Abstract
Discovery of effective radiosensitization strategies that improve the therapeutic ratio for patients with lung cancer has been a goal of researchers and an area of vigorous investigation for the past several decades. A pure radiosensitizer is a drug, a modality of therapy or an intervention that, on its own, lacks direct anti-tumor activity but enhances the cytotoxicity of radiotherapy when employed in combination. In this chapter we outline the previous and ongoing attempts to radiosensitize lung cancers through improved tumor oxygenation, augmentation of the effectiveness of radiotherapy in hypoxic tumor cells, and use of drugs that modulate with DNA repair and apoptosis. To date, no pure radiosensitization strategy has established itself in standard practice but the current research suggests that this field continues to hold great promise for the improvement of outcome in patients with lung cancer.
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References
Albert JM, Cao C, Kim KW et al (2007) Inhibition of Poly(ADP-Ribose) polymerase enhances cell death and improves tumor growth delay in irradiated lung cancer models. Clin Cancer Res 13:3033–3042
Ang KK (2010) More lessons learned from the suffocation of hypoxia. J Clin Oncol 28(18):2941–2943
Bandyopadhyay K, Banères JL, Martin A et al (2009) Spermidinyl-CoA-based HAT inhibitors block DNA repair and provide cancer-specific chemo- and radio-sensitization. Cell Cycle 8(17):2779–2788
Becker A, Hansgen G, Bloching M et al (1998) Oxygenation of squamous cell carcinoma of the head and neck: comparison of primary tumors, neck node metastases, and normal tissue. Int J Radiat Oncol Biol Phys 42:35–41
Bellini MJ, Polo MP, de Alaniz MJ et al (2003) Effect of simvastatin on the uptake and metabolic conversion of palmitic, dihomo-gamma-linoleic and alpha-linolenic acids in A549 cells. Prostaglandins Leukot Essent Fatty Acids 69:351–357
Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. The Cochrane Database of Systematic Rev 2005, Issue 3. Art. No.: CD005005.pub2. DOI: 10.1002/14651858.CD005005.pub2
Bernier J, Denekamp J, Rojas A et al (1999) ARCON: accelerated radiotherapy with carboge n and nicotinamide in non small cell lung cancer: a phase I/II study by the EORTC. Radiother Oncol 52(2):149–156
Bohlius J, Schmidlin K, Brillant C et al (2009) Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials. Lancet 373(9674):1532–1542
Bortolussi S, Bakeine JG, Ballarini F et al (2011) Boron uptake measurements in a rat model for boron neutron capture therapy of lung tumors. Appl Radiat Isot 69(2):394–398
Brizel DM, Rosner GL, Prosnitz LR et al (1995) Patterns and variability of tumor oxygenation in human soft tissue sarcomas, cervical carcinomas, and lymph node metastases. Int J Radiat Oncol Biol Phys 32:1121–1125
Brizel DM, Scully SP, Harrelson JM et al (1996) Tumor oxygenation predicts for the likelihood of distant metastases in human soft tissue sarcoma. Cancer Res 56(5):941–943
Brown JM, Gaccia AJ (1998) The unique physiology of solid tumors: opportunities (and problems) for cancer therapy. Cancer Res 58:1408–1416
Brown JM, Diehn M, Loo BW (2010) Stereotactic ablative radiotherapy should be combined with a hypoxic cell radiosensitizer. IJROBP 78(2):323–327
Bui QC, Lieber M, Withers HR et al (2004) The efficacy of hyperbaric oxygen therapy in the treatment of radiation-induced late side effects. Int J Radiat Oncol Biol Phys 60(3):871–878
Cerchietti LC, Bonomi MR, Navigante AH et al (2005) Phase I/II study of selective cyclooxygenase-2 inhibitor celecoxib as a radiation sensitizer in patients with unresectable brain metastases. J Neurooncol 71(1):73–81
Chalmers AJ, Lakshman M, Chan N et al (2010) Poly(ADP-ribose) polymerase inhibition as a model for synthetic lethality in developing radiation oncology targets. Semin Radiat Oncol 20(4):274–281
Chinnaiyan P, Huang S, Vallabhaneni G et al (2005) Mechanisms of enhanced radiation response following epidermal growth factor receptor signaling inhibition by erlotinib (Tarceva). Cancer Res 65(8):3328–3335
Choy H, Nabid A, Stea B et al (2005) Phase II multicenter study of induction chemotherapy followed by concurrent efaproxiral (RSR13) and thoracic radiotherapy for patients with locally advanced non-small-cell lung cancer. JCO 23(25):5918–5928
Chung EJ, Brown AP, Asano H et al (2009) In vitro and in vivo radiosensitization with AZD6244 (ARRY-142886), an inhibitor of mitogen-activated protein kinase/extracellular signal-regulated kinase 1/2 kinase. Clin Cancer Res 15(9):3050–3057
Cuneo KC, Fu A, Osusky K, Huamani J, Hallahan DE, Geng L (2007) Histone deacetylase inhibitor NVP-LAQ824 sensitizes human nonsmall cell lung cancer to the cytotoxic effects of ionizing radiation. Anticancer Drugs 18:793–800
Dantzer F, de La Rubia G, Menissier-De Murcia J et al (2000) Base excision repair is impaired in mammalian cells lacking Poly(ADP-ribose) polymerase-1. Biochemistry 39:7559–7569
de Murcia JM, Niedergang C, Trucco C et al (1997) Requirement of poly(ADP-ribose) polymerase in recovery from DNA damage in mice and in cells. Proc Natl Acad Sci USA 94:7303–7307
de Ruysscher D, Bussink J, Rodrigus P et al (2007) Concurrent celecoxib versus placebo in patients with stage II–III non-small cell lung cancer: a randomised phase II trial. Radiother Oncol 84(1):23–25
Eschmann SM, Paulsen F, Reimold M (2005) Prognostic impact of hypoxia imaging with 18F-misonidazole PET in non-small cell lung cancer and head- and neck-cancer before radiotherapy. J Nucl Med 46(2):253–260
Eschwège F, Sancho-Garnier H, Chassagne D et al (1997) Results of a European randomized trial of Etanidazole combined with radiotherapy in head- and neck-carcinomas. Int J Radiat Oncol Biol Phys 39(2):275–281
Fyles AW, Milosevic M, Wong R et al (1998) Oxygenation predicts radiation response and survival in patients with cervix cancer. Radiother Oncol 48:149–156
Geng L, Cuneo KC, Fu A et al (2006) Histone deacetylase (HDAC) inhibitor LBH589 increases duration of gamma-H2AX foci and confines HDAC4 to the cytoplasm in irradiated non-small cell lung cancer. Cancer Res 66(23):11298–11304
Grimes KR, Warren GW, Fang F et al (2006) Cyclooxygenase-2 inhibitor, nimesulide, improves radiation treatment against non-small cell lung cancer both in vitro and in vivo. Oncol Rep 16(4):771–776
Hann CL, Daniel VC, Sugar EA et al (2008) Therapeutic efficacy of ABT-737, a selective inhibitor of BCL-2, in small cell lung cancer. Cancer Res 68:2321–2328
Helleday T, Petermann E, Lundin C et al (2008) DNA repair pathways as targets for cancer therapy. Nat Rev Cancer 8:193–204
Henk JM, Kunkler PB, Smith CW (1977) Radiotherapy and hyperbaric oxygen in head- and neck-cancer. Final report of first controlled clinical trial. Lancet 2:101–103
Henke M, Laszig R, Rube C et al (2003) Erythropoietin to treat head- and neck-cancer patients with anaemia undergoing radiotherapy: Randomised, double-blind, placebo-controlled trial. Lancet 362:1255–1260
Hockel M, Knoop C, Schlenger K et al (1993) Intratumoral PO2 predicts survival in advanced cancer of the uterine cervix. Radiother Oncol 26:45–50
Hoskin PJ, Rojas AM, Bentzen SM et al (2010) Radiotherapy with concurrent carbogen and nicotinamide in bladder carcinoma. J Clin Oncol 28(33):4912–4918
Janssens GO, Terhaard CH, Doornaert PA et al (2011)Acute toxicity profile and compliance to accelerated radiotherapy plus carbogen and nicotinamide for clinical stage T2-4 laryngeal cancer: results of a phase III randomized trial. Int J Radiat Oncol Biol Phys. [Epub ahead of print]
Kaanders JH, Pop LA, Marres HA et al (1998) Accelerated radiotherapy with carbogen and nicotinamide (ARCON) for laryngeal cancer. Radiother Oncol 48(2):115–122
Kaanders JH, Bussink J, van der Kogel AJ (2004) Clinical studies of hypoxia modification in radiotherapy. Semin Radiat Oncol 14:233–240
Khanzada UK, Pardo OE, Meier C et al (2006) Potent inhibition of small-cell lung cancer cell growth by simvastatin reveals selective functions of Ras isoforms in growth factor signalling. Oncogene 25:877–887
Kim BM, Won J, Maeng KA et al (2009) Nimesulide, a selective COX-2 inhibitor, acts synergistically with ionizing radiation against A549 human lung cancer cells through the activation of caspase-8 and caspase-3. Int J Oncol 34(5):1467–1473
Klenke FM, Abdollahi A, Bischof M et al (2011) Celecoxib enhances radiation response of secondary bone tumors of a human non-small cell lung cancer via antiangiogenesis in vivo. Strahlenther Onkol 187(1):45–51 Epub 2010 Dec 23
Komaki R, Liao Z, Milas L (2004) Improvement strategies for molecular targeting: cyclooxygenase-2 inhibitors as radiosensitizers for non-small cell lung cancer. Semin Oncol 31(1 Suppl 1):47–53
Kriegs M, Kasten-Pisula U, Rieckmann T et al (2010) The epidermal growth factor receptor modulates DNA double-strand break repair by regulating non-homologous end-joining. DNA Repair 9(8):889–897
Laurie SA, Jeyabalan N, Nicholas G et al (2006) Association between anemia arising during therapy and outcomes of chemoradiation for limited small-cell lung cancer. J Thorac Oncol 1(2):146–151
Le Q, Erler JT, Giaccia A (2007) Tumor hypoxia and metastasis in non-small-cell lung cancers. JTO 2(8):S154–S155
Le QT, Moon J, Redman M, Williamson SK, Lara PN Jr, Goldberg Z, Gaspar LE, Crowley JJ, Moore DF Jr, Gandara DR (2009) Phase II study of tirapazamine, cisplatin, and etoposide and concurrent thoracic radiotherapy for limited-stage small-cell lung cancer: SWOG 0222. J Clin Oncol 27(18):3014–3019
Lee DJ, Cosmatos D, Marcial VA et al (1995) Results of an RTOG phase III trial (RTOG 85-27) comparing radiotherapy plus etanidazole with radiotherapy alone for locally advanced head- and neck-carcinomas. Int J Radiat Oncol Biol Phys 32(3):567–576
Leyland-Jones B (2003) BEST Investigators and Study Group, Breast cancer trial with erythropoietin terminated unexpectedly. Lancet Oncol 4:459–460
Liu W, Chen Y, Wang W et al (2003) Combination of radiation and celebrex (celecoxib) reducemammary and lung tumor growth. Am J Clin Oncol 26(4):S103–S109
Liu SK, Coackley C, Krause M et al (2008) A novel poly(ADP-ribose) polymerase inhibitor, ABT-888, radiosensitizes malignant human cell lines under hypoxia. Radiother Oncol 88(2):258–268
Loriot Y, Mordant P, Brown BD et al (2010) Inhibition of BCL-2 in small cell lung cancer cell lines with oblimersen, an antisense BCL-2 oligodeoxynucleotide (ODN): in vitro and in vivo enhancement of radiation response. Anticancer Res 30(10):3869–3878
MacRae R, Shyr Y, Johnson D (2002) Declining hemoglobin during chemoradiotherapy for locally advanced non-small cell lung cancer is significant. Radiother Oncol 64(1):37–4
Manegold C, von Pawel J, Zaitloukal P et al (2008) B017704: a phase III randomized study of first-line bevacizumab combined with cisplatin/gemcitabine (CG) in patients (pts) with advanced or recurrent non-squamous, non-small cell lung cancer (NSCLC). Ann Oncol 19:viii1
Marks PA, Richon VM, Rifkind RA et al (2000) Histone deacetylase inhibitors: inducers of differentiation or apoptosis of transformed cells. JNCI J Natl Cancer Inst 92(15):1210–1216
Moretti L, Li B, Kim KW et al (2010) AT-101, a pan-Bcl-2 inhibitor, leads to radiosensitization of non-small cell lung cancer. J Thorac Oncol 5(5):680–687
Mok TS, Wu YL, Thongprasert S et al (2009) Gefitinib or carboplatin paclitaxel in pulmonary adenocarcinoma. N Engl J Med 361:947–957
Nagata Y, Takahashi A, Ohnishi K et al (2010) Effect of rapamycin, an mTOR inhibitor, on radiation sensitivity of lung cancer cells having different p53 gene status. Int J Oncol 37(4):1001–1010
Nishimura Y, Nakagawa K, Takeda K et al (2007) Phase I/II Trial of sequential chemoradiotherapy using a novel hypoxic cell radiosensitizer, Doranidazole (PR-350), in patients with locally advanced non–small-cell lung cancer (WJTOG-0002). IJROBP 69(3):786–792
Ohsaki Y, Tanno S, Fujita Y et al (2000) Epidermal growth factor receptor expression correlates with poor prognosis in non-small cell lung cancer patients with p53 overexpression. Oncol Rep 7:603–607
Overgaard J (1994) Clinical evaluation of nitroimidazoles as modifiers of hypoxia in solid tumors. Oncol Res 6:509–518
Overgaard J, Hansen HS, Overgaard M et al (1998) A randomized double-blind Phase III study of nimorazole as a hypoxic radiosensitizer of primary radiotherapy in supraglottic larynx and pharynx carcinoma. Results of the Danish head and neck cancer study (DAHANCA) protocol 5–85. Radiother Oncol 46:135–146
Park SY, Kim YM, Pyo H (2010) Gefitinib radiosensitizes non-small cell lung cancer cells through inhibition of ataxia telangiectasia mutated. Mol Cancer 9:222
Rischin D, Peters LJ, O’Sullivan B et al (2010) Tirapazamine, cisplatin, and radiation versus cisplatin and radiation for advanced squamous cell carcinoma of the head and neck (TROG 02.02, HeadSTART): a phase III trial of the Trans-Tasman Radiation Oncology Group. J Clin Oncol 28(18):2989–2995
Roa W, Chen H, Alexander A et al (2005) Enhancement of radiation sensitivity with BH3I-1 in non-small cell lung cancer. Clin Invest Med 28(2):55–63
Robnett TJ, Machtay M, Hahn SM et al (2002) Pathological response to preoperative chemoradiation worsens with anemia in non-small cell lung cancer patients. Cancer J 8:263–267
Rubin P, Hanley J, Keys HM et al (1979) Carbogen breathing during radiation therapy. The RTOG study. IJROBP 5:1963–1970
Sanli T, Liu C, Rashid A et al (2011) Lovastatin sensitizes lung cancer cells to ionizing radiation: modulation of molecular pathways of radioresistance and tumor suppression. J Thorac Oncol 6(3):439–450
Scott C, Suh J, Stea B et al (2007) Improved survival, quality of life, and quality-adjusted survival in breast cancer patients treated with efaproxiral (Efaproxyn) plus whole-brain radiation therapy for brain metastases. AJCO 30(6):580–587
Shannon AM, Telfer BA, Smith PD et al (2009) The mitogen-activated protein/extracellular signal-regulated kinase kinase 1/2 inhibitor AZD6244 (ARRY-142886) enhances the radiation responsiveness of lung and colorectal tumor xenografts. Clin Cancer Res 15:6619–6629
Sobolewski C, Cerella C, Dicato M et al (2010) The role of cyclooxygenase-2 in cell proliferation and cell death in human malignancies. Int J Cell Biol 2010:215158
Suh JH, Stea B, Nabid A et al (2006) Phase III study of efaproxiral as an adjunct to whole-brain radiation therapy for brain metastases. JCO 24(1):106–114
Tanaka T, Munshi A, Brooks C et al (2008) Gefitinib radiosensitizes non-small cell lung cancer cells by suppressing cellular DNA repair capacity. Clin Cancer Res 14(4):1266–1273
Toulany M, Kehlbach R, Florczak U et al (2008a) Targeting of AKT1 enhances radiation toxicity of human tumor cells by inhibiting DNA-PKcs-dependent DNA double-strand break repair. Mol Cancer Ther 7(7):1772–1781
Toulany M, Dittmann K, Fehrenbacher B et al (2008b) PI3K-Akt signaling regulates basal, but MAP-kinase signaling regulates radiation-induced XRCC1 expression in human tumor cells in vitro. DNA Repair 7(10):1746–1756
Tsao MS, Sakurada A, Cutz JC et al (2005) Erlotinib in lung cancer—molecular and clinical predictors of outcome. N Engl J Med 353(2):133–144
Turrisi AT, Kim K, Blum R et al (1999) Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. N Engl J Med 340(4):265–271
Vansteenkiste J, Pirker R, Massuti B et al (2002) Double-blind, placebo-controlled, ran-domized phase III trial of darbepoetin-alfa in lung cancer patients receiving chemotherapy. JNCI 94:1211–1220
Vansteenkiste J, Van Cutsem E, Dumez H et al (2008) Early phase II trial of oral vorinostat in relapsed or refractory breast, colorectal, or non-small cell lung cancer. Invest New Drugs 26(5):483–488
Watson ER, Halnan KE, Dische S et al (1978) Hyperbaric oxygen and radiotherapy: a medical research council trial in carcinoma of the cervix. Br J Radiol 51:879–887
Wilson WR, Denny WA, Pullen SM et al (1996) Tertiary amine N-oxides as bioreductive drugs: DACA N-oxide, nitracrine N-oxide and AQ4 N. Br J Cancer  (Suppl 27):S43–S47
Wood CD, Thornton TM, Sabio G et al (2009) Nuclear localization of p38 MAPK in response to DNA damage. Int J Biol Sci 5(5):428–437
Yamamoto M, Izumi Y, Horinouchi H et al (2009) Systemic administration of hemoglobin vesicle elevates tumor tissue oxygen tension and modifies tumor response to irradiation. J Surg Res 151(1):48–54
Zhang Y, Adachi M, Zhao X et al (2004) Histone deacetylase inhibitors FK228, N-(2-aminophenyl)-4-[N-(pyridin-3-yl-methoxycarbonyl)amino- methyl] benzamide and m-carboxycinnamic acid bis-hydroxamide augment radiation-induced cell death in gastrointestinal adenocarcinoma cells. Int J Cancer 110(2):301–308
Zhang F, Zhang T, Teng ZH et al (2009) Sensitization to gamma-irradiation-induced cell cycle arrest and apoptosis by the histone deacetylase inhibitor trichostatin a in non-small cell lung cancer (NSCLC) cells. Cancer Biol Ther 8(9):823–831
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Brade, A.M., Allibhai, Z. (2011). Radiation Sensitizers. In: Jeremic, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_278
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