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Clinical Investigation |
1 Nuclear Medicine Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and 2 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
Correspondence: For correspondence or reprints contact: Peter M. Smith-Jones, PhD, Nuclear Medicine Service, Box 77, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021. E-mail: smith-jp{at}mskcc.org
| ABSTRACT |
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| INTRODUCTION |
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PET is an emerging functional imaging technology, which is now broadly applied for imaging human tumors (2). 18F-FDG PET has become an important clinical tool in detecting primary and metastatic breast cancer as well as monitoring treatment response, recurrence, and general prognosis (3). The molecular basis for the success of 18F-FDG PET is the rapid reduction of tumor glucose metabolism in effective therapies (4), and this has been shown to be a very reliable early indicator of tumor response. However, 18F-FDG PET may be abnormal in benign disease as well as active inflammation. For example, response assessment can be confounded by posttreatment inflammatory change in the weeks after radiation therapy of head and neck cancers and optimal times for 18F-FDG PET to determine response can be 35 mo after treatment (5).
17-Allylamino-17-demethoxygeldanamycin (17AAG) is the first of a new class of drugs that downregulates several oncoproteins overexpressed by breast cancer and is currently in early clinical trials. One such target is HER2 (c-erbB2 or Her-2/neu), a protooncogene, which encodes the 185-kDa transmembrane protein human epidermal growth factor receptor 2 (6). HER2 protein overexpression is observed in 25%30% of primary breast cancers (7). Recently, other malignanciessuch as nonsmall cell lung cancer (8,9), ovarian cancer (9), gastric carcinomas (10), osteosarcoma (11), prostate cancer (12), renal cell carcinoma (13), pancreatic adenocarcinoma (14), salivary duct carcinoma (15), rectal cancer (16), bladder cancer (17), and biliary cancer (18)have all been shown to have overexpression of HER2. In humans, HER2 is expressed at low levels in some normal tissues such as heart (19).
17AAG is the first of a new class of drugs that have a novel mechanism of action and targets Hsp90, a molecular chaperone, which is responsible for the correct folding, stability, and function of a range of oncoproteins that are mutated or overexpressed in cancer (20). These include the androgen receptor and the HER family of receptor tyrosine kinases (21). HER2 is considered a clinically important molecule and routine testing is performed by many centers, especially for breast cancers. However, testing relies on invasive sampling (22). In current clinical trials with 17AAG, biopsies have been obtained in only a fraction of patients and only during the first cycle of therapy, because biopsies are invasive and a majority of patients have tumors that cannot be sampled without significant risk to the patient. The most common methods used to measure HER2 expression at the DNA and protein levels are fluorescence in situ hybridization and immunohistochemical staining (IHC). IHC is the more common method, but it is a very subjective method, which can result in low levels of agreement with regard to intensity and extent of tumor membrane staining.
| MATERIALS AND METHODS |
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Tumor Model
Breast cancer cell line BT474 (American Type Culture Collection) was grown in a 1:1 mixture of Dulbecco's modified Eagle medium/F-12 medium supplemented with 2 mmol/L glutamine, 50 units/mL penicillin, 50 units/mL streptomycin, and 10% heat-inactivated fetal bovine serum (Gemini Bioproducts) at a temperature of 37°C in an environment containing 5% CO2. Before use, the cells were trypsinized, counted, and suspended in Matrigel (Collaborative Biomedical Products).
Eight mice were selected for tumor size (50200 mg) from a larger pool of mice. Tumors were allowed to develop over a period of 14 d after the subcutaneous placement (on day 2014) of 0.72 mg/d 17ß-estradiol pellets just below the left shoulder, followed by injection of 1 x 107 BT474 tumor cells combined with Matrigel on the right hip. Four- to 6-wk-old nu/nu athymic female mice were obtained from the National Cancer InstituteFrederick Cancer Center and maintained in ventilated cages. The animals were fed and given water ad lib. Experiments were performed under an Institutional Animal Care and Use Committeeapproved protocol and the experiments followed institutional guidelines for the proper and humane use of animals in research. BT474 tumor cells (1 x 107) were injected together with Matrigel on their right hip. Before tumor cell inoculation, 0.72 mg/d 17ß-estradiol pellets (Innovative Research of America) were placed subcutaneously just below their left shoulder. Tumors (50200 mg) developed after a period of 1418 d.
PET Studies
These animals were divided into 2 groups of 5 mice each. Both groups were injected with either 15 MBq 18F-FDG or 38 MBq 68Ga-F(ab')2-herceptin in the tail vein. At 1 and 3 h after injection, respectively, the animals were sedated using isoflurane and imaged with a microPET camera (Concorde Microsystems Inc.). Coincident data were collected for the 511-keV
-rays with a 250- to 750-keV window for 10 min. The images were reconstructed and regions of interest (ROIs) were drawn around the tumors and major organs. One group of animals then received a total of 150 mg/kg of 17AAG dissolved in an egg phospholipid, over 24 h in 3 doses of 50 mg/kg each (day 0). The other group of animals was not treated. The animals were then imaged with a regimen of weekly 18F-FDG or biweekly 68Ga-F(ab')2-herceptin on alternating days for the next 3 wk, and the tumor size and body mass were monitored.
Tumor volumes were determined by external vernier caliper measurements along the longest axis (x-axis) and the axis perpendicular to the longest axis (y-axis). The tumor volume was then estimated by using the following formula:
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| RESULTS |
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| DISCUSSION |
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The effect of 17AAG on HER2-positive tumors has been published (23). In athymic mice, with CWRSA6 prostate cancer xenografts, a single dose of 50 mg/kg 17AAG suppressed HER2 expression at 4 h after injection, but HER2 levels had returned to normal by 48 h after injection. In the current experimental setting, a higher dose of 17AAG lowered expression of HER2 until 5 d after treatment and had a stronger long-term effect on the overall growth of the tumors, which was apparent at 9 d after treatment. However, the 68Ga-F(ab')2-herceptin imaging does rapidly show the desired effect of 17AAG on HER2-positive tumors.
Over the past year, several groups have published phase I clinical trials on 17AAG therapy (2427). 17AAG binds to and inactivates Hsp90, but direct measurement of the biomarker in the target tissue is problematic and investigators have used indirect measurements, such as the upregulation of Hsp70 or downregulation of such client proteins as LCK, Raf-1, CDK4, and so forth. Goetz et al. (24) used peripheral blood mononuclear cells (PBMCs) to study the effect of 17AAG on biomarkers and saw no significant change in Hsp90 levels, but they reported an induction of Hsp70 levels at all doses studied (15431 mg/m2/wk, up to 4 wk). Grem et al. (25) used a more frequent dosing scheme (1056 mg/m2/d, 5 d/wk every 3 wk) and monitored protein levels in PBMCs. They found an increase in Hsp70 at doses of >14 mg/m2 (15/16 patients) and decreases in Raf-1 at doses of >28 mg/m2 (5/8 patients). Ramanathan et al. (26) also used PBMCs and Hsp90/Hsp70 levels to monitor 17AAG effects (10395 mg/m2/wk) but concluded that they were uninformative pharmacodynamic markers. Banerji et al. (27) looked at the effects of 17AAG (10450 mg/m2/wk) on peripheral blood leukocytes (PBLs) as well as tumor biopsies. Induction of Hsp70 levels in PBLs was seen at low doses of 17AAG (80 mg/m2/wk). At the highest dose level (450 mg/m2/wk), PBLs showed cRaf-1, LCK, and CDK4 depletions and Hsp70 inductions in 3 of 3, 0 of 4, 0 of 4, and 3 of 4 patients, respectively. At the higher dose level (320450 mg/m2/wk), tumor biopsies revealed LCK and CDK4 depletions and Hsp70 inductions in 4 of 6, 8 of 9, and 8 of 9 patients. However, these authors noted a lack of correlation between biomarkers found in PBLs and tumor biopsies. These reports show the need for a noninvasive method for determining the effects of 17AAG on Hsp90 levels, and clinical trials with 68Ga-F(ab')2-herceptin are planned.
| CONCLUSION |
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| ACKNOWLEDGMENTS |
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| References |
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