Abstract
Background
There is increasing evidence that tumor hypoxia plays a significant role in the chemoresistance of melanoma, but to our knowledge, real-time tumor oxygenation during isolated limb infusion (ILI) has not been studied. We sought to demonstrate the feasibility of measuring real-time alterations in tissue oxygenation.
Methods
Consecutive patients with histologically confirmed in-transit melanoma were enrolled onto a prospective single-arm pilot study and administered the hypoxia marker drug EF5. All patients were treated with ILI. Optical spectroscopy readings were obtained at three locations: two discrete target lesions and one normal skin control. Measurements were taken at 11 predefined time points during ILI.
Results
A total of six patients were enrolled onto this pilot study. Intratumor and normal skin optical spectroscopy readings were found to have discrete inflection points throughout the duration of therapy, corresponding with established time points. Baseline hypoxia as measured by both optical spectroscopy and EF5 immunofluorescence was variable, but on the basis of optical spectra, tumors appeared to become more hypoxic compared to normal skin after tourniquet application. The optical hypoxia signature was variable between patients while hemoglobin absorption increased.
Conclusions
To our knowledge, this is the first use of real-time optical spectroscopy to evaluate oxygenation and perfusion within melanoma lesions during regional chemotherapy. We report our development of this new noninvasive means of assessing tumor vascular function, which has the potential to be a powerful tool for noninvasive examination of the melanoma tumor microenvironment.
Similar content being viewed by others
References
Chapman PB, Hauschild A, Robert C, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011;364:2507–16.
Flaherty KT, Robert C, Hersey P, et al. Improved survival with MEK inhibition in BRAF-mutated melanoma. N Engl J Med. 2012;367:107–14.
Sosman Ja, Kim KB, Schuchter L, et al. Survival in BRAF V600-mutant advanced melanoma treated with vemurafenib. N Engl J Med. 2012;366:707–14.
Dewhirst MW, Cao Y, Moeller B. Cycling hypoxia and free radicals regulate angiogenesis and radiotherapy response. Nat Rev Cancer. 2008;8:425–37.
Conover DL, Fenton BM, Foster TH, Hull EL. An evaluation of near infrared spectroscopy and cryospectrophotometry estimates of haemoglobin oxygen saturation in a rodent mammary tumour model. Phys Med Biol. 2000;45:2685–700.
Finlay JC, Foster TH. Hemoglobin oxygen saturations in phantoms and in vivo from measurements of steady-state diffuse reflectance at a single, short source-detector separation. Med Phys. 2004;31:1949.
Kim JG, Zhao D, Song Y, Constantinescu A, Mason RP, Liu H. Interplay of tumor vascular oxygenation and tumor pO2 observed using near-infrared spectroscopy, an oxygen needle electrode, and 19F MR pO2 mapping. J Biomed Opt. 2003;8:53–62.
Liu H, Gu Y, Kim JG, Mason RP. Near-infrared spectroscopy and imaging of tumor vascular oxygenation. Methods Enzymol. 2004;386:349–78.
Palmer GM, Viola RJ, Schroeder T, Yarmolenko PS, Dewhirst MW, Ramanujam N. Quantitative diffuse reflectance and fluorescence spectroscopy: tool to monitor tumor physiology in vivo. J Biomed Opt. 2009;14:024010.
Vishwanath K, Yuan H, Barry WT, Dewhirst MW, Ramanujam N. Using optical spectroscopy to longitudinally monitor physiological changes within solid tumors. Neoplasia. 2009;11:889–900.
Brown JQ, Wilke LG, Geradts J, Kennedy S, Palmer GM, Ramanujam N. Quantitative optical spectroscopy: a robust tool for direct measurement of breast cancer vascular oxygenation and total hemoglobin content in vivo. Cancer Res. 2009;69:2919–26.
Cerussi A, Hsiang D, Shah N, et al. Predicting response to breast cancer neoadjuvant chemotherapy using diffuse optical spectroscopy. Proc Natl Acad Sci USA. 2007;104:4014–9.
Cerussi AE, Tanamai VW, Hsiang D, Butler J, Mehta RS, Tromberg BJ. Diffuse optical spectroscopic imaging correlates with final pathological response in breast cancer neoadjuvant chemotherapy. Philos Trans A Math Phys Eng Sci. 2011;369:4512–30.
Ueda S, Roblyer D, Cerussi A, et al. Baseline tumor oxygen saturation correlates with a pathologic complete response in breast cancer patients undergoing neoadjuvant chemotherapy. Cancer Res. 2012;72:4318–28.
Murphy BW, Webster RJ, Quirk CJ, Clay CD, Heenan PJ, Sampson DD. Toward the discrimination of early melanoma from common and dysplastic nevus using fiber optic diffuse reflectance spectroscopy. J Biomed Opt. 2005;10:1–9.
Koch CJ, Hahn SM, Rockwell K, Covey JM, McKenna WG, Evans SM. Pharmacokinetics of EF5 [2-(2-nitro-1-H-imidazol-1-yl)-N-(2,2,3,3,3-pentafluoropropyl) acetamide] in human patients: implications for hypoxia measurements in vivo by 2-nitroimidazoles. Cancer Chemother Pharmacol. 2001;48:177–87.
Jenkins WT, Evans SM, Koch CJ. Hypoxia and necrosis in rat 9L glioma and Morris 7777 hepatoma tumors: comparative measurements using EF5 binding and the Eppendorf needle electrode. Int J Radiat Oncol Biol Phys. 2000;46:1005–17.
Koch CJ. Measurement of absolute oxygen levels in cells and tissues using oxygen sensors and 2-nitroimidazole EF5. Methods Enzymol. 2002;352:3–31.
Palmer GM, Ramanujam N. Monte Carlo-based inverse model for calculating tissue optical properties. Part I: theory and validation on synthetic phantoms. Appl Opt. 2006;45:1062–71.
Palmer GM, Zhu C, Breslin TM, Xu F, Gilchrist KW, Ramanujam N. Monte Carlo-based inverse model for calculating tissue optical properties. Part II: application to breast cancer diagnosis. Appl Opt. 2006;45:1072–8.
Dang EV, Barbi J, Yang HY, et al. Control of T(H)17/T(reg) balance by hypoxia-inducible factor 1. Cell. 2011;146:772–84.
Du R, Lu KV, Petritsch C, et al. HIF1alpha induces the recruitment of bone marrow-derived vascular modulatory cells to regulate tumor angiogenesis and invasion. Cancer Cell. 2008;13:206–20.
Palazón A, Aragonés J, Morales-Kastresana A, de Landázuri MO, Melero I. Molecular pathways: hypoxia response in immune cells fighting or promoting cancer. Clin Cancer Res. 2012;18:1207–13.
Sitkovsky M, Lukashev D. Regulation of immune cells by local-tissue oxygen tension: HIF1 alpha and adenosine receptors. Nat Rev Immunol. 2005;5:712–21.
Gerweck LE, Vijayappa S, Kozin S. Tumor pH controls the in vivo efficacy of weak acid and base chemotherapeutics. Mol Cancer Ther. 2006;5:1275–9.
Kroon HM, Moncrieff M, Kam PCa, Thompson JF. Outcomes following isolated limb infusion for melanoma. A 14-year experience. Ann Surg Oncol. 2008;15:3003–13.
Prescott DM, Charles HC, Poulson JM, et al. The relationship between intracellular and extracellular pH in spontaneous canine tumors. Clin Cancer Res. 2000;6:2501–5.
Siemann DW, Chapman M, Beikirch A. Effects of oxygenation and pH on tumor cell response to alkylating chemotherapy. Int J Radiat Oncol Biol Phys. 1991;20:287–9.
Acknowledgment
This work was supported by NIH R01-CA40355, NIH 5T32CA093245-10, and the Melanoma Research Alliance.
Disclosure
GMP and Duke University have financial interest in Zenalux Biomedical Inc., which is commercializing optical spectroscopy technologies.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Speicher, P.J., Beasley, G.M., Jiang, B. et al. Hypoxia in Melanoma: Using Optical Spectroscopy and EF5 to Assess Tumor Oxygenation Before and During Regional Chemotherapy for Melanoma. Ann Surg Oncol 21, 1435–1440 (2014). https://doi.org/10.1245/s10434-013-3222-0
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-013-3222-0