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Enhancing effect of bevacizumab in the classic bleomycin, etoposide, cisplatin treatment applied in human testicular germ cell tumors

Yıl 2025, Cilt: 50 Sayı: 3, 683 - 692, 30.09.2025
https://doi.org/10.17826/cumj.1662892

Öz

Purpose: This study aimed to evaluate the therapeutic potential of Bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor, in combination with the standard Bleomycin, Etoposide, and Cisplatin (BEP) regimen for the treatment of testicular germ cell tumors (TGCTs). The primary focus was to investigate its ability to enhance treatment efficacy while reducing cytotoxic side effects.
Materials and Methods: The half-maximal inhibitory concentration (IC₅₀) of the BEP regimen was determined in the 1618-K human TGCT cell line and subsequently combined with varying concentrations of Bevacizumab. Cell viability was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Expression levels of VEGF, Bax, Bcl-2, and Caspase-3 were analyzed by immunohistochemistry.
Results: Bevacizumab significantly reduced cell viability in a dose-dependent manner. Bax expression in Group 2 (2.05 ± 1.04) was significantly lower than in the control group (8.63 ± 2.57;). Caspase-3 expression in Group 2 (0.49 ± 0.08) was markedly decreased compared with the control (5.10 ± 3.82), and a similar reduction was also observed in Group 3. Despite the absence of substantial changes in apoptotic markers, the reduction in cell viability suggests that Bevacizumab may act through alternative mechanisms.
Conclusion: By targeting tumor vascularity, Bevacizumab may enhance the therapeutic efficacy of the BEP regimen in TGCT treatment. These findings support the potential role of Bevacizumab as an adjunctive agent in TGCT therapy and highlight the need for further validation through in vivo studies.

Etik Beyan

This study was approved by the Afyon Kocatepe University Human Ethics Committee (AKÜİEK) with the approval number 2017/2/45 on February 3, 2017.

Destekleyen Kurum

This study was supported by the Afyon Health Sciences University Scientific Research Projects (BAP) with the project number 17-SAĞ.BİL-03.

Proje Numarası

2017/2/45

Kaynakça

  • Das MK, Evensen HSF, Furu K, Haugen TB. miRNA-302s may act as oncogenes in human testicular germ cell tumours. Sci Rep. 2019;9:14377.
  • Maruyama Y, Sadahira T, Mitsui Y, Araki M, Wada K, Tanimoto R et al. Prognostic impact of bleomycin pulmonary toxicity on the outcomes of patients with germ cell tumors. Med Oncol. 2018;35:80.
  • Kayıkçı M, Çam H. Tedavi evresi I nonseminomatöz testis tümörlerinde tedavi yaklaşımları. Düzce Tıp Fak Derg. 2005;3:40–4.
  • Kwan E, Beck S, Amir E, Jewett M, Sturgeon J, Cartwright L et al. Impact of granulocyte-colony stimulating factor on bleomycin-induced pneumonitis in chemotherapy-treated germ cell tumors. Clin Genitourin Cancer. 2017;16:E193–9.
  • Kawai Y, Nakao T, Kunimura N, Kohda Y, Gemba M. Relationship of intracellular calcium and oxygen radicals to cisplatin-related renal cell injury. J Pharmacol Sci. 2006;100:65–72.
  • Mori R, Fujimoto D, Ito M, Tomii K. Bevacizumab for ramucirumab refractory malignant pleural effusion in non-small cell lung cancer: a case report and review of the literature. Oncotarget. 2017;8:50296–50305.
  • Imai A, Ichigo S, Matsunami K, Takagi H, Kawabata I. Ovarian function following targeted anti-angiogenic therapy with bevacizumab. Mol Clin Oncol. 2017;6:807–10.
  • Zheng Y, Zhou R, Cai J, Yang N, Wen Z, Zhang Z et al. Matrix stiffness triggers lipid metabolic cross-talk between tumor and stromal cells to mediate bevacizumab resistance in colorectal cancer liver metastases. Cancer Res. 2023;83:3411–24.
  • Lenz HJ, Parikh A, Spigel DR, Cohn AL, Yoshino T, Kochenderfer M et al. Modified FOLFOX6 plus bevacizumab with and without nivolumab for first-line treatment of metastatic colorectal cancer: phase 2 results from the CheckMate 9X8 randomized clinical trial. J Immunother Cancer. 2023;11:e008409.
  • Liu M, Hales BF, Robaire B. Effects of four chemotherapeutic agents, bleomycin, etoposide, cisplatin, and cyclophosphamide, on DNA damage and telomeres in a mouse spermatogonial cell line. Biol Reprod. 2014;90:72.
  • Gershenson DM, Morris M, Cangir A, Kavanagh JJ, Stringer CA, Edwards CL et al. Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin. J Clin Oncol. 1990;8:715–20.
  • Feldman DR. State-of-the-art management of germ cell tumors. Am Soc Clin Oncol Educ Book. 2018;38:319–23.
  • Iwamoto H, Izumi K, Natsagdorj A, Makino T, Nohara T, Shigehara K et al. Effectiveness and safety of pegfilgrastim in BEP treatment for patients with germ cell tumor. In Vivo. 2018;32:899–903.
  • Demirtaş Z. Germ hücreli tümör olgularının değerlendirilmesi. (Uzmanlık Tezi). Ankara: Gazi Üniversitesi; 2011.
  • Oltvai ZN, Milliman CL, Korsmeyer SJ. Bcl-2 heterodimerizes in vivo with a conserved homolog, Bax, that accelerates programmed cell death. Cell. 1993;74:609–19.
  • Gross A, Jockel J, Wei MC, Korsmeyer SJ. Enforced dimerization of Bax results in its translocation, mitochondrial dysfunction, and apoptosis. EMBO J. 1998;17:3878–85.
  • Miyashita T, Reed JC. Tumor suppressor p53 is a direct transcriptional activator of the human Bax gene. Cell. 1995;80:293–7.
  • Hardwick JM, Soane L. Multiple functions of Bcl-2 family proteins. Cold Spring Harb Perspect Biol. 2013;5:a008722.
  • Senger DR, Galli SJ, Dvorak AM, Perruzzi CA, Harvey VS, Dvorak HF. Tumor cells secrete a vascular permeability factor that promotes accumulation of ascites fluid. Science. 1983;219:983–5.
  • Holmes K, Roberts OL, Thomas AM, Cross MJ. Vascular endothelial growth factor receptor-2: structure, function, intracellular signaling, and therapeutic inhibition. Cell Signal. 2007;19:2003–12.
  • Enemri ES, Livingston DJ, Nicholson DW, Salvesen G, Thornberry NA, Wong WW, Yuan J. Human ICE/CED-3 protease nomenclature. Cell. 1996;87:171–80.
  • Gervais FG, Xu D, Robertson GS, Vaillancourt JP, Zhu Y, Huang J et al. Involvement of caspases in proteolytic cleavage of Alzheimer's amyloid-beta precursor protein and amyloidogenic A beta peptide formation. Cell. 1999;97:395–406.
  • Boatright KM, Salvesen GS. Mechanisms of caspase activation. Curr Opin Cell Biol. 2003;15:725–31.
  • Walters J, Pop C, Scott FL, Drag M, Swartz P, Mattos C et al. A constitutively active and uninhibitable caspase-3 zymogen efficiently induces apoptosis. Biochem J. 2009;424:335–45.
  • Salvesen GS. Caspases: opening the boxes and interpreting the arrows. Cell Death Differ. 2002;9:3–5.
  • Gallaher BW, Hille R, Raile K, Kiess W. Apoptosis: live or die--hard work either way! Horm Metab Res. 2001;33:511–9.

İnsan testis germ hücreli tümörlerinde uygulanan klasik bleomisin, etoposid, sisplatin tedavisinin bevacizumab ile güçlendirilmesinin etkisi

Yıl 2025, Cilt: 50 Sayı: 3, 683 - 692, 30.09.2025
https://doi.org/10.17826/cumj.1662892

Öz

Amaç: Bu çalışmanın amacı, testiküler germ hücreli tümörlerin (GCTT) tedavisinde yaygın olarak kullanılan Bleomisin, Etoposid ve Sisplatin (BEP) kombinasyon tedavisinin etkinliğini artırmak ve sitotoksik yan etkilerini azaltmak üzere vasküler endotelyal büyüme faktörü (VEGF) inhibitörü olan Bevacizumab’ın terapötik potansiyelini değerlendirmektir.
Gereç ve Yöntem: 1618-K insan GCTT hücre hattında BEP tedavisinin yarı maksimal inhibitör konsantrasyonu (IC₅₀) belirlendi. Bu doz, farklı konsantrasyonlardaki Bevacizumab ile birlikte uygulandı. Hücre canlılığı 3-(4,5-dimetiltiyazol-2-il)-2,5-difeniltetrazolyum bromür (MTT) testi ile değerlendirildi. VEGF, Bax, Bcl-2 ve Kaspaz-3’ün ekspresyon düzeyleri immünohistokimya tekniği ile incelendi.
Bulgular: Bevacizumab, doz bağımlı olarak hücre canlılığını anlamlı şekilde azaltmıştır. A Bax ekspresyonu Grup 2’de (2,05±1,04) kontrol grubuna (8,63±2,57) göre anlamlı şekilde azalmıştır. Caspase-3 düzeyi Grup 2’de (0,49±0,08) kontrol grubuna (5,10±3,82) göre anlamlı olarak azalmış, Grup 3’te de benzer bir azalma görülmüştür. Apoptotik belirteçlerde anlamlı değişiklik olmamasına rağmen, hücre canlılığındaki azalma Bevacizumab’ın farklı mekanizmalarla etkili olabileceğini göstermektedir.
Sonuç: Bevacizumab’ın tümör vaskülaritesini hedef alarak BEP tedavisinin etkinliğini artırabileceği düşünülmektedir. Bu bulgular, Bevacizumab’ın GCTT tedavisinde destekleyici bir ajan olarak kullanılma potansiyeline işaret etmekte ve in vivo çalışmalarla desteklenmesi gerektiğini göstermektedir.

Etik Beyan

Bu çalışma, Afyon Kocatepe Üniversitesi İnsan Etik Kurulu'ndan (AKÜİEK) 03.02.2017 tarihinde 2017/2/45 numaralı onay ile etik kurul onayı almıştır.

Destekleyen Kurum

Bu çalışma, Afyon Sağlık Bilimleri Üniversitesi Bilimsel Araştırma Projeleri (BAP) tarafından 17-SAĞ.BİL-03 proje numarası ile desteklenmiştir.

Proje Numarası

2017/2/45

Kaynakça

  • Das MK, Evensen HSF, Furu K, Haugen TB. miRNA-302s may act as oncogenes in human testicular germ cell tumours. Sci Rep. 2019;9:14377.
  • Maruyama Y, Sadahira T, Mitsui Y, Araki M, Wada K, Tanimoto R et al. Prognostic impact of bleomycin pulmonary toxicity on the outcomes of patients with germ cell tumors. Med Oncol. 2018;35:80.
  • Kayıkçı M, Çam H. Tedavi evresi I nonseminomatöz testis tümörlerinde tedavi yaklaşımları. Düzce Tıp Fak Derg. 2005;3:40–4.
  • Kwan E, Beck S, Amir E, Jewett M, Sturgeon J, Cartwright L et al. Impact of granulocyte-colony stimulating factor on bleomycin-induced pneumonitis in chemotherapy-treated germ cell tumors. Clin Genitourin Cancer. 2017;16:E193–9.
  • Kawai Y, Nakao T, Kunimura N, Kohda Y, Gemba M. Relationship of intracellular calcium and oxygen radicals to cisplatin-related renal cell injury. J Pharmacol Sci. 2006;100:65–72.
  • Mori R, Fujimoto D, Ito M, Tomii K. Bevacizumab for ramucirumab refractory malignant pleural effusion in non-small cell lung cancer: a case report and review of the literature. Oncotarget. 2017;8:50296–50305.
  • Imai A, Ichigo S, Matsunami K, Takagi H, Kawabata I. Ovarian function following targeted anti-angiogenic therapy with bevacizumab. Mol Clin Oncol. 2017;6:807–10.
  • Zheng Y, Zhou R, Cai J, Yang N, Wen Z, Zhang Z et al. Matrix stiffness triggers lipid metabolic cross-talk between tumor and stromal cells to mediate bevacizumab resistance in colorectal cancer liver metastases. Cancer Res. 2023;83:3411–24.
  • Lenz HJ, Parikh A, Spigel DR, Cohn AL, Yoshino T, Kochenderfer M et al. Modified FOLFOX6 plus bevacizumab with and without nivolumab for first-line treatment of metastatic colorectal cancer: phase 2 results from the CheckMate 9X8 randomized clinical trial. J Immunother Cancer. 2023;11:e008409.
  • Liu M, Hales BF, Robaire B. Effects of four chemotherapeutic agents, bleomycin, etoposide, cisplatin, and cyclophosphamide, on DNA damage and telomeres in a mouse spermatogonial cell line. Biol Reprod. 2014;90:72.
  • Gershenson DM, Morris M, Cangir A, Kavanagh JJ, Stringer CA, Edwards CL et al. Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin. J Clin Oncol. 1990;8:715–20.
  • Feldman DR. State-of-the-art management of germ cell tumors. Am Soc Clin Oncol Educ Book. 2018;38:319–23.
  • Iwamoto H, Izumi K, Natsagdorj A, Makino T, Nohara T, Shigehara K et al. Effectiveness and safety of pegfilgrastim in BEP treatment for patients with germ cell tumor. In Vivo. 2018;32:899–903.
  • Demirtaş Z. Germ hücreli tümör olgularının değerlendirilmesi. (Uzmanlık Tezi). Ankara: Gazi Üniversitesi; 2011.
  • Oltvai ZN, Milliman CL, Korsmeyer SJ. Bcl-2 heterodimerizes in vivo with a conserved homolog, Bax, that accelerates programmed cell death. Cell. 1993;74:609–19.
  • Gross A, Jockel J, Wei MC, Korsmeyer SJ. Enforced dimerization of Bax results in its translocation, mitochondrial dysfunction, and apoptosis. EMBO J. 1998;17:3878–85.
  • Miyashita T, Reed JC. Tumor suppressor p53 is a direct transcriptional activator of the human Bax gene. Cell. 1995;80:293–7.
  • Hardwick JM, Soane L. Multiple functions of Bcl-2 family proteins. Cold Spring Harb Perspect Biol. 2013;5:a008722.
  • Senger DR, Galli SJ, Dvorak AM, Perruzzi CA, Harvey VS, Dvorak HF. Tumor cells secrete a vascular permeability factor that promotes accumulation of ascites fluid. Science. 1983;219:983–5.
  • Holmes K, Roberts OL, Thomas AM, Cross MJ. Vascular endothelial growth factor receptor-2: structure, function, intracellular signaling, and therapeutic inhibition. Cell Signal. 2007;19:2003–12.
  • Enemri ES, Livingston DJ, Nicholson DW, Salvesen G, Thornberry NA, Wong WW, Yuan J. Human ICE/CED-3 protease nomenclature. Cell. 1996;87:171–80.
  • Gervais FG, Xu D, Robertson GS, Vaillancourt JP, Zhu Y, Huang J et al. Involvement of caspases in proteolytic cleavage of Alzheimer's amyloid-beta precursor protein and amyloidogenic A beta peptide formation. Cell. 1999;97:395–406.
  • Boatright KM, Salvesen GS. Mechanisms of caspase activation. Curr Opin Cell Biol. 2003;15:725–31.
  • Walters J, Pop C, Scott FL, Drag M, Swartz P, Mattos C et al. A constitutively active and uninhibitable caspase-3 zymogen efficiently induces apoptosis. Biochem J. 2009;424:335–45.
  • Salvesen GS. Caspases: opening the boxes and interpreting the arrows. Cell Death Differ. 2002;9:3–5.
  • Gallaher BW, Hille R, Raile K, Kiess W. Apoptosis: live or die--hard work either way! Horm Metab Res. 2001;33:511–9.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Histoloji ve Embriyoloji
Bölüm Araştırma
Yazarlar

Deniz Koç 0009-0004-5237-7640

Murat Serkant Ünal 0000-0003-1992-7909

Proje Numarası 2017/2/45
Yayımlanma Tarihi 30 Eylül 2025
Gönderilme Tarihi 23 Mart 2025
Kabul Tarihi 23 Ağustos 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 50 Sayı: 3

Kaynak Göster

MLA Koç, Deniz ve Murat Serkant Ünal. “Enhancing effect of bevacizumab in the classic bleomycin, etoposide, cisplatin treatment applied in human testicular germ cell tumors”. Cukurova Medical Journal, c. 50, sy. 3, 2025, ss. 683-92, doi:10.17826/cumj.1662892.