0074). Ang1 expression levels in RCC and in Trichostatin A order other tumor types were lower than in normal kidney tissue (P < 0.001). VEGF, VEGFR2, and CD31 gene expression levels were all higher in ccRCC than in other tumors (8.4-fold for VEGF, P < 0.001; 6.3-fold for VEGFR2, P < 0.001; and 4.0-fold
for CD31, P < 0.001; Figure 1). VEGF gene expression level was 3.4-fold higher in ccRCC than in normal kidney (P = 0.0499). Plasma Ang2 was significantly higher in patients with metastatic RCC (n = 50; median 3720 pg/ml; range [1010, 29,006]) compared to plasma from healthy controls (n = 26; median 2255 pg/ml; [664, 6545]) and patients with stage I disease (n = 39; median 1394 pg/ml; [520, 7784]; P < 0.001; Figure 2A). Characteristics for the metastatic RCC Ganetespib order cohort are shown in Table 2. Ang2 levels were also measured in patients at baseline, approximately day 29 (median day 34.5) after sunitinib initiation and at the time of disease
progression on sunitinib. Plasma Ang2 levels decreased on sunitinib therapy (n = 39 pairs; median baseline 3387 pg/ml, range [1010, 14149], median on sunitinib (day 29) 1721 pg/ml; [325, 6584], P < 0.01) and increased from day 29 at the time of disease progression (n = 28 pairs; 2654.56 pg/ml; [1284, 10555]; P < 0.01; Figure 2B). Of the patients with baseline and day 29 samples, 5 of the 39 (13%) had dose modifications during this period and of the 28 patients in the day 29/progression group, 7 (25%) had dose modifications during the time they were on therapy. The effects of single agent mL4-3 (Ang1 inhibitor), L1-7 (Ang2 inhibitor), and trebananib (Ang1/2 inhibitor) were assessed on A498 RCC tumor growth. As single agents, trebananib and L1-7 slowed A498 RCC tumor growth compared to Fc control. mL4-3 showed little effect on A498 RCC tumor growth (Figure 3A). To assess the impact of Ang inhibition on tumor perfusion, ASL MRI was performed on three or more tumors in each group at baseline, 1 and 3 weeks after treatment. A significant reduction in tumor perfusion was observed after trebananib or L1-7
treatment but not mL4-3 compared to Fc control group at day 7 (Fc: 142.9 ± 17.5 ml/100 g per min vs L1-7: 50.6 ± 23.6 ml/100 g per min, P = 0.006; vs trebananib: 60.2 ± 22.8 ml/100 g per min, unless P = 0.008; vs mL4-3: 113.1 ± 24.8 ml/100 g per min, P = 0.204) and day 21 (Fc: 88.4 ± 40.9 ml/100 g per min vs L1-7: 28.1 ± 7.3 ml/100 g per min, P = 0.049; vs trebananib: 37.8 ± 11.3 ml/100 g per min, P = 0.029; vs mL4-3: 68.4 ± 14.5 ml/100 g per min, P = 0.566; Figure 3, B (representative images) and C). This is consistent with previous reports that Ang2 blockade inhibits tumor angiogenesis in other tumor models [9] and [20]. Sunitinib is an established treatment for patients with RCC; however, despite initial responses, resistance develops in all patients. We assessed the effect of combining Ang1 and/or Ang2 inhibition and VEGFR inhibition with sunitinib (Figure 4).
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