title: Significant cytotoxic activity in vitro of the EGFR tyrosine kinase inhibitor gefitinib in acute myeloblastic leukaemia.
abstract: OBJECTIVE
  Gefitinib inhibits epidermal growth factor receptor (EGFR) signalling, but may also act by non-EGFR dependent mechanisms. We have investigated the activity of gefitinib in haematological tumour cells, in particular acute myeloblastic leukaemia (AML).
  
  
  METHODS
  Cytotoxic activity of gefitinib, alone or in combination with standard anti-leukaemic drugs, was assessed by the short-term fluorometric microculture cytotoxicity assay in tumour cells from 117 patients representing five haematological and five non-haematological malignancies. In AML, the EGFR status was analysed by immunochemistry. Gefitinib-induced apoptosis was investigated in a subset of AML samples, as well as in the leukaemia cell line MV-4-11, using a multiparametric high content screening assay. To confirm activation of caspase-3 in cells treated with gefitinib, a blocking test was carried out in which MV4-11 cells were pretreated with the specific caspase inhibitor DEVD-FMK.
  
  
  RESULTS
  Gefitinib showed highest cytotoxic activity in AML (n = 19) with many samples being sensitive at concentrations achievable in clinical practice (<10 microM), and no difference between previously untreated and relapsed patients. No correlation between the activity of gefitinib and standard antileukaemic drugs (cytarabine, doxorubicin, etoposide) was observed. Combining gefitinib with these drugs resulted in mainly additive or synergistic (etoposide) effects, with no evidence of sequence dependency. The AML cells did not express the EGFR. Gefitinib induced apoptosis, which was at least partly mediated by activation of the caspase-3 pathway.
  
  
  CONCLUSIONS
  In vitro, gefitinib has significant cytotoxic activity in AML by inducing apoptosis through non-EGFR dependent pathways.
authors.affiliation: Division of Clinical Pharmacology, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Elin
authors.initials: E
authors.lastname: Lindhagen
authors.forename: Anna
authors.initials: A
authors.lastname: Eriksson
authors.forename: Malin
authors.initials: M
authors.lastname: Wickström
authors.forename: Katarina
authors.initials: K
authors.lastname: Danielsson
authors.forename: Birgitta
authors.initials: B
authors.lastname: Grundmark
authors.forename: Roger
authors.initials: R
authors.lastname: Henriksson
authors.forename: Peter
authors.initials: P
authors.lastname: Nygren
authors.forename: Anna
authors.initials: A
authors.lastname: Aleskog
authors.forename: Rolf
authors.initials: R
authors.lastname: Larsson
authors.forename: Martin
authors.initials: M
authors.lastname: Höglund
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017209:Apoptosis / Q000187:drug effects*; D053148:Caspase 3 / Q000378:metabolism; D004354:Drug Screening Assays, Antitumor / Q000379:methods; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005260:Female; D000077156:Gefitinib; D006801:Humans; D007120:Immunochemistry; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011799:Quinazolines / Q000494:pharmacology* / Q000627:therapeutic use; D014407:Tumor Cells, Cultured
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; C512478:EGFR protein, human; D066246:ErbB Receptors; C505407:CASP3 protein, human; D053148:Caspase 3; D000077156:Gefitinib