Comparison of high-dose Cisplatin-based chemoradiotherapy and Cetuximab-based bioradiotherapy for p16-positive oropharyngeal squamous cell carcinoma in the context of revised HPV-based staging

Aim: To perform a comparison of Cisplatin vs. Cetuximab in p16-positive oropharyngeal squamous cell carcinoma (OPSCC) in the context of the revised HPV-based staging.Background: Previous reports comparing these agents in head and neck cancer have included heterogenous disease and p16-status.Materials and methods: A retrospective review was conducted from 2006 to 2016 of patients with p16-positive OPSCC who underwent definitive radiotherapy concurrent with either triweekly Cisplatin (n?=?251) or Cetuximab (n?=?40). AJCC 8th Edition staging was adapted.Results: Median follow-up for surviving patients was 40 months. On multivariate analysis for all-comers, comparing Cisplatin and Cetuximab, 3-year locoregional recurrence (LRR): 6% vs. 16% (p?=?0.07), 3-year distant metastasis (DM): 8% vs. 21% (p?=?0.04), 3-year overall recurrence rate (ORR): 11% vs. 29% (p?=?0.01), and 3-year cause-specific survival (CSS): 94% vs. 79% (p?=?0.06), respectively. On stage-based subgroup analysis, for stage III disease, 3-year LRR: 5% vs. 10% (p?=?0.51), 3-year DM: 7% vs. 16% (p?=?0.32), 3-year ORR: 10% vs. 23% (p?=?0.15), and 3-year CSS: 95% vs. 82% (p?=?0.38). For stage III disease, 3-year LRR: 10% vs. 40% (p?=?0.07), 3-year DM: 9% vs. 43% (p?=?0.07), 3-year ORR: 15% vs. 55% (p?=?0.04), and 3-year CSS: 94% vs. 57% (p?=?0.048).Conclusions: When given concurrently with radiotherapy, Cetuximab and triweekly Cisplatin demonstrated comparable efficacy for AJCC 8th Edition stage I–II p16-positive OPSCC. However, Cetuximab appeared to be associated with higher rates of treatment failure and cancer-related deaths in stage III disease. Upon availability of the RTOG 1016 trial results, analysis based on the revised HPV-based staging should be performed to confirm these findings.     

Platinum cytotoxic drugs in the municipal wastewater and drinking water,a validation method and health risk assessment

Three cancerostatic platinum compounds (CPCs) including cisplatin, carboplatin and oxaliplatin are complexes of Pt and classified as probable carcinogenic compounds to humans. This study aimed to perform health risk assessment of platinum cytotoxic drugs for drinking water by developing a sensitive analytical method in the water resource of Qom Province in the central part of Iran. Concentrations of the platinum drugs were determined, including 052 ± 0.2 µg/L for cisplatin, 0.94 ± 0.36 µg/L for carboplatin and 0.27 ± 0.16 µg/L for oxaliplatin in influent samples, and 0.24 ± 0.07 µg/L for cisplatin, 0.28 ± 0.05 µg/L for carboplatin and 0.11 ± 0.01 µg/L for oxaliplatin in effluent samples. The results indicated that in all the well water samples related to the groundwater, the concentration of the platinum-based compounds was lower than the calculated limits of quantification (LOQ); the concentration of cisplatin, carboplatin and oxaliplatin across the samples in the station of drinking water distribution was also below the limits of detection (LOD). The resulting margin of exposure (MOE) is lower than one (MOE < 1) for the three groups including children, pregnant women and lactation women related to cisplatin and carboplatin was determined through exposure to raw and untreated drinking water. Further research is recommended to be conducted in this area, particularly environmental fate of metabolites and transformation products.     

Structural Basis for Human DNA Polymerase Kappa to Bypass Cisplatin Intrastrand Cross-Link (Pt-GG) Lesion as an Efficient and Accurate Extender

Cisplatin (cis-diamminedichloroplatinum) is a common chemotherapeutic drug that reacts with the N7 atoms of adjacent guanines in DNA to form the Pt-1,2-d(GpG) intrastrand cross-link (Pt-GG), a major product to block DNA replication. Translesion DNA synthesis has been implicated in chemoresistance during cisplatin treatment of cancer due to Pt-GG lesion bypass. Gene knockdown studies in human cells have indicated a role for polκ during translesion synthesis of the Pt-GG lesion. However, the bypass activity of polκ with cisplatin lesions has not been well characterized. In this study, we investigated polκ's ability to bypass Pt-GG lesion in vitro and determined two crystal structures of polκ in complex with Pt-GG DNA. The ternary complex structures represent two consecutive stages of lesion bypass: nucleotide insertion opposite the 5′G (Pt-GG2) and primer extension immediately after the lesion (Pt-GG3). Our biochemical data showed that polκ is very efficient and accurate in extending DNA primers after the first G of the Pt-GG lesion. The structures demonstrate that the efficiency and accuracy is achieved by stably accommodating the bases with the cisplatin adduct in the active site for proper Watson–Crick base pairing with the incoming nucleotide in both the second insertion and post-insertion complexes. Our studies suggest that polκ works as an extender for efficient replication of the Pt-GG lesion in cells. This work holds promise for considering polκ, along with polη, as potential targets for drug design, which together could improve the efficacy of cisplatin treatment for cancer therapy.     

ENHANCEMENT OF 5-FLUOROURACIL CYTOTOXICITY BY CISPLATIN IN BRAIN TUMOUR CELL LINES

Cisplatin reportedly plays an important role as a chemical modulator in enhancing the chemotherapeutic effects of 5-fluorouracil on tumour cells. The aim of the present study was to test the synergistic cytotoxicity of cisplatin and 5-fluorouracil in 5-fluorouracil-resistant (C6) and -sensitive (9L) rat brain tumour cell lines. Survival fractions, determined using colony-formation assays, were compared following 5-fluorouracil treatment, with and without cisplatin. The presence of cisplatin (1–10μm ) enhanced cytotoxicity by more than three times compared with 5-fluorouracil alone in 5-fluorouracil-resistant C6 cells, whereas no enhancement effects were noted in 9L cells. These results suggest that a cisplatin-fluorouracil-based regimen may be promising in the treatment of 5-fluorouracil-resistant brain tumours.     

Evidence for the involvement of nitric oxide in cisplatin-induced toxicity in rats

Cisplatin treatment of rats results into a significant increase in the activity of Ca²⁺-independent nitric oxide synthase (NOS) in kidneys and liver. Significant enhancement of lipid peroxidation in gastric mucosa, kidneys and liver was also observed. The administration of N ^G-nitro-l-arginine methyl ester, an inhibitor of NOS, markedly reduced renal and gastrointestinal toxicity, and also decreased the content of blood urea nitrogen, serum creatinine, and incidence of diarrhoea along with a significant inhibition in lipid peroxidation in the target organs. The present report, while demonstrating the beneficial effect of the blockade of NO pathways during cisplatin chemotherapy, may be helpful in developing strategies for combating some of the toxic side-effects of the drug.Present address: Department of Dermatology, Case Western Reserve University, Cleveland. OH 44106. USA.     

The application of renal cells in culture in studying drug-induced nephrotoxicity

Summary Kidney cells in culture represent one of many in vitro approaches for studying drug-induced nephrotoxicity. Pontential advantages of cell culture systems compared to more traditional in vitro models include a) the ability to examine direct effects at the cellular level, b) extended viability, c) ability for long-term storage, and d) capabilities for automation. Primary cultures of kidney tubules as well as cell lines of kidney origin are currently under evaluation as model systems for the assement of nephrotoxicity. The application of two renal cell systems, rabbit primary proximal tubule cultures and the pig kidney cell line, LLC-PK₁, in studying mechanisms of drug-induced nephrotoxicity is described in this communication. Potentially valuable insights intothe renal pathogenesis associated with the antitumor agent, cis-diamminedichloroplatium II, and the aminoglycoside antibiotic, gentamicin, have been obtained utilizing these renal cell models. Challenges in renal cll culture involve the characterization and mainternance of differentiated properties and the development of technologies to a) study bidirectional transport-toxicity of drugs, and b) provide a dynamic vs. static fluid environment as in vivo. Despite these unique challeges as well as the universal challeges involved in extrapolating any in vitro data to the in vivo situation, recent studies indicate that renal cells in culture are useful in the elucidation of mechanisms of drug-induced renal injury. This paper was presented at a Symposium on the Physiology and Toxicology of the Kidney In Vitro co-sponsored by The Society of Toxicology (SOT) and the Tissue Culture Association held at the 27th annual meeting of the SOT in Dallas, Texas in 1988.