title: Combined therapy with direct and indirect angiogenesis inhibition results in enhanced antiangiogenic and antitumor effects.
abstract: The multifaceted nature of the angiogenic process in malignant neoplasms suggests that protocols that combine antiangiogenic agents may be more effective than single-agent therapies. However it is unclear which combination of agents would be most efficacious and will have the highest degree of synergistic activity while maintaining low overall toxicity. Here we investigate the concept of combining a "direct" angiogenesis inhibitor (endostatin) with an "indirect" antiangiogenic compound [SU5416, a vascular endothelial growth factor receptor 2 (VEGFR2) receptor tyrosine kinase (RTK) inhibitor]. These angiogenic agents were more effective in combination than when used alone in vitro (endothelial cell proliferation, survival, migration/invasion, and tube formation tests) and in vivo. The combination of SU5416 and low-dose endostatin further reduced tumor growth versus monotherapy in human prostate (PC3), lung (A459), and glioma (U87) xenograft models, and reduced functional microvessel density, tumor microcirculation, and blood perfusion as detected by intravital microscopy and contrast-enhanced Doppler ultrasound. One plausible explanation for the efficacious combination could be that, whereas SU5416 specifically inhibits vascular endothelial growth factor signaling, low-dose endostatin is able to inhibit a broader spectrum of diverse angiogenic pathways directly in the endothelium. The direct antiangiogenic agent might be able to suppress alternative angiogenic pathways up-regulated by the tumor in response to the indirect, specific pathway inhibition. For future clinical evaluation of the concept, a variety of agents with similar mechanistic properties could be tested.
authors.affiliation: Departments of Radiation Oncology, German Cancer Research Center (dkfz), Heidelberg, Germany.
authors.forename: Amir
authors.initials: A
authors.lastname: Abdollahi
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Lipson
authors.forename: Axel
authors.initials: A
authors.lastname: Sckell
authors.forename: Heike
authors.initials: H
authors.lastname: Zieher
authors.forename: Frank
authors.initials: F
authors.lastname: Klenke
authors.forename: Daniel
authors.initials: D
authors.lastname: Poerschke
authors.forename: Alexandra
authors.initials: A
authors.lastname: Roth
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Han
authors.forename: Martin
authors.initials: M
authors.lastname: Krix
authors.forename: Marc
authors.initials: M
authors.lastname: Bischof
authors.forename: Philip
authors.initials: P
authors.lastname: Hahnfeldt
authors.forename: Hermann-Josef
authors.initials: HJ
authors.lastname: Grone
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.forename: Lynn
authors.initials: L
authors.lastname: Hlatky
authors.forename: Peter E
authors.initials: PE
authors.lastname: Huber
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology; D020533:Angiogenesis Inhibitors / Q000494:pharmacology*; D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D002289:Carcinoma, Non-Small-Cell Lung / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology; D002455:Cell Division / Q000187:drug effects; D002465:Cell Movement / Q000187:drug effects; D002470:Cell Survival / Q000187:drug effects; D004357:Drug Synergism; D043169:Endostatins / Q000494:pharmacology*; D004730:Endothelium, Vascular / Q000166:cytology / Q000187:drug effects; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007211:Indoles / Q000494:pharmacology*; D008175:Lung Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008819:Mice, Nude; D016513:Mice, SCID; D009369:Neoplasms / Q000098:blood supply* / Q000188:drug therapy / Q000473:pathology; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000188:drug therapy; D011471:Prostatic Neoplasms / Q000098:blood supply / Q000188:drug therapy / Q000473:pathology; D011758:Pyrroles / Q000494:pharmacology*; D014463:Ultrasonography; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D023041:Xenograft Model Antitumor Assays
chemical_list: D020533:Angiogenesis Inhibitors; D043169:Endostatins; D007211:Indoles; D011758:Pyrroles; D042461:Vascular Endothelial Growth Factor A; C116890:Semaxinib