Emerging concepts for PI3K/mTOR inhibition as a potential treatment for osteosarcoma

Patients with metastatic and recurrent osteosarcoma fare poorly, and new therapeutic strategies are needed to improve survival. Several recent complementary genomic and pathway analyses of both murine and human osteosarcoma have revealed common aberrations of the phosphoinositide 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) pathway in osteosarcoma. Preclinical data demonstrate that inhibition of PI3K and mTOR with either a combination of single agents or dual inhibiting compounds can decrease cell proliferation and induce cell cycle arrest and apoptosis. With a lack of available clinical agents active in osteosarcoma, PI3K/mTOR inhibition represents a potential vulnerability in osteosarcoma that warrants clinical investigation.

[1]  A. Thyss,et al.  Off-label use of targeted therapies in osteosarcomas: data from the French registry OUTC’S (Observatoire de l’Utilisation des Thérapies Ciblées dans les Sarcomes) , 2015, BMC Cancer.

[2]  Natalie K. Wolf,et al.  A Sleeping Beauty forward genetic screen identifies new genes and pathways driving osteosarcoma development and metastasis , 2015, Nature Genetics.

[3]  R. Kurzrock,et al.  Phase I combination of pazopanib and everolimus in PIK3CA mutation positive/PTEN loss patients with advanced solid tumors refractory to standard therapy , 2015, Investigational New Drugs.

[4]  Elizabeth Stewart,et al.  Systematic screening identifies dual PI3K and mTOR inhibition as a conserved 2 therapeutic vulnerability in osteosarcoma 3 , 2015 .

[5]  Helen X. Chen,et al.  Phase II study of cixutumumab in combination with temsirolimus in pediatric patients and young adults with recurrent or refractory sarcoma: A report from the children's oncology group , 2015, Pediatric blood & cancer.

[6]  Adam Kiezun,et al.  Complementary genomic approaches highlight the PI3K/mTOR pathway as a common vulnerability in osteosarcoma , 2014, Proceedings of the National Academy of Sciences.

[7]  Li Ding,et al.  Recurrent somatic structural variations contribute to tumorigenesis in pediatric osteosarcoma. , 2014, Cell reports.

[8]  J. Blay,et al.  Results of an international randomized phase III trial of the mammalian target of rapamycin inhibitor ridaforolimus versus placebo to control metastatic sarcomas in patients after benefit from prior chemotherapy. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  L. Qin,et al.  Cixutumumab and temsirolimus for patients with bone and soft-tissue sarcoma: a multicentre, open-label, phase 2 trial. , 2013, The Lancet. Oncology.

[10]  S. Ferrari,et al.  The Combination of Sorafenib and Everolimus Abrogates mTORC1 and mTORC2 Upregulation in Osteosarcoma Preclinical Models , 2013, Clinical Cancer Research.

[11]  S. Lipshultz,et al.  Phase II trial of trastuzumab in combination with cytotoxic chemotherapy for treatment of metastatic osteosarcoma with human epidermal growth factor receptor 2 overexpression: a report from the children's oncology group. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  Dafydd G. Thomas,et al.  Results of a phase II study of sirolimus and cyclophosphamide in patients with advanced sarcoma. , 2012, European journal of cancer.

[13]  Levi Garraway,et al.  High‐throughput genotyping in osteosarcoma identifies multiple mutations in phosphoinositide‐3‐kinase and other oncogenes , 2012, Cancer.

[14]  G. Bacci,et al.  High grade osteosarcoma of the extremities metastatic to the lung: long-term results in 323 patients treated combining surgery and chemotherapy, 1985-2005. , 2010, Surgical oncology.

[15]  L. Mirabello,et al.  Osteosarcoma incidence and survival rates from 1973 to 2004 , 2009, Cancer.

[16]  Jing Ma,et al.  Copy number gains in EGFR and copy number losses in PTEN are common events in osteosarcoma tumors , 2008, Cancer.

[17]  P. Houghton,et al.  Phase I study of everolimus in pediatric patients with refractory solid tumors. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  E. Kleinerman,et al.  Osteosarcoma: a randomized, prospective trial of the addition of ifosfamide and/or muramyl tripeptide to cisplatin, doxorubicin, and high-dose methotrexate. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  M. Semik,et al.  Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  W. Winkelmann,et al.  Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  P. Casali,et al.  Sorafenib and everolimus for patients with unresectable high-grade osteosarcoma progressing after standard treatment: a non-randomised phase 2 clinical trial. , 2015, The Lancet. Oncology.

[22]  J. Blay,et al.  Phase II study of the mammalian target of rapamycin inhibitor ridaforolimus in patients with advanced bone and soft tissue sarcomas. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[23]  C. Beauchamp Second and Subsequent Recurrences of Osteosarcoma: Presentation, Treatment, and Outcomes of 249 Consecutive Cooperative Osteosarcoma Study Group Patients , 2009 .