Analyses of Potential Predictive Markers and Survival Data for a Response to Sunitinib in Patients with Metastatic Renal Cell Carcinoma

作者：Dornbusch Juana^*; Zacharis Aristeidis; Meinhardt Matthias; Erdmann Kati; Wolff Ingmar; Froehner Michael; Wirth Manfred P; Zastrow Stefan; Fuessel Susanne

来源：PLos One, 2013, 8(9): e76386.

DOI：10.1371/journal.pone.0076386

Background: Patients with metastatic clear cell renal cell carcinoma (ccRCC) are frequently treated with tyrosine kinase inhibitors (TKI) such as sunitinib. It inhibits angiogenic pathways by mainly targeting the receptors of VEGF and PDGF. In ccRCC, angiogenesis is characterized by the inactivation of the von Hippel-Lindau gene (VHL) which in turn leads to the induction of HIF1 alpha target genes such as CA9 and VEGF. Furthermore, the angiogenic phenotype of ccRCC is also reflected by endothelial markers (CD31, CD34) or other tumor-promoting factors like Ki67 or survivin.
Methods: Tissue microarrays from primary tumor specimens of 42 patients with metastatic ccRCC under sunitinib therapy were immunohistochemically stained for selected markers related to angiogenesis. The prognostic and predictive potential of theses markers was assessed on the basis of the objective response rate which was evaluated according to the RECIST criteria after 3, 6, 9 months and after last report (12-54 months) of sunitinib treatment. Additionally, VHL copy number and mutation analyses were performed on DNA from cryo-preserved tumor tissues of 20 ccRCC patients.
Results: Immunostaining of HIF-1 alpha, CA9, Ki67, CD31, pVEGFR1, VEGFR1 and -2, pPDGFR alpha and -beta was significantly associated with the sunitinib response after 6 and 9 months as well as last report under therapy. Furthermore, HIF-1 alpha, CA9, CD34, VEGFR1 and -3 and PDGRF alpha showed significant associations with progression-free survival (PFS) and overall survival (OS). In multivariate Cox proportional hazards regression analyses high CA9 membrane staining and a response after 9 months were independent prognostic factors for longer OS. Frequently observed copy number loss and mutation of VHL gene lead to altered expression of VHL, HIF-1 alpha, CA9, and VEGF.
Conclusions: Immunoexpression of HIF-1 alpha, CA9, Ki67, CD31, pVEGFR1, VEGFR1 and -2, pPDGFR alpha and -beta in the primary tumors of metastatic ccRCC patients might support the prediction of a good response to sunitinib treatment.

• 出版日期2013-9-27