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• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
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  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies

Definitions

• Tumors influence the surrounding host str ⁇ ma by inducing angiogenesis to supply their oxygen and nutrient needs, allowing them to grow.
• angiogenesis is tightly associated with Tumors.
• angiogenesis inhibitors are regulated by the balance between angiogenic nnd anti-ongiogenic fuc or$l ⁇ 2.
• the induction of angiogenesis by tumor-derived pro-angiogcnic proteins is a discrete component of the malignant phcnotypc. Decreased production of angiogenesis inhibitors or increased
• ungiogenic peptides can shiA the balance towards u pro-angiogcnic state*, permitting tumor growth.
• a tumor increases in size, it disrupts its surrounding stro a and recruits still more host blood vessels. This paracrine relationship between a tumor and its blood supply represents a potential point of attack for an itumor therapy.
• VEGF vascular cndothclial cell growth factor
• VEGF-induced angiogenesis angiogenic in It is secreted by n wide variety of human tumors, and inhibition of VEGF- induced angiogenesis, either by neutralizing antibodies or a dominant negative soluble receptor,
• VEGF vascular endothelial growth factor
• Physiologic regulators of VEGF expression include hypoxia9 ⁇ l0 and cytokines ⁇ .
• oncogcnic mutations of ras and p53 are associated with increases in intratumoral VEGF levels and a poor
• the inve ⁇ .ioson provides a method of reducing tumor radio resistance or chemotherapy res.stance in a cancer patient being or to be treated with radiation or chemotherapy, by administering to the patient a substance that inhibits chemotherapy or rad t ation-induced VEGF expression or that blocks VEGF activity in the patient.
• the substance can be an anti-VEGF antibody, and can be administered (preferably IV) shordy ( M hours) prior to chemotherapy or radiation treatment.
• preferably is administered intravenously, either prior to, du ⁇ ng, or following radiation or chemotherapy administration.
• FIGURE 1 VEGF levels in Lewis lung carcinoma in vivo and in vitro.
• Cs were plated in six-well plates at low density (25% confluence), allowed to attach overnight, and then irradiated with 0, 5, ⁇ vi, or 20 Gy. Conditioned media was collected every 24 hrs, and cells were detached with trypsin and counted. VEGF levels were normalized to the number of cells and reported as total pg VEGF/10 6 cells. No VEGF was detectable in unconditioned media.
• FIG. 1 VEGF expression in human tumor cell line*.
• Subconflucnt cells from human tumor cell lines (Seg-1 esophageal adcnocarcinoma, SQ20B squamous cell carcinoma, Ul melanoma, and U87 and T98 glioblastoma) were exposed to 10 Gy of ioni ing radiation.
• Conditioned media from radiated and unirradiaicd cells was collected 24 hours later.
• VEGF levels in conditioned media were measured by EL1SA and normalized to cell number.
• FIGURE 3 Effect of VEGF blockade prior to treatment with ionizing radiation in mouse tumors and human xcnografts. LLC cells (1 x 10 ⁇ ) were injected subcutancously into the hindlimbs of female C57B1 6 mice. SQ20B squamous cell carcinoma cells (5 x 10 6 ) and Scg-1 csophagca! adcnocarcinoma cells (3 xl O 6 ) were injccicd into the hindlimbs of female a l hymic nude mice.
• Tumors were allowed lo attain a mean size between 350-450 mm -1 (LLC, 442 ⁇ 14 mm 3 ; SQ20B, 372 ⁇ 16 mm 3 ; Scg-1, 407 ⁇ 20 mm 5 ), after which treatment was begun.
• LLC 350-450 mm -1
• SQ20B 372 ⁇ 16 mm 3
• Scg-1 407 ⁇ 20 mm 5
• mice were administered inirapcritonualry 16 and 3 hrs before the first IR treatment and 3 hours before the second IR treatment (3 doses total); goat anti- mouse VEGF-164 antibody alone administered as described. Untreated controls received nonimmune goal IgG.
• B Effect of VEGF blockade prior to ionizing radiation in SQ20B xenografts. Mice were treated as follows: IR, 40 Gy administered as four 10 Gy doses on days 0, 1 ,2, and 3; IR (40 Gy) plus monoclonal anti-human VEGF-165 antibody, 10 ⁇ g administered intrapcritoncally two to three hours before each dose of IR; monoclonal anti-human VEGF-165 antibody alone administered identically to the combined treatment group.
• FIGURE 4 Effect of manipulating VEGF levels in vitro on rR * r ⁇ cdiatcd vascular endothclial cell killing.
• MTT assays HUVECs were plated in 96-well plates al 1 x 103 cells/well and treated with either differing concentrations of rccombinant human VEGF-165 or monoclonal anti-human VEGF-165 antibody prior to treatment with IR, and abscrbancc readings measured at varying time points after IR (sec Methods).
• clonogcnic survival assays For clonogcnic survival assays,
• HUVECs were treated with different concentrations of VEGF or a polyelonal goat anti-VEGF-
• HUVECs pretreated with a monoclonal anti-VEGF- 165 antibody prior to irradiation.
• Ionizing radiation induces tumor VEGF production In vivo and in vitro
• LLC cells (1 x 10*) were injected subcutancously in the hindlimbs of female C57BL/6 mice and allowed to grow to a volume of 510 ⁇ 11 mm'
• VEGF levels were measured by ELIS ⁇ and normalized to total tumor protein. VEGF levels in extracts from control tumors remained relatively constant (46 to
• Plasma VEGF levels remained low or undctcctablc in control and irradiated animals (data not shown).
• VEGF mRNA levels were assessed in the same tumors by
• VEGF transcripts were induced 3-fold two days after exposure to I (Fi ⁇ ure 1 A). Moreover, VEGF mP: ., levels remained elevated for fourteen days. These f i ndings demonstrate that IR induces VEGF expression in vivo.
• VEGF levels in LLC-condiiioned media exhibited an IR dose-dependent increase within 24 hours.
• VEGF expression was also studied in irradiated human tumor cell li nes: Seg-1 (esophageal adenocarcinoma)13 ; SQ20B (a radioresistant squamous cell carcinoma li foi e )14 ; Ul (melanoma); and T98 and U87 (glioblastoma). Under basal conditions, these tumor ceil lines secreted widely differing levels of VEGF, with U87 cells producing the most VEGF and Ul meianoma cells the .east ( Figure 2). All demonstrated an IR-dependem increase in VEGF production within 24 hours of treatment with 10 Gy ( Figure 2). These findings demonstrate that IR induces VEGF expression in diverse tumor cell types.
• mice bearing LLC tumors (559 ⁇ 51 mm 3 ) were treated with a polyelonal goat antibody directed against recombinant murine VEGF-164 (R & D Systems, 10 ⁇ g qd by intrape ⁇ toneal injection) or with nonimmune goat IgG.
• tumors from control animals had attained a volume of 2713 * 346 mm 3
• SQ20B cells (5 x J 0 6 ) were implanted in the hindlimbs of female athymic nude mice and allowed to attain a volume of 372 ⁇ 16 mm 3 (Figure 3B), after which they were treated with IR alone (40 Gy given as four 10 Gy fractions), ami-VEGF antibody alone (10 ⁇ g inlraperitoneally each day for four doses), or combined IR and anti-VEGF antibody (10 ⁇ g antibody administered 3 hours prior lo treatment wilh IR). On day 19, tumors in untreated controls reached a mean volume of 3671 ⁇ 790 mm 3 .
• Blocking VEGF increases cndothellal cell killing by ionizing radiation
• IR growth blockade for endothelial cells
• IR msy disrupt the paracrine relationship between the tumor and its blood supply and emphasizes the potential importance of combining an angiogenesis inhibitor with a DNA damaging agent.
• IR is a major therapeutic modality that is effective in the treatment of relatively .mall tumors and of large tumors only with considerable toxicity to normal tissues. Depriving the tumor endothelium of VEGF using neutralizing antibodies prior lo IR exposure or pretreating tumor vessels with antiangiogcnic peptides represent strategics to increase the anti-tumor effects of IR with minimal toxicity to normal tissues.
• Lewis lung carcinoma cells gifts of J. Folkman
• SQ20B cells were grown as previously described 19.21.22.
• Hurnan urnbilical vcin endothclial ⁇ ⁇ HUWECs were
• Tumor volume was determined by direct measurement with calipers and calculated by the formula (length x width x depth 2) and reported as the mean volume ⁇ s.e.m., as previously described 19,21. Tumors were allowed ⁇ Q ⁇ t ⁇ Q ⁇ of m ⁇ QQ ⁇ ⁇
• mice were divided into experimental groups and treatment begun.
• Tumors were irradiated using a GE Maxitron X-ray generator operating at 150 kV, 30 mA, using a 1 mm aluminum fil t er at a dose ra t e of 188 cGy/min..
• Mice were shielded with lead except for the t umor-bearing right hmdlimb. The care and treatment of animals was in accordance with institutional guidelines.
• mice were chosen from each LLC experimental group such t ha t the overall group mean tumor volume was affected as little as possible and euthanized to ob t ain tumor t issue.
• Tumor extracts were prepared by homogenizing tumors in RTP A buffer (150 mM Nad, 10 mM Tris, 5 mM EDT ⁇ , Triton -100 0.S%, and dithi 0 threitol 1 ⁇ M, P H 7.5, PMSF 50 ⁇ M, lcupcptin 1 ⁇ g/ml, and apro inin 2 ⁇ g/mi).
• VEGF levels were measured in tumor extract supernatants by ELISA (R & D Systems), and protein assays were performed by Lowry assay. VEGF levels were normalized to total extract protein concentration and expressed as pg VEGF/mg total extract protein. VEGF levels in tumor cell conditioned media were also measured by ELISA and were normalized to cell number in each well. At least three wells per time point were measured. ⁇ - Ao
• HUVECs and LCs were plated in EGM-2 media. Eighteen hours after plating, HUVEC media was replaced with media in which the VEGF supplied by the manufacturer was omitted, and a defined amount (0-50 ng/ml) of rccombinant VEGF-165 (R & D Systems, Inc.) had been added. Four hours later, cells were irradiated with doses of 0-900 cGy using , GE Maxitron X-ray generator operating at 250 kV, 26 mA, with a 0.5 mm copper filter at a dose rale r 1 18 cGy/min.
• HUVECs were plated in serum-free EGM-2 containing 5 ng ml VEGF-165. Four hours before irradiation, polyelonal antibodies to human VEGF-165 (R & D Systems, Inc.) were added to the media. Media was replaced with serum- containing media 48 hours after IR and the cells incubated for colony counting.
• PB VEGF PB VEGF (pg)
• Tumor volume (% untreated control volume for untreated controls)
• RNA was isolated from cultured cells and tumor tissue using the ⁇ uanidinc thiocyanate method23 utilizing Trizol Ls (Lifc ⁇ ⁇ 25 ⁇ g ⁇ ⁇ ⁇ ⁇ . ⁇
• HUVECs were plated (1 x 10 1 cells/well in 96 well plates) in EGM-2 media and allowed to attach overnight. Media was replaced with EGM-2 media containing different concentrations of recombinant human vmV- 165 (R & D Systems, Inc.).
• concentration of VEGF-165 was kept constant and varying concentrations of either a neutralizing polyelonal or monoclonal anti-human VEGF-165 antibody (R & D Systems, Inc.) were added prior to treatment with IR. 72 or 96 hours after IR, cells were pulsed with 3-[4. 5-
• VEGF VascuJar cndotheJiaJ ⁇ factor.
• Angiostatin a novel angiogenesis inhibitor that mediates the suppression of melas i ascs by a Lewis lung carcinoma. Cell 79, 315-328 (1994).

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