Cabozantinib Resolves Bone Scans in Tumor-Naïve Mice Harboring Skeletal Injuries

The receptor tyrosine kinase inhibitor cabozantinib (XL184, BMS-907351 Cometriq) has displayed impressive clinical activity against several indications, culminating in its recent approval for medullary thyroid cancer. Among malignancies with tropism for the bone (prostate, breast), one striking feat...

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Main Authors: Michael G. Doran, Daniel E. Spratt, John Wongvipat, David Ulmert, Brett S. Carver, Charles L. Sawyers, Michael J. Evans
Format: Article
Language:English
Published: SAGE Publishing 2014-10-01
Series:Molecular Imaging
Online Access:https://doi.org/10.2310/7290.2014.00026
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author Michael G. Doran
Daniel E. Spratt
John Wongvipat
David Ulmert
Brett S. Carver
Charles L. Sawyers
Michael J. Evans
author_facet Michael G. Doran
Daniel E. Spratt
John Wongvipat
David Ulmert
Brett S. Carver
Charles L. Sawyers
Michael J. Evans
author_sort Michael G. Doran
collection DOAJ
description The receptor tyrosine kinase inhibitor cabozantinib (XL184, BMS-907351 Cometriq) has displayed impressive clinical activity against several indications, culminating in its recent approval for medullary thyroid cancer. Among malignancies with tropism for the bone (prostate, breast), one striking feature of early clinical reports about this drug has been the rapid and complete resolution of bone scans, a phenomenon almost never observed even among therapies already shown to confer survival benefit. In castration-resistant prostate cancer, not all conventional response indicators change as dramatically posttreatment, raising the possibility that cabozantinib may impair the ability of bone-seeking radionuclides to integrate within the remodeling bone. To test this hypothesis, we surgically induced bone remodeling via physical insult in non–tumor-bearing mice and performed 18 F-sodium fluoride ( 18 F-NaF) positron emission tomographic (PET) and technetium 99m–methylene diphosphonate ( 99m Tc-MDP) single-photon emission computed tomographic (SPECT) scans pre- and posttreatment with cabozantinib and related inhibitors. A consistent reduction in the accumulation of either radiotracer at the site of bone remodeling was observed in animals treated with cabozantinib. Given that cabozantinib is known to inhibit several receptor tyrosine kinases, we drugged animals with various permutations of more selective inhibitors to attempt to refine the molecular basis of bone scan resolution. Neither the vascular endothelial growth factor receptor (VEGFR) inhibitor axitinib, the MET inhibitor crizotinib, nor the combination was capable of inhibiting 18 F-NaF accumulation at known bioactive doses. In summary, although the mechanism by which cabozantinib suppresses radionuclide incorporation into foci undergoing bone remodeling remains unknown, that this phenomenon occurs in tumor-naïve models indicates that caution should be exercised in interpreting the clinical significance of this event.
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spelling doaj-art-ef405d08c19d442a82309a912e6f08832025-01-03T00:12:14ZengSAGE PublishingMolecular Imaging1536-01212014-10-011310.2310/7290.2014.0002610.2310_7290.2014.00026Cabozantinib Resolves Bone Scans in Tumor-Naïve Mice Harboring Skeletal InjuriesMichael G. DoranDaniel E. SprattJohn WongvipatDavid UlmertBrett S. CarverCharles L. SawyersMichael J. EvansThe receptor tyrosine kinase inhibitor cabozantinib (XL184, BMS-907351 Cometriq) has displayed impressive clinical activity against several indications, culminating in its recent approval for medullary thyroid cancer. Among malignancies with tropism for the bone (prostate, breast), one striking feature of early clinical reports about this drug has been the rapid and complete resolution of bone scans, a phenomenon almost never observed even among therapies already shown to confer survival benefit. In castration-resistant prostate cancer, not all conventional response indicators change as dramatically posttreatment, raising the possibility that cabozantinib may impair the ability of bone-seeking radionuclides to integrate within the remodeling bone. To test this hypothesis, we surgically induced bone remodeling via physical insult in non–tumor-bearing mice and performed 18 F-sodium fluoride ( 18 F-NaF) positron emission tomographic (PET) and technetium 99m–methylene diphosphonate ( 99m Tc-MDP) single-photon emission computed tomographic (SPECT) scans pre- and posttreatment with cabozantinib and related inhibitors. A consistent reduction in the accumulation of either radiotracer at the site of bone remodeling was observed in animals treated with cabozantinib. Given that cabozantinib is known to inhibit several receptor tyrosine kinases, we drugged animals with various permutations of more selective inhibitors to attempt to refine the molecular basis of bone scan resolution. Neither the vascular endothelial growth factor receptor (VEGFR) inhibitor axitinib, the MET inhibitor crizotinib, nor the combination was capable of inhibiting 18 F-NaF accumulation at known bioactive doses. In summary, although the mechanism by which cabozantinib suppresses radionuclide incorporation into foci undergoing bone remodeling remains unknown, that this phenomenon occurs in tumor-naïve models indicates that caution should be exercised in interpreting the clinical significance of this event.https://doi.org/10.2310/7290.2014.00026
spellingShingle Michael G. Doran
Daniel E. Spratt
John Wongvipat
David Ulmert
Brett S. Carver
Charles L. Sawyers
Michael J. Evans
Cabozantinib Resolves Bone Scans in Tumor-Naïve Mice Harboring Skeletal Injuries
Molecular Imaging
title Cabozantinib Resolves Bone Scans in Tumor-Naïve Mice Harboring Skeletal Injuries
title_full Cabozantinib Resolves Bone Scans in Tumor-Naïve Mice Harboring Skeletal Injuries
title_fullStr Cabozantinib Resolves Bone Scans in Tumor-Naïve Mice Harboring Skeletal Injuries
title_full_unstemmed Cabozantinib Resolves Bone Scans in Tumor-Naïve Mice Harboring Skeletal Injuries
title_short Cabozantinib Resolves Bone Scans in Tumor-Naïve Mice Harboring Skeletal Injuries
title_sort cabozantinib resolves bone scans in tumor naive mice harboring skeletal injuries
url https://doi.org/10.2310/7290.2014.00026
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