Increased therapeutic effect on medullary thyroid cancer using a combination of radiation and tyrosine kinase inhibitors

PLoS One. 2020 May 27;15(5):e0233720. doi: 10.1371/journal.pone.0233720. eCollection 2020.

Abstract

Since patients with medullary thyroid cancer (MTC) often have metastatic disease at the time of diagnosis, the development of efficient systemic treatment options for MTC is important. Vandetanib and cabozantinib are two tyrosine kinase inhibitors (TKIs) that were recently approved by FDA and EMA for systemic treatment of metastatic MTC. Additionally, since MTC is of a neuroendocrine tumour type, treatment with radiolabelled somatostatin analogues (e.g. 177Lu-octreotate) is a valid option for patients with MTC. The aim of this study was to investigate the potentially increased therapeutic effect of combining radiation therapy with these TKIs for treatment of MTC in a mouse model. Nude mice carrying patient-derived MTC tumours (GOT2) were treated with external beam radiotherapy (EBRT) and/or one of the two TKIs vandetanib or cabozantinib. The tumour volume was determined and compared with that of mock-treated controls. The treatment doses were chosen to give a moderate effect as monotherapy to be able to detect any increased therapeutic effect from the combination therapy. At the end of follow-up, tumours were processed for immunohistochemical (IHC) analyses. The animals in the combination therapy groups showed the largest reduction in tumour volume and the longest time to tumour progression. Two weeks after start of treatment, the tumour volume for these mice was reduced by about 70-75% compared with controls. Furthermore, also EBRT and TKI monotherapy resulted in a clear anti-tumour effect with a reduced tumour growth compared with controls. The results show that an increased therapeutic effect could be achieved when irradiation is combined with TKIs for treatment of MTC. Future studies should evaluate the potential of using 177Lu-octreotate therapy in combination with TKIs in patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anilides / pharmacology*
  • Animals
  • Carcinoma, Neuroendocrine / enzymology
  • Carcinoma, Neuroendocrine / pathology
  • Carcinoma, Neuroendocrine / therapy*
  • Chemoradiotherapy*
  • Female
  • Humans
  • Mice
  • Mice, Inbred BALB C
  • Mice, Nude
  • Neoplasm Proteins / antagonists & inhibitors*
  • Neoplasm Proteins / metabolism
  • Piperidines / pharmacology*
  • Protein-Tyrosine Kinases / antagonists & inhibitors*
  • Protein-Tyrosine Kinases / metabolism
  • Pyridines / pharmacology*
  • Quinazolines / pharmacology*
  • Thyroid Neoplasms / enzymology
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / therapy*
  • Xenograft Model Antitumor Assays

Substances

  • Anilides
  • Neoplasm Proteins
  • Piperidines
  • Pyridines
  • Quinazolines
  • cabozantinib
  • Protein-Tyrosine Kinases
  • vandetanib

Supplementary concepts

  • Thyroid cancer, medullary

Grants and funding

This study was supported by grants from the Swedish Research Council (grant no. 21073), the Swedish Cancer Society (grant no. 3427), BioCARE – a National Strategic Research Program at the University of Gothenburg, the Swedish state under the agreement between the Swedish government and the county councils – the ALF-agreement (ALFGBG-725031), the King Gustav V Jubilee Clinic Cancer Research Foundation to EFA, as well as grants from the Sahlgrenska University Hospital Research Funds, the Assar Gabrielsson Cancer Research Foundation, the Adlerbertska Research Foundation, the Herbert & Karin Jacobsson Foundation, the Royal Society of Arts and Sciences in Gothenburg (KVVS), and the Wilhelm and Martina Lundgren Research Foundation to VS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.