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Toward the Goal of Personalized Therapy in Pancreatic Cancer by Targeting the Molecular Phenotype

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Part of the book series: Advances in Experimental Medicine and Biology ((volume 779))

Abstract

The purpose of this article is to provide a critical review of the molecular alterations in pancreatic cancer that are clinically investigated as therapeutic targets and their potential impact on clinical outcomes. Adenocarcinoma of exocrine pancreas is generally associated with poor prognosis and the conventional therapies are marginally effective. Advances in understanding the genetic regulation of normal and neoplastic development of pancreas have led to development and clinical evaluation of new therapeutic strategies that target the signaling pathways and molecular alterations in pancreatic cancer. Applications have begun to utilize the genetic targets as biomarkers for prediction of therapeutic responses and selection of treatment options. The goal of accomplishing personalized tumor-specific therapy with tolerable side effects for patients with pancreatic cancer is hopefully within reach in the foreseeable future.

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References

  1. Siegel R, Ward E, Brawley O, et al. Cancer statistics, 2011. CA Cancer J Clin. 2011;61:212–36.

    Article  PubMed  Google Scholar 

  2. Vincent A, Herman J, Schulick R, et al. Pancreatic cancer. Lancet. 2011;378:607–20.

    Article  PubMed  Google Scholar 

  3. Hong S-M, Park JY, Hruban RH, et al. Molecular signatures of pancreatic cancer. Arch Pathol Lab Med. 2011;135:716–27.

    PubMed  CAS  Google Scholar 

  4. Hingorani SR. From inception to invasion: modeling pathways to pancreatic cancer. In: Lowy AM et al., editors. Pancreatic cancer. New York: Springer; 2008. p. 159–79.

    Chapter  Google Scholar 

  5. Lonardo E, Hermann PC, Heeschen C. Pancreatic cancer stem cells—update and future perspectives. Mol Oncol. 2010;4:431–42.

    Article  PubMed  Google Scholar 

  6. Neesse A, Michl P, Frese KK, et al. Stromal biology and therapy in pancreatic cancer. Gut. 2011;60:861–8.

    Article  PubMed  Google Scholar 

  7. Hruban RH, Goggins M, Parsons J, et al. Progression model for pancreatic cancer. Clin Cancer Res. 2000;6:2969–72.

    PubMed  CAS  Google Scholar 

  8. Yee NS, Furth EE, Pack M. Clinicopathologic and molecular features of pancreatic adenocarcinoma associated with Peutz-Jeghers syndrome. Cancer Biol Ther. 2003;2:38–47.

    PubMed  Google Scholar 

  9. Koorstra J-BM, Hustinx SR, Offerhaus GJA, et al. Pancreatic carcinogenesis. Pancreatology. 2008;8:110–25.

    Article  PubMed  Google Scholar 

  10. Chun SG, Yee NS. Werner’s syndrome as a hereditary risk factor for exocrine pancreatic cancer: potential role of WRN in pancreatic tumorigenesis and patient-tailored therapy. Cancer Biol Ther. 2010;10:430–7.

    Article  PubMed  CAS  Google Scholar 

  11. Hackel PO, Zwick E, Prenzel N, et al. Epidermal growth factor receptors: critical mediators of multiple receptor pathways. Curr Opin Cell Biol. 1999;11:184–9.

    Article  PubMed  CAS  Google Scholar 

  12. Sanvito F, Herrera PL, Huarte J, et al. TGF-beta 1 influences the relative development of the exocrine and endocrine pancreas in vitro. Development. 1994;120:3451–62.

    PubMed  CAS  Google Scholar 

  13. Cras-Meneur C, Elghazi L, Czernichow P, et al. Epidermal growth factor increases undifferentiated pancreatic embryonic cells in vitro: a balance between proliferation and differentiation. Diabetes. 2001;50:1571–9.

    Article  PubMed  CAS  Google Scholar 

  14. Korc M, Friess H, Yamanaka Y, et al. Overexpression of the epidermal growth factor receptor in human pancreatic cancer is associated with concomitant increases in the levels of epidermal growth factor and transforming growth factor alpha. J Clin Invest. 1992;90:1352–60.

    Article  PubMed  CAS  Google Scholar 

  15. Lemoine NR, Hughes CM, Barton CM, et al. The epidermal growth factor receptor in human pancreatic cancer. J Pathol. 1992;166:7–12.

    Article  PubMed  CAS  Google Scholar 

  16. Yamanaka Y, Friess H, Kobrin MS, et al. Coexpression of epidermal growth factor receptor and ligands in human pancreatic cancer is associated with enhanced tumor aggressiveness. Anticancer Res. 1993;13:565–9.

    PubMed  CAS  Google Scholar 

  17. Xiong HQ, Rosenberg A, LoBuglio A, et al. Cetuximab, a monoclonal antibody targeting the epidermal factor receptor, in combination with gemcitabine for advanced pancreatic cancer: a multicenter phase II trial. J Clin Oncol. 2004;22:2610–6.

    Article  PubMed  CAS  Google Scholar 

  18. Cascinu S, Berardi R, Labianca R, et al. Cetuximab plus gemcitabine and cisplatin compared with gemcitabine and cisplatin alone in patients with advanced pancreatic cancer: a randomised, multicentre, phase II trial. Lancet Oncol. 2008;9:39–44.

    Article  PubMed  CAS  Google Scholar 

  19. Philip PA, Benedetti J, Corless CL, et al. Phase III study comparing gemcitabine plus cetuximab versus gemcitabine in patients with advanced pancreatic adenocarcinoma: southwest oncology group–directed intergroup trial S0205. J Clin Oncol. 2010;28:3605–10.

    Article  PubMed  CAS  Google Scholar 

  20. Moore M, Goldstein D, Hamm J, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–6.

    Article  PubMed  CAS  Google Scholar 

  21. Beltran PJ, Mitchell P, Chung Y-A, et al. AMG 479, a fully human anti-insulin-like growth factor receptor type I monoclonal antibody, inhibits the growth and survival of pancreatic carcinoma cells. Mol Cancer Ther. 2009;8:1095–105.

    Article  PubMed  CAS  Google Scholar 

  22. Birchmeier W, Brinkmann V, Niemann C, et al. Role of HGF/SF and c-Met in morphogenesis and metastasis of epithelial cells. CIBA Found Symp. 1997;212:230–40.

    PubMed  CAS  Google Scholar 

  23. Perugini RA, McDade TP, Vittimberga FJ, et al. The molecular and cellular biology of pancreatic cancer. Crit Rev Eukaryot Gene Expr. 1998;8:377–93.

    Article  PubMed  CAS  Google Scholar 

  24. Li C, Wu J-J, Hynes M. c-Met is a marker of pancreatic cancer stem cells and therapeutic target. Gastroenterology. 2011;141:2218–27.

    Article  PubMed  CAS  Google Scholar 

  25. Kim ST, Lim DH, Jang K-T, et al. Impact of KRAS mutations on clinical outcomes in pancreatic cancer patients treated with first-line gemcitabine-based chemotherapy. Mol Cancer Ther. 2011;10:1993–9.

    Article  PubMed  CAS  Google Scholar 

  26. Pylayeva-Gupta Y, Grabocka E, Bar-Sagi D. RAS oncogenes: weaving a tumorigenic web. Nature Rev Cancer. 2011;11:761–74.

    Article  CAS  Google Scholar 

  27. Almoguera C, Shibata D, Forrester K, et al. Most human carcinomas of the exocrine pancreas contain mutant c-K-ras genes. Cell. 1988;53:549–54.

    Article  PubMed  CAS  Google Scholar 

  28. Fernandez-Medarde A, Santos E. Ras in cancer and developmental diseases. Genes Cancer. 2011;2:344–58.

    Article  PubMed  CAS  Google Scholar 

  29. Berndt N, Hamilton AD, Sebti SM. Targeting protein prenylation for cancer therapy. Nature Rev Cancer. 2011;11:775–91.

    Article  CAS  Google Scholar 

  30. Cohen SJ, Ho L, Ranganathan S, et al. Phase II and pharmacodynamic study of the farnesyltransferase inhibitor R115777 as initial therapy in patients with metastatic pancreatic adenocarcinoma. J Clin Oncol. 2003;21:1301–6.

    Article  PubMed  CAS  Google Scholar 

  31. Macdonald JS, McCoy S, Whitehead RP, et al. A phase II study of farnesyl transferase inhibitor R115777 in pancreatic cancer: a southwest oncology group (SWOG 9924) study. Inves New Drug. 2005;23:485–7.

    Article  CAS  Google Scholar 

  32. Van Cutsem E, van de Velde H, Karasek P, et al. Phase III trial of gemcitabine plus tipifarnib compared with gemcitabine plus placebo in advanced pancreatic cancer. J Clin Oncol. 2004;22:1430–8.

    Article  PubMed  CAS  Google Scholar 

  33. Martin NE, Brunner TB, Kiel KD, et al. A phase I trial of the dual farnesyltransferase and geranylgeranyltransferase inhibitor L-778,123 and radiotherapy for locally advanced pancreatic cancer. Clin Cancer Res. 2004;10:5447–54.

    Article  PubMed  CAS  Google Scholar 

  34. Lobell RB, Liu D, Buser CA, et al. Preclinical and clinical pharmacodynamic assessment of L-778,123, a dual inhibitor of farnesyl:protein transferase and geranylgeranyl:protein transferase type-1. Mol Cancer Ther. 2002;1:747–58.

    PubMed  CAS  Google Scholar 

  35. Green J, Lipton A. Anticaner properties of zoledronic acid. Cancer Invest. 2010;28:944–57.

    Article  PubMed  CAS  Google Scholar 

  36. Tassone P, Tagliaferri P, Viscomi C, et al. Zoledronic acid induces antiproliferative and apoptotic effects in human pancreatic cancer cells in vitro. Brit J Cancer. 2003;88:1971–8.

    Article  PubMed  CAS  Google Scholar 

  37. Märten A, Lilienfeld-Toal M, Büchler MW, et al. Zoledronic acid has direct antiproliferative and antimetastatic effect on pancreatic carcinoma cells and acts as an antigen for delta2 gamma/delta T cells. J Immunother. 2007;30:370–7.

    Article  PubMed  CAS  Google Scholar 

  38. Gjertsen MK, Buanes T, Rosseland AR, et al. Intradermal ras peptide vaccination with ­granulocytemacrophage colony-stimulating factor as adjuvant: clinical and immunological responses in patients with pancreatic adenocarcinoma. Int J Cancer. 2001;92:441–50.

    Article  PubMed  CAS  Google Scholar 

  39. Weden S, Klemp M, Gladhaug IP, et al. Long-term follow-up of patients with resected pancreatic cancer following vaccination against mutant K-ras. Int J Cancer. 2011;128:1120–8.

    Article  PubMed  CAS  Google Scholar 

  40. Toubaji A, Achtar M, Provenzano M, et al. Pilot study of mutant ras peptide-based vaccine as an adjuvant treatment in pancreatic and colorectal cancers. Cancer Immunol Immunother. 2008;57:1413–20.

    Article  PubMed  CAS  Google Scholar 

  41. Carbone DP, Ciernik IF, Kelley MJ, et al. Immunization with mutant p53- and K-ras-derived peptides in cancer patients: immune response and clinical outcome. J Clin Oncol. 2005;23:5099–107.

    Article  PubMed  Google Scholar 

  42. Seufferlein T, Van Lint J, Liptay S, et al. Transforming growth factor alpha activates Ha-Ras in human pancreatic cancer cells with Ki-ras mutations. Gastroenterology. 1999;116:1441–52.

    Article  PubMed  CAS  Google Scholar 

  43. Geary RS, Leeds JM, Henry SP, et al. Antisense oligonucleotide inhibitors for the treatment of cancer: 1. Pharmacokinetic properties of phosphorothioate Oligodeoxynucleotides. Anticancer Drug Des. 1997;12:383–93.

    PubMed  CAS  Google Scholar 

  44. Alberts SR, Schroeder M, Erlichman C, et al. Gemcitabine and ISIS-2503 for patients with locally advanced or metastatic pancreatic adenocarcinoma: a north central cancer treatment group phase II trial. J Clin Oncol. 2004;24:2944–50.

    Google Scholar 

  45. Strong JE, Coffey MC, Tang D, et al. The molecular basis of viral oncolysis: usurpation of the Ras signaling pathway by reovirus. EMBO J. 1998;17:3351–62.

    Article  PubMed  CAS  Google Scholar 

  46. Etoh T, Himeno Y, Matsumoto T, et al. Oncolytic viral therapy for human pancreatic cancer cells by reovirus. Clin Cancer Res. 2003;9:1218–23.

    PubMed  CAS  Google Scholar 

  47. Friday BB, Adjei AA. Advances in targeting the Ras/Raf/MEK/Erk mitogen-activated protein kinase cascade with MEK inhibitors for cancer therapy. Clin Cancer Res. 2008;14:342–6.

    Article  PubMed  CAS  Google Scholar 

  48. LoRusso PM, Adjei AA, Varterasian M, et al. Phase I and pharmacodynamic study of the oral MEK inhibitor CI-1040 in patients with advanced malignancies. J Clin Oncol. 2005;23:5281–93.

    Article  PubMed  CAS  Google Scholar 

  49. Bodoky G, Timcheva C, Spigel DR, et al. A phase II open-label randomized study to assess the efficacy and safety of selumetinib (AZD6244 [ARRY-142886]) versus capecitabine in patients with advanced or metastatic pancreatic cancer who have failed first-line gemcitabine therapy. Invest New Drug. 2011;30:1272–3.

    Article  Google Scholar 

  50. Courtney KD, Corcoran RB, Engelman JA. The PI3K pathway as drug target in human cancer. J Clin Oncol. 2010;28:1075–83.

    Article  PubMed  CAS  Google Scholar 

  51. Semba C, Moriya T, Kimura W, et al. Phosphorylated Akt/PKB controls cell growth and apoptosis in intraductal papillary-mucinous tumor and invasive ductal adenocarcinoma of the pancreas. Pancreas. 2003;26:250–7.

    Article  PubMed  CAS  Google Scholar 

  52. Yamamoto S, Tomita Y, Hoshida Y, et al. Prognostic significance of activated Akt expression in pancreatic ductal adenocarcinoma. Clin Cancer Res. 2004;10:2846–50.

    Article  PubMed  CAS  Google Scholar 

  53. Stanger BZ, Stiles B, Lauwers GY, et al. Pten constrains centroacinar cell expansion and malignant transformation in the pancreas. Cancer Cell. 2005;8:185–95.

    Article  PubMed  CAS  Google Scholar 

  54. Gupta AK, Cerniglia GJ, Mick R, et al. HIV protease inhibitors block Akt signaling and radiosensitize tumor cells both In vitro and In vivo. Cancer Res. 2005;65:8256–65.

    Article  PubMed  CAS  Google Scholar 

  55. Brunner TB, Geiger M, Grabenbauer GG, et al. Phase 1 trial of the human immunodeficiency virus protease inhibitor nelfinavir and chemoradiation for locally, advanced pancreatic cancer. J Clin Oncol. 2008;26:2699–706.

    Article  PubMed  CAS  Google Scholar 

  56. Schmelzle T, Hall MN. TOR, a central controller of cell growth. Cell. 2000;103:253–62.

    Article  PubMed  CAS  Google Scholar 

  57. Ito D, Fujimoto K, Mori T, et al. In vivo antitumor effect of the mTOR inhibitor CCI-779 and gemcitabine in xenograft models of human pancreatic cancer. Int J Cancer. 2006;118:2337–43.

    Article  PubMed  CAS  Google Scholar 

  58. Javle MM, Shroff RT, Xiong H, et al. Inhibition of the mammalian target of rapamycin (mTOR) in advanced pancreatic cancer: results of two phase II studies. BMC Cancer. 2010;10:368.

    Article  PubMed  CAS  Google Scholar 

  59. Marks PA, Xu W-S. Histone deacetylase inhibitors: potential in cancer therapy. J Cell Biochem. 2009;107:600–8.

    Article  PubMed  CAS  Google Scholar 

  60. Zhou W, Liang IC, Yee NS. Histone deacetylase 1 is required for exocrine pancreatic epithelial proliferation in development and cancer. Cancer Biol Ther. 2011;11:659–70.

    Article  PubMed  CAS  Google Scholar 

  61. Kumagai T, Wakimoto N, Yin D, et al. Histone deacetylase inhibitor, suberoylanilide hydroxamic acid (Vorinostat, SAHA) profoundly inhibits the growth of human pancreatic cancer cells. Int J Cancer. 2007;121:656–65.

    Article  PubMed  CAS  Google Scholar 

  62. Arnold NB, Arkus N, Gunn J, et al. The histone deacetylase inhibitor suberoylanilide hydroxamic acid induces growth inhibition and enhances gemcitabine-induced cell death in pancreatic cancer. Clin Cancer Res. 2007;13:18–26.

    Article  PubMed  CAS  Google Scholar 

  63. Chun SG, Zhou W, Yee NS. Combined targeting of histone deacetylases and hedgehog signaling enhances cytotoxicity in pancreatic cancer. Cancer Biol Ther. 2009;8:1328–39.

    PubMed  CAS  Google Scholar 

  64. Jackman M, Lindon C, Nigg EA, et al. Active cyclin B1-Cdk1 first appears on centrosomes in prophase. Nat Cell Biol. 2003;5:143–8.

    Article  PubMed  CAS  Google Scholar 

  65. Gray Jr PJ, Bearss DJ, Han H, et al. Identification of human polo-like kinase 1 as a potential therapeutic target in pancreatic cancer. Mol Cancer Ther. 2004;3:641–6.

    Article  PubMed  CAS  Google Scholar 

  66. Weichert W, Schmidt M, Jacob J, et al. Overexpression of polo-like kinase 1 is a common and early event in pancreatic cancer. Pancreatology. 2005;5:259–65.

    Article  PubMed  CAS  Google Scholar 

  67. Gumireddy K, Reddy MV, Cosenza SC, et al. ON01910, a non-ATP-competitive small molecule inhibitor of Plk1, is a potent anticancer agent. Cancer Cell. 2005;7:275–86.

    Article  PubMed  CAS  Google Scholar 

  68. Attia S, Kolesar J, Mahoney MR, et al. A phase 2 consortium (P2C) trial of 3-aminopyridine-2-carboxaldehyde thiosemicarbazone (3-AP) for advanced adenocarcinoma of the pancreas. Invest New Drugs. 2008;26:369–79.

    Article  PubMed  CAS  Google Scholar 

  69. Rosen ED, et al. PPARγ. A nuclear regulator of metabolism, differentiation, and cell growth. J Biol Chem. 2001;276:37731–4.

    Article  PubMed  CAS  Google Scholar 

  70. Takeuchi Y, Takahashi M, Sakano K, et al. Suppression of N-nitrosobis(2-oxopropyl)amine-induced pancreatic carcinogenesis in hamsters by pioglitazone, a ligand of peroxisome proliferator-activated receptor γ. Carcinogenesis. 2007;28:1692–6.

    Article  PubMed  CAS  Google Scholar 

  71. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. New Engl J Med. 2011;364:1817–25.

    Article  PubMed  CAS  Google Scholar 

  72. Clark JW. Rubitecan. Expert Opin Investig Drugs. 2006;15:71–9.

    Article  PubMed  CAS  Google Scholar 

  73. Abou-Alfa GK, Letourneau R, Harker G, et al. Randomized phase III study of exatecan and gemcitabine compared with gemcitabine alone in untreated advanced pancreatic cancer. J Clin Oncol. 2006;24:4441–7.

    Article  PubMed  CAS  Google Scholar 

  74. Joshi KS, Rathos MJ, Joshi RD, et al. In vitro antitumor properties of a novel cyclin-dependent kinase inhibitor, P276-00. Mol Cancer Ther. 2007;6:918–25.

    Article  PubMed  CAS  Google Scholar 

  75. Wang LM, Ren DM. Flavopiridol, the first cyclin-dependent kinase inhibitor: recent advances in combination chemotherapy. Mini Rev Med Chem. 2010;10:1058–70.

    Article  PubMed  CAS  Google Scholar 

  76. Carvajal RD, Tse A, Shah MA, et al. A phase II study of flavopiridol (Alvocidib) in combination with docetaxel in refractory, metastatic pancreatic cancer. Pancreatology. 2009;9:404–9.

    Article  PubMed  CAS  Google Scholar 

  77. Wiezorek J, Holland P, Graves J. Death receptor agonists as a targeted therapy for cancer. Clin Cancer Res. 2010;16:1701–8.

    Article  PubMed  CAS  Google Scholar 

  78. Murdaca G, Colombo BM, Cagnati P, et al. Update upon efficacy and safety of TNF-α inhibitors. Expert Opin Drug Saf. 2012;11:1–5. Epub ahead of print.

    Article  PubMed  CAS  Google Scholar 

  79. Ozawa F, Friess H, Kleeff J, et al. Effects and expression of TRAIL and its apoptosis-promoting receptors in human pancreatic cancer. Cancer Lett. 2001;163:71–81.

    Article  PubMed  CAS  Google Scholar 

  80. Yee NS. Zebrafish as a biological system for identifying and evaluating therapeutic targets and compounds. In: Han H, Grippo PJ, editors. Drug discovery in pancreatic cancer: models and techniques. New York: Springer; 2010. p. 95–112.

    Chapter  Google Scholar 

  81. Thayer SP, di Magliano MP, Heiser PW, et al. Hedgehog is an early and late mediator of pancreatic cancer tumorigenesis. Nature. 2003;425:851–6.

    Article  PubMed  CAS  Google Scholar 

  82. Berman DM, Karhadkar S, Maitra A, et al. Widespread requirement for Hedgehog ligand stimulation in growth of digestive tract tumours. Nature. 2003;425:846–51.

    Article  PubMed  CAS  Google Scholar 

  83. Morton JP, Mongeau ME, Klimstra DS, et al. Sonnic hedgehog acts at multiple stages of pancreatic tumorigenesis. Proc Natl Acad Sci USA. 2007;104:5103–8.

    Article  PubMed  CAS  Google Scholar 

  84. Rudin CM, Hann CL, Laterra J, et al. Treatment of medulloblastoma with hedgehog pathway inhibitor GDC-0449. N Engl J Med. 2009;36:1173–8.

    Article  Google Scholar 

  85. Von Hoff DD, LoRusso PM, Rudin CM, et al. Inhibition of the hedgehog pathway in advanced basal-cell carcinoma. N Engl J Med. 2009;36:1164–72.

    Article  Google Scholar 

  86. Olive KP, Jacobetz MA, Davidson CJ, et al. Inhibition of hedgehog signaling enhances ­delivery of chemotherapy in a mouse model of pancreatic cancer. Science. 2009;324:1457–61.

    Article  PubMed  CAS  Google Scholar 

  87. Miele L, Golde T, Osborne B. Notch signaling in cancer. Curr Mol Med. 2006;6:905–18.

    Article  PubMed  CAS  Google Scholar 

  88. Wang Z, Zhang Y, Li Y, et al. Down-regulation of notch-1 contributes to cell growth inhibition and apoptosis in pancreatic cancer cells. Mol Cancer Ther. 2006;5:483–93.

    Article  PubMed  CAS  Google Scholar 

  89. Wang Z, Banerjee S, Li Y, et al. Down-regulation of notch-1 inhibits invasion by inactivation of nuclear factor-kappaB, vascular endothelial growth factor, and matrix metalloproteinase-9 in pancreatic cancer cells. Cancer Res. 2006;66:2778–84.

    Article  PubMed  CAS  Google Scholar 

  90. Puolakkainen PA, Brekken RA, Muneer S, et al. Enhanced growth of pancreatic tumors in SPARC-null mice is associated with decreased deposition of extracellular matrix and reduced tumor cell apoptosis. Mol Cancer Res. 2004;2:215–24.

    PubMed  CAS  Google Scholar 

  91. Von Hoff DD, Ramanathan RK, Borad MJ, et al. Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. J Clin Oncol. 2011;29:4548–54.

    Article  CAS  Google Scholar 

  92. Bloomston M, Zervos EE, Rosemurgy II AS, et al. Matrix metalloproteinases and their role in pancreatic cancer: a review of preclinical studies and clinical trials. Ann Surg Oncol. 2002;9:668–74.

    Article  PubMed  Google Scholar 

  93. Bramhall SR, Neoptolemos JP, Stamp GW, et al. Imbalance of expression of matrix metalloproteinases (MMPs) and tissue inhibitors of the matrix metalloproteinases (TIMPs) in human pancreatic carcinoma. J Pathol. 1997;182:347–55.

    Article  PubMed  CAS  Google Scholar 

  94. Zervos EE, Norman JG, Gower WR, et al. Matrix metalloproteinase inhibition attenuates human pancreatic cancer growth in vitro and decreases mortality and tumorigenesis in vivo. J Surg Res. 1997;69:367–71.

    Article  PubMed  CAS  Google Scholar 

  95. Haq M, Shafii A, Zervos EE, et al. Addition of matrix metalloproteinase inhibition to conventional cytotoxic therapy reduces tumor implantation and prolongs survival in a murine model of human pancreatic cancer. Cancer Res. 2000;60:3207–11.

    PubMed  CAS  Google Scholar 

  96. Bramhall SR, Rosemurgy A, Brown PD, et al. Marimastat as first-line therapy for patients with unresectable pancreatic cancer: a randomized trial. J Clin Oncol. 2001;19:3447–55.

    PubMed  CAS  Google Scholar 

  97. Bramhall SR, Schulz J, Nemunaitis J, et al. A double-blind placebo-controlled, randomized study comparing gemcitabine and marimastat with gemcitabine and placebo as first line therapy in patients with advanced pancreatic cancer. Br J Cancer. 2002;87:161–7.

    Article  PubMed  CAS  Google Scholar 

  98. Moore MJ, Hamm J, Dancey J, et al. Comparison of gemcitabine versus the matrix metalloproteinase inhibitor BAY 12–9566 in patients with advanced or metastatic adenocarcinoma of the pancreas: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2003;21:3296–302.

    Article  PubMed  CAS  Google Scholar 

  99. Williams CS, Mann M, DuBois RN. The role of cyclooxygenases in inflammation, cancer, and development. Oncogene. 1999;18:7908–16.

    Article  PubMed  CAS  Google Scholar 

  100. Molina MA, Sitja-Arnau M, Lemoine MG, et al. Increased cyclooxygenase-2 expression in human pancreatic carcinomas and cell lines: growth inhibition by Nonsteroidal anti-inflammatory drugs. Cancer Res. 1999;59:4356–62.

    PubMed  CAS  Google Scholar 

  101. Yip-Schneider MT, Barnard DS, Billings SD, et al. Cyclooxygenase-2 expression in human pancreatic adenocarcinomas. Carcinogenesis. 2000;21:139–46.

    Article  PubMed  CAS  Google Scholar 

  102. Merati K, Said Siadaty M, Andea A, et al. Expression of inflammatory modulator COX-2 in pancreatic ductal adenocarcinoma and its relationship to pathologic and clinical parameters. Amer J Clin Oncol. 2001;24:447–52.

    Article  CAS  Google Scholar 

  103. El-Rayes BF, Ali S, Sarkar FH, et al. Cyclooxygenase-2-dependent and—independent effects of celecoxib in pancreatic cancer cell lines. Mol Cancer Ther. 2004;3:1421–6.

    PubMed  CAS  Google Scholar 

  104. El-Rayes BF, Zalupski MM, Shields AF, et al. A phase II study of celecoxib, gemcitabine, and cisplatin in advanced pancreatic cancer. Invest New Drugs. 2005;23:583–90.

    Article  PubMed  CAS  Google Scholar 

  105. Kindler HL, Friberg G, Singh DA, et al. Phase II trial of bevacizumab plus gemcitabine in patients with advanced pancreatic cancer. J Clin Oncol. 2005;23:8033–40.

    Article  PubMed  CAS  Google Scholar 

  106. Kindler HL, Niedzwiecki D, Hollis D, et al. Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the cancer and leukemia group B (CALGB 80303). J Clin Oncol. 2010;28:3617–22.

    Article  PubMed  CAS  Google Scholar 

  107. Javle M, Yu J, Garrett C, et al. Bevacizumab combined with gemcitabine and capecitabine for advanced pancreatic cancer: a phase II study. Br J Cancer. 2009;100:1842–5.

    Article  PubMed  CAS  Google Scholar 

  108. Crane CH, Winter K, Regine WF, et al. Phase II study of Bevacizumab with concurrent capecitabine and radiation followed by maintenance gemcitabine and Bevacizumab for locally advanced pancreatic cancer: Radiation Therapy Oncology Group RTOG 0411. J Clin Oncol. 2009;27:4096–102.

    Article  PubMed  CAS  Google Scholar 

  109. Ko AH, Dito E, Schillinger B, et al. A phase II study evaluating bevacizumab in combination with fixed-dose rate gemcitabine and low-dose cisplatin for metastatic pancreatic cancer: is an anti-VEGF strategy still applicable? Invest New Drugs. 2008;26:463–71.

    Article  PubMed  CAS  Google Scholar 

  110. Ko AH, Venook AP, Bergsland EK, et al. A phase II study of bevacizumab plus erlotinib for gemcitabine-refractory metastatic pancreatic cancer. Cancer Chemother Pharmacol. 2010;66:1051–7.

    Article  PubMed  CAS  Google Scholar 

  111. Howard OMZ, Ben-Baruch A, Oppenheim JJ. Chemokines: progress toward identifying molecular targets for therapeutic agents. Trends Biotechnol. 1996;14:46–51.

    Article  PubMed  CAS  Google Scholar 

  112. Monti P, Leone BE, Marchesi F, et al. The CC chemokine MCP-1/CCL2 in pancreatic cancer progression: regulation of expression and potential mechanisms of anti-malignant activity. Cancer Res. 2003;63:7451–61.

    PubMed  CAS  Google Scholar 

  113. Hynes RO, Lively JC, McCarty JH, et al. The diverse roles of integrins and their ligands in angiogenesis. Cold Spring Harb Symp Quant Biol. 2002;67:143–53.

    Article  PubMed  CAS  Google Scholar 

  114. Lee BH, Ruoslahti E. alpha5beta1 integrin stimulates Bcl-2 expression and cell survival through Akt, focal adhesion kinase, and Ca2+/calmodulin-dependent protein kinase IV. J Cell Biochem. 2005;95:1214–23.

    Article  PubMed  CAS  Google Scholar 

  115. Mettouchi A, Meneguzzi G. Distinct roles of beta1 integrins during angiogenesis. Eur J Cell Biol. 2005;95:1214–23.

    Google Scholar 

  116. Bhaskar V, Zhang D, Fox M, et al. A function blocking anti-mouse integrin α5β1 antibody inhibits angiogenesis and impedes tumor growth in vivo. J Translat Med. 2007;5:61.

    Article  CAS  Google Scholar 

  117. Argani P, Iacobuzio-Donahue C, Ryu B, et al. Mesothelin is overexpressed in the vast majority of ductal adenocarcinomas of the pancreas: identification of a new pancreatic cancer marker by serial analysis of gene expression (SAGE). Clin Cancer Res. 2001;7:3862–8.

    PubMed  CAS  Google Scholar 

  118. Ryu B, Jones J, Blades NJ, et al. Relationships and differentially expressed genes among pancreatic cancers examined by large-scale serial analysis of gene expression. Cancer Res. 2002;62:819–26.

    PubMed  CAS  Google Scholar 

  119. Pastan I, Hassan R, FitzGerald DJP, et al. Immunotoxin therapy of cancer. Nat Rev Cancer. 2006;6:559–65.

    Article  PubMed  CAS  Google Scholar 

  120. Kreitman RJ, Hassan R, Fitzgerald DJ, et al. Phase I trial of continuous infusion of anti-mesothelin recombinant immunotoxin SS1P. Clin Cancer Res. 2009;15:5274–9.

    Article  PubMed  CAS  Google Scholar 

  121. Hole N, Stern PL. A 72 kD trophoblast glycoprotein defined by a monoclonal antibody. Br J Cancer. 1988;57:239–46.

    Article  PubMed  CAS  Google Scholar 

  122. Southall PJ, Boxer GM, Bagshawe KD, et al. Immunohistological distribution of 5 T4 antigen in normal and malignant tissues. Br J Cancer. 1990;61:89–95.

    Article  PubMed  CAS  Google Scholar 

  123. Borghaei H, Alpaugh K, Hedlund G, et al. Phase I dose escalation, pharmacokinetic and pharmacodynamic study of naptumomab estafenatox alone in patients with advanced cancer and with docetaxel in patients with advanced non-small-cell lung cancer. J Clin Oncol. 2009;27:4116–23.

    Article  PubMed  CAS  Google Scholar 

  124. Arnett SO, Teillaud J-L, Wurch T. IBC’s 21st annual antibody engineering and 8th annual antibody therapeutics international conferences and 2010 annual meeting of the antibody society. mAbs. 2011;3:133–52.

    Article  PubMed  Google Scholar 

  125. Hammarstrom S. The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues. Seminars Cancer Biol. 1999;9:67–81.

    Article  CAS  Google Scholar 

  126. Lutterbuese R, Raum T, Kischel R, et al. Potent control of tumor growth by CEA/CD3-bispecific single antibody constructs that are not competitively inhibited by soluble CEA. J Immunother. 2009;32:341–52.

    Article  PubMed  CAS  Google Scholar 

  127. Wente M, Jain A, Kono E, et al. Prostate stem cell antigen is a putative target for immunotherapy in pancreatic cancer. Pancreas. 2005;31:119–25.

    Article  PubMed  CAS  Google Scholar 

  128. Katari UL, Keiman JM, Worth AC, et al. Engineered T cells for pancreatic cancer treatment. HPB. 2011;13:643–50.

    Article  PubMed  Google Scholar 

  129. Brower V. Telomerase-based therapies emerging slowly. J Natl Cancer Inst. 2010;102:520–1.

    Article  PubMed  CAS  Google Scholar 

  130. Fonsatti E, Maio M, Altomonte M, et al. Biology and clinical applications of CD40 in cancer treatment. Semin Oncol. 2010;37:517–23.

    Article  PubMed  CAS  Google Scholar 

  131. Beatty GL, Chiorean EG, Fishman MP, et al. CD40 Agonists alter tumor stroma and show efficacy against pancreatic carcinoma in mice and humans. Science. 2011;331:1612–6.

    Article  PubMed  CAS  Google Scholar 

  132. Leach DR, Krummel MF, Allison JP. Enhancement of antitumor immunity by CTLA-4 blockade. Science. 1996;271:1734–6.

    Article  PubMed  CAS  Google Scholar 

  133. Salama AK, Hodi FS. Cytotoxic T-lymphocyte-associated antigen-4. Clin Cancer Res. 2011;17:4622–8.

    Article  PubMed  CAS  Google Scholar 

  134. Royal RE, Levy C, Turner K, et al. Phase 2 trial of single agent ipilimumab (anti-CTLA-4) for locally advanced or metastatic pancreatic adenocarcinoma. J Immunother. 2010;33:828–33.

    Article  PubMed  CAS  Google Scholar 

  135. Okazaki T, Honjo T. The PD-1-PD-L pathway in immunological tolerance. Trends Immunol. 2006;27:195–201.

    Article  PubMed  CAS  Google Scholar 

  136. Nomi T, Sho M, Akahori T, et al. Clinical significance and therapeutic potential of the programmed death-1 ligand/programmed death-1 pathway in human pancreatic cancer. Clin Cancer Res. 2007;13:2151–7.

    Article  PubMed  CAS  Google Scholar 

  137. O’Brien P, O’Connor BF. Seprase: an overview of an important matrix serine protease. Biochim Biophys Acta. 2008;1784:1130–45.

    Article  PubMed  CAS  Google Scholar 

  138. Adams S, Miller GT, Jesson MI, et al. PT-100, a small molecule dipeptidyl peptidase inhibitor, has potent antitumor effects and augments antibody-mediated cytotoxicity via a novel immune mechanism. Cancer Res. 2004;64:5471–80.

    Article  PubMed  CAS  Google Scholar 

  139. Spano JP, Chodkiewicz C, Maurel J, et al. Efficacy of gemcitabine plus axitinib compared with gemcitabine alone in patients with advanced pancreatic cancer: an open-label randomised phase II study. Lancet. 2008;371:2101–8.

    Article  PubMed  CAS  Google Scholar 

  140. Kindler HL, Ioka T, Richel D, et al. Axitinib plus gemcitabine versus placebo plus gemcitabine in patients with advanced pancreatic adenocarcinoma: a double-blind randomized phase 3 study. Lancet. 2011;12:256–62.

    Article  CAS  Google Scholar 

  141. O’Reilly EM, Niedzwiecki D, Hall M, et al. A cancer and leukemia group B phase II study of sunitinib malate in patients with previously treated metastatic pancreatic adenocarcinoma (CALGB 80603). Oncologist. 2010;15:1310–9.

    Article  PubMed  CAS  Google Scholar 

  142. Richards DA, Kuefler PR, Becerra C, et al. Gemcitabine plus enzastaurin or single-agent gemcitabine in locally advanced or metastatic pancreatic cancer: results of a phase II, randomized, noncomparative study. Invest New Drugs. 2011;29:144–53.

    Article  PubMed  CAS  Google Scholar 

  143. Yee NS. Brca2 deficiency and Trp53 deregulation in pancreatic cancer. Implications for therapeutic targeting. Cancer Biol Ther. 2011;11:969–73.

    Article  PubMed  CAS  Google Scholar 

  144. Skoulidis F, Cassidy LD, Pisupati V, et al. Germline Brca2 heterozygosity promotes Kras (G12D)-driven carcinogenesis in a murine model of familial pancreatic cancer. Cancer Cell. 2010;18:499–509.

    Article  PubMed  CAS  Google Scholar 

  145. Rowley M, Ohashi A, Mondal G, et al. Inactivation of Brca2 promotes Trp53-associated but inhibits KrasG12D-dependent pancreatic cancer development in mice. Gastroenterology. 2011;140:1303–13.

    Article  PubMed  CAS  Google Scholar 

  146. Feldmann G, Karikari C, dal Molin M, et al. Inactivation of Brca2 cooperates with Trp53R172H to induce invasive pancreatic ductal adenocarcinomas in mice: a mouse model of familial pancreatic cancer. Cancer Biol Ther. 2011;11:959–68.

    Article  PubMed  CAS  Google Scholar 

  147. Sonnenblick A, Kadouri L, Appelbaum L, et al. Complete remission, in BRCA2 mutation carrier with metastatic pancreatic adenocarcinoma, treated with cisplatin based therapy. Cancer Biol Ther. 2011;12:165–8.

    Article  PubMed  CAS  Google Scholar 

  148. Fogelman DR, Wolff RA, Kopetz S, et al. Evidence for the efficacy of iniparib, a PARP-1 inhibitor, in BRCA2-associated pancreatic cancer. Anticancer Res. 2011;31:1417–20.

    PubMed  Google Scholar 

  149. Villarroel MC, Rajeshkumar NV, Garrido-Laguna I, et al. Personalizing cancer treatment in the age of global genomic analyses: PALB2 gene mutations and the response to DNA damaging agents in pancreatic cancer. Mol Cancer Ther. 2011;10:3–8.

    Article  PubMed  CAS  Google Scholar 

  150. Farrell JJ, Elsaleh H, Garcia M, et al. Human equilibrative nucleoside transporter 1 levels predict response to gemcitabine in patients with pancreatic cancer. Gastroenterology. 2009;136:187–95.

    Article  PubMed  Google Scholar 

  151. Li C, Heidt DG, Dalerba P, et al. Identification of pancreatic cancer stem cells. Cancer Res. 2007;67:1030–7.

    Article  PubMed  CAS  Google Scholar 

  152. Hermann PC, Huber SL, Herrler T, et al. Distinct populations of cancer stem cells determine tumor growth and metastatic activity in human pancreatic cancer. Cell Stem Cell. 2007;1:313–23.

    Article  PubMed  CAS  Google Scholar 

  153. Al-Aynati MM, Radulovich N, Riddell RH, et al. Epithelial-cadherin and beta-catenin expression changes in pancreatic intraepithelial neoplasia. Clin Cancer Res. 2004;10:1235–40.

    Article  PubMed  CAS  Google Scholar 

  154. Shah AN, Summy JM, Zhang J, et al. Development and characterization of gemcitabine-resistant pancreatic tumor cells. Ann Surg Oncol. 2007;14:3629–37.

    Article  PubMed  Google Scholar 

  155. Arumugam T, Ramachandran V, Fournier KF, et al. Epithelial to mesenchymal transition contributes to drug resistance in pancreatic cancer. Cancer Res. 2009;69:5820–8.

    Article  PubMed  CAS  Google Scholar 

  156. Wellner U, Schubert J, Burk UC, et al. The EMT-activator ZEB1 promotes tumorigenicity by repressing stemness-inhibiting microRNAs. Nat Cell Biol. 2009;11:1487–95.

    Article  PubMed  CAS  Google Scholar 

  157. Collisson EA, Sadanandam A, Olson P, et al. Subtypes of pancreatic ductal adenocarcinoma and their differing responses to therapy. Nat Med. 2011;17:500–3.

    Article  PubMed  CAS  Google Scholar 

  158. Gittes GK. Developmental biology of the pancreas: a comprehensive review. Dev Biol. 2009;326:4–35.

    Article  PubMed  CAS  Google Scholar 

  159. Tiso N, Moro E, Argenton F. Zebrafish pancreas development. Mol Cell Endocrinol. 2009;312:24–30.

    Article  PubMed  CAS  Google Scholar 

  160. Yee NS, Pack M. Zebrafish as a model for pancreatic cancer research. Methods Mol Med. 2004;103:273–98.

    Google Scholar 

  161. Yee NS, Lorent K, Pack M. Exocrine pancreas development in zebrafish. Dev Biol. 2005;284:84–101.

    Article  PubMed  CAS  Google Scholar 

  162. Yee NS, Gong W, Huang Y, et al. Mutation of RNA pol III subunit rpc2/polr3b leads to deficiency of subunit rpc11 and disrupts zebrafish digestive development. PLoS Biol. 2007;5:2484–92.

    Article  CAS  Google Scholar 

  163. Yee NS, Zhou W, Liang IC. Transient receptor potential ion channel Trpm7 regulates exocrine pancreatic epithelial proliferation by Mg2+-sensitive Socs3a signaling in development and cancer. Dis Model Mech. 2011;4:240–54.

    Article  PubMed  CAS  Google Scholar 

  164. Yee NS, Zhou W, Lee M. Transient receptor potential channel TRPM8 is over-expressed and required for cellular proliferation of pancreatic adenocarcinoma. Cancer Lett. 2010;297:49–55.

    Article  PubMed  CAS  Google Scholar 

  165. Yee NS, Zhou LM, et al. Targeted silencing of TRPM7 ion channel induces replicative senescence and produces enhanced cytotoxicity with gemcitabine in pancreatic adenocarcinoma. Cancer Lett. 2012;318:99–105.

    Article  PubMed  CAS  Google Scholar 

  166. Yee NS, Brown RD, Lee MS, et al. TRPM8 ion channel is aberrantly expressed and required for preventing replicative senescence in pancreatic adenocarcinoma: potential role of TRPM8 as a biomarker and target. Cancer Biol Ther. 2012;13:592–9.

    Article  PubMed  CAS  Google Scholar 

  167. Yee NS, Zhou W, Chun SG, et al. Targeting developmental regulators of zebrafish exocrine pancreas as a therapeutic approach in human pancreatic cancer. Biology Open 2012;1:295–307.

    Google Scholar 

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Correspondence to Nelson S. Yee M.D. Ph.D. R.Ph. .

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Yee, N.S. (2013). Toward the Goal of Personalized Therapy in Pancreatic Cancer by Targeting the Molecular Phenotype. In: El-Deiry, W. (eds) Impact of Genetic Targets on Cancer Therapy. Advances in Experimental Medicine and Biology, vol 779. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6176-0_5

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