Centro Nacional de Investigaciones Oncologicas, Madrid, Spain.
Laboratorio de Dianas Terapeuticas, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain.
Clin Cancer Res. 2015 Nov 1;21(21):4811-8. doi: 10.1158/1078-0432.CCR-14-3222. Epub 2015 Jul 13.
PURPOSE: nab-Paclitaxel plus gemcitabine was superior to gemcitabine alone for patients with metastatic pancreatic cancer (MPC) in the phase III MPACT trial. This study evaluated the association of secreted protein acidic and rich in cysteine (SPARC) levels with efficacy as an exploratory endpoint. EXPERIMENTAL DESIGN: Patients with previously untreated MPC (N = 861) received nab-paclitaxel plus gemcitabine or gemcitabine alone. Baseline SPARC level was measured in the tumor stroma and epithelia (archival biopsies) and plasma. Experiments were performed in pancreatic cancer mouse models in which SPARC was intact or deleted. RESULTS: SPARC was measured in the tumor stroma of 256 patients (30%), the tumor epithelia of 301 patients (35%), and plasma of 343 patients (40%). Stroma-evaluable samples were from metastases (71%), from the pancreas (11%), or of unidentifiable origin (insufficient tissue to determine; 17%). For all patients, stromal SPARC level [high (n = 71) vs. low (n = 185)] was not associated with overall survival (OS; HR, 1.019; P = 0.903); multivariate analysis confirmed this lack of association. There was no association between stromal SPARC level and OS in either treatment arm. Neither tumor epithelial SPARC nor plasma SPARC was associated with OS. Results from a SPARC knockout mouse model treated with nab-paclitaxel plus gemcitabine revealed no correlation between SPARC expression and tumor progression or treatment efficacy. CONCLUSIONS: SPARC levels were not associated with efficacy in patients with MPC. This exploratory analysis does not support making treatment decisions regarding nab-paclitaxel plus gemcitabine or gemcitabine alone in MPC based on SPARC expression.
目的:在 III 期 MPACT 试验中,与单独使用吉西他滨相比,白蛋白紫杉醇联合吉西他滨在转移性胰腺癌(MPC)患者中具有优势。本研究评估了分泌富含半胱氨酸的酸性蛋白(SPARC)水平与疗效的关联,这是一个探索性终点。
实验设计:861 例未经治疗的 MPC 患者接受白蛋白紫杉醇联合吉西他滨或吉西他滨单药治疗。在肿瘤基质和上皮(存档活检)和血浆中测量基线 SPARC 水平。在 SPARC 完整或缺失的胰腺癌小鼠模型中进行了实验。
结果:在 256 例患者(30%)的肿瘤基质中、在 301 例患者(35%)的肿瘤上皮中以及在 343 例患者(40%)的血浆中测量了 SPARC。可评估基质的样本来自转移灶(71%)、胰腺(11%)或来源不明(组织不足,无法确定;17%)。对于所有患者,基质 SPARC 水平[高(n=71)与低(n=185)]与总生存期(OS)无关(HR,1.019;P=0.903);多变量分析证实了这种无关联。在任一治疗组中,基质 SPARC 水平与 OS 均无关联。肿瘤上皮 SPARC 或血浆 SPARC 均与 OS 无关。用白蛋白紫杉醇联合吉西他滨治疗的 SPARC 基因敲除小鼠模型的结果显示,SPARC 表达与肿瘤进展或治疗效果之间没有相关性。
结论:SPARC 水平与 MPC 患者的疗效无关。这项探索性分析不支持根据 SPARC 表达来决定在 MPC 中使用白蛋白紫杉醇联合吉西他滨或吉西他滨单药治疗。
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