Skip to main content

Advertisement

Log in

Imatinib mesylate and its potential implications for gynecologic cancers

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Among gynecologic malignancies, ovarian carcinoma is the most frequent cause of death, with the majority of patients presenting at advanced stage. There is a high rate of recurrence despite first-line chemotherapy. Sarcoma of the uterus, while accounting for a small percent of uterine cancers, is also associated with a high-recurrence rate and poor overall survival. Therefore, the development of novel treatment strategies is paramount. Imatinib mesylate (Gleevec; Novartis Pharmaceuticals Corp., East Hanover, NJ) is a tyrosine kinase inhibitor with activity against abl, c-kit, and platelet derived growth factor receptor (PDGFR), and is approved for the treatment of chronic myelogenous leukemia and gastrointestinal stromal tumor. Preclinical data provides evidence for c-kit and PDGFR expression in ovarian epithelial carcinomas and uterine sarcomas and have led to clinical trials evaluating the use of imatinib in these malignancies. Additionally, inhibition of PDGFR signaling has been proposed as an effective mechanism of chemotherapy by lowering tumor interstitial fluid pressure. Recent data have also suggested benefit with metronomic scheduling of cytotoxic agents at lower doses at more frequent dosing intervals, in combination with other targeted therapies. While activity of this agent remains to be established, further studies of imatinib in gynecologic malignancies are warranted, to demonstrate not only single-agent activity and the enhancement of cytotoxicity of other antineoplastic agents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Jemal A, Thomas A, Murray T, et al.:Cancer statistics 2002. CA Cancer J Clin 2002, 52:23–47.

    Article  PubMed  Google Scholar 

  2. Harper P:Current clinical practices for ovarian cancers. Semin Oncol 2002, 29:3–6.

    PubMed  CAS  Google Scholar 

  3. Ozols RF:Future directions in the treatment of ovarian cancer. Semin Oncol 2002, 29:32–42.

    Article  PubMed  CAS  Google Scholar 

  4. Fletcher JA:Role of c-kit and platelet-derived growth factor receptors as oncoproteins. Semin Oncol 2004, 31:4–11.

    Article  PubMed  CAS  Google Scholar 

  5. Arber DA, Tamayo R, Weiss LM, et al.:Paraffin section determination of the c-kit gene product (CD117) in human tissues:value in the diagnosis of mast cell disorders. Hum Pathol 1998, 29:498–504.

    Article  PubMed  CAS  Google Scholar 

  6. Druker BJ, Tamura S, Buchdunger E, et al.:Effects of a selective inhibitor of the abl tyrosine kinase on the growth of bcr-abl positive cells. Nature Medicine 1996, 2:561–566.

    Article  PubMed  CAS  Google Scholar 

  7. Druker BJ, Talpaz M, Resta DJ, et al.:Efficacy and safety of a specific inhibitor of the bcr-abl tyrosine kinase in chronic myeloid leukemia. N Engl J Med 2001, 344:1031–1037.

    Article  PubMed  CAS  Google Scholar 

  8. Druker BJ, Sawyers CL, Kantarjian H, et al.:Activity of a specific inhibitor of the bcr-abl tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med 2001, 344:1038–1042.

    Article  PubMed  CAS  Google Scholar 

  9. Joensuu H, Roberts P, Sarlomo-Rikala M, et al.:Effect of tyrosine kinase inhibitor STI-571 in a patient with metastatic gastrointestinal stromal tumor. N Engl J Med 2001, 344: 1052–1056.

    Article  PubMed  CAS  Google Scholar 

  10. Demetri GD, von Mehren M, Blanke CD, et al.:Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002, 347: 472–480.

    Article  PubMed  CAS  Google Scholar 

  11. Tonary AM, Macdonald EA, Faught W, et al.:Lack of expression of c-kit in ovarian cancers is associated with poor prognosis. Int J Cancer 2000, 89:242–250.

    Article  PubMed  CAS  Google Scholar 

  12. Parrott JA, Kim G, Skinner MK:Expression and action of kit ligand stem cell factor in normal human and bovine ovarian surface epithelium and ovarian cancer. Biol Reprod 2000, 62:1600–1609. This is an early report of c-kit differential expression in ovarian cancer.

    Article  PubMed  CAS  Google Scholar 

  13. Schmandt RE, Broaddus R, Lu KH, et al.:Expression of c-abl, c-kit, and platelet-derived growth factor receptor-beta in ovarian serous carcinoma and normal ovarian surface epithelium. Cancer 2003, 98:758–764.

    Article  PubMed  CAS  Google Scholar 

  14. George D:Platelet-derived growth factor receptors:a therapeutic target in solid tumors. Semin Oncol 2001, 28:27–33.

    Article  PubMed  CAS  Google Scholar 

  15. Heldin CH, Westermark B:Mechanism of action and in vivo role of platelet derived growth factor. Physiol Rev 1999, 79:1283–1316.

    PubMed  CAS  Google Scholar 

  16. Henriksen R, Funa K, Wilander E, et al.:Expression and prognostic significance of platelet-derived growth factor and its receptors in epithelial ovarian neoplasms. Cancer Res 1993, 53:4550–4554. This study demonstrated the potential clinical relevance of PDGFR expression on prognosis for patients with epithelial ovarian carcinoma.

    PubMed  CAS  Google Scholar 

  17. Matei D, Graeber TG, Baldwin RL, et al.:Gene expression in epithelial ovarian carcinoma. Oncogene 2002, 21:6289–6298.

    Article  PubMed  CAS  Google Scholar 

  18. Matei D, Chang DD, Jeng MH:Imatinib mesylate (Gleevec) inhibits ovarian cancer cell growth through a mechanism dependent on platelet-derived growth factor receptor α and akt inactivation. Clin Cancer Res 2004, 10:681–690. This study demonstrated the mechanism of growth inhibition of imatinib mesylate is dependent on PDGFR modulation.

    Article  PubMed  CAS  Google Scholar 

  19. Heldin CK, Rubin K, Pietras K, Ostman A:High interstitial fluid pressure - an obstacle in cancer chemotherapy. Nat Rev Cancer 2004, 4:806–813.

    Article  PubMed  CAS  Google Scholar 

  20. Jain RK. Transport of molecules in the tumor interstitium:a review. Cancer Res 1987, 47:3039–3051.

    PubMed  CAS  Google Scholar 

  21. Boucher Y:Interstitial hypertension in superficial metastatic melanomas in humans. Cancer Res 1991, 51:6691–6694.

    PubMed  CAS  Google Scholar 

  22. Less JR:Interstitial hypertension in human breast and colorectal tumors. Cancer Res 1992, 52:6371–6374.

    PubMed  CAS  Google Scholar 

  23. Gutmann R:Interstitial hypertension in head and neck tumors in patients:correlation with tumor size. Cancer Res 1992, 52:1993–1995.

    PubMed  CAS  Google Scholar 

  24. Pietras K, Rubin K, Sjoblom, et al.:Inhibition of PDGFR signaling in tumor stroma enhances antitumor effect of chemotherapy. Cancer Res 2002, 62:5476–5484.

    PubMed  CAS  Google Scholar 

  25. Pietras K, Stumm M, Hubert M, et al.:STI571 enhances the therapeutic index of epothilone by a tumor selective increase of drug uptake. Clin Cancer Res 2003, 9:3779–3787. In this study, a novel mechanism of targeted therapeutic agent was shown to enhance a cytotoxic agent’s anticancer activity.

    PubMed  CAS  Google Scholar 

  26. Pietras K:Increasing tumor uptake of drugs with imatinib. Semin Oncol 2004, 31:18–23.

    Article  PubMed  CAS  Google Scholar 

  27. Hanahan D, Bergers G, Bergsland E:Less is more, regularly:metronomic dosing of cytotoxic drugs can target tumor angiogenesis in mice. J Clin Invest 2000, 105:1045–1047. This paper proposes a new way of thinking about drug administration, combining cytotoxic activity of chemotherapy against tumor cells and supporting cells of tumor vasculature with molecular targeted agents.

    PubMed  CAS  Google Scholar 

  28. Klement G:Continuous low dose therapy with vinblastine and VEGF receptor-2 antibody induces sustained tumor regression without overt toxicity. J Clin Invest 2000, 105:15–24.

    Article  Google Scholar 

  29. Browder T:Antiangiogenic scheduling of chemotherapy improves efficacy against experimental drugresistant cancer. Cancer Res 2000, 60:1878–1886.

    PubMed  CAS  Google Scholar 

  30. Bergers G, Song S, Meyer-Morse N, et al.:Benefits of targeting both pericytes and endothelial cells in the tumor vasculature with kinase inhibitors. J Clin Invest 2003, 111:1287–1295.

    Article  PubMed  CAS  Google Scholar 

  31. Olah KS, Gee H, Blunt S, et al.:Retrospective analysis of 318 cases of uterine sarcoma. Eur J Cancer 1991, 27:1095–1099.

    Article  PubMed  CAS  Google Scholar 

  32. Nordal RR, Thoresen SO:Uterine sarcomas in Norway 1956–1992:incidence, survival, and mortality. Eur J Cancer 1997, 33:907–911.

    Article  PubMed  CAS  Google Scholar 

  33. Leath CA, Straughn JM, Conner MG, et al.:Immunohistochemical evaluation of the c-kit proto-oncogene in sarcomas of the uterus. J Reprod Med 2004, 49:71–75.

    PubMed  Google Scholar 

  34. Corless CL, Heinrich MC, Dimitrijevic S, et al.:Correlation of imatinib response with activation of KIT and PDGF receptors in a variety of cancers:results of the CSTIB2225 trial [abstract]. Proc Am Soc Clin Oncol 2003, 22:195.

    Google Scholar 

  35. Chugh R, Thomas K, Wathen PF, et al.:Imatinib mesylate in soft tissue and bone sarcomas:interim results of a sarcoma alliance for research through collaboration (SARC) phase II trial [abstract]. J Clin Oncol 2004, 22.

  36. Posadas EM, Hussain MM, Espina V, et al.:A phase II clinical trial with proteomic profiling of imatinib mesylate in patients with refractory or relapsed epithelial ovarian cancer [abstract]. J Clin Oncol 2004, 22.

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dushkin, H., Schilder, R.J. Imatinib mesylate and its potential implications for gynecologic cancers. Curr. Treat. Options in Oncol. 6, 115–120 (2005). https://doi.org/10.1007/s11864-005-0019-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-005-0019-9

Keywords

Navigation