Cited by 19Ovarian cancer diagnosis and treatmentAutophagy in Disease and TherapyCalcium signaling and nucleotide metabolism

Repurposing Itraconazole and Hydroxychloroquine to Target Lysosomal Homeostasis in Epithelial Ovarian Cancer

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Marastoni, Stefano, Madariaga, Ainhoa, Pesic, Aleksandra, Nair, Sree Narayanan, Li, Zhu Juan, Shalev, Zvi, Ketela, Troy, Colombo, Ilaria +18 more·2022·Cancer Research Communications

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Abstract

Drug repurposing is an attractive option for oncology drug development. Itraconazole is an antifungal ergosterol synthesis inhibitor that has pleiotropic actions including cholesterol antagonism, inhibition of Hedgehog and mTOR pathways. We tested a panel of 28 epithelial ovarian cancer (EOC) cell lines with itraconazole to define its spectrum of activity. To identify synthetic lethality in combination with itraconazole, a whole-genome drop-out genome-scale clustered regularly interspaced short palindromic repeats sensitivity screen in two cell lines (TOV1946 and OVCAR5) was performed. On this basis, we conducted a phase I dose-escalation study assessing the combination of itraconazole and hydroxychloroquine in patients with platinum refractory EOC (NCT03081702). We identified a wide spectrum of sensitivity to itraconazole across the EOC cell lines. Pathway analysis showed significant involvement of lysosomal compartments, the trans-golgi network and late endosomes/lysosomes; similar pathways are phenocopied by the autophagy inhibitor, chloroquine. We then demonstrated that the combination of itraconazole and chloroquine displayed Bliss defined synergy in EOC cancer cell lines. Furthermore, there was an association of cytotoxic synergy with the ability to induce functional lysosome dysfunction, by chloroquine. Within the clinical trial, 11 patients received at least one cycle of itraconazole and hydroxychloroquine. Treatment was safe and feasible with the recommended phase II dose of 300 and 600 mg twice daily, respectively. No objective responses were detected. Pharmacodynamic measurements on serial biopsies demonstrated limited pharmacodynamic impact. In vitro, itraconazole and chloroquine have synergistic activity and exert a potent antitumor effect by affecting lysosomal function. The drug combination had no clinical antitumor activity in dose escalation. Significance: The combination of the antifungal drug itraconazole with antimalarial drug hydroxychloroquine leads to a cytotoxic lysosomal dysfunction, supporting the rational for further research on lysosomal targeting in ovarian cancer.

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  1. [1]Noone AM, Krapcho M, Miller D, Brest A, Yu M, Ruhl J,. SEER Cancer Statistics Review, 1975–2015, NCI, Bethesda, MD, https//seer.cancer.gov/csr/1975_2015/, based Novemb 2017 SEER data submission, posted to SEER web site, April; 2018.

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Authors
Marastoni, S., Madariaga, A., Pesic, A., Nair, S. N., Li, Z. J., Shalev, Z., Ketela, T., Colombo, I., Mandilaras, V., Cabanero, M., Bruce, J. P., Li, X., Garg, S., Wang, L., Chen, E. X., Gill, S., Dhani, N. C., Zhang, W., Pintilie, M., Bowering, V., Koritzinsky, M., Rottapel, R., Wouters, B. G., Oza, A. M., Joshua, A. M., & Lheureux, S.
Affiliations
  • University Health Network (CA)
  • Universitat Autònoma de Barcelona (ES)
  • Princess Margaret Cancer Centre (CA)
  • Toronto General Hospital (CA)
  • 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
  • 2Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Corresponding author
Joshua, Anthony M.
Venue
Cancer Research Communications
Published
2022-05-04
Volume
2
Issue
5
Pages
293-306
ISSN
2767-9764 (ISSN-L)
OpenAlex
W4224857498
Cited by
19
References
52
Citations by year
2026: 6 · 2025: 6 · 2024: 3 · 2023: 4
FWCI
2.74
Type
journal article
Language
en
Open access
Locations
  • Cancer Research Communications (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
Funders
Government of Ontario (OICR-TRI-Ovarian)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
  • Health Sciences › Medicine › Epidemiology › Autophagy in Disease and Therapy
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Physiology › Calcium signaling and nucleotide metabolism
Keywords
itraconazole, hydroxychloroquine, drug repurposing, epithelial ovarian cancer, lysosomal dysfunction, lysosomal homeostasis, synthetic lethality, chloroquine, synergistic cytotoxicity, late endosomes, trans-Golgi network, platinum-refractory ovarian cancer, pharmacodynamics
MeSH terms
Carcinoma, Ovarian Epithelial, Antifungal Agents, Antineoplastic Agents, Chloroquine, Female, Homeostasis, Humans, Hydroxychloroquine, Lysosomes, Ovarian Neoplasms, Itraconazole, Drug Repositioning

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