Research Papers:

Double autophagy modulators reduce 2-deoxyglucose uptake in sarcoma patients

Mau-Shin Chi _, Cheng-Yen Lee, Su-Chen Huang, Kai-Lin Yang, Hui-Ling Ko, Yen-Kung Chen, Chen-Han Chung, Kuang-Wen Liao and Kwan-Hwa Chi

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Oncotarget. 2015; 6:29808-29817. https://doi.org/10.18632/oncotarget.5060

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Mau-Shin Chi1,3, Cheng-Yen Lee1, Su-Chen Huang1, Kai-Lin Yang1, Hui-Ling Ko1, Yen-Kung Chen2, Chen-Han Chung3, Kuang-Wen Liao3, Kwan-Hwa Chi1,4

1Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

2Department of Nuclear Medicine and PET Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

3Institue of Molecular Medicine and Bioengineering, National Chiao-Tung University, Hsinchu, Taiwan

4School of Medicine and Institute of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan

Correspondence to:

Kwan-Hwa Chi, e-mail: [email protected]

Keywords: hydroxychloroquine, sirolimus, soft tissue sarcoma

Received: April 21, 2015     Accepted: August 26, 2015     Published: September 07, 2015


Rationale: According to the metabolic symbiosis model, cancer stromal fibroblasts could be hijacked by surrounding cancer cells into a state of autophagy with aerobic glycolysis to help provide recycled nutrients. The purpose of this study was to investigate whether combined treatment with the autophagy inhibitor: hydroxychloroquine (HCQ) and the autophagy inducer: sirolimus (rapamycin, Rapa) would reduce glucose utilization in sarcoma patients.

Methods: Ten sarcoma patients who failed first-line treatment were enrolled in this study. They were treated with 1 mg of Rapa and 200 mg of HCQ twice daily for two weeks. The standardized uptake values (SUV) from pretreatment and posttreatment [18F]-fluorodeoxyglucose positron emission tomography (FDG PET) scans were reviewed, and changes from the baseline SUVmax were evaluated.

Results: Based on FDG PET response criteria, six patients had a partial response; three had stable disease, and one had progressive disease. Nevertheless, none of them showed a reduction in tumor volume. The mean SUVmax reduction in the 34 lesions evaluated was − 19.6% (95% CI = −30.1% to −9.1%), while the mean volume change was +16.4% (95% CI = +5.8% to + 27%). Only grade 1 toxicities were observed. Elevated serum levels of lactate dehydrogenase were detected after treatment in most metabolic responders.

Conclusions: The results of reduced SUVmax without tumor volume reduction after two weeks of Rapa and HCQ treatment may indicate that non-proliferative glycolysis occurred mainly in the cancer associated fibroblast compartment, and decreased glycolytic activity was evident from Rapa + HCQ double autophagy modulator treatment.

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