The methylation status of the IGFBP-3 gene is strongly associated with cisplatin sensitivity in patients with non-small cell lung cancer (NSCLC). In this study, we found in vitro evidence that linked the presence of an unmethylated promoter with poor response to radiation. Our data also indicate that radiation might sensitize chemotherapy-resistant cells by reactivating IGFBP-3-expression through promoter demethylation, inactivating the PI3K/AKT pathway. We also explored the IGFBP-3 methylation effect on overall survival (OS) in a population of 40 NSCLC patients who received adjuvant therapy after R0 surgery. Our results indicate that patients harboring an unmethylated promoter could benefit more from a chemotherapy schedule alone than from a multimodality therapy involving radiotherapy and platinum-based treatments, increasing their OS by 2.5 y (p = .03). Our findings discard this epi-marker as a prognostic factor in a patient population without adjuvant therapy, indicating that radiotherapy does not improve survival for patients harboring an unmethylated IGFBP-3 promoter.
Keywords: ATCC, American Type Culture Collection; BS, bisulfite sequencing; CDDP cisplatin; ECACC, European Collection of Cell Cultures; IGFBP-3; IGFBP-3, insulin-like growth factor binding protein-3; IGFIR/AKT; IR, Ionizing radiation; NSCLC; NSCLC, non-small cell lung cancer; OS, overall survival; hypermethylation; qMSP, quantitative methylation specific PCR; radiotherapy.