Division of Molecular Biotherapy, Cancer Chemotherapy Center, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Gastroenterological Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Sci Rep. 2021 Jul 23;11(1):15125. doi: 10.1038/s41598-021-94584-9.
The vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) axis is an essential regulator of angiogenesis and important therapeutic target in cancer. Ramucirumab is an anti-VEGFR2 monoclonal antibody used for the treatment of several cancers. Increased circulating VEGF-A levels after ramucirumab administration are associated with a worse prognosis, suggesting that excess VEGF-A induced by ramucirumab negatively affects treatment efficacy and that neutralizing VEGF-A may improve treatment outcomes. Here, we evaluated the effect of combination treatment with an anti-VEGFR2 antibody and anti-VEGF-A antibody on gastric tumor progression and normal tissues using a preclinical BALB/c-nu/nu mouse xenograft model. After anti-VEGFR2 antibody treatment in mice, a significant increase in plasma VEGF-A levels was observed, mirroring the clinical response. The elevated VEGF-A was host-derived. Anti-VEGF-A antibody co-administration enhanced the anti-tumor effect of the anti-VEGFR2-antibody without exacerbating the toxicity. Mechanistically, the combination treatment induced intra-tumor molecular changes closely related to angiogenesis inhibition and abolished the gene expression changes specifically induced by anti-VEGFR2 antibody treatment alone. We particularly identified the dual treatment-selective downregulation of ZEB1 expression, which was critical for gastric cancer cell proliferation. These data indicate that the dual blockade of VEGF-A and VEGFR2 is a rational strategy to ensure the anti-tumor effect of angiogenesis-targeting therapy.
血管内皮生长因子 (VEGF)/VEGF 受体 (VEGFR) 轴是血管生成的重要调节剂,也是癌症治疗的重要靶点。雷莫芦单抗是一种抗 VEGFR2 单克隆抗体,用于治疗多种癌症。雷莫芦单抗给药后循环 VEGF-A 水平升高与预后不良相关,这表明雷莫芦单抗诱导的过量 VEGF-A 对治疗效果产生负面影响,而中和 VEGF-A 可能改善治疗效果。在这里,我们使用临床前 BALB/c-nu/nu 小鼠异种移植模型评估了抗 VEGFR2 抗体和抗 VEGF-A 抗体联合治疗对胃肿瘤进展和正常组织的影响。在小鼠中进行抗 VEGFR2 抗体治疗后,观察到血浆 VEGF-A 水平显著升高,与临床反应一致。升高的 VEGF-A 是宿主来源的。抗 VEGF-A 抗体联合给药增强了抗 VEGFR2 抗体的抗肿瘤作用,而没有加重毒性。从机制上讲,联合治疗诱导了与血管生成抑制密切相关的肿瘤内分子变化,并消除了仅由抗 VEGFR2 抗体治疗单独诱导的基因表达变化。我们特别鉴定了双重治疗对 ZEB1 表达的选择性下调,这对胃癌细胞增殖至关重要。这些数据表明,双重阻断 VEGF-A 和 VEGFR2 是确保血管生成靶向治疗抗肿瘤效果的合理策略。