAIWAN, 2 Hematology/Oncology, Taipei Veteran General Hospital, Taipei,<br />

TAIWAN, 3 Department of Pathology, Chi-Mei Foundation Medical Center, Tainan,<br />

TAIWAN<br />

Background: Gastrointestinal stromal tumor (GIST) is a mutant oncoprotein c-Kit<br />

droved cancer. Patients suffered drug resistance after prolonged standard treatment of<br />

tyrosine kinase inhibitor (TKI), imatinib mesylate (IM). Inhibition of heat-shock<br />

protein 90 (Hsp90), a chaperone responsible for protein maturation and stability,<br />

causing its client proteins degradation, as c-Kit, is a developing <strong>the</strong>rapy for cancer.<br />

However, <strong>the</strong> mechanisms of Hsp90 inhibition-induced c-Kit downregulation in<br />

post-translational and transcriptional levels have rarely been investigated.<br />

Methods and results: Our data showed that NVP-AUY922 (AUY922), a new<br />

class of Hsp90 inhibitor, inhibited <strong>the</strong> growth of GIST882 and GIST48 cells with<br />

mutant c-Kit protein expression that was accompanied with reduction of both<br />

total and phosphor-c-Kit protein and induction of apoptosis. Pharmacological<br />

inhibition on ei<strong>the</strong>r autophagy or proteasome degradation pathway could<br />

partially reverse endogenous c-Kit turnover and AUY922-induced c-Kit<br />

reduction. These findings were fur<strong>the</strong>r confirmed by <strong>the</strong> co-localization of c-Kit<br />

with ei<strong>the</strong>r LC-3B or acridine orange-labeled autophagosome in confocal<br />

microscopy, and delay of c-Kit degradation by silencing autophagosome essential<br />

Beclin-1 protein. In addition, AUY922 could also reduce c-Kit mRNA without<br />

affecting its degradation. Our preliminary data showed that activities and nuclear<br />

levels of several transcription factors in GIST cells were diminished after<br />

AUY922 treatment. DNA affinity precipitation assay and chromatin<br />

immunoprecipitation (ChIP) will be performed to validate <strong>the</strong> binding of <strong>the</strong><br />

candidate transcript factors on <strong>the</strong> c-Kit promoter.<br />

Annals of Oncology<br />

Conclusions: This is <strong>the</strong> first report showing <strong>the</strong> involvement of autophagy in<br />

endogenous as well as Hsp90 inhibitor-induced c-Kit degradation. Moreover,<br />

AUY922 treatment resulted in downregulation of c-Kit through protein degradation<br />

and transcriptional mRNA regulation in GIST cells. These findings address <strong>the</strong><br />

mechanisms of AUY922 on c-Kit protein downregulation and highlight <strong>the</strong> potential<br />

use of AUY922 in TKI-refractory, c-Kit-expressing GIST.<br />

Disclosure: All authors have declared no conflicts of interest.<br />

1680P MOLECULAR PROFILING OF HIGH-RISK LOCALIZED<br />

PROSTATE CANCER (HRLPC) TREATED WITH DOCETAXEL<br />

(D) AND COMPLETE ANDROGEN BLOCKADE (CAB) PRIOR<br />

TO RADICAL PROSTATECTOMY<br />

M. Marín-Aguilera 1 , A. Font 2 , E. Gallardo 3 , A. Alcaraz 4 , V. Pereira 5 , M.J. Ribal 4 ,<br />

J. Areal 6 , N. Hannaoui 7 , P. Gascon 8 , B. Mellado 5<br />

1 Translational Oncology Laboratory, Fundacio Clínic per a la Recerca Biomèdica,<br />

Barcelona, SPAIN, 2 Medical Oncology, Institut Català d’Oncologia-Badalona,<br />

Badalona, SPAIN, 3 Oncologia Medica, Hospital de Sabadell Corporacis Parc<br />

Tauli, Sabadell, SPAIN, 4 Urology, Hospital Clínic, Barcelona, SPAIN, 5 Medica<br />

Oncology, Hospital Clínic, Barcelona, SPAIN, 6 Urology, Hospital Germans Trias i<br />

Pujol, Badalona, SPAIN, 7 Urology, Hospital Parc Tauli, Sabadell, SPAIN,<br />

8 Medical Oncology, Hospital Clinic y Provincial de Barcelona, Barcelona, SPAIN<br />

Background: HRLPC has an increased risk of positive margins and recurrence after<br />

local treatment. Neoadjuvant docetaxel has not shown to increase <strong>the</strong> percentage of<br />

pathological complete responses (pRCs) respect to hormone-<strong>the</strong>rapy alone. In a<br />

previous phase II trial of neoadjuvant D plus CAB in patients with HRLPC we<br />

reported a 6% pRCs. (Mellado B, Br J Cancer 2009). We proposed that <strong>the</strong> molecular<br />

analysis of residual tumor cells after D + CAB may help to identify molecular<br />

mechanisms of treatment resistance.<br />

Methods: 93 genes potentially involved in D resistance were selected from a previous<br />

molecular study of our group (Marin-Aguilera M, Mol Cancer Ther <strong>2012</strong>). Gene<br />

transcriptional levels were analyzed by using Taqman low density arrays in 28<br />

formalin-fixed paraffin-embedded (FFPE) tumors from HRLPC patients treated with<br />

D + CAG prior radical prostatectomy, and in 36 HRLPC patients who underwent<br />

radical prostatectomy without neoadjuvant <strong>the</strong>rapy. GUSB housekeeping gene was<br />

<strong>the</strong> reference for normalization. Gene expression determination was performed with<br />

RQ Manager Software for manual data analysis.<br />

Results: Differential gene expression of 67.7% (63 of 93 analyzed genes) was found<br />

in neoadjuvant treated tumors versus samples without neoadjuvant treatment (P <<br />

0.05). Among <strong>the</strong>m, <strong>the</strong>re were found differences in <strong>the</strong> expression of genes related<br />

with androgen receptor signalling, NFkB transcription factor and<br />

epi<strong>the</strong>lial-mesenquimal transition processes. Data on gene expression and its<br />

correlation with clinical outcome will be presented at <strong>the</strong> meeting.<br />

Conclusions: Residual tumor cells in prostatectomy specimens after neoadjuvant<br />

hormone- and chemo<strong>the</strong>rapy treatment already exhibits a gene expression profile<br />

that may be involved in hormone/chemo resistant phenotype.<br />

Disclosure: All authors have declared no conflicts of interest.<br />

1681P THE ROLE OF MACROPHAGES POLARIZATION IN<br />

PREDICTING PROGNOSIS IN RADICALLY RESECTED<br />

GASTRIC CANCER<br />

F. Pantano 1 , P. Berti 1 , F.M. Guida 1 , S. Intagliata 1 , F. Graziano 2 , G. Perrone 3 ,<br />

A. Onetti Muda 3 , B. Vincenzi 1 , G. Tonini 1 , D. Santini 1<br />

1 Medical Oncology, University Campus Bio-Medico, Rome, ITALY, 2 Medical<br />

Oncology, Ospedale di Urbino, Urbino, ITALY, 3 Department of Pathology,<br />

University Campus Bio-Medico, Rome, ITALY<br />

Introduction: Macrophages are one of <strong>the</strong> major populations of tumor-infiltrating<br />

immune cells. Tumor associated Macrophages (TAM) present two different phenotypes<br />

or polarizations: classical (M1) characterized by immunostimulation activity and tumor<br />

suppression; alternative (M2) characterized by angiogenesis, tumor promotion, and<br />

immune suppression. Despite <strong>the</strong>se opposite properties, most of <strong>the</strong> previous studies<br />

focused merely on evaluating absolute TAM count. In this work, for <strong>the</strong> first time in<br />

literature, we evaluated <strong>the</strong> correlation between <strong>the</strong> two forms of TAM with survival<br />

time in patients affected by gastric cancer after radical surgery.<br />

Methods: 52 chemo- and radio-naïve gastric cancer patients undergone to resection for<br />

curative intent were included in this retrospective study. Two slides were prepared for<br />

each patients and double-stained for CD68/NOS2 (M1) or CD68/CD163 (M2) and five<br />

representative high-power fields (×400 magnification) per slide were evaluated for TAM<br />

count. The median value of <strong>the</strong> two macrophage populations density (M1 = 7.0; M2 =<br />

6.4) and <strong>the</strong> median value of M1/M2 ratio (1.16) was used as cut-off.<br />

Results: 27 patients with M1 density above <strong>the</strong> median had a significantly higher<br />

survival compared to those below <strong>the</strong> median (median OS of 25.6 months,<br />

CI95%:22.33-44.85 vs 17.1 months, CI95%:13.66-27.98; P = 0.041). 26 patients with<br />

M1/M2 ratio above <strong>the</strong> median showed median OS of 27.2 months<br />

(CI95%:25.45-47.51) compared to 15.5 months (CI95%:11.36-25.50) of <strong>the</strong> patients<br />

below <strong>the</strong> median (P = 0.001). No statistically significant difference in terms of M1/<br />

M2 ratio was observed between intestinal vs diffuse histological type. No association<br />

ix538 | <strong>Abstract</strong>s Volume 23 | Supplement 9 | September <strong>2012</strong>

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