Hyperthermia improves the antitumour effect of metronomic cyclophosphamide in a rat transplantable brain tumour.

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Radiother Oncol. 2008 Mar;86(3):435-42. Epub 2008 Mar 4.
Borkamo ED, Fluge O, Mella O, Akslen LA, Bruland O, Dahl O.Section of Oncology, Institute of Medicine, University of Bergen, Bergen, Norway.

As low-dose metronomic Cyclophosphamide(Sendoxan) (CTX) and
hyperthermia (HT) both exert antitumour effects in part through
antiangiogenic mechanisms, interactive effects of the two modalities
were explored.
MATERIALS AND METHODS: Subcutaneously implanted rat
tumours (BT4An) were treated with CTX 35 mg/kg i.p. three doses a week
for two weeks, local water-bath HT yielding mean tumour temperature of
43 degrees C for one hour at day 0, both modalities combined
(CTX-HT(0)), or saline. TUNEL assays, immunohistochemical staining of
thrombospondin 1 (TSP-1) and real time RT-PCR of TSP-1 mRNA were
analysed the first three hours after completed treatment day 0.

RESULTS: Metronomic dosed CTX (p=0.006) and HT (p<0.001) both
delayed tumour growth. The combined regimen was superior to either
modality alone (p<0.001). Complete tumour regressions were observed
in CTX (6%), HT (12%), and CTX-HT(0) (41%) treated rats. TSP-1 protein
was specifically upregulated in the vascular matrix of tumours
receiving CTX (weak), HT (moderate) and CTX-HT(0) (strong). In
contrast, reduced expression of TSP-1 protein was observed in tumour
cells after HT alone and CTX-HT(0). TUNEL assays indicated induction of
apoptosis by HT and CTX-HT(0) 90 minutes after end of the first
CONCLUSION: A single session of local HT enhances the
effects of low-dose metronomic CTX, possibly in part mediated through a
differential effect on TSP-1 protein levels in tumour cells and tumour