Hyaluronidase improves the efficacy of nab-paclitaxel after prolonged angiogenesis inhibition in preclinical models for esophagogastric cancer.

Background: Long-term anti-angiogenesis leads to pruned vasculature, densely deposited extracellular matrix (ECM), and consequently reduced chemotherapy delivery in esophagogastric cancer (EGC). To address this issue, we evaluated the efficacy of adding a hyaluronidase or a NO-donor to the regimen of chemotherapy and anti-angiogenic drugs.
Methods: A patient-derived EGC xenograft model was developed. Grafted mice were randomly assigned to four experimental groups and one control group. The experimental groups received DC101, a murine angiogenesis inhibitor, and nab-paclitaxel (NPTX), with the addition of hyaluronidase (PEGPH20), or NO-donor (nitroglycerine, NTG), or their combination, respectively. We compared tumor growth during 17 days of treatment. We performed immunohistochemistry for ECM components hyaluronan (HA) and collagen, CD31 for endothelial cells, and γH2AX for DNA damage. The positively stained areas were quantified, and vessel diameters were measured using QuPath software.
Results: Prolonged DC101 treatment induced deposition of HA (p<0.01) and collagen (p<0.01). HA was effectively degraded by PEGPH20 (p<0.001), but not by NTG as expected. Both PEGPH20 (p<0.05) and NTG (p<0.01) dilated vessels collapsed in response to long-term DC101 treatment. However, only PEGPH20 (rather than NTG) was found to significantly inhibit tumor growth (p<0.05) in combination with NPTX and DC101.
Conclusions: These findings suggest that the mechanical barrier of HA is the major reason responsible for the resistance developed during prolonged anti-angiogenesis in EGC. Incorporating PEGPH20 into the existing treatment regimen is promising to improve outcomes for patients with EGC.
Competing Interests: Declaration of Competing Interest HWML has acted as a consultant or advisory role for AstraZeneca, Beigene, BMS, and MSD (all related to checkpoint inhibitors) and for Amphera, Daiichi-Sankyo, Dragonfly, Eli Lilly, Nordic Pharma, and Servier; and has received research funding, medication supply, or both from Incyte, Merck, Roche, and Servier (all related to checkpoint inhibitors) and from Bayer, BMS, Celgene, Janssen, Eli Lilly, Nordic Pharma, and Philips; and speaker roles for Astellas (related to checkpoint inhibitors), Benecke, Daiichi-Sankyo, JAAP, Medtalks, Novartis, and Travel Congress Management. MFB has received research funding from Celgene, Lead Pharma, and Frame Therapeutics, and acted as a consultant to Servier, Olympus, and Wholomics. None of these companies were involved in the design, conduct, or analysis of this study or drafting of the manuscript and decision to publish.
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