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Published on: February 28, 2014
Circulating endothelial cells are an early predictor in renal cell carcinoma for tumor response to sunitinib
Viktor Gruenwald1, Gernot Beutel, Susanne Schuch-Jantsch
1Hannover Medical School, Germany. Gruenwald.Viktor@MH-Hannover.de
Background:
Tyrosine kinase inhibitors (TKI) have enriched the therapeutic options in patients with renal cell carcinoma (RCC), which frequently induce morphological changes in tumors. However, only little is known about the biological activity of TKI. Circulating endothelial cells (CEC) have been associated with endothelial damage and, hence, may serve as a putative marker for the biological activity of TKI. The main objective of our study was to evaluate the predictive value of CEC, monocytes, and soluble vascular endothelial growth factor receptor (sVEGFR)-2 in RCC patients receiving sunitinib treatment.
Methods:
Analyses of CEC, monocytes, and sVEGFR-2 were accomplished for twenty-six consecutive patients with metastatic RCC who received treatment with sunitinib (50 mg, 4 wks on 2 wks off schedule) at our institution in 2005 and 2006.
Results:
In RCC patients CEC are elevated to 49 ± 44/ml (control 8 ± 8/ml; P = 0.0001). Treatment with sunitinib is associated with an increase in CEC within 28 days of treatment in patients with a Progression free survival (PFS) above the median to 111 ± 61 (P = 0.0109), whereas changes in patients with a PFS below the median remain insignificant 69 ± 61/ml (P = 0.1848). Monocytes and sVEGFR2 are frequently altered upon sunitinib treatment, but fail to correlate with clinical response, defined by PFS above or below the median.
Conclusions:
Sunitinib treatment is associated with an early increase of CEC in responding patients, suggesting superior endothelial cell damage in these patients as a putative predictive biomarker.
Insights
Circulating endothelial cells (CEC) increase early in patients with renal cell carcinoma (RCC) who respond to sunitinib, indicating potential as a predictive biomarker for treatment effectiveness.
Area of Science:
- Oncology
- Pharmacology
- Biomarkers
Background:
- Tyrosine kinase inhibitors (TKIs) are used for renal cell carcinoma (RCC) but their biological activity is not well understood.
- Circulating endothelial cells (CEC) may indicate endothelial damage and serve as a marker for TKI biological activity.
Purpose of the Study:
- To evaluate circulating endothelial cells (CEC), monocytes, and soluble vascular endothelial growth factor receptor (sVEGFR)-2 as predictive biomarkers in metastatic RCC patients receiving sunitinib.
Main Methods:
- CEC, monocytes, and sVEGFR-2 were analyzed in 26 metastatic RCC patients treated with sunitinib (50 mg, 4 weeks on/2 weeks off).
Main Results:
- RCC patients had elevated CEC (49 ± 44/ml) compared to controls (8 ± 8/ml).
- Sunitinib treatment increased CEC within 28 days in patients with progression-free survival (PFS) above the median (111 ± 61/ml), but not in those with below-median PFS (69 ± 61/ml).
- Monocytes and sVEGFR2 levels changed with sunitinib but did not correlate with PFS.
Conclusions:
- An early increase in CEC during sunitinib treatment is associated with response in RCC patients.
- CEC elevation suggests greater endothelial damage in responding patients, potentially serving as a predictive biomarker for sunitinib efficacy.
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