Abstract
The phase III CONFIRM clinical trials demonstrated that metastatic colorectal cancer patients with elevated serum lactate dehydrogenase (LDH) had improved outcome when the vascular endothelial growth factor receptor (VEGFR) inhibitor PTK/ZK (Vatalanib) was added to FOLFOX4 chemotherapy. We investigated the hypothesis that high intratumoral expression of genes regulated by hypoxia-inducible factor-1 alpha (HIF1α), namely LDHA, glucose transporter-1 (GLUT-1), VEGFA, VEGFR1, and VEGFR2, were predictive of outcome in CONFIRM-1. Tumor tissue was isolated by laser-capture microdissection from 85 CONFIRM-1 tumor specimens; FOLFOX4/placebo n=42, FOLFOX4/PTK/ZK n=43. Gene expression was analyzed using quantitative RT-PCR. In univariate analyses, elevated mRNA expression of LDHA, GLUT-1, and VEGFR1 were associated with response to FOLFOX4/PTK/ZK. In univariate and multivariate analyses, elevated LDHA and VEGFR1 mRNA levels were associated with improved progression-free survival in FOLFOX4/PTK/ZK patients. Furthermore, increased HIF1α and VEGFR2 mRNA levels were associated with decreased survival in FOLFOX/placebo patients but not in patients who received FOLFOX4/PTK/ZK. These are the first data suggesting intratumoral mRNA expression of genes involved in angiogenesis/HIF pathway may predict outcome to VEGFR-inhibitors. Biomarkers that assist in directing VEGFR-inhibitors toward patients with an increased likelihood of benefit will improve the cost-effectiveness of these promising agents.
Publication types
-
Clinical Trial, Phase III
-
Multicenter Study
-
Randomized Controlled Trial
-
Research Support, Non-U.S. Gov't
MeSH terms
-
Adult
-
Aged
-
Aged, 80 and over
-
Antineoplastic Combined Chemotherapy Protocols / administration & dosage
-
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
-
Biomarkers, Tumor / biosynthesis
-
Biomarkers, Tumor / genetics
-
Colorectal Neoplasms / blood supply
-
Colorectal Neoplasms / drug therapy*
-
Colorectal Neoplasms / genetics*
-
Colorectal Neoplasms / pathology
-
Disease-Free Survival
-
Female
-
Fluorouracil / administration & dosage
-
Glucose Transporter Type 1 / biosynthesis
-
Glucose Transporter Type 1 / genetics
-
Humans
-
Hypoxia-Inducible Factor 1, alpha Subunit / biosynthesis
-
Hypoxia-Inducible Factor 1, alpha Subunit / genetics
-
Leucovorin / administration & dosage
-
Male
-
Middle Aged
-
Neovascularization, Pathologic / drug therapy
-
Neovascularization, Pathologic / genetics
-
Neovascularization, Pathologic / pathology
-
Organoplatinum Compounds / administration & dosage
-
Phthalazines / administration & dosage
-
Pyridines / administration & dosage
-
RNA, Messenger / genetics
-
Transcriptome
-
Vascular Endothelial Growth Factor A / biosynthesis
-
Vascular Endothelial Growth Factor A / genetics
-
Vascular Endothelial Growth Factor Receptor-1 / antagonists & inhibitors
-
Vascular Endothelial Growth Factor Receptor-1 / biosynthesis
-
Vascular Endothelial Growth Factor Receptor-1 / genetics
-
Vascular Endothelial Growth Factor Receptor-2 / antagonists & inhibitors
-
Vascular Endothelial Growth Factor Receptor-2 / biosynthesis
-
Vascular Endothelial Growth Factor Receptor-2 / genetics
Substances
-
Biomarkers, Tumor
-
Glucose Transporter Type 1
-
HIF1A protein, human
-
Hypoxia-Inducible Factor 1, alpha Subunit
-
Organoplatinum Compounds
-
Phthalazines
-
Pyridines
-
RNA, Messenger
-
VEGFA protein, human
-
Vascular Endothelial Growth Factor A
-
vatalanib
-
Vascular Endothelial Growth Factor Receptor-1
-
Vascular Endothelial Growth Factor Receptor-2
-
Leucovorin
-
Fluorouracil