Tag Archives: Liz Tilberis Award

Estrogen Replacement Therapy Speeds Growth of ER+ Ovarian Cancer & Increases Risk of Lymph Node Metastasis

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Estrogen therapy used by menopausal women causes “estrogen receptor positive” (ER+) ovarian cancer to grow five times faster, according to a new study being published by researchers at the University of Colorado Cancer Center in the November 1 issue of Cancer Research.

Estrogen therapy used by menopausal women causes so-called “estrogen receptor positive” (ER+) ovarian cancer to grow five times faster, according to a new study being published tomorrow by researchers at the University of Colorado Cancer Center.

Menopausal estrogen replacement therapy (ERT) also significantly increases the likelihood of the cancer metastasizing to the lymph nodes, according to the study, which will be published in the November 1 issue of Cancer Research. The study was released online on Oct. 19, 2010. Cancer Research, published by the American Association for Cancer Research, is the world’s largest (based upon circulation) medical journal devoted specifically to cancer research.

The effect of ERT was shown in mouse models of estrogen receptor positive (ER+) ovarian cancer, which accounts for about 60 percent of all human ovarian cancer cases. Ovarian cancer is one of the deadliest cancers affecting women. This year alone, nearly 22,000 women will be newly diagnosed with ovarian cancer and an estimated 13,850 women will die from the disease, according to the National Cancer Institute.

Monique Spillman, M.D., Ph.D., Gynecologic Oncologist, University of Colorado Hospital; Assistant Professor, Obstetrics & Gynecology, University of Colorado School of Medicine.

“We showed that estrogen replacement substantially increases proliferation and risk of distant lymph node metastasis in ER+ tumors,” says Monique Spillman, M.D., Ph.D., the study’s lead researcher, a gynecologic oncologist at University of Colorado Hospital and assistant professor at of obstetrics and gynecology at the University of Colorado School of Medicine.

For the first time, Spillman and her team measured ovarian cancer growth in the abdomen of mice using novel techniques for visualizing the cancer. In mice with ER+ ovarian cancer cells, which were tagged with a firefly-like fluorescent protein that allowed them to be tracked, the introduction of estrogen therapy made the tumors grow five times faster than in mice that did not receive the ERT. The risk of the cancer moving to the lymph nodes increased to 26 percent in these mice compared with 6 percent in mice that did not receive ERT.

The team also found that the estrogen-regulated genes in ovarian cancer reacted differently than ER+ genes found in breast cancer, helping to explain why current anti-estrogen therapies used with breast cancer, such as tamoxifen, are largely ineffective against ovarian cancer.

“Breast cancer and ovarian cancer are often linked when talking about hormone replacement therapy, but we found that only 10 percent of the ER+ genes overlapped,” Spillman says. “We were able to identify estrogen-regulated genes specific to ER+ ovarian cancer that are not shared with ER+ breast cancers. We believe these genes can be specifically targeted with new anti-estrogen therapies that could more effectively treat ER+ ovarian cancers.”

“Breast cancer and ovarian cancer are often linked when talking about hormone replacement therapy, but we found that only 10 percent of the ER+ genes overlapped.  We were able to identify estrogen-regulated genes specific to ER+ ovarian cancer that are not shared with ER+ breast cancers. We believe these genes can be specifically targeted with new anti-estrogen therapies that could more effectively treat ER+ ovarian cancers.”

— Monique Spillman, M.D., Ph.D., Gynecologic Oncologist, University of Colorado Hospital; Assistant Professor, Obstetrics & Gynecology, University of Colorado School of Medicine.

Spillman and her team now will begin to screen current anti-estrogen therapies against the newly identified ovarian cancer genes to identify the [biological] pathways and compounds relevant to the treatment for ER+ ovarian cancer.

This study looked at the effect of estrogen replacement therapy in mice that already possessed ER+ ovarian cancer cells. It did not test whether the estrogen replacement actually could cause the development of these cancer cells. The study also dealt only with estrogen replacement, which is linked to higher risks of ovarian cancer, not combined estrogen/progesterone therapy that is used with women who retain their uteruses.

This research is too early to draw implications for use of estrogen replacement therapy in women, Spillman cautions. “We cannot make clinical recommendations based on what is happening in mice,” says Spillman, one of just eight gynecological oncologists in Colorado. “Every woman is different and needs to talk to her doctor about the decision to use hormone replacement therapy.”

The study was funded by a Gynecologic Cancer Foundation Career Development Award and the Liz Tilberis Scholars Award from the Ovarian Cancer Research Foundation. This competitive award, a $450,000 three-year grant, is given to early-career researchers who are developing techniques for early diagnosis and improved care for women with ovarian cancer.

About the University of Colorado Cancer Center

The University of Colorado Cancer Center is the Rocky Mountain region’s only National Cancer Institute-designated comprehensive cancer center. NCI has given only 40 cancer centers this designation, deeming membership as “the best of the best.” Headquartered on the University of Colorado Denver Anschutz Medical Campus, UCCC is a consortium of three state universities (Colorado State University, University of Colorado at Boulder and University of Colorado Denver) and five institutions (The Children’s Hospital, Denver Health, Denver VA Medical Center, National Jewish Health and University of Colorado Hospital). Together, our 440+ members are working to ease the cancer burden through cancer care, research, education and prevention and control. Learn more at www.uccc.info.

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Trojan Horse* For Ovarian Cancer–Nanoparticles Turn Immune System Soldiers Against Tumor Cells

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In a feat of trickery, Dartmouth Medical School immunologists have devised a Trojan horse to help overcome ovarian cancer, unleashing a surprise killer in the surroundings of a hard-to-treat tumor. Using nanoparticles–ultra small bits– the team has reprogrammed a protective cell that ovarian cancers have corrupted to feed their growth, turning the cells back from tumor friend to foe. Their research, published online July 13 for the August Journal of Clinical Investigation, offers a promising approach to orchestrate an attack against a cancer whose survival rates have barely budged over the last three decades …

Hanover, N.H.—In a feat of trickery, Dartmouth Medical School immunologists have devised a Trojan horse to help overcome ovarian cancer, unleashing a surprise killer in the surroundings of a hard-to-treat tumor.

Using nanoparticles–ultra small bits– the team has reprogrammed a protective cell that ovarian cancers have corrupted to feed their growth, turning the cells back from tumor friend to foe. Their research, published online July 13 for the August Journal of Clinical Investigation, offers a promising approach to orchestrate an attack against a cancer whose survival rates have barely budged over the last three decades.

Dr. Jose Conejo-Garcia (right) with graduate student Juan Cubillos-Ruiz (Photo Source: Dartmouth Medical School News Release,

Dr. Jose Conejo-Garcia (right) with graduate student Juan Cubillos-Ruiz (Photo Source: Dartmouth Medical School News Release, 13 Jul. 09)

“We have modulated elements of the tumor microenvironment that are not cancer cells, reversing their role as accomplices in tumor growth to attackers that boost responses against the tumor,” said Dr. Jose Conejo-Garcia, assistant professor of microbiology and immunology and of medicine, who led the research. “The cooperating cells hit by the particles return to fighters that immediately kill tumor cells.”

The study, in mice with established ovarian tumors, involves a polymer now in clinical trials for other tumors. The polymer interacts with a receptor that senses danger to activate cells that trigger an inflammatory immune response.

The Dartmouth work focuses on dendritic cells–an immune cell particularly abundant in the ovarian cancer environment. It does take direct aim at tumor cells, so it could be an amenable adjunct to other current therapies.

“The cooperating cells hit by the particles return to fighters that immediately kill tumor cells.” —Dr. Jose Conejo-Garcia

“That’s the beautiful part of story–people usually inject these nanoparticles to target tumor cells. But we found that these dendritic cells that are commonly present in ovarian cancer were preferentially and avidly engulfing the nanoparticles. We couldn’t find any tumor cells taking up the nanoparticles, only the dendritic cells residing in the tumor,” explained Juan R. Cubillos-Ruiz, graduate student and first author.

Dendritic cells are phagocytes–the soldiers of the immune system that gobble up bacteria and other pathogens, but ovarian cancer has co-opted them for its own use, he continued. “So we were trying to restore the attributes of these dendritic cells–the good guys; they become Trojan horses.”

Cancer is more than tumor cells; many other circulating cells including the dendritic phagocytes converge to occupy nearby space. The dendritic cells around ovarian cancer scoop up the nanocomplexes, composed of a polymer and small interfering RNA (siRNA) molecules to silence their immunosuppressive activity.

Nanoparticle incorporation transforms them from an immunosuppressive to an immunostimulatory cell type at tumor locations, provoking anti-tumor responses and also directly killing tumor cells. The effect is particularly striking with an siRNA designed to silence the gene responsible for making an immune protein called PD-L.

The new findings also raise a warning flag about the use of gene silencing complexes in cancer treatment. Inflammation is a helpful immune response, but the researchers urge caution when using compounds that can enhance inflammation in a patient already weakened by cancer.

Ovarian cancer, which claims an estimated 15,000 US lives a year, is an accessible disease for nanoparticle delivery, according to the investigators. Instead of systemic administration, complexes can be put directly into the peritoneal cavity where the phagocytes take them up.

Samples of human ovarian cancer cells show similar responses to nanoparticle stimulation, the researchers observed, suggesting feasibility in the clinical setting. It could be part of a “multimodal approach,” against ovarian cancer, said Conejo-Garcia also a member of the Dartmouth’s Norris Cotton Cancer Center. “The prevailing treatment is surgical debulking, followed by chemotherapy. Our findings could complement those because they target not the tumor cells themselves, but different cells present around the tumor.”

Co-authors are Xavier Engle, Uciane K. Scarlett, Diana Martinez, Amorette Barber, Raul Elgueta, Li Wang, Yolanda Nesbeth and Charles Sentman of Dartmouth; Yvon Durant of University of New Hampshire, Andrew T Gewirtz of Emory, and Ross Kedl of University of Colorado.

The work was supported by grants from the National Institutes of Health, including the National Cancer Institute and National Center for Research Resources, a Liz Tilberis Award from the Ovarian Cancer Research Fund, and the Norris Cotton Cancer Center Nanotechnology Group Award.

Read an interview of Jose Conejo – Garcia with the Ovarian Cancer Research Fund.

Source: Trojan Horse for Ovarian Cancer–Nanoparticles Turn Immune System Soldiers against Tumor Cells, News Release, Dartmouth Medical School, July 13, 2009 (summarizing Cubillos-Ruiz JR, Engle X, Scarlett UK, et. al. Polyethylenimine-based siRNA nanocomplexes reprogram tumor-associated dendritic cells via TLR5 to elicit therapeutic antitumor immunity. J Clin Invest. 2009 Aug 3;119(8):2231-2244. doi: 10.1172/JCI37716. Epub 2009 Jul 13).

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* The Trojan Horse was a tale from the Trojan War, as told in Virgil’s Latin epic poem The Aeneid. The events in this story from the Bronze Age took place after Homer’s Iliad, and before Homer’s Odyssey. It was the strategy that allowed the Greeks finally to enter the city of Troy and end the conflict. In the best-known version, after a fruitless 10-year siege of Troy, the Greeks built a huge horse figure and hid a select force of men within it. The Greeks left the Horse at the city gates of Troy and pretended to sail away.  Thereafter, the Trojans pulled the Horse into their city as a victory trophy. That night the Greek force crept out of the Horse and opened the gates for the returning Greek army, which had sailed back to Troy under cover of night. The Greek army entered and destroyed the city, decisively ending the war. A “Trojan Horse” has come to mean any trick that causes a target to invite a foe into a securely protected bastion or place.