isotretinoin and Liver-Neoplasms

We report a neonate with 4S neuroblastoma and MYCN amplification, but favorable Shimada histology, successfully treated with chemotherapy and 13-cis-retinoic acid without stem cell transplantation. MYCN amplification in neuroblastoma is usually associated with unfavorable Shimada histology; the presence of these features in infants with 4S disease confers a poor prognosis. A small number of infants with 4S neuroblastoma and MYCN amplification have favorable Shimada histology. In this subgroup of infants, histopathology may be equally important in predicting outcome.

Topics: Adrenal Gland Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Carboplatin; Cyclophosphamide; Doxorubicin; Etoposide; Female; Gene Amplification; Genes, myc; Genes, Neoplasm; Hepatomegaly; Humans; Infant, Newborn; Isotretinoin; Liver Neoplasms; Lymphatic Metastasis; Magnetic Resonance Imaging; Neuroblastoma; Prognosis; Remission Induction; Risk Factors

Adenocarcinoma of the pancreas is a cancer with extremely poor prognosis and limited therapeutic options. Retinoids are derivatives of vitamin A involved in the control of many biological functions, including cell growth and differentiation and the induction of apoptosis. On the basis of pre-clinical evidence and some clinical data, we conducted a phase II study of 13-cis-retinoic acid (13-cis-RA) in combination with gemcitabine in patients with unresectable pancreatic carcinoma.. Patients with histologically confirmed unresectable pancreatic carcinoma were treated with gemcitabine 1000 mg/m2 on days 8, 15, 22 plus 13-cis-RA 1 mg/kg on days 1-14 for six cycles. The end points included the objective response rate and median survival.. Thirty patients were recruited, 15 men and 15 women; 20 patients were evaluable. The median age was 65 years (range 44-79 years) and the median Karnofsky performance status was 80% (range 60-100%). The median follow-up was 21 months. One patient achieved a partial remission, seven patients had stable disease and 12 patients developed progressive disease. Toxicity was mainly haematological, with eight cases of grade 3 and four cases of grade 4 neutropenia, thrombocytopenia and anaemia. The median survival was 7.8 months (range 2.6-21.6 months).. The combination of gemcitabine and 13-cis-RA was well tolerated, but we did not see improvement in the response rate. Further studies with other retinoids may be beneficial to patients with unresectable pancreatic cancer.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Deoxycytidine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Gemcitabine; Humans; Isotretinoin; Liver Neoplasms; Lung Neoplasms; Male; Maximum Tolerated Dose; Middle Aged; Palliative Care; Pancreatic Neoplasms; Pilot Projects; Prognosis; Ribonucleotide Reductases; Survival Rate; Treatment Outcome

To evaluate the therapeutic effects and systemic toxicities of a capecitabine-based home therapy regimen in patients with metastatic renal cell carcinoma, 30 patients were enrolled in a phase II clinical trial. Treatment consisted of oral capecitabine combined with subcutaneous recombinant human interferon-alpha 2a, recombinant human interleukin-2 and oral 13-cis-retinoic acid. There were two (7%) complete responses (CRs) and eight (27%) partial remissions (PRs), for an overall objective response rate of 34% (95% CI 17-53%). Except one, all responses are ongoing, with a median duration of 9+ and 8+ months for CRs and PRs, respectively. Additionally, 12 patients (40%) reached stable disease. Eight patients (27%) showed continued disease progression despite treatment. Therapy was well tolerated and was given in the outpatient setting. Capecitabine-related World Health Organization (WHO) grade 2 and 3 toxicities were observed in five and two patients respectively, and were limited to fatigue, nausea/vomiting, diarrhoea, stomatitis, dermatitis and hand-and-foot syndrome. The substitution of capecitabine for 5-FU in the pre-existing biochemotherapy regimen did not result in a reduced therapeutic efficacy and showed significant anti-tumour activity in patients with advanced renal cell carcinoma.

Topics: Administration, Oral; Adult; Aged; Antineoplastic Agents; Capecitabine; Carcinoma, Renal Cell; Deoxycytidine; Female; Fluorouracil; Humans; Injections, Subcutaneous; Interferon alpha-2; Interferon-alpha; Interleukin-2; Isotretinoin; Kidney Neoplasms; Liver Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Recombinant Proteins; Treatment Outcome

Hypertriglyceridemia is a metabolic complication of retinoid therapy. In this study, we analyzed whether retinoids increase the expression of apo C-III, an antagonist of plasma triglyceride catabolism. In men, isotretinoin treatment (80 mg/d; 5 d) resulted in elevated plasma apo C-III, but not apo E concentrations. In human hepatoma HepG2 cells, retinoids increased apo C-III mRNA and protein production. Transient transfection experiments indicated that retinoids increase apo C-III expression at the transcriptional level. This increased apo C-III transcription is mediated by the retinoid X receptor (RXR), since LG1069 (4-[1-(5,6,7,8-tetrahydro-3,5,5,8, 8-pentamethyl-2-naphtalenyl)ethenyl]benzoic acid), a RXR-specific agonist, but not TTNPB ((E)- 4-[2-(5,6,7,8-tetrahydro-5,5,8, 8-tetramethyl-2-naphtalenyl)propenyl]benzoic acid), a retinoic acid receptor (RAR)-specific agonist, induced apo C-III mRNA in HepG2 cells and primary human hepatocytes. Mutagenesis experiments localized the retinoid responsiveness to a cis-element consisting of two imperfect AGGTCA sequences spaced by one oligonucleotide (DR-1), within the previously identified C3P footprint site. Cotransfection assays showed that RXR, but not RAR, activates apo C-III transcription through this element either as a homo- or as a heterodimer with the peroxisome proliferator-activated receptor. Thus, apo C-III is a target gene for retinoids acting via RXR. Increased apo C-III expression may contribute to the hypertriglyceridemia and atherogenic lipoprotein profile observed after retinoid therapy.

Topics: Adult; Apolipoprotein C-III; Apolipoproteins C; Benzoates; Bexarotene; Carcinoma, Hepatocellular; Cells, Cultured; Dimerization; Double-Blind Method; Gene Expression Regulation; HeLa Cells; Humans; Hypertriglyceridemia; Isotretinoin; Liver; Liver Neoplasms; Male; Mutagenesis, Site-Directed; Promoter Regions, Genetic; Receptors, Cytoplasmic and Nuclear; Receptors, Retinoic Acid; Recombinant Fusion Proteins; Regulatory Sequences, Nucleic Acid; Retinoid X Receptors; Retinoids; Tetrahydronaphthalenes; Transcription Factors; Transcription, Genetic; Transfection; Tumor Cells, Cultured

Hepatocellular carcinoma (HCC) is the most common form of liver cancer. The number of cases is increasing and the trend for the next few years is not encouraging. HCC is usually detected in the advanced stages of the disease, and pharmacological therapies are not entirely effective. For this reason, it is necessary to search for new therapeutic options. The objective of this work was to evaluate the effect of the drugs isotretinoin and thalidomide on

Topics: Carcinoma, Hepatocellular; Cell Proliferation; Cell Survival; Dose-Response Relationship, Drug; Down-Regulation; Gene Expression Regulation, Neoplastic; Hep G2 Cells; Humans; Isotretinoin; Liver Neoplasms; Promoter Regions, Genetic; Proteomics; Proto-Oncogene Proteins c-myc; Thalidomide

Two hepatoma cell lines were incubated for 72 h with ATRA and its analog 13cisRA and according to MTT assay, Hep3B cells were highly susceptible whereas HepG2 cells were more resistant to the treatment. At the high concentration of 166 microM, retinoids were able to induce apoptosis in both cell lines and the highest effect was observed in HepG2 cells treated with ATRA. TUNEL-based photometric ELISA showed that at the same retinoid concentration tested by flow cytometry, both cell lines showed apoptosis whereas plasma membranes were not significantly disrupted. Inhibitors of apoptosis Bcl-xL and survivin were downregulated in Hep3B cells by treatment with both retinoids. Bax, a pro-apoptotic protein, was not significantly upregulated in Hep3B cells, but was slightly increased in HepG2 cells treated with 13cisRA. Both procaspase-3 and procaspase-8 were cleaved in Hep3B cells, suggesting apoptosis could be triggered through the extrinsic pathway. In the case of HepG2 cells, lack of caspase activation suggests a mechanism dependent on other kind of proteases.

Topics: Apoptosis; bcl-2-Associated X Protein; bcl-X Protein; Blotting, Western; Carcinoma, Hepatocellular; Caspases; Cell Line, Tumor; Dose-Response Relationship, Drug; Enzyme Activation; Enzyme-Linked Immunosorbent Assay; Flow Cytometry; Humans; In Situ Nick-End Labeling; Inhibitor of Apoptosis Proteins; Isotretinoin; Liver Neoplasms; Microtubule-Associated Proteins; Neoplasm Proteins; Retinoids; Survivin

In order to elucidate the relation between cell signal transduction and cell differentiation, the effect of two differentiation inducers--all trans-retinoic acid (ATRA) and 13 cis-retinoic acid (13 cis-RA) on the specific activities (nmol/hr.mg protein) of phosphatidyl choline specific phospholipase D (PC-PLD) in 7721 human hepatocarcinoma cell line was studied. It was found that ATRA and 13 cis-RA increased the specific activities of membrane bound PC-PLD on 2nd and 4th day of cell culture respectively. If the PC-PLD activities were calculated as activity per bottle cells, the effect of ATRA on the 2nd day was also higher than that of 13 cis-RA, while the reverse was true on the 4th day, revealing a postponed effect of 13 cis-RA as compared with ATRA. The increase of PC-PLD was higher when the culture medium was refreshed every day than that when the medium was unrefreshed, suggesting that a factor might be existed in the fresh medium which could enhance the stimulating effect of retinoic acids on PC-PLD. The effect of ATRA on PC-PLD specific activity were higher on 2nd day than that on 4th day, owing to the accelerated proliferation of the cells on 4th day, leading to the increase of protein contents and decrease of the enzyme specific activity calculated on the base of protein contents. Whereas, the effect of 13 cis-RA on PC-PLD specific activity were higher on 4th day than that on 2nd day, because the increase of enzyme activity was higher than the increase of protein contents on 4th day. The relation between the elevation of PC-PLD and protein kinases was further studied and discovered that ATRA decreased both the specific activities of membrane bound and cytosolic protein kinase C (PKC) as well as tyrosine protein kinase (TPK) either in 2nd or 4th day of cell culture, which indicated that the increasing effect of ATRA on membrane bound PC-PLD was not resulted from the stimulating effect of PKC and TPK on PC-PLD, and its mechanism remains to be further investigated.

Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Humans; Isotretinoin; Liver Neoplasms; Phosphatidylcholines; Phospholipase D; Tretinoin; Tumor Cells, Cultured