Skip to main content
Top
Published in: Journal of Cancer Research and Clinical Oncology 12/2015

01-12-2015 | Original Article – Cancer Research

Novel EGFR-specific immunotoxins based on panitumumab and cetuximab show in vitro and ex vivo activity against different tumor entities

Authors: Judith Niesen, Christoph Stein, Hannes Brehm, Grit Hehmann-Titt, Rolf Fendel, Georg Melmer, Rainer Fischer, Stefan Barth

Published in: Journal of Cancer Research and Clinical Oncology | Issue 12/2015

Login to get access

Abstract

Purpose

The epidermal growth factor receptor (EGFR) is overexpressed in many solid tumors. EGFR-specific monoclonal antibodies (mAbs), such as cetuximab and panitumumab, have been approved for the treatment of colorectal and head and neck cancer. To increase tissue penetration, we constructed single-chain fragment variable (scFv) antibodies derived from these mAbs and evaluated their potential for targeted cancer therapy. The resulting scFv-based EGFR-specific immunotoxins (ITs) combine target specificity of the full-size mAb with the cell-killing activity of a toxic effector domain, a truncated version of Pseudomonas exotoxin A (ETA′).

Methods

The ITs and corresponding imaging probes were tested in vitro against four solid tumor entities (rhabdomyosarcoma, breast, prostate and pancreatic cancer). Specific binding and internalization of the ITs scFv2112-ETA′ (from cetuximab) and scFv1711-ETA′ (from panitumumab) were demonstrated by flow cytometry and for the scFv-SNAP-tag imaging probes by live cell imaging. Cytotoxic potential of the ITs was analyzed in cell viability and apoptosis assays. Binding of the ITs was proofed ex vivo on rhabdomyosarcoma, prostate and breast cancer formalin-fixed paraffin-embedded biopsies.

Results

Both novel ITs showed significant pro-apoptotic and anti-proliferative effects toward the target cells, achieving IC50 values of 4 pM (high EGFR expression) to 460 pM (moderate EGFR expression). Additionally, rapid internalization and specific in vitro and ex vivo binding on patient tissue were confirmed.

Conclusions

These data demonstrate the potent therapeutic activity of two novel EGFR-specific ETA′-based ITs. Both molecules are promising candidates for further development toward clinical use in the treatment of various solid tumors to supplement the existing therapeutic regimes.
Appendix
Available only for authorised users
Literature
go back to reference Amoury M et al (2013) SNAP-tag based agents for preclinical in vitro imaging in malignant diseases. Curr Pharm Des 19:5429–5436CrossRefPubMed Amoury M et al (2013) SNAP-tag based agents for preclinical in vitro imaging in malignant diseases. Curr Pharm Des 19:5429–5436CrossRefPubMed
go back to reference Armistead PM et al (2007) Expression of receptor tyrosine kinases and apoptotic molecules in rhabdomyosarcoma: correlation with overall survival in 105 patients. Cancer 110:2293–2303. doi:10.1002/cncr.23038 CrossRefPubMed Armistead PM et al (2007) Expression of receptor tyrosine kinases and apoptotic molecules in rhabdomyosarcoma: correlation with overall survival in 105 patients. Cancer 110:2293–2303. doi:10.​1002/​cncr.​23038 CrossRefPubMed
go back to reference Asano R et al (2013) Multimerization of anti-(epidermal growth factor receptor) IgG fragments induces an antitumor effect: the case for humanized 528 scFv multimers. FEBS J 280:4816–4826. doi:10.1111/febs.12451 CrossRefPubMed Asano R et al (2013) Multimerization of anti-(epidermal growth factor receptor) IgG fragments induces an antitumor effect: the case for humanized 528 scFv multimers. FEBS J 280:4816–4826. doi:10.​1111/​febs.​12451 CrossRefPubMed
go back to reference Azemar M et al (2000) Recombinant antibody toxins specific for ErbB2 and EGF receptor inhibit the in vitro growth of human head and neck cancer cells and cause rapid tumor regression in vivo. Int J Cancer 86:269–275CrossRefPubMed Azemar M et al (2000) Recombinant antibody toxins specific for ErbB2 and EGF receptor inhibit the in vitro growth of human head and neck cancer cells and cause rapid tumor regression in vivo. Int J Cancer 86:269–275CrossRefPubMed
go back to reference Bachran D et al (2010) Epidermal growth factor receptor expression affects the efficacy of the combined application of saponin and a targeted toxin on human cervical carcinoma cells. Int J Cancer 127:1453–1461. doi:10.1002/ijc.25123 CrossRefPubMed Bachran D et al (2010) Epidermal growth factor receptor expression affects the efficacy of the combined application of saponin and a targeted toxin on human cervical carcinoma cells. Int J Cancer 127:1453–1461. doi:10.​1002/​ijc.​25123 CrossRefPubMed
go back to reference Barnea I, Ben-Yosef R, Karaush V, Benhar I, Vexler A (2013) Targeting EGFR-positive cancer cells with cetuximab-ZZ-PE38: results of in vitro and in vivo studies. Head Neck 35:1171–1177. doi:10.1002/hed.23093 CrossRefPubMed Barnea I, Ben-Yosef R, Karaush V, Benhar I, Vexler A (2013) Targeting EGFR-positive cancer cells with cetuximab-ZZ-PE38: results of in vitro and in vivo studies. Head Neck 35:1171–1177. doi:10.​1002/​hed.​23093 CrossRefPubMed
go back to reference Barth S (2002) Technology evaluation: bL22, NCI. Curr opin Mol Ther 4:72–75PubMed Barth S (2002) Technology evaluation: bL22, NCI. Curr opin Mol Ther 4:72–75PubMed
go back to reference Bruell D et al (2003) The recombinant anti-EGF receptor immunotoxin 425(scFv)-ETA′ suppresses growth of a highly metastatic pancreatic carcinoma cell line. Int J Oncol 23:1179–1186PubMed Bruell D et al (2003) The recombinant anti-EGF receptor immunotoxin 425(scFv)-ETA′ suppresses growth of a highly metastatic pancreatic carcinoma cell line. Int J Oncol 23:1179–1186PubMed
go back to reference Bruell D et al (2005) Recombinant anti-EGFR immunotoxin 425(scFv)-ETA′ demonstrates anti-tumor activity against disseminated human pancreatic cancer in nude mice. Int J Mol Med 15:305–313PubMed Bruell D et al (2005) Recombinant anti-EGFR immunotoxin 425(scFv)-ETA′ demonstrates anti-tumor activity against disseminated human pancreatic cancer in nude mice. Int J Mol Med 15:305–313PubMed
go back to reference Bruns CJ, Harbison MT, Kuniyasu H, Eue I, Fidler IJ (1999) In vivo selection and characterization of metastatic variants from human pancreatic adenocarcinoma by using orthotopic implantation in nude mice. Neoplasia (New York, NY) 1:50–62CrossRef Bruns CJ, Harbison MT, Kuniyasu H, Eue I, Fidler IJ (1999) In vivo selection and characterization of metastatic variants from human pancreatic adenocarcinoma by using orthotopic implantation in nude mice. Neoplasia (New York, NY) 1:50–62CrossRef
go back to reference Chaudhary VK, FitzGerald DJ, Adhya S, Pastan I (1987) Activity of a recombinant fusion protein between transforming growth factor type alpha and Pseudomonas toxin. Proc Natl Acad Sci USA 84:4538–4542PubMedCentralCrossRefPubMed Chaudhary VK, FitzGerald DJ, Adhya S, Pastan I (1987) Activity of a recombinant fusion protein between transforming growth factor type alpha and Pseudomonas toxin. Proc Natl Acad Sci USA 84:4538–4542PubMedCentralCrossRefPubMed
go back to reference Cizeau J, Grenkow DM, Brown JG, Entwistle J, MacDonald GC (2009) Engineering and biological characterization of VB6-845, an anti-EpCAM immunotoxin containing a T-cell epitope-depleted variant of the plant toxin bouganin. J Immunother (Hagerstown, Md : 1997) 32:574–584. doi:10.1097/CJI.0b013e3181a6981c CrossRef Cizeau J, Grenkow DM, Brown JG, Entwistle J, MacDonald GC (2009) Engineering and biological characterization of VB6-845, an anti-EpCAM immunotoxin containing a T-cell epitope-depleted variant of the plant toxin bouganin. J Immunother (Hagerstown, Md : 1997) 32:574–584. doi:10.​1097/​CJI.​0b013e3181a6981c​ CrossRef
go back to reference de Goeij BE et al (2014) HER2 monoclonal antibodies that do not interfere with receptor heterodimerization-mediated signaling induce effective internalization and represent valuable components for rational antibody-drug conjugate design. mAbs 6:392–402. doi:10.4161/mabs.27705 PubMedCentralCrossRefPubMed de Goeij BE et al (2014) HER2 monoclonal antibodies that do not interfere with receptor heterodimerization-mediated signaling induce effective internalization and represent valuable components for rational antibody-drug conjugate design. mAbs 6:392–402. doi:10.​4161/​mabs.​27705 PubMedCentralCrossRefPubMed
go back to reference de Larco JE, Todaro GJ (1978) Epithelioid and fibroblastic rat kidney cell clones: epidermal growth factor (EGF) receptors and the effect of mouse sarcoma virus transformation. J Cell Physiol 94:335–342. doi:10.1002/jcp.1040940311 CrossRefPubMed de Larco JE, Todaro GJ (1978) Epithelioid and fibroblastic rat kidney cell clones: epidermal growth factor (EGF) receptors and the effect of mouse sarcoma virus transformation. J Cell Physiol 94:335–342. doi:10.​1002/​jcp.​1040940311 CrossRefPubMed
go back to reference Faller BA, Burtness B (2009) Treatment of pancreatic cancer with epidermal growth factor receptor-targeted therapy. Biologics 3:419–428PubMedCentralPubMed Faller BA, Burtness B (2009) Treatment of pancreatic cancer with epidermal growth factor receptor-targeted therapy. Biologics 3:419–428PubMedCentralPubMed
go back to reference Freeman DJ (2009) Safety and efficacy of panitumumab in the treatment of metastatic colorectal cancer. Clin Med 2009(1):633–645 Freeman DJ (2009) Safety and efficacy of panitumumab in the treatment of metastatic colorectal cancer. Clin Med 2009(1):633–645
go back to reference Gilabert-Oriol R et al (2013) Modified trastuzumab and cetuximab mediate efficient toxin delivery while retaining antibody-dependent cell-mediated cytotoxicity in target cells. Mol Pharm 10:4347–4357. doi:10.1021/mp400444q CrossRefPubMed Gilabert-Oriol R et al (2013) Modified trastuzumab and cetuximab mediate efficient toxin delivery while retaining antibody-dependent cell-mediated cytotoxicity in target cells. Mol Pharm 10:4347–4357. doi:10.​1021/​mp400444q CrossRefPubMed
go back to reference Hussain AF, Kampmeier F, von Felbert V, Merk HF, Tur MK, Barth S (2011) SNAP-tag technology mediates site specific conjugation of antibody fragments with a photosensitizer and improves target specific phototoxicity in tumor cells. Bioconjugate Chem 22:2487–2495. doi:10.1021/bc200304k CrossRef Hussain AF, Kampmeier F, von Felbert V, Merk HF, Tur MK, Barth S (2011) SNAP-tag technology mediates site specific conjugation of antibody fragments with a photosensitizer and improves target specific phototoxicity in tumor cells. Bioconjugate Chem 22:2487–2495. doi:10.​1021/​bc200304k CrossRef
go back to reference Jakobovits A, Yang XD, Gallo M, Jia X (2001) Human monoclonal antibodies to epidermal growth factor receptor. US Patent Jakobovits A, Yang XD, Gallo M, Jia X (2001) Human monoclonal antibodies to epidermal growth factor receptor. US Patent
go back to reference Kamat V et al (2008) Enhanced EGFR inhibition and distinct epitope recognition by EGFR antagonistic mAbs C225 and 425. Cancer Biol Ther 7:726–733CrossRefPubMed Kamat V et al (2008) Enhanced EGFR inhibition and distinct epitope recognition by EGFR antagonistic mAbs C225 and 425. Cancer Biol Ther 7:726–733CrossRefPubMed
go back to reference Kampmeier F, Ribbert M, Nachreiner T, Dembski S, Beaufils F, Brecht A, Barth S (2009) Site-specific, covalent labeling of recombinant antibody fragments via fusion to an engineered version of 6-O-alkylguanine DNA alkyltransferase. Bioconjugate Chem 20:1010–1015. doi:10.1021/bc9000257 CrossRef Kampmeier F, Ribbert M, Nachreiner T, Dembski S, Beaufils F, Brecht A, Barth S (2009) Site-specific, covalent labeling of recombinant antibody fragments via fusion to an engineered version of 6-O-alkylguanine DNA alkyltransferase. Bioconjugate Chem 20:1010–1015. doi:10.​1021/​bc9000257 CrossRef
go back to reference Kim GP, Grothey A (2008) Targeting colorectal cancer with human anti-EGFR monoclonocal antibodies: focus on panitumumab. Biologics 2:223–228PubMedCentralPubMed Kim GP, Grothey A (2008) Targeting colorectal cancer with human anti-EGFR monoclonocal antibodies: focus on panitumumab. Biologics 2:223–228PubMedCentralPubMed
go back to reference Mamot C, Ritschard R, Kung W, Park JW, Herrmann R, Rochlitz CF (2006) EGFR-targeted immunoliposomes derived from the monoclonal antibody EMD72000 mediate specific and efficient drug delivery to a variety of colorectal cancer cells. J Drug Target 14:215–223. doi:10.1080/10611860600691049 CrossRefPubMed Mamot C, Ritschard R, Kung W, Park JW, Herrmann R, Rochlitz CF (2006) EGFR-targeted immunoliposomes derived from the monoclonal antibody EMD72000 mediate specific and efficient drug delivery to a variety of colorectal cancer cells. J Drug Target 14:215–223. doi:10.​1080/​1061186060069104​9 CrossRefPubMed
go back to reference Matthey B, Engert A, Klimka A, Diehl V, Barth S (1999) A new series of pET-derived vectors for high efficiency expression of Pseudomonas exotoxin-based fusion proteins. Gene 229:145–153CrossRefPubMed Matthey B, Engert A, Klimka A, Diehl V, Barth S (1999) A new series of pET-derived vectors for high efficiency expression of Pseudomonas exotoxin-based fusion proteins. Gene 229:145–153CrossRefPubMed
go back to reference Mendelsohn J (2002) Targeting the epidermal growth factor receptor for cancer therapy. J Clin Oncol 20:1s–13sPubMed Mendelsohn J (2002) Targeting the epidermal growth factor receptor for cancer therapy. J Clin Oncol 20:1s–13sPubMed
go back to reference Muller KM, Arndt KM, Strittmatter W, Pluckthun A (1998) The first constant domain (C(H)1 and C(L)) of an antibody used as heterodimerization domain for bispecific miniantibodies. FEBS Lett 422:259–264CrossRefPubMed Muller KM, Arndt KM, Strittmatter W, Pluckthun A (1998) The first constant domain (C(H)1 and C(L)) of an antibody used as heterodimerization domain for bispecific miniantibodies. FEBS Lett 422:259–264CrossRefPubMed
go back to reference Murthy U, Basu A, Rodeck U, Herlyn M, Ross AH, Das M (1987) Binding of an antagonistic monoclonal antibody to an intact and fragmented EGF-receptor polypeptide. Arch Biochem Biophys 252:549–560CrossRefPubMed Murthy U, Basu A, Rodeck U, Herlyn M, Ross AH, Das M (1987) Binding of an antagonistic monoclonal antibody to an intact and fragmented EGF-receptor polypeptide. Arch Biochem Biophys 252:549–560CrossRefPubMed
go back to reference Nabholtz JM et al (2012) P3-14-01: panitumumab in combination with FEC 100 (5-fluorouracile, epirubicin, cyclophosphamide) followed by docetaxel (T) in patients with operable, triple negative breast cancer (TNBC): final results of a multicentre neoadjuvant pilot phase II study. Cancer Res 71:P3-14-01–P13-14-01. doi:10.1158/0008-5472.sabcs11-p3-14-01 CrossRef Nabholtz JM et al (2012) P3-14-01: panitumumab in combination with FEC 100 (5-fluorouracile, epirubicin, cyclophosphamide) followed by docetaxel (T) in patients with operable, triple negative breast cancer (TNBC): final results of a multicentre neoadjuvant pilot phase II study. Cancer Res 71:P3-14-01–P13-14-01. doi:10.​1158/​0008-5472.​sabcs11-p3-14-01 CrossRef
go back to reference Nicholson RI, Gee JM, Harper ME (2001) EGFR and cancer prognosis. Eur J Cancer 37(Suppl 4):S9–S15CrossRefPubMed Nicholson RI, Gee JM, Harper ME (2001) EGFR and cancer prognosis. Eur J Cancer 37(Suppl 4):S9–S15CrossRefPubMed
go back to reference Pardo A, Stocker M, Kampmeier F, Melmer G, Fischer R, Thepen T, Barth S (2012) In vivo imaging of immunotoxin treatment using Katushka-transfected A-431 cells in a murine xenograft tumour model. Cancer Immunol Immunother (CII) 61:1617–1626. doi:10.1007/s00262-012-1219-3 CrossRef Pardo A, Stocker M, Kampmeier F, Melmer G, Fischer R, Thepen T, Barth S (2012) In vivo imaging of immunotoxin treatment using Katushka-transfected A-431 cells in a murine xenograft tumour model. Cancer Immunol Immunother (CII) 61:1617–1626. doi:10.​1007/​s00262-012-1219-3 CrossRef
go back to reference Ricci C et al (2000) Expression of HER/erbB family of receptor tyrosine kinases and induction of differentiation by glial growth factor 2 in human rhabdomyosarcoma cells. Int J Cancer 87:29–36CrossRefPubMed Ricci C et al (2000) Expression of HER/erbB family of receptor tyrosine kinases and induction of differentiation by glial growth factor 2 in human rhabdomyosarcoma cells. Int J Cancer 87:29–36CrossRefPubMed
go back to reference Schiffer S et al (2013) Species-dependent functionality of the human cytolytic fusion proteins granzyme B-H22(scFv) and H22(scFv)-angiogenin in macrophages. Antibodies 2:9–18. doi:10.3390/antib2010009 CrossRef Schiffer S et al (2013) Species-dependent functionality of the human cytolytic fusion proteins granzyme B-H22(scFv) and H22(scFv)-angiogenin in macrophages. Antibodies 2:9–18. doi:10.​3390/​antib2010009 CrossRef
go back to reference Schlessinger J Givol D, Bellot F, Kris R, Ricca G, Cheadle C, South V (2001) Monoclonal antibodies specific to human epidermal growth factor receptor an therapeutic methods employing same. US Patent Schlessinger J Givol D, Bellot F, Kris R, Ricca G, Cheadle C, South V (2001) Monoclonal antibodies specific to human epidermal growth factor receptor an therapeutic methods employing same. US Patent
go back to reference Schmidt M, Vakalopoulou E, Schneider DW, Wels W (1997) Construction and functional characterization of scFv(14E1)-ETA—a novel, highly potent antibody-toxin specific for the EGF receptor. Br J Cancer 75:1575–1584PubMedCentralCrossRefPubMed Schmidt M, Vakalopoulou E, Schneider DW, Wels W (1997) Construction and functional characterization of scFv(14E1)-ETA—a novel, highly potent antibody-toxin specific for the EGF receptor. Br J Cancer 75:1575–1584PubMedCentralCrossRefPubMed
go back to reference Singh R, Samant U, Hyland S, Chaudhari PR, Wels WS, Bandyopadhyay D (2007) Target-specific cytotoxic activity of recombinant immunotoxin scFv(MUC1)-ETA on breast carcinoma cells and primary breast tumors. Mol Cancer Ther 6:562–569. doi:10.1158/1535-7163.MCT-06-0604 CrossRefPubMed Singh R, Samant U, Hyland S, Chaudhari PR, Wels WS, Bandyopadhyay D (2007) Target-specific cytotoxic activity of recombinant immunotoxin scFv(MUC1)-ETA on breast carcinoma cells and primary breast tumors. Mol Cancer Ther 6:562–569. doi:10.​1158/​1535-7163.​MCT-06-0604 CrossRefPubMed
go back to reference Stocker M, Tur MK, Sasse S, Krussmann A, Barth S, Engert A (2003) Secretion of functional anti-CD30-angiogenin immunotoxins into the supernatant of transfected 293T-cells. Protein Expr Purif 28:211–219CrossRefPubMed Stocker M, Tur MK, Sasse S, Krussmann A, Barth S, Engert A (2003) Secretion of functional anti-CD30-angiogenin immunotoxins into the supernatant of transfected 293T-cells. Protein Expr Purif 28:211–219CrossRefPubMed
go back to reference Thorpe SJ, Turner C, Heath A, Feavers I, Vatn I, Natvig JB, Thompson KM (2003) Clonal analysis of a human antimouse antibody (HAMA) response. Scand J Immunol 57:85–92CrossRefPubMed Thorpe SJ, Turner C, Heath A, Feavers I, Vatn I, Natvig JB, Thompson KM (2003) Clonal analysis of a human antimouse antibody (HAMA) response. Scand J Immunol 57:85–92CrossRefPubMed
go back to reference Tur MK et al (2003) Recombinant CD64-specific single chain immunotoxin exhibits specific cytotoxicity against acute myeloid leukemia cells. Cancer Res 63:8414–8419PubMed Tur MK et al (2003) Recombinant CD64-specific single chain immunotoxin exhibits specific cytotoxicity against acute myeloid leukemia cells. Cancer Res 63:8414–8419PubMed
go back to reference Voigt M, Braig F, Gothel M, Schulte A, Lamszus K, Bokemeyer C, Binder M (2012) Functional dissection of the epidermal growth factor receptor epitopes targeted by panitumumab and cetuximab. Neoplasia (New York, NY) 14:1023–1031CrossRef Voigt M, Braig F, Gothel M, Schulte A, Lamszus K, Bokemeyer C, Binder M (2012) Functional dissection of the epidermal growth factor receptor epitopes targeted by panitumumab and cetuximab. Neoplasia (New York, NY) 14:1023–1031CrossRef
go back to reference von Minckwitz G et al (2005) Phase I clinical study of the recombinant antibody toxin scFv(FRP5)-ETA specific for the ErbB2/HER2 receptor in patients with advanced solid malignomas. Breast Cancer Res (BCR) 7:R617–R626. doi:10.1186/bcr1264 CrossRef von Minckwitz G et al (2005) Phase I clinical study of the recombinant antibody toxin scFv(FRP5)-ETA specific for the ErbB2/HER2 receptor in patients with advanced solid malignomas. Breast Cancer Res (BCR) 7:R617–R626. doi:10.​1186/​bcr1264 CrossRef
go back to reference Weidle UH, Georges G, Brinkmann U (2012) Fully human targeted cytotoxic fusion proteins: new anticancer agents on the horizon. Cancer Genomics Proteomics 9:119–133PubMed Weidle UH, Georges G, Brinkmann U (2012) Fully human targeted cytotoxic fusion proteins: new anticancer agents on the horizon. Cancer Genomics Proteomics 9:119–133PubMed
go back to reference Wolf P, Gierschner D, Buhler P, Wetterauer U, Elsasser-Beile U (2006) A recombinant PSMA-specific single-chain immunotoxin has potent and selective toxicity against prostate cancer cells. Cancer Immunol Immunother (CII) 55:1367–1373. doi:10.1007/s00262-006-0131-0 CrossRef Wolf P, Gierschner D, Buhler P, Wetterauer U, Elsasser-Beile U (2006) A recombinant PSMA-specific single-chain immunotoxin has potent and selective toxicity against prostate cancer cells. Cancer Immunol Immunother (CII) 55:1367–1373. doi:10.​1007/​s00262-006-0131-0 CrossRef
go back to reference Wolf P et al (2010) Preclinical evaluation of a recombinant anti-prostate specific membrane antigen single-chain immunotoxin against prostate cancer. J Immunother (Hagerstown, Md: 1997). doi:10.1097/CJI.0b013e3181c5495c Wolf P et al (2010) Preclinical evaluation of a recombinant anti-prostate specific membrane antigen single-chain immunotoxin against prostate cancer. J Immunother (Hagerstown, Md: 1997). doi:10.​1097/​CJI.​0b013e3181c5495c​
Metadata
Title
Novel EGFR-specific immunotoxins based on panitumumab and cetuximab show in vitro and ex vivo activity against different tumor entities
Authors
Judith Niesen
Christoph Stein
Hannes Brehm
Grit Hehmann-Titt
Rolf Fendel
Georg Melmer
Rainer Fischer
Stefan Barth
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Journal of Cancer Research and Clinical Oncology / Issue 12/2015
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-015-1975-5

Other articles of this Issue 12/2015

Journal of Cancer Research and Clinical Oncology 12/2015 Go to the issue