Current Cancer Drug Targets - Volume 5, Issue 2, 2005

In this review we provide a brief background on the cell cycle and then focus on two novel and emerging areas of cell cycle research that may prove to have significant relevance to the development of novel anticancer agents. In particular, we review the emerging evidence to suggest that histone deacetylase inhibitors may possess cancer cell-specific cytotoxicity due to their ability to target a novel G2/M checkpoint. We also review the recent literature supporting the proposition that inhibition of E2F activity in epithelial cancer cells may prove to be a useful differentiation therapy that operates via cell cycle-dependent and cell cycleindependent mechanisms.

The diatomic radical nitric oxide has been the focus of numerous studies involved with every facet of cancer. It has been implicated in carcinogenesis, progression, invasion, metastasis, angiogenesis, escape from immune surveillance, and modulation of therapeutic response. In recent years, an increasing number of studies have suggested the possible involvement of nitric oxide in multiple cancer types, including melanoma. It is perhaps not surprising that conflicting viewpoints have arisen as to whether nitric oxide is beneficial or deleterious in cancer. However, it has become clear that nitric oxide possesses modulatory properties in a number of signal transduction pathways that depend on concentration and context. Our laboratory has shown that tumor expression of inducible nitric oxide synthase in melanoma patients results in poor survival. Furthermore, we demonstrated that the removal of endogenous nitric oxide in melanoma cell lines led to increased sensitivity to cisplatin-induced apoptosis in a p53-dependent manner. Others have shown antiapoptotic properties of NO in melanoma cells. However, several studies also suggest that NO can inhibit metastasis and diminish resistance. Despite the apparently conflicting observations, it is evident that NO is involved in melanoma pathology. The purpose of this review is to summarize the current literature relating to the role of NO in cancer with particular emphasis on its relevance to therapeutic resistance in melanoma. Recent evidence suggests the involvement of an intricate and complex interplay between reactive nitrogen species and reactive oxygen species. The importance of nitric oxide and its balance with other oxidative agents in the regulation of cancer cell response to therapies will be discussed. This balance may serve as an important focal point in determining patient response to therapy. The ability to control this balance could significantly influence outcome.

Curcumin (diferuloyl methane), the yellow pigment in turmeric (Curcuma longa), is a potent chemopreventive agent that inhibits proliferation of cancer cells by arresting them at various phases of the cell cycle depending upon the cell type. Curcumin-induced apoptosis mainly involves the mitochondria-mediated pathway in various cancer cells of different tissues of origin. In some cell types like thymocytes, curcumin induces apoptosis-like changes whereas in many other normal and primary cells curcumin is either inactive or inhibits proliferation, but does not appear to induce apoptosis. These together with reports that curcumin protects cells against apoptosis induced by other agents, underscore the need for further understanding of the multiple mechanisms of cell death unleashed by curcumin. Tumor cells often evade apoptosis by expressing several antiapoptotic proteins, down-regulation and mutation of proapoptotic genes and alterations in signaling pathways that give them survival advantage and thereby allow them to resist therapy-induced apoptosis. Many researchers including ourselves, have demonstrated the involvement of several pro and antiapoptotic molecules in curcumin-induced apoptosis, and ways to sensitize chemoresistant cancer cells to curcumin treatment. This review describes the mechanisms of curcumin-induced apoptosis currently known, and suggests several potential strategies that include down-regulation of antiapoptotic proteins by antisense oligonucleotides, use of proapoptotic peptides and combination therapy, and other novel approaches against chemoresistant tumors. Several factors including pharmacological safety, scope for improvement of structure and function of curcumin and its ability to attack multiple targets are in favor of curcumin being developed as a drug for prevention and therapy of various cancers.

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, accounting for approximately 5 to 10% of all cancers. It is estimated to cause approximately 1 million deaths annually. Currently, no adjuvant or palliative treatment modalities have been conclusively shown to prolong survival in HCC. Despite the high mortality and frequency of this cancer, surgical resection is an option for only a small proportion of patients, less than 18%. Liver cirrhosis is the most common cause of HCC and necessitates the preservation as much liver as possible, resulting in local ablation, intra-arterial and systemic treatments being major therapeutic modalities. Through better understanding of the molecular basis of hepatocarcinogenesis, new preventative and treatment modalities have recently emerged. This article reviews the current treatment options and new therapeutic advances for HCC including antiangiogenesis therapy, targeted therapy and antisense gene targeting. Future clinical trials and research will help to evaluate and improve both systemic and targeted molecular therapies for this complex disease.

Neuroendocrine tumors (NETs) represent a large group of neoplasms deriving from pluripotent stem cells or from differentiated neuroendocrine cells that are characterized by the expression of different peptides and biogenic amines. These rare tumors tend to grow slowly and are notoriously difficult to localize, at least in the early stages. Diagnostics involve blood, urine and biochemical examination as well as imaging modalities. Imaging is achieved by a variety of techniques such as radiological morphological imaging methods, for example, sonography, computerized tomography (CT) / magnetic resonance imaging (MRI), angiography and finally, nuclear functional imaging methods such as metaiodobenzylguanidine (MIBG), somatostatin receptor scintigraphy (SRS), vasoactive intestinal peptide receptor scintigraphy (VIPRS) and positron emission tomography (PET) using 18F labeled deoxyglucose (FDG) and fluorinated dihydroxyphenylalanine (18FDOPA) as a radioisotopic marker. 131I-labeled MIBG is a well-established radiopharmaceutical for localization and therapy of phechromocytoma and paraganglioma. The majority of neuroendocrine tumors possess a high density of somatostatin receptors. This observation provided the basis for the development of various radiolabeled somatostatin peptide analogs as imaging agents and therapeutics in nuclear medicine. FDG-PET is now performed in a wide variety of tumors and indications, including diagnosis, staging, re-staging and evaluation of the response to treatment. 18F-DOPA-PET may be useful if 18F-FDG-PET scan result is negative. 99mTc-pentavalent dimercaptosuccinic acid (99mTc-DMSA-V) or 99mTc sestamibi (99mTc-MIBI) or 99mTctetrofosmin is used only for diagnosis of certain NETs such as medullary thyroid cancer. The expiences with other nuclear medicinie imaging and therapy modalities such as cholecystokinin (CCK)-B / gastrin-receptors, bombesin / gastrin-releasing peptide receptor scintigraphy are still limited, and further clinical studies are needed. The studies using vascular endothelial growth factor (VEGF) for tumor angiogenesis imaging, annexin-V for imaging apoptosis and agents for hypoxia imaging are still in an early stage and the clinical role for these agents needs to be defined. In conclusion, no single imaging technique identifies all the metastatic sites of NETs. The best results may be obtained with a combination of functional imaging such as PET or / and SRS and morphologic imaging with CT and / or MR imaging. Many molecular imaging and therapy modalities fur NETs are recently under investigation or being developed, the usefulness of these modalities, however, has to be evaluated by well-designed and multicentre studies.