INTERACTIONS ENTRE THERAPIES CIBLEES ANTI-ANGIOGÉNIQUES (BEVACIZUMAB, SORAFÉNIB) ET TRANSPORTEURS D’EFFLUX

Abstract : Treatment of cancers is a public health problem and based on surgery, radiotherapy, chemotherapy, hormone therapy and targeted therapies. Recent medical advances allowed progression-free survival of cancer patients, and even their overall survival. Among the new therapeutic strategies, blocking of angiogenesis was the subject of several clinical trials.Intervention of membrane transporters (influx and / or efflux) plays an important pharmacokinetic and pharmacogenetic role in anticancer drugs resistance.We observed in patients with HCC, a great pharmacokinetics parameters variability of sorafenib (tyrosine kinase inhibitor, anti-angiogenic drug and P-gp and BCRP substrat) and a tendency to a better clinical response in the ABCB1 3435 CT, ABCG2 34 GA, ABCG2 1143CT and ABCG2 421CA heterozygous group than in the homozygous group (wild type and mutant).Our work showns in vitro that pretreatment with anti-angiogenic drugs such as bevacizumab and sorafenib resulted in a resistance reversion to doxorubicin (P-gp substrate) in an IGROV1 – DXR cells (resistant to doxorubicin and P-gp overexpressing cells) by modulating the functionality of P-glycoprotein. This reversion is measured by the significant increase in intracellular doxorubicin concentrations in IGR OV1-DXR cells.In vivo in human colorectal cancer xenograft mice, bevacizumab pretreatment led to a significant increase in plasma concentrations of SN38 (active metabolite of irinotecan and P-gp substrate), as well as plasma AUC and Cmax of irinotecan (P-gp substrate) after oral administration of irinotecan. Similarly, a significant increase in plasma AUC of sorafenib after bevacizumab pretreatment was observed on the same experimental model.Knowledge and use of activity modulation of efflux pumps by anti-angiogenic targeted therapies would be interesting to translate into cancer therapy for increased clinic response and resistance reversion of the tumor and endothelial cells overexpressing efflux transporters, particularly P-gp.
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Mahamadou Tandia. INTERACTIONS ENTRE THERAPIES CIBLEES ANTI-ANGIOGÉNIQUES (BEVACIZUMAB, SORAFÉNIB) ET TRANSPORTEURS D’EFFLUX. Cancer. Université Paris-Saclay, 2017. Français. ⟨NNT : 2017SACLS424⟩. ⟨tel-01827017⟩

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