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Clinical Trial
. 2012 Sep 25;107(7):1044-50.
doi: 10.1038/bjc.2012.369. Epub 2012 Aug 21.

Vascular density analysis in colorectal cancer patients treated with vatalanib (PTK787/ZK222584) in the randomised CONFIRM trials

A Giatromanolaki  1 , M I Koukourakis, E Sivridis, K C Gatter, T Trarbach, G Folprecht, M M Shi, D Lebwohl, T Jalava, D Laurent, G Meinhardt, A L Harris; Tumour and Angiogenesis Research Group
Affiliations
Clinical Trial

Vascular density analysis in colorectal cancer patients treated with vatalanib (PTK787/ZK222584) in the randomised CONFIRM trials

A Giatromanolaki et al. Br J Cancer. .

Abstract

Background: Pharmacological inhibitors of vascular endothelial growth factor (VEGF) receptors, like vatalanib, have been tested in randomised trials (CONFIRM (Colorectal Oral Novel therapy For the Inhibition of Angiogenesis and Retarding of Metastases) 1 and 2) in colorectal cancer showing activity in a subgroup of patients with high serum LDH expression. In the current study, we assessed the predictive role of vascular density (VD) in patients treated in the above trials.

Methods: Paraffin-embedded materials from 141 patients were analysed with immunohistochemistry for the expression of the CD31 (pan-endothelial cell marker) and of phosphorylated pVEGFR2/KDR on endothelial cells. The VD was correlated with response to therapy and with progression-free (PFS) and overall survival (OS).

Results: A significant association of pVEGFR2/KDR+ VD with poor response in the placebo group was noted (response rates (RRs) 15% (3/20) when high VD vs 52% (26/50) when low VD; P=0.006). The RR increased from 15 (3/20) to 50% (11/22) in tumours with high VD when vatalanib was added to chemotherapy (P=0.02). A significantly improved PFS was noted in patients with high pVEGFR2/KDR+ VD when treated with vatalanib (P=0.002). A similar effect was also noted in patients with high CD31+ VD (P=0.07). Overall survival was marginally improved (P=0.07).

Conclusion: Assessment of the activated vessel density may allow the stratification of patients recruited in randomised trials with VEGFR-targeting anti-angiogenic agents, unmasking their therapeutic potential and enabling their introduction in the clinical practice for the benefit of specific patient subgroups, at the same time reducing the cost of therapy.

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Conflict of interest statement

Author TT – Consultant or Advisory Role; Schering. Author GF – Honoraria; Novartis. Authors MMS and DL – Employment or Leadership Position; Novartis. Author TJ – Employment or Leadership Position; Bayer Oy. Author DL – Employment or Leadership Position; Bayer Pharma AG. Author GM – Employment or Leadership Position; Bayer Pharmaceuticals. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Immunohistochemical figures of colon carcinomas with low (A) and high (B) CD31+ VD, and low (C) and high (D) pVEGFR2/KDR+ VD (magnification × 200; arrows show vessels).
Figure 2
Figure 2
Response rates (complete and partial vs non-response) according to the administration of vatalanib and the CD31+ (A) and pVEGFR2/KDR+ (B) VD.
Figure 3
Figure 3
Progression-free and OS stratified for vatalanib administration in patients with high pVEGFR2/KDR+ (A and B) and high CD31+ (C and D) VD. P-values refer to Mantel–Haenszel and Gehan–Breslow–Wilcoxon methods, respectively. pts, patients.
See this image and copyright information in PMC

References

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