Priority Research Papers:

Potent efficacy of metronomic topotecan and pazopanib combination therapy in preclinical models of primary or late stage metastatic triple-negative breast cancer

Teresa Di Desidero, Ping Xu, Shan Man, Guido Bocci and Robert S. Kerbel _

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Oncotarget. 2015; 6:42396-42410. https://doi.org/10.18632/oncotarget.6377

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Teresa Di Desidero1,2,*, Ping Xu1,*, Shan Man1, Guido Bocci2 and Robert S. Kerbel1,3

1 Biologic Sciences Platform, Sunnybrook Research Institute, Toronto, Canada

2 Divisione di Farmacologia, Dipartimento di Medicina Clinica e Sperimentale, University of Pisa, Pisa, Italy

3 Department of Medical Biophysics, University of Toronto, Toronto, Canada

* These authors have contributed equally to this work

Correspondence to:

Guido Bocci, email:

Robert S. Kerbel, email:

Keywords: metronomic chemotherapy, topotecan, pazopanib, metastatic triple negative breast cancer

Received: August 13, 2015 Accepted: November 16, 2015 Published: November 24, 2015


Metronomic chemotherapy has shown promising activity in numerous preclinical studies and also some phase II clinical studies involving various tumor types, and is currently undergoing phase III trial evaluation. Triple-negative breast cancer (TNBC) is an aggressive histological subtype with limited treatment options and very poor prognosis following progression after standard chemotherapeutic regimens. Herein, we evaluated the potential therapeutic impact and molecular mechanisms of topotecan administered in a continuous low-dose metronomic (LDM) manner, alone or in concurrent combination with pazopanib, an antiangiogenic tyrosine kinase inhibitor (TKI), in a triple-negative, primary and metastatic breast cancer orthotopic model; potential molecular mechanisms of efficacy were also studied, especially the impact of hypoxic conditions. The combination of metronomic topotecan and pazopanib significantly enhanced antitumor activity compared to monotherapy with either drug and prolonged survival, even in the advanced metastatic survival setting, with a marked decrease in tumor vascularity, proliferative index, and the induction of apoptosis. Significant changes in tumor angiogenesis, cancer cell proliferation, apoptosis, HIF1α levels, HIF-1 target genes and ABCG2 were found both in vitro and in tumor tissue. Notably, the pazopanib and metronomic topotecan combination treatment inhibited expression of HIF1α and ABCG2 genes in cells grown under hypoxic conditions, and this was associated with an increased intracellular concentration of the active form of topotecan. Our results suggest a potential novel therapeutic option for the treatment of metastatic triple-negative breast cancer patients.

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