Antitumor spectra of anthracyclines against gastric cancer tissues obtained from surgical specimens with reference to P-glycoprotein expression

Background and Objectives: Although the mechanism of P-glycoprotein (Pgp)-r elated resistance of doxorubicin is known, it has not been clarified for ot her anthracycline derivatives. We have examined the chemosensitivity of gas tric cancer tissues to three anthracyclines in relation to Pgp expression. Methods: Sixty-six surgical specimens obtained from patients with gastric c ancer were subjected to histoculture drug response assay using doxorubicin (DXR), epirubicin (EPT), and 4'-O-tetrahydropyranyldoxorubicin (pirarubicin ; THP). The cutoff concentrations used were 15 mu g/ml for DXR and EPI and 17 mu g/ml for THP. Results: A 50% or more inhibition index (I.I.) was regarded as sensitive, a t which the correlation rates were 95.8% (23/24) and 74.2% (49/66) for DXR- EPI and DXR-THP, respectively. Twenty-six specimens were immunohistochemica lly stained with monoclonal antibody to Pgp, with a positive rate of 53.8% (14/26). In Pgp-positive specimens, all cases were resistant to DXR and 28. 6% (4/14) of cases were sensitive to THP, while the antitumor activity of E PI was essentially identical to that of DXR. Conclusions: The expression of Pgp might affect resistance to DXR and EPI, although THP may partially impair this resistance, suggesting the clinical usefulness of THP in treatment of DXR-refractory gastric carcinoma. J. Surg . Oncol. 1998;69:173-177. (C) 1998 Wiley-Liss, Inc.