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2016 ; 7
(37
): 59087-59097
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Vorinostat and hydroxychloroquine improve immunity and inhibit autophagy in
metastatic colorectal cancer
#MMPMID27463016
Patel S
; Hurez V
; Nawrocki ST
; Goros M
; Michalek J
; Sarantopoulos J
; Curiel T
; Mahalingam D
Oncotarget
2016[Sep]; 7
(37
): 59087-59097
PMID27463016
show ga
Hydroxychloroquine (HCQ) enhances the anti-cancer activity of the histone
deacetylase inhibitor, vorinostat (VOR), in pre-clinical models and early phase
clinical studies of metastatic colorectal cancer (mCRC). Mechanisms could include
autophagy inhibition, accumulation of ubiquitinated proteins, and subsequent
tumor cell apoptosis. There is growing evidence that autophagy inhibition could
lead to improved anti-cancer immunity. To date, effects of autophagy on immunity
have not been reported in cancer patients. To address this, we expanded an
ongoing clinical study to include patients with advanced, refractory mCRC to
evaluate further the clinical efficacy and immune effects of VOR plus HCQ.
Refractory mCRC patients received VOR 400 milligrams orally with HCQ 600
milligrams orally daily, in a 3-week cycle. The primary endpoint was median
progression-free survival (mPFS). Secondary endpoints include median overall
survival (mOS), adverse events (AE), pharmacodynamic of inhibition of autophagy
in primary tumors, immune cell analyses, and cytokine levels. Twenty patients
were enrolled (19 evaluable for survival) with a mPFS of 2.8 months and mOS of
6.7 months. Treatment-related grade 3-4 AEs occurred in 8 patients (40%), with
fatigue, nausea/vomiting, and anemia being the most common. Treatment
significantly reduced CD4+CD25hiFoxp3+ regulatory and PD-1+ (exhausted) CD4+ and
CD8+ T cells and decreased CD45RO-CD62L+ (naive) T cells, consistent with
improved anti-tumor immunity. On-study tumor biopsies showed increases in
lysosomal protease cathepsin D and p62 accumulation, consistent with autophagy
inhibition. Taken together, VOR plus HCQ is active, safe and well tolerated in
refractory CRC patients, resulting in potentially improved anti-tumor immunity
and inhibition of autophagy.
|Adult
[MESH]
|Aged
[MESH]
|Antineoplastic Agents/*therapeutic use
[MESH]
|Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
[MESH]