title: all-trans retinoic acid for treating germ cell tumors. In vitro activity and results of a phase II trial.
abstract: BACKGROUND
  Germ cell tumors (GCTs) are characterized by a capacity to differentiate in vivo and in vitro. The authors' previous work highlighted the finding that retinoid-mediated GCT differentiation in vitro correlates with expression of the retinoic acid receptor-gamma.
  
  
  METHODS
  Six human GCT cell lines were studied to determine whether their growth and differentiation were linked to the retinoic acid response pathway. The maturation and growth inhibitory responses to all-trans retinoic acid (RA) were studied as well as the expression of retinoic acid receptor-gamma (RAR-gamma). The clinical antitumor activity of RA was studied in a Phase II trial of RA in patients with chemotherapy-refractory GCTs.
  
  
  RESULTS
  The RA response pathway was correlated with the control of growth and maturation in three of the six GCT cell lines studied. In one GCT cell line, RA induced RAR-gamma expression and terminal differentiation. In a second, there was high basal expression of RAR-gamma and poor basal proliferative potential. A third cell line showed a more mature basal phenotype than other cell lines studied and marked growth inhibition when treated with RA. Sixteen patients were treated with RA for an average of 7 weeks in the clinical trial. No complete or partial responses were noted.
  
  
  CONCLUSIONS
  A Phase II clinical trial of RA failed to show significant clinical antitumor activity in patients with chemotherapy-refractory GCTs. However in vitro data suggest that the control of growth and maturation in some GCT cell lines involve the RA signaling pathway. Further studies are warranted to define the role that other retinoids with receptor selectivity or more favorable pharmacologic properties may play in the maturation or antitumor responses of GCTs.
authors.affiliation: Laboratory of Molecular Medicine, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Moasser
authors.forename: R J
authors.initials: RJ
authors.lastname: Motzer
authors.forename: K S
authors.initials: KS
authors.lastname: Khoo
authors.forename: P
authors.initials: P
authors.lastname: Lyn
authors.forename: B A
authors.initials: BA
authors.lastname: Murphy
authors.forename: G J
authors.initials: GJ
authors.lastname: Bosl
authors.forename: E
authors.initials: E
authors.lastname: Dmitrovsky
mesh_terms: D000293:Adolescent; D000328:Adult; D002454:Cell Differentiation / Q000187:drug effects; D002455:Cell Division / Q000187:drug effects; D005260:Female; D015870:Gene Expression; D006131:Growth Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy*; D012333:RNA, Messenger / Q000235:genetics; D012334:RNA, Neoplasm / Q000235:genetics; D018168:Receptors, Retinoic Acid / Q000235:genetics / Q000378:metabolism; D014212:Tretinoin / Q000627:therapeutic use*; D014407:Tumor Cells, Cultured; D000097768:Retinoic Acid Receptor gamma
chemical_list: D006131:Growth Inhibitors; D012333:RNA, Messenger; D012334:RNA, Neoplasm; D018168:Receptors, Retinoic Acid; D014212:Tretinoin; D000097768:Retinoic Acid Receptor gamma