Thrombospondin-1 plus irinotecan: a novel antiangiogenic-chemotherapeutic combination that inhibits the growth of advanced human colon tumor xenografts in mice

Chemotherapy for the treatment of advanced or metastatic colon cancer, utilizing agents such as 5-fluorouracil (5-FU) and irinotecan (CPT-11), produce a 5-year survival of about 10%. Thus, the identification of new, effective, therapeutic regimens to treat this disease remains critically important. To this end, selected antiangiogenic agents, compounds that inhibit neovascularization, have been shown to produce a modest tumor growth-inhibitory effect with little systemic toxicity. Thus these agents are attractive candidates for use with conventional chemotherapeutic agents to treat this disease. To evaluate this approach, experiments were undertaken to assess the cytotoxic and antineoplastic activity of CPT-11 and the antiangiogenic agent thrombospondin-1 (TSP-1) in the HT-29 model of human colon cancer. These agents were chosen since CPT-11 is a camptothecin analogue efficacious in the treatment of colon cancer and TSP-1 is a human glycoprotein that possess antiangiogenic activity. As expected, in vitro studies revealed that a 5-day exposure to TSP-1 at concentrations up to 130 μg/ml was not cytotoxic alone and did not affect the cytotoxicity of CPT-11, or of its active metabolite SN38, in HT-29 cells. Similarly, in human umbilical vein endothelial cells, TSP-1 alone induced only a slight cell growth-inhibitory effect and did not significantly increase the cytotoxicity of either CPT-11 or SN38. The antineoplastic activities of TSP-1 and CPT-11 were assessed in athymic (nude) female mice bearing advanced subcutaneous xenografts of HT-29 cells. Mice received TSP-1 alone (5–40 mg/kg per day) intraperitoneally (i.p.), CPT-11 alone (100–300 mg/kg, i.p.), TSP-1 (10 mg/kg per day) plus CPT-11 (125 mg/kg), or TSP-1 (20 mg/kg per day) plus CPT-11 (150 mg/kg). TSP-1 was injected daily (Monday through Friday) for 4 weeks (20 injections in total) whereas CPT-11 was administered once weekly on days 0, 7, 14 and 21. By day 28, treatment with TSP-1 alone (5, 10 or 20 mg/kg per day) induced a dose-dependent inhibition of xenograft growth. Further, treatment with 10 or 20 mg/kg per day resulted in an average treated tumor size/control tumor size (T/C) on day 28 of 0.68 (range 0.64–0.71) or 0.58 (range 0.54–0.60), respectively. CPT-11 at all doses significantly inhibited tumor growth with an average T/C value of 0.21 (range 0.15–0.27). However, the 250 and 300 mg/kg regimens induced significant toxicity and mortality. When TSP-1 was combined with CPT-11, a significant (P≤0.05) inhibition of tumor growth also was observed (T/C ≤0.17, range 0.11–0.20). Importantly, this enhanced tumor growth inhibition was obtained without significant toxicity. The therapeutic implications of these findings are discussed.