title: Potent antitumor effects of ZD6474 on neuroblastoma via dual targeting of tumor cells and tumor endothelium.
abstract: Among children with relapsed or refractory neuroblastoma, the prognosis is poor and novel therapeutic strategies are needed to improve long-term survival. As with other solid tumors, high vascular density within neuroblastoma is associated with advanced disease, and therapeutic regimens directed against the tumor vasculature may provide clinical benefit. The receptor tyrosine kinase RET is widely expressed in neuroblastoma and is known to activate key signal transduction pathways involved in tumor cell survival and progression including Ras/mitogen-activated protein kinase and phosphatidylinositol 3-kinase/Akt. We investigated the effect of dual targeting of tumor cells and tumor endothelium with ZD6474, a small-molecule tyrosine kinase inhibitor of vascular endothelial growth factor (VEGF) receptor 2, epidermal growth factor receptor, and RET. ZD6474 inhibited the phosphorylation of RET in neuroblastoma cells and had a direct effect on tumor cell viability in seven neuroblastoma cell lines. In a human neuroblastoma xenograft model, ZD6474 inhibited tumor growth by 85% compared with treatment with vehicle alone. In contrast, no significant inhibition of tumor growth was observed after treatment with bevacizumab, an antihuman VEGF monoclonal antibody, or the epidermal growth factor receptor inhibitor erlotinib, either alone or in combination. Immunohistochemical analysis showed that ZD6474 treatment led to an increase in endothelial cell apoptosis along with inhibition of VEGF receptor-2 activation on tumor endothelium. In conclusion, dual targeting of tumor cells, potentially through RET inhibition, and tumor vasculature with ZD6474 leads to potent antitumor effects. This approach merits further investigation for patients with neuroblastoma.
authors.affiliation: Department of Vascular Biology, Boston Children's Hospital, Boston, Massachusetts, USA. Paul.Beaudry@CalgaryHealthRegion.ca
authors.forename: Paul
authors.initials: P
authors.lastname: Beaudry
authors.forename: Monique
authors.initials: M
authors.lastname: Nilsson
authors.forename: Matthew
authors.initials: M
authors.lastname: Rioth
authors.forename: Daniela
authors.initials: D
authors.lastname: Prox
authors.forename: David
authors.initials: D
authors.lastname: Poon
authors.forename: Lanwei
authors.initials: L
authors.lastname: Xu
authors.forename: Patrick
authors.initials: P
authors.lastname: Zweidler-Mckay
authors.forename: Anderson
authors.initials: A
authors.lastname: Ryan
authors.forename: Judah
authors.initials: J
authors.lastname: Folkman
authors.forename: Sandra
authors.initials: S
authors.lastname: Ryeom
authors.forename: John
authors.initials: J
authors.lastname: Heymach
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000494:pharmacology; D017209:Apoptosis / Q000187:drug effects; D049109:Cell Proliferation / Q000187:drug effects; D002470:Cell Survival / Q000187:drug effects; D016503:Drug Delivery Systems; D004727:Endothelium / Q000187:drug effects* / Q000473:pathology; D066246:ErbB Receptors / Q000378:metabolism; D006801:Humans; D008297:Male; D051379:Mice; D008819:Mice, Nude; D009447:Neuroblastoma / Q000473:pathology*; D010766:Phosphorylation / Q000187:drug effects; D010880:Piperidines / Q000494:pharmacology*; D051096:Proto-Oncogene Proteins c-ret / Q000378:metabolism; D011799:Quinazolines / Q000494:pharmacology*; D014407:Tumor Cells, Cultured; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000378:metabolism; D023041:Xenograft Model Antitumor Assays
chemical_list: D000970:Antineoplastic Agents; D010880:Piperidines; D011799:Quinazolines; C512478:EGFR protein, human; D066246:ErbB Receptors; D051096:Proto-Oncogene Proteins c-ret; C099282:RET protein, human; D040301:Vascular Endothelial Growth Factor Receptor-2; C452423:vandetanib