Abstract
To predict the sensitivity of colorectal cancer to 5‐fluorouracil (5‐FU), we compared the gene expression of surgically obtained colorectal cancer specimens with chemosensitivity to 5‐FU as detected by 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyl‐2H tetrazolium bromide (MTT) assay. Eighty‐eight patients with advanced and/or metastatic colorectal cancer provided written informed consent and entered the trial from September 2000 to October 2001. Fresh surgical specimens were used for the MTT assay, and sensitivity to 5‐FU was evaluated at a cutoff concentration of 50 μg/ml and 48‐h incubation time. Frozen samples were stored at −80°C until mRNA analysis of thymidylate synthetase (TS), dihydropyri‐midine dehydrogenase (DPD), thymidine phosphorylase (TP), es‐nucleoside transporter (NT), and E2F1 by real‐time RT‐PCR. The correlations between the variables were analyzed, and the predictive value of these mRNAs was assessed statistically using a receiver operating characteristic (ROC) curve. NT and DPD, TP and DPD, and TP and NT mRNA expression levels correlated significantly, while TS and E2F1 showed no correlations. High NT expression was associated with low sensitivity to 5‐FU (P<0.013), as were high DPD and E2F1 expression (P<0.022 for both). High TP mRNA expression correlated with low sensitivity to 5‐FU (P<0.034), although high TS mRNA expression did not. ROC curves indicated that DPD and NT mRNAs were possible predictors of sensitivity to 5‐FU, with cutoff values of 0.6 and 0.4, respectively. The sensitivity of colorectal cancer to 5‐FU may be regulated by DPD, the rate‐limiting enzyme of catabolism, and NT, an important transmembrane transporter of nucleosides.
References
- 1. Mamounas E, Wieand S, Wolmark N, Bear HD, Atkins JN, Song K, Jones J, Rockette, H . Comparative efficacy of adjuvant chemotherapy in patients with Dukes' B versus Dukes' C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Project Studies (C‐01, C‐02, C‐03, C‐04). J Clin Oncol 1999; 2: 1349–55. [DOI] [PubMed] [Google Scholar]
- 2. Wolmark N, Bryant J, Smith R, Grem J, Allegra C, Hyams D, Atkins J, Dimitrov N, Oishi R, Prager D, Fehrenbacher L, Romond E, Colangelo L, Fisher B. Adjuvant 5‐fluorouracil and leucovorin with or without interferon alfa‐2a in colon carcinoma: National Surgical Adjuvant Breast and Bowel Project protocol C‐05. J Natl Cancer Inst 1998; 2: 1810–6. [DOI] [PubMed] [Google Scholar]
- 3. Dignam JJ, Colangelo L, Tian W, Jones J, Smith R, Wickerham DL, Wolmark N. Outcomes among African‐Americans and Caucasians in colon cancer adjuvant therapy trials: findings from the National Surgical Adjuvant Breast and Bowel Project. J Natl Cancer Inst 1999; 91: 1933–40. [DOI] [PubMed] [Google Scholar]
- 4. Papamichael D. The use of thymidylate synthase inhibitors in the treatment of advanced colorectal cancer: current status. Stem Cells 2000; 18: 166–75. [DOI] [PubMed] [Google Scholar]
- 5. Advanced Colorectal Cancer Meta‐analysis Project . Modulation of fluorouracil by leucovorin in patients with advanced colorectal cancer: evidence in terms of response rate. J Clin Oncol 1992; 10: 896–903. [DOI] [PubMed] [Google Scholar]
- 6. Fujita K, Kubota T, Matsuzaki SW, Otani Y, Watanabe M, Teramoto T, Kumai K, Kitajima M. Further evidence for the value of the chemosensitivity test in deciding appropriate chemotherapy for advanced gastric cancer. Anticancer Res 1998; 18: 1973–8. [PubMed] [Google Scholar]
- 7. Abe S, Kubota T, Matsuzaki SW, Otani Y, Watanabe M, Teramoto T, Kumai K, Kitajima M. Chemosensitivity test is useful in evaluating the appropriate adjuvant cancer chemotherapy for stage III non‐scirrhous and scirrhous gastric cancers. Anticancer Res 1999; 19: 4581–6. [PubMed] [Google Scholar]
- 8. Kubota T, Egawa T, Otani Y, Furukawa T, Saikawa Y, Yoshida M, Watanabe M, Kitajima M. Cancer chemotherapy chemosensitivity testing is useful in evaluating the appropriate adjuvant cancer chemotherapy for stages III/IV gastric cancers without peritoneal dissemination. Anticancer Res 2003; 23: 583–8. [PubMed] [Google Scholar]
- 9. Kabeshima Y, Kubota T, Watanabe M, Hasegawa H, Yamauchi T, Yorozuya K, Furukawa T, Otani Y, Kitajima M. Clinical usefulness of chemosensitivity testing in evaluating the optimal adjuvant chemotherapy for advanced colorectal cancer. Anticancer Res 2002; 22: 3033–8. [PubMed] [Google Scholar]
- 10. Ishikawa Y, Kubota T, Otani Y, Watanabe M, Teramoto T, Kumai K, Kitajima M, Takechi T, Okabe H, Fukushima M. Dihydropyrimidine dehy‐drogenase activity and messenger RNA level may be related to the antitumor effect of 5‐fluorouracil on human tumor xenografts in nude mice. Clin Cancer Res 1999; 5: 883–9. [PubMed] [Google Scholar]
- 11. Ishikawa Y, Kubota T, Otani Y, Watanabe M, Teramoto T, Kumai K, Takechi T, Okabe H, Fukushima M, Kitajima M. Dihydropyrimidine dehydrogenase and messenger RNA levels in gastric cancer: possible predictor for sensitivity to 5‐fluorouracil. Jpn J Cancer Res 2000; 91: 105–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Mosmann T. Rapid colorimetric assay for cellular growth and survival: application to proliferation and cytotoxicity assays. J Immunol Methods 1983; 65: 55–63. [DOI] [PubMed] [Google Scholar]
- 13. Japanese Society for Cancer of the Colon and Rectum, editors. The general rules for the clinical and pathological study of cancer of the colon, rectum and anus. 6th ed. Tokyo : Kanehara Shuppan Co Ltd; 1998. [Google Scholar]
- 14. Fukushima M, Okabe H, Takechi T, Ichikawa W, Hirayama R. Induction of thymidine phosphorylase by interferon and taxanes occurs only in human cancer cells with low thymidine phosphorylase activity. Cancer Lett 2002; 187: 103–10. [DOI] [PubMed] [Google Scholar]
- 15. Johnston PG, Lenz HJ, Leichman CG, Danenberg KD, Allegra CJ, Danenberg PV, Leichman L. Thymidylate synthase gene and protein expression correlate and are associated with response to 5‐fluorouracil in human colorectal and gastric tumors. Cancer Res 1995; 6: 1407–12. [PubMed] [Google Scholar]
- 16. Lenz HJ, Leichman CG, Danenberg KD, Danenberg PV, Groshen S, Cohen H, Laine L, Crookes P, Silberman H, Baranda J, Garcia Y, Li J, Leichman L. Thymidylate synthase mRNA level in adenocarcinoma of the stomach: a predictor for primary tumor response and overall survival. J Clin Oncol 1996; 14: 176–82. [DOI] [PubMed] [Google Scholar]
- 17. Leichman CG, Lenz HJ, Leichman L, Danenberg K, Baranda J, Groshen S, Boswell W, Metzger R, Tan M, Danenberg PV. Quantitation of intratumoral thymidylate synthase expression predicts for disseminated colorectal cancer response and resistance to protracted‐infusion fluorouracil and weekly leucovorin. J Clin Oncol 1997; 15: 3223–9. [DOI] [PubMed] [Google Scholar]
- 18. Takechi T, Koizumi K, Tsujimoto H, Fukushima M. Screening of differentially expressed genes in 5‐fluorouracil‐resistant human gastrointestinal tumor cells. Jpn J Cancer Res 2001; 92: 696–703. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Mori K, Hasegawa M, Nishida M, Toma H, Fukuda M, Kubota T, Nagasue N, Yamana H, Hirakawa YS, Chung K, Ikeda T, Takasaki K, Oka M, Kameyama M, Toi M, Fujii H, Kitamura M, Murai M, Sasaki H, Ozono S, Makuuchi H, Shimada Y, Onishi Y, Aoyagi S, Mizutani K, Ogawa M, Nakao A, Kinoshita H, Tono T, Imamoto H, Nakashima Y, Manabe T. Expression levels of thymidine phosphorylase and dihydropyrimidine dehydrogenase in various human tumor tissues. Int J Oncol 2000; 17: 33–8. [DOI] [PubMed] [Google Scholar]
- 20. Etienne M, Cheradame S, Fischel JL, Formento P, Dassonville O, Renee N, Schneider M, Thyss A, Demard F, Milano G. Response to fluorouracil therapy in cancer patients: the role of tumoral dihydropyrimidine dehydrogenase activity. J Clin Oncol 1995; 13: 1663–70. [DOI] [PubMed] [Google Scholar]
- 21. Inada T, Ichikawa A, Kubota T, Ogata Y, Moossa AR, Hoffman RM. 5‐FU‐induced apoptosis correlates with efficacy against human gastric and colon cancer xenografts in nude mice. Anticancer Res 1997; 17: 1965–72. [PubMed] [Google Scholar]
- 22. Kobayashi N, Kubota T, Watanabe M, Otani Y, Teramoto T, Kitajima M. Pyrimidine nucleoside phosphorylase and dihydropyrimidine dehydrogenase indicate chemosensitivity of human colon cancer specimens to doxifluridine and 5‐fluorouracil, respectively. J Infect Chemother 1999; 5: 144–8. [DOI] [PubMed] [Google Scholar]
- 23. Beck A, Etienne MC, Cheradame S, Fischel JL, Formento P, Renee N, Milano G. A role for dihydropyrimidine dehydrogenase and thymidylate synthase in tumour sensitivity to fluorouracil. Eur J Cancer 1994; 30A: 1517–22. [DOI] [PubMed] [Google Scholar]
- 24. Salonga D, Danenberg KD, Johnson M, Metzger R, Groshen S, Tsao‐Wei DD, Lenz HJ, Leichman CG, Leichman L, Diasio RB, Danenberg PV. Colorectal tumors responding to 5‐fluorouracil have low gene expression levels of dihydropyrimidine dehydrogenase, thymidylate synthase, and thymidine phosphorylase. Clin Cancer Res 2000; 6: 1322–7. [PubMed] [Google Scholar]
- 25. McLeod HL, Sludden J, Murray GI, Keenan RA, Davidson AI, Park K, Koruth M, Cassidy J. Characterization of dihydropyrimidine dehydrogenase in human colorectal tumors. Br J Cancer 1998; 77: 461–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Johnston SJ, Ridge SA, Cassidy J, McLeod HL. Regulation of dihydropyrimidine dehydrogenase in colorectal cancer. Clin Cancer Res 1999; 5: 2556–70. [PubMed] [Google Scholar]
- 27. Uetake H, Ichikawa W, Takechi T, Fukushima M, Nihei Z, Sugihara K. Relationship between intratumoral dihydropyrimidine dehydrogenase activity and gene expression in human colorectal cancer. Clin Cancer Res 1999; 5: 2836–9. [PubMed] [Google Scholar]
- 28. Rauchwerger DR, Firby PS, Hedley DW, Moore MJ. Equilibrative‐sensitive nucleoside transporter and its role in gemcitabine sensitivity. Cancer Res 2000; 60: 6075–9. [PubMed] [Google Scholar]
- 29. Mackey JR, Jennings LL, Clarke ML, Santos CL, Dabbagh L, Vsianska M, Koski SL, Coupland RW, Baldwin SA, Young JD, Cass CE. Immunohistochemical variation of human equilibrative nucleoside transporter 1 protein in primary breast cancers. Clin Cancer Res 2002; 8: 110–6. [PubMed] [Google Scholar]
- 30. Boyer CR, Karjian PL, Wahl GM, Pegram M, Neuteboom ST. Nucleoside transport inhibitors, dipyridamole and p‐nitrobenzylthioinosine, selectively potentiate the antitumor activity of NB1011. Anticancer Drugs 2002; 13: 29–36. [DOI] [PubMed] [Google Scholar]