@article{VergoteMacarullaHirschetal.2023,
  author    = {Vergote, Ignace and Macarulla, Teresa and Hirsch, Fred R. and Hagemann, Carsten and Miller, David Scott},
  title     = {Tumor Treating Fields (TTFields) therapy concomitant with taxanes for cancer treatment},
  series = {Cancers},
  volume    = {15},
  journal   = {Cancers},
  number    = {3},
  issn      = {2072-6694},
  doi       = {10.3390/cancers15030636},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-305007},
  year      = {2023},
  abstract  = {Non-small cell lung cancer, ovarian cancer, and pancreatic cancer all present with high morbidity and mortality. Systemic chemotherapies have historically been the cornerstone of standard of care (SOC) regimens for many cancers, but are associated with systemic toxicity. Multimodal treatment combinations can help improve patient outcomes; however, implementation is limited by additive toxicities and potential drug-drug interactions. As such, there is a high unmet need to develop additional therapies to enhance the efficacy of SOC treatments without increasing toxicity. Tumor Treating Fields (TTFields) are electric fields that exert physical forces to disrupt cellular processes critical for cancer cell viability and tumor progression. The therapy is locoregional and is delivered noninvasively to the tumor site via a portable medical device that consists of field generator and arrays that are placed on the patient's skin. As a noninvasive treatment modality, TTFields therapy-related adverse events mainly consist of localized skin reactions, which are manageable with effective acute and prophylactic treatments. TTFields selectively target cancer cells through a multi-mechanistic approach without affecting healthy cells and tissues. Therefore, the application of TTFields therapy concomitant with other cancer treatments may lead to enhanced efficacy, with low risk of further systemic toxicity. In this review, we explore TTFields therapy concomitant with taxanes in both preclinical and clinical settings. The summarized data suggest that TTFields therapy concomitant with taxanes may be beneficial in the treatment of certain cancers.},
  language  = {en}
}
@phdthesis{Krenz2023,
  author    = {Krenz, Bastian},
  title     = {The immune-evasive potential of MYC in pancreatic ductal adenocarcinoma},
  doi       = {10.25972/OPUS-32590},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-325903},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Pancreatic ductal adenocarcinoma (PDAC) is predominantly driven by mutations in KRAS and TP53. However, PDAC tumors display deregulated levels of MYC and are a paradigm example for MYC-driven and -addicted tumors. For many years MYC was described as a transcription factor that regulates a pleiotropic number of genes to drive proliferation. Recent work sheds a different light on MYC biology. First, changes in gene expression that come along with the activation of MYC are mild and MYC seems to act more as a factor that reduces stress and increases resilience towards challenges during transcription. Second, MYC is a strong driver of immune evasion in different entities. In this study we depleted MYC in murine PDAC cells and revealed the immune dependent regression of tumors in an orthotope transplant model, as well as the activation of the innate immune system using global expression analysis, immunoblotting and fCLIP. These experiments revealed that endogenous double-stranded RNA is binding as a viral mimicry to Toll-like receptor 3, causing activation of TBK1 and downstream activation of a proimmunogenic transcription program. The regression of tumors upon depletion of MYC is dependent on this pathway since the knockout of TBK1 prevents regression of tumors after depletion of MYC. We can summarize this study in three main findings: First, the dominant and most important function of MYC in tumors is not to drive proliferation but to promote immune evasion and prevent immune-dependent regression of tumors. Second, cells monitor defects or delay in splicing and RNA processing and activate the immune system to clear cells that face problems with co-transcriptional processing. Third, MYC suppresses the activation of the cell-intrinsic innate immune system and shields highly proliferating cells from the recognition by the immune system. To translate this into a therapeutically approach, we replaced the shRNA mediated depletion of MYC by treatment with cardiac glycosides. Upon treatment with cardiac glycosides tumor cells reduce uptake of nutrients, causing a downregulation of MYC translation, inhibition of proliferation, glycolysis and lactate secretion. Lactate is a major reason for immune evasion in solid tumors since it dampens, amongst others, cytotoxic T cells and promotes regulatory T cells. Treatment of mice with cardiac glycosides causes a complete and immune-dependent remission of PDAC tumors in vivo, pointing out that cardiac glycosides have strong proimmunogenic, anti-cancer effects. More detailed analyses will be needed to dissect the full mechanism how cardiac glycosides act on MYC translation and immune evasion in PDAC tumors.},
  subject      = {Bauchspeicheldr{\"u}senkrebs},
  language  = {en}
}
@article{BolmZemskovZelleretal.2022,
  author    = {Bolm, Louisa and Zemskov, Sergii and Zeller, Maria and Baba, Taisuke and Roldan, Jorge and Harrison, Jon M. and Petruch, Natalie and Sato, Hiroki and Petrova, Ekaterina and Lapshyn, Hryhoriy and Braun, Ruediger and Honselmann, Kim C. and Hummel, Richard and Dronov, Oleksii and Kirichenko, Alexander V. and Klinkhammer-Schalke, Monika and Kleihues-van Tol, Kees and Zeissig, Sylke R. and Rades, Dirk and Keck, Tobias and Fernandez-del Castillo, Carlos and Wellner, Ulrich F. and Wegner, Rodney E.},
  title     = {Concepts and outcomes of perioperative therapy in stage IA-III pancreatic cancer — a cross-validation of the National Cancer Database (NCDB) and the German Cancer Registry Group of the Society of German Tumor Centers (GCRG/ADT)},
  series = {Cancers},
  volume    = {14},
  journal   = {Cancers},
  number    = {4},
  issn      = {2072-6694},
  doi       = {10.3390/cancers14040868},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-262174},
  year      = {2022},
  abstract  = {(1) Background: The aim of this study is to assess perioperative therapy in stage IA-III pancreatic cancer cross-validating the German Cancer Registry Group of the Society of German Tumor Centers — Network for Care, Quality, and Research in Oncology, Berlin (GCRG/ADT) and the National Cancer Database (NCDB). (2) Methods: Patients with clinical stage IA-III PDAC undergoing surgery alone (OP), neoadjuvant therapy (TX) + surgery (neo + OP), surgery+adjuvantTX (OP + adj) and neoadjuvantTX + surgery + adjuvantTX (neo + OP + adj) were identified. Baseline characteristics, histopathological parameters, and overall survival (OS) were evaluated. (3) Results: 1392 patients from the GCRG/ADT and 29,081 patients from the NCDB were included. Patient selection and strategies of perioperative therapy remained consistent across the registries for stage IA-III pancreatic cancer. Combined neo + OP + adj was associated with prolonged OS as compared to neo + OP alone (17.8 m vs. 21.3 m, p = 0.012) across all stages in the GCRG/ADT registry. Similarly, OS with neo + OP + adj was improved as compared to neo + OP in the NCDB registry (26.4 m vs. 35.4 m, p < 0.001). (4) Conclusion: The cross-validation study demonstrated similar concepts and patient selection criteria of perioperative therapy across clinical stages of PDAC. Neoadjuvant therapy combined with adjuvant therapy is associated with improved overall survival as compared to either therapy alone.},
  language  = {en}
}
@article{MainzSarhanRothetal.2022,
  author    = {Mainz, Laura and Sarhan, Mohamed A. F. E. and Roth, Sabine and Sauer, Ursula and Maurus, Katja and Hartmann, Elena M. and Seibert, Helen-Desiree and Rosenwald, Andreas and Diefenbacher, Markus E. and Rosenfeldt, Mathias T.},
  title     = {Autophagy blockage reduces the incidence of pancreatic ductal adenocarcinoma in the context of mutant Trp53},
  series = {Frontiers in Cell and Developmental Biology},
  volume    = {10},
  journal   = {Frontiers in Cell and Developmental Biology},
  issn      = {2296-634X},
  doi       = {10.3389/fcell.2022.785252},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-266005},
  year      = {2022},
  abstract  = {Macroautophagy (hereafter referred to as autophagy) is a homeostatic process that preserves cellular integrity. In mice, autophagy regulates pancreatic ductal adenocarcinoma (PDAC) development in a manner dependent on the status of the tumor suppressor gene Trp53. Studies published so far have investigated the impact of autophagy blockage in tumors arising from Trp53-hemizygous or -homozygous tissue. In contrast, in human PDACs the tumor suppressor gene TP53 is mutated rather than allelically lost, and TP53 mutants retain pathobiological functions that differ from complete allelic loss. In order to better represent the patient situation, we have investigated PDAC development in a well-characterized genetically engineered mouse model (GEMM) of PDAC with mutant Trp53 (Trp53\(^{R172H}\)) and deletion of the essential autophagy gene Atg7. Autophagy blockage reduced PDAC incidence but had no impact on survival time in the subset of animals that formed a tumor. In the absence of Atg7, non-tumor-bearing mice reached a similar age as animals with malignant disease. However, the architecture of autophagy-deficient, tumor-free pancreata was effaced, normal acinar tissue was largely replaced with low-grade pancreatic intraepithelial neoplasias (PanINs) and insulin expressing islet β-cells were reduced. Our data add further complexity to the interplay between Atg7 inhibition and Trp53 status in tumorigenesis.},
  language  = {en}
}
@article{FayezFeineisMudogoetal.2017,
  author    = {Fayez, Shaimaa and Feineis, Doris and Mudogo, Virima and Awale, Suresh and Bringmann, Gerhard},
  title     = {Ancistrolikokines E-H and related 5,8\('\)-coupled naphthylisoquinoline alkaloids from the Congolese liana \(Ancistrocladus\) \(likoko\) with antiausterity activities against PANC-1 human pancreatic cancer cells},
  series = {RSC Advances},
  volume    = {7},
  journal   = {RSC Advances},
  number    = {85},
  doi       = {10.1039/c7ra11200a},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-172008},
  pages     = {53740-53751},
  year      = {2017},
  abstract  = {A striking feature of the metabolite profile of \(Ancistrocladus\) \(likoko\) (Ancistrocladaceae) is the exclusive production of 5,8\('\)-linked naphthylisoquinoline alkaloids varying in their OMe/OH substitution patterns and in the hydrogenation degree in their isoquinoline portions. Here we present nine new compounds of this coupling type isolated from the twigs of this remarkable Central African liana. Three of them, the ancistrolikokines E (9), E\(_2\) (10), and F (11), are the first 5,8\('\)-linked naphthyldihydroisoquinolines found in nature with \(R\)-configuration at C-3. The fourth new metabolite, ancistrolikokine G (12), is so far the only representative of the 5,8\('\)-coupling type that belongs to the very rare group of alkaloids with a fully dehydrogenated isoquinoline portion. Moreover, five new \(N\)-methylated naphthyltetrahydroisoquinolines, named ancistrolikokines A\(_2\) (13), A\(_3\) (14), C\(_2\) (5), H (15), and H\(_2\) (16) are presented, along with six known 5,8\('\)-linked alkaloids, previously identified in related African \(Ancistrocladus\) species, now found for the first time in \(A.\) \(likoko\). The structural elucidation was achieved by spectroscopic analysis (HRESIMS, 1D and 2D NMR) and by chemical (oxidative degradation) and chiroptical (electronic circular dichroism) methods. The new ancistrolikokines showed moderate to good preferential cytotoxic activities towards pancreatic PANC-1 cells in nutrient-deprived medium (NDM), without causing toxicity under normal, nutrient-rich conditions, with ancistrolikokine H\(_2\) (16) being the most potent compound.},
  language  = {en}
}
@article{ChioreanVonHoffRenietal.2016,
  author    = {Chiorean, E. G. and Von Hoff, D. D. and Reni, M. and Arena, F. P. and Infante, J. R. and Bathini, V. G. and Wood, T. E. and Mainwaring, P. N. and Muldoon, R. T. and Clingan, P. R. and Kunzmann, V. and Ramanathan, R. K. and Tabernero, J. and Goldstein, D. and McGovern, D. and Lu, B. and Ko, A.},
  title     = {CA19-9 decrease at 8 weeks as a predictor of overall survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer},
  series = {Annals of Oncology},
  volume    = {27},
  journal   = {Annals of Oncology},
  number    = {4},
  doi       = {10.1093/annonc/mdw006},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-189659},
  pages     = {654-660},
  year      = {2016},
  abstract  = {Background A phase I/II study and subsequent phase III study (MPACT) reported significant correlations between CA19-9 decreases and prolonged overall survival (OS) with nab-paclitaxel plus gemcitabine (nab-P + Gem) treatment for metastatic pancreatic cancer (MPC). CA19-9 changes at week 8 and potential associations with efficacy were investigated as part of an exploratory analysis in the MPACT trial. Patients and methods Untreated patients with MPC (N = 861) received nab-P + Gem or Gem alone. CA19-9 was evaluated at baseline and every 8 weeks. Results Patients with baseline and week-8 CA19-9 measurements were analyzed (nab-P + Gem: 252; Gem: 202). In an analysis pooling the treatments, patients with any CA19-9 decline (80\%) versus those without (20\%) had improved OS (median 11.1 versus 8.0 months; P = 0.005). In the nab-P + Gem arm, patients with (n = 206) versus without (n = 46) any CA19-9 decrease at week 8 had a confirmed overall response rate (ORR) of 40\% versus 13\%, and a median OS of 13.2 versus 8.3 months (P = 0.001), respectively. In the Gem-alone arm, patients with (n = 159) versus without (n = 43) CA19-9 decrease at week 8 had a confirmed ORR of 15\% versus 5\%, and a median OS of 9.4 versus 7.1 months (P = 0.404), respectively. In the nab-P + Gem and Gem-alone arms, by week 8, 16\% (40/252) and 6\% (13/202) of patients, respectively, had an unconfirmed radiologic response (median OS 13.7 and 14.7 months, respectively), and 79\% and 84\% of patients, respectively, had stable disease (SD) (median OS 11.1 and 9 months, respectively). Patients with SD and any CA19-9 decrease (158/199 and 133/170) had a median OS of 13.2 and 9.4 months, respectively. Conclusion This analysis demonstrated that, in patients with MPC, any CA19-9 decrease at week 8 can be an early marker for chemotherapy efficacy, including in those patients with SD. CA19-9 decrease identified more patients with survival benefit than radiologic response by week 8.},
  language  = {en}
}
@article{SchuetzeRoehringVorlovaetal.2015,
  author    = {Sch{\"u}tze, Friedrich and R{\"o}hring, Florian and Vorlov{\´a}, Sandra and G{\"a}tzner, Sabine and Kuhn, Anja and Erg{\"u}n, S{\"u}leyman and Henke, Erik},
  title     = {Inhibition of lysyl oxidases improves drug diffusion and increases efficacy of cytotoxic treatment in 3D tumor models},
  series = {Scientific Reports},
  volume    = {5},
  journal   = {Scientific Reports},
  number    = {17576},
  doi       = {10.1038/srep17576},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-145109},
  year      = {2015},
  abstract  = {Tumors are characterized by a rigid, highly cross-linked extracellular matrix (ECM), which impedes homogeneous drug distribution and potentially protects malignant cells from exposure to therapeutics. Lysyl oxidases are major contributors to tissue stiffness and the elevated expression of these enzymes observed in most cancers might influence drug distribution and efficacy. We examined the effect of lysyl oxidases on drug distribution and efficacy in 3D in vitro assay systems. In our experiments elevated lysyl oxidase activity was responsible for reduced drug diffusion under hypoxic conditions and consequently impaired cytotoxicity of various chemotherapeutics. This effect was only observed in 3D settings but not in 2D-cell culture, confirming that lysyl oxidases affect drug efficacy by modification of the ECM and do not confer a direct desensitizing effect. Both drug diffusion and efficacy were strongly enhanced by inhibition of lysyl oxidases. The results from the in vitro experiments correlated with tumor drug distribution in vivo, and predicted response to therapeutics in murine tumor models. Our results demonstrate that lysyl oxidase activity modulates the physical barrier function of ECM for small molecule drugs influencing their therapeutic efficacy. Targeting this process has the potential to significantly enhance therapeutic efficacy in the treatment of malignant diseases.},
  language  = {en}
}
@article{GrimmigMoenchKreckeletal.2016,
  author    = {Grimmig, Tanja and Moench, Romana and Kreckel, Jennifer and Haack, Stephanie and Rueckert, Felix and Rehder, Roberta and Tripathi, Sudipta and Ribas, Carmen and Chandraker, Anil and Germer, Christoph T. and Gasser, Martin and Waaga-Gasser, Ana Maria},
  title     = {Toll Like Receptor 2, 4, and 9 Signaling Promotes Autoregulative Tumor Cell Growth and VEGF/PDGF Expression in Human Pancreatic Cancer},
  series = {International Journal of Molecular Sciences},
  volume    = {17},
  journal   = {International Journal of Molecular Sciences},
  number    = {12},
  doi       = {10.3390/ijms17122060},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165743},
  pages     = {2060},
  year      = {2016},
  abstract  = {Toll like receptor (TLR) signaling has been suggested to play an important role in the inflammatory microenvironment of solid tumors and through this inflammation-mediated tumor growth. Here, we studied the role of tumor cells in their process of self-maintaining TLR expression independent of inflammatory cells and cytokine milieu for autoregulative tumor growth signaling in pancreatic cancer. We analyzed the expression of TLR2, -4, and -9 in primary human cancers and their impact on tumor growth via induced activation in several established pancreatic cancers. TLR-stimulated pancreatic cancer cells were specifically investigated for activated signaling pathways of VEGF/PDGF and anti-apoptotic Bcl-xL expression as well as tumor cell growth. The primary pancreatic cancers and cell lines expressed TLR2, -4, and -9. TLR-specific stimulation resulted in activated MAP-kinase signaling, most likely via autoregulative stimulation of demonstrated TLR-induced VEGF and PDGF expression. Moreover, TLR activation prompted the expression of Bcl-xL and has been demonstrated for the first time to induce tumor cell proliferation in pancreatic cancer. These findings strongly suggest that pancreatic cancer cells use specific Toll like receptor signaling to promote tumor cell proliferation and emphasize the particular role of TLR2, -4, and -9 in this autoregulative process of tumor cell activation and proliferation in pancreatic cancer.},
  language  = {en}
}
@phdthesis{Kuen2017,
  author    = {Kuen, Janina},
  title     = {Influence of 3D tumor cell/fibroblast co-culture on monocyte differentiation and tumor progression in pancreatic cancer},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-156226},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2017},
  abstract  = {Pancreatic cancer (PC) remains one of the most challenging solid tumors to treat with a high unmet medical need as patients poorly respond to standard-of-care-therapies. Prominent desmoplastic reaction involving cancer-associated fibroblasts (CAFs) and the immune cells in the tumor microenvironment (TME) and their cross-talk play a significant role in tumor immune escape and progression. To identify the key cellular mechanisms induce an immunosuppressive tumor microenvironment, we established 3D co-culture model with pancreatic cancer cells, CAFs, monocyte as well as T cells. Using this model, we analysed the influence of tumor cells and fibroblasts on monocytes and their immune suppressive phenotype. Phenotypic characterization of the monocytes after 3D co-culture with tumor/fibroblast spheroids was performed by analysing the expression of defined cell surface markers and soluble factors. Functionality of these monocytes and their ability to influence T cell phenotype and proliferation was investigated. 3D co-culture of monocytes with pancreatic cancer cells and fibroblasts induced the production of immunosuppressive cytokines which are known to promote polarization of M2 like macrophages and myeloid derived suppressive cells (MDSCs). These co-culture spheroid polarized monocyte derived macrophages (MDMs) were poorly differentiated and had an M2 phenotype. The immunosuppressive function of these co-culture spheroids polarized MDMs was demonstrated by their ability to inhibit autologous CD4+ and CD8+ T cell activation and proliferation in vitro, which we could partially reverse by 3D co-culture spheroid treatment with therapeutic molecules that are able to re-activate spheroid polarized MDMs or block immune suppressive factors such as Arginase-I. In conclusion, we generated a physiologically relevant 3D co-culture model, which can be used as a promising tool to study complex cell-cell interactions between different cell types within the tumor microenvironment and to support drug screening and development. In future, research focused on better understanding of resistance mechanisms to existing cancer immunotherapies will help to develop new therapeutic strategies in order to combat cancer.},
  subject      = {monocyte},
  language  = {en}
}
@article{HaddadChenCarlinetal.2012,
  author    = {Haddad, Dana and Chen, Chun-Hao and Carlin, Sean and Silberhumer, Gerd and Chen, Nanhai G. and Zhang, Qian and Longo, Valerie and Carpenter, Susanne G. and Mittra, Arjun and Carson, Joshua and Au, Joyce and Gonen, Mithat and Zanzonico, Pat B. and Szalay, Aladar A. and Fong, Yuman},
  title     = {Imaging Characteristics, Tissue Distribution, and Spread of a Novel Oncolytic Vaccinia Virus Carrying the Human Sodium Iodide Symporter},
  series = {PLoS One},
  volume    = {7},
  journal   = {PLoS One},
  number    = {8},
  doi       = {10.1371/journal.pone.0041647},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-130041},
  pages     = {e41647},
  year      = {2012},
  abstract  = {Introduction: Oncolytic viruses show promise for treating cancer. However, to assess therapy and potential toxicity, a noninvasive imaging modality is needed. This study aims to determine the in vivo biodistribution, and imaging and timing characteristics of a vaccinia virus, GLV-1h153, encoding the human sodium iodide symporter (hNIS. Methods: GLV-1h153 was modified from GLV-1h68 to encode the hNIS gene. Timing of cellular uptake of radioiodide \(^{131}\)I in human pancreatic carcinoma cells PANC-1 was assessed using radiouptake assays. Viral biodistribution was determined in nude mice bearing PANC-1 xenografts, and infection in tumors confirmed histologically and optically via Green Fluorescent Protein (GFP) and bioluminescence. Timing characteristics of enhanced radiouptake in xenografts were assessed via \(^{124}\)I-positron emission tomography (PET). Detection of systemic administration of virus was investigated with both \(^{124}\)I-PET and 99m-technecium gamma-scintigraphy. Results: GLV-1h153 successfully facilitated time-dependent intracellular uptake of \(^{131}\)I in PANC-1 cells with a maximum uptake at 24 hours postinfection (P < 0.05). In vivo, biodistribution profiles revealed persistence of virus in tumors 5 weeks postinjection at 10\(^9\) plaque-forming unit (PFU)/gm tissue, with the virus mainly cleared from all other major organs. Tumor infection by GLV-1h153 was confirmed via optical imaging and histology. GLV-1h153 facilitated imaging virus replication in tumors via PET even at 8 hours post radiotracer injection, with a mean \% ID/gm of 3.82 \(\pm\) 60.46 (P < 0.05) 2 days after intratumoral administration of virus, confirmed via tissue radiouptake assays. One week post systemic administration, GLV1h153-infected tumors were detected via \(^{124}\)I-PET and 99m-technecium-scintigraphy. Conclusion: GLV-1h153 is a promising oncolytic agent against pancreatic cancer with a promising biosafety profile. GLV-1h153 facilitated time-dependent hNIS-specific radiouptake in pancreatic cancer cells, facilitating detection by PET with both intratumoral and systemic administration. Therefore, GLV-1h153 is a promising candidate for the noninvasive imaging of virotherapy and warrants further study into longterm monitoring of virotherapy and potential radiocombination therapies with this treatment and imaging modality.},
  language  = {en}
}
@article{KunzmannHerrmannBluemeletal.2014,
  author    = {Kunzmann, Volker and Herrmann, Ken and Bluemel, Christina and Kapp, Markus and Hartlapp, Ingo and Steger, Ulrich},
  title     = {Intensified neoadjuvant chemotherapy with nab-paclitaxel plus gemcitabine followed by FOLFIRINOX in a patient with locally advanced unresectable pancreatic cancer},
  series = {Case Reports in Oncology},
  volume    = {7},
  journal   = {Case Reports in Oncology},
  number    = {3},
  issn      = {1662-6575},
  doi       = {10.1159/000367966},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-120189},
  pages     = {648-55},
  year      = {2014},
  abstract  = {The prognosis of patients with locally advanced pancreatic cancer can be improved if secondary complete (R0) resection is possible. In patients initially staged as unresectable this may be achieved with neoadjuvant treatment which is usually chemoradiotherapy based. We report the case of a 46-year-old patient with an unresectable, locally advanced pancreatic cancer (pT4 Nx cM0 G2) who was treated with a sequential neoadjuvant chemotherapy regimen consisting of 2 cycles of nab-paclitaxel plus gemcitabine followed by 4 cycles of FOLFIRINOX. Neoadjuvant chemotherapy resulted in secondary resectability (R0 resection). After 2 cycles of nab-paclitaxel plus gemcitabine, the patient already had a complete metabolic remission as measured by integrated fludeoxyglucose ((18)F) positron emission tomography and computerized tomography. After a follow-up of 18 months the patient is alive without progression of disease. We propose to assess the clinical benefit of sequencing the combinations nab-paclitaxel plus gemcitabine and FOLFIRINOX as neoadjuvant therapy for patients with locally advanced and initially unresectable pancreatic cancer in a controlled clinical trial.},
  language  = {en}
}
@phdthesis{Munt2011,
  author    = {Munt, Meike},
  title     = {Untersuchung zur Wirksamkeit eines neuen anti-VEGF-Antik{\"o}rpers in Kombination mit Rapamycin beim Pankreaskarzinom im C57BL/6-Mausmodell},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-70854},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2011},
  abstract  = {Das Pankreaskarzinom stellt aufgrund seiner hohen Letalit{\"a}t ein bisher ungel{\"o}stes Behandlungs¬problem dar. Da die Erkrankung meist erst in einem sp{\"a}ten Stadium erkannt wird, sehr aggressiv verl{\"a}uft und effektive systemische Therapien bisher fehlen, betr{\"a}gt die 5-Jahres{\"u}berlebensrate nur etwa 1-4 \%. Daher ist die Entwicklung neuer Therapie¬strategien dringend notwendig. Geeignet daf{\"u}r sind neuartige Ans{\"a}tze einer gezielten Krebstherapie, die sich speziell gegen die tumorbiologischen Ver{\"a}nderungen des Pankreas¬karzinoms richten. Ziel dieser Arbeit war es, die beiden Wirkstoffe Rapamycin und anti-VEGF-Antik{\"o}rper allein und in Kombination auf ihre antitumor{\"o}sen Eigenschaften gegen{\"u}ber Panc02-Tumor¬zellen in drei aufeinander folgenden Versuchsans{\"a}tzen an einem Metasta¬sierungs¬modell in vivo zu unter¬suchen. Beurteilt wurden dabei zun{\"a}chst die {\"U}ber¬lebens¬zeit der Tiere und die Tumor¬aus¬dehnung in der Leber. Anschließend wurden anhand einer quantitativen PCR und der Immun¬histo¬logie die Auswirkungen des Tumors auf verschiedene Zellmarker und Zytokine im Milz-, Leber- und Tumorgewebe bestimmt. Aus den erhobenen Ergebnissen geht hervor, dass mit der Kombinationsbehandlung aus Rapa¬mycin (1,5 mg/kg/d) und anti-VEGF-Antik{\"o}rper das beste Tumor¬an¬sprechen mit einer der l{\"a}ngsten {\"U}berlebens¬zeiten und einem sehr geringen Tumor¬befall zu erreichen war. Die Monotherapie mit Rapa¬mycin zeigte zwar ebenfalls im Vergleich zu den anderen Behandlungsgruppen einen geringeren Tumorbefall, war aber mit einer k{\"u}rzeren {\"U}berlebenszeit assoziiert. Ein Grund f{\"u}r ein einge¬schr{\"a}nktes {\"U}berleben der mit Rapamycin behandelten Tiere k{\"o}nnte das Neben¬wirkungs¬profil von Rapa¬mycin sein. Die Behandlung mit dem anti-VEGF-Antik{\"o}rper erzielte weder hinsichtlich der {\"U}ber¬lebens¬zeit noch bez{\"u}glich des Tumorbefalls {\"u}berzeugende Ergebnisse. Der fehlende Antitumoreffekt der anti-VEGF-Antik{\"o}rper¬therapie k{\"o}nnte in der kurzen Behandlungsdauer des Antik{\"o}rpers begr{\"u}ndet sein. Bei der {\"U}berpr{\"u}fung der Dosierung von Rapamycin schnitt die Gruppe mit der niedrigsten Rapa¬mycindosis von 0,75 mg/kg/d am besten ab. Neben der l{\"a}ngsten {\"U}berlebenszeit wies sie ver¬glichen mit den anderen Gruppen den geringsten Tumorbefall auf. Ein erneuter Versuchsansatz mit der Kombination aus der reduzierten Rapamycin¬dosis (0,75 mg/kg/d) und dem anti-VEGF-Antik{\"o}rper konnte den zuvor erzielten Vorteil der Kombi¬nations¬behandlung nicht vollends best{\"a}tigen. Die Tumor¬aus¬breitung entsprach zwar dem Ergebnis der in der zweiten Versuchsreihe am besten abge¬schnittenen Gruppe, die {\"U}ber¬lebenszeit lag aber deutlich unter der der Vergleichs¬gruppen. In der Real-Time PCR ergab sich hinsichtlich des lymphozyt{\"a}ren Infiltra¬tions¬musters folgendes Bild: Im Milz-, Leber- und Tumorgewebe lag die Zahl der zyto¬toxischen T-Zellen {\"u}ber der der T-Helferzellen. Vor allem im Tumor¬gewebe war die Gen¬expression von CD8 deutlich erh{\"o}ht und teilweise mit einem besseren Tumor¬ansprechen assoziiert. Dies k{\"o}nnte auf eine effiziente Tumorimmunantwort der zyto¬toxischen T-Zellen hindeuten. Die Expression von CD4 war dagegen in allen drei Geweben relativ gering. Ferner konnte in der Real-Time PCR und in der Immun¬histo¬logie eine Steigerung der CD25-Genexpression im Leber- und Tumorgewebe im Vergleich zum Milzgewebe nachgewiesen werden. Dies k{\"o}nnte auf eine Ansammlung supprimierender regulatorischer T-Zellen im Tumor und damit eine ineffizientere Tumor¬immunantwort hindeuten. H{\"a}ufig liegt in Tumoren ein {\"U}berwiegen der Th2-Zellen vor. In unserer Studie zeigten die Th1-Zytokine wie IL-2, IFN-gamma or TNF-alpha eine heterogene Expression, sodass eine definitive Aussage {\"u}ber einen Th1/Th2-Shift nicht getroffen werden kann. Des Weiteren wurden die Auswirkungen des Tumors auf B7-H1 und PD-L2 sowie auf PD-1, einen ihrer Rezeptoren, untersucht. Die Ergebnisse best{\"a}tigen die Theorie des Tumorimmunescape-Mechanismus. Die in dieser Arbeit erhobenen Ergebnisse sollten nun dazu verwendet werden, gezielt neue immuno¬logische und anti¬angio¬genetische Therapiestrategien f{\"u}r die Behandlung des Pankreas¬karzinoms in der Klinik zu entwickeln. Allerdings zeigt die vorliegende Arbeit auch Ans{\"a}tze und Probleme auf, die zun{\"a}chst in weiteren Studien zu l{\"o}sen sind. So stellten beispielsweise die Neben¬wirkungen der Rapamycinbehandlung einen limitierenden Faktor in der Behandlung der Tiere dar. Auch sollte gekl{\"a}rt werden, ob der schwache Effekt der anti-VEGF-Anti¬k{\"o}rper¬behand¬lung in dieser Arbeit mit der kurzen Behandlungsdauer erkl{\"a}rt werden kann und m{\"o}glicherweise eine l{\"a}ngere Anwendung der VEGF-Antik{\"o}rper bessere Resultate erzielt.},
  subject      = {Sirolimus},
  language  = {de}
}
@phdthesis{Becker2011,
  author    = {Becker, Melanie},
  title     = {Untersuchungen zu prognoserelevanten Faktoren beim exokrinen Pankreaskarzinom - Eine retrospektive Patientenanalyse an der Chirurgischen Universit{\"a}tsklinik W{\"u}rzburg von 1990 bis 2004},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-70462},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2011},
  abstract  = {In einer retrospektiven Analyse wurden 224 Patienten mit exokrinem Pankreaskarzinom zwischen 1990 und 2004 an der Chirurgischen Universit{\"a}tsklinik W{\"u}rzburg erfasst. Ihre Daten wurden im Hinblick auf f{\"u}r die Erkrankung prognoserelevanten Faktoren ausgewertet. Es zeigte sich ein leichtes {\"U}berwiegen der Erkrankung beim m{\"a}nnlichen Geschlecht, sowie ein Altersgipfel in der 7. und 8. Lebensdekade. 29\% zeigten Fernmetastasen, 48\% regionalen Lymphknotenbefall und 36\% mit T4 einen lokal fortgeschrittenen Tumor. CA 19-9 zeigte sich signifikant abh{\"a}ngig von der lokalen Ausdehnung T des Prim{\"a}rtumors und hatte signifikanten Einfluss auf die M{\"o}glichkeit einer R0-Resektion. 50\% aller Patienten wurden mit kurativer Intention operiert, bei 33\% konnte R0 erreicht werden. R0 best{\"a}tigte sich wie bereits vorbeschrieben als wichtigster prognostischer Faktor f{\"u}r das Gesamt{\"u}berleben, daneben konnte f{\"u}r das Alter, die lokale Tumorausdehnung (T), den regionalen Lymphknotenstatus (N), Fernmetastasierung (M) und den histologischen Differenzierungsgrad (G) signifikanter prognostischer Einfluss nachgewiesen werden. Nach R0-Resektion h{\"a}ngt das Gesamt{\"u}berleben signifikant von N, G, der Perineuralscheideninfiltration und dem Auftreten einer postoperativen Infektion ab. F{\"u}r den Faktor der Perineuralscheideninfiltration wurde die Signifikanz in einer Subgruppenanalyse bei 35 Patienten im Stadium IIB nach R0-Resektion best{\"a}tigt.},
  subject      = {Bauchspeicheldr{\"u}senkrebs},
  language  = {de}
}
@phdthesis{Rasche2008,
  author    = {Rasche, Leo},
  title     = {Tumortherapie mit Cocktails aus humanen monoklonalen Antik{\"o}rpern},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-35809},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2008},
  abstract  = {Humane oder humanisierte monoklonale Antik{\"o}rper haben sich in den letzten zehn Jahren als Arzneimittel etabliert. Sie sind hochspezifisch und zeigen in ihrer Anwendung im Vergleich zu konventionellen Therapeutika viel weniger Nebenwirkungen. In den 80er Jahren gelang es am Pathologischen Institut der Universit{\"a}t W{\"u}rzburg eine Reihe von humanen Antik{\"o}rpern aus Patienten zu isolieren, die hochspezifisch mit malignen Zellen reagieren und diese sowohl in vitro als auch im experimentellen Tiermodel selektiv durch Induktion von Apoptose t{\"o}ten. Um die Wirkungsweise von monoklonalen Antik{\"o}rpern in der Krebstherapie zu erh{\"o}hen, werden die meisten in Kombination mit herk{\"o}mmlichen Methoden, wie Chemotherapie, eingesetzt. Die ideale Therapieform sind hinsichtlich der Nebenwirkungen sog. Cocktails aus verschiedenen monoklonalen Antik{\"o}rpern. Allerdings sind die Studien hierzu noch wenig fortgeschritten. Das Ziel dieser Arbeit war es, in pr{\"a}klinischen Versuchsreihen den Einsatz verschiedener tumorspezifischer humaner monoklonaler Antik{\"o}rper als Cocktail und in Kombination mit Chemotherapie zu evaluieren. Hierzu wurden neun Antik{\"o}rper in 32 verschiedenen Antik{\"o}rperkombinationen hinsichtlich ihrer Auswirkungen auf die in vitro Proliferation einer Pankreaskarzinom-Zellinie untersucht. In Immunfluoreszenz-Aufnahmen ließ sich zeigen, dass kombinierte Antik{\"o}rper an unterschiedlichen Stellen an der Zelle binden, was eindeutig auf verschiedene Zielstrukturen hinweist. Einige werden dabei endozytiert, w{\"a}hrend andere auf der Zellmembran bleiben. Interessanterweise ließen sich Kombinationen identifizieren, deren antiproliferative Wirkung sowohl additiv als auch synergistisch ist, das heißt gr{\"o}ßer als die Summe ihrer Einzelaktivit{\"a}ten. Wurden Antik{\"o}rper mit Zytostatika (5-Flurouracil) kombiniert, so ließen sich ebenfalls synergistische Effekte beobachten. In FACS-Analysen zeigt sich ein gesteigertes Bindungsverhalten der Antik{\"o}rper, wenn die Zellen mit 5-FU vorinkubiert wurden. Zusammenfassend best{\"a}tigen die Ergebnisse dieser Arbeit die Beobachtung, dass die Wirkung humaner monoklonaler Antik{\"o}rper in Kombination mit Chemotherapie erh{\"o}ht werden kann. F{\"u}r die Zukunft humaner Antik{\"o}rper als Therapiemittel gegen maligne Erkrankungen mag allerdings noch wichtiger sein, dass Antik{\"o}per in Cocktails tats{\"a}chlich synergistische Wirkung zeigen k{\"o}nnen.},
  subject      = {Monoklonaler Antik{\"o}rper},
  language  = {de}
}
@phdthesis{Fertinger2007,
  author    = {Fertinger, Julia},
  title     = {Untersuchungen zur Expression von Toll-like Rezeptoren im Pankreas- und Nierenzellkarzinom sowie im kolorektalen Karzinom},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-22952},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2007},
  abstract  = {Die dauerhafte Aktivierung des Transkriptionsfaktors NF-\&\#312;B f{\"u}hrt zu einem inflammatorischen Reiz, der f{\"u}r die Entstehung und Progression von Tumoren von großer Bedeutung ist. In diesem Zusammenhang wurde das Expressionsmuster von Toll-like Rezeptoren stadienabh{\"a}ngig f{\"u}r das Pankreas- und Nierenzellkarzinom sowie das kolorektale Karzinom analysiert. Die Ergebnisse der hier vorliegenden Arbeit weisen auf eine besondere Rolle bei der Tumorprogression durch Toll-like Rezeptoren hin. Diese Arbeit zeigt, dass TLRs nicht nur wie bislang beschrieben, die humorale Immunantwort stimulieren, sondern durch Expression auf oder in Tumorzellen Einfluss auf das weitere Tumorwachstum nehmen k{\"o}nnen. Die Daten lassen damit schlussfolgern, dass je nach Tumorgewebe Toll-like Rezeptoren unterschiedlich stark exprimiert werden und eine bisher wenig ber{\"u}cksichtigte Kausalit{\"a}t hinsichtlich der Tumorprogression vermuten lassen. Eine virale Pathogenese durch das Genom per se in Interaktion mit den TLRs sei besonders bei Progression des Pankreaskarzinoms durch TLR7 und TLR8 vermutet. Eine {\"a}hnliche Kausalit{\"a}t bei Progression sei vor allem durch Interaktion viraler Genome mit TLR7, TLR8 und TLR9 beim kolorektalen Karzinom vermutet. Die Aktivierung von TLR7, TLR8 und TLR9 scheint beim Nierenzellkarzinom ebenfalls eine Rolle zu spielen. Auch ein bakterieller Faktor bei Tumorprogression kann vermutet werden. Diese Ergebnisse weisen auf eine Kombination einer bakteriellen und viralen Pathogenese beim Pankreaskarzinom hin und liefern somit eine m{\"o}gliche mitbegr{\"u}ndende Kausalit{\"a}t f{\"u}r die schlechte Prognose und rasche Progression dieses b{\"o}sartigsten Tumors. Der chronische Entz{\"u}ndungsreiz stellt einen außerordentlich wichtigen Prozess bei Tumorprogression dar. Diese mit der Zielsetzung der Arbeit verbundenen Erkenntnisse weisen neue Wege f{\"u}r die Tumortherapie auf, einen chronischen Entz{\"u}ndungsprozess durch Blockierung von Toll-like Rezeptoren zu unterbinden. Somit k{\"o}nnten Wachstum, Neoangiogenese und Metastasierung m{\"o}glicherweise verlangsamt oder sogar verhindert werden. Die Therapie maligner Erkrankungen mit herk{\"o}mmlichen zytostatischen Methoden zielt vorwiegend auf die stoffwechselabh{\"a}ngigen Vorg{\"a}nge der Zellproliferation ab. Es befindet sich aber nur ein relativ kleiner Anteil aller Tumorzellen in einer Proliferationsphase. Die Entdeckung und Differenzierung zellst{\"a}ndiger, tumorassoziierter Antigene und die Herstellung spezifischer Antik{\"o}rper stellt in diesem Zusammenhang ein neuartiges, zellphasenunabh{\"a}ngiges Wirkprinzip dar. Das l{\"a}sst auf eine effektivere und nebenwirkungs{\"a}rmere Tumortherapie hoffen. Bei verschiedenen Tumorerkrankungen erweist sich die Immuntherapie mit Antik{\"o}rpern zunehmend als eine erfolgsversprechende Therapieform. Sie hat sich mittlerweile neben den herk{\"o}mmlichen Behandlungsans{\"a}tzen, der Operation, Chemotherapie und Bestrahlung, als vierte S{\"a}ule fest etabliert. Insbesondere beim kolorektalen Karzinom sowie bei Lymphomen entwickelte sich die immunologische Tumortherapie in den letzten Jahren von der experimentellen Phase zu einer Standardtherapie. Da die Expression von Toll-like Rezeptoren auf Tumoren, wie in der vorliegenden Arbeit gesehen, stark hochreguliert ist und eine vergleichsweise geringe Expression auf Normalgewebe ersichtlich war, eignen sich Toll-like Rezeptoren daher als potentielle Ziele f{\"u}r eine immunologische Tumortherapie mit monoklonalen Antik{\"o}rpern.},
  language  = {de}
}