The failure of chemotherapy to stop glioblastoma may be linked to a deficiency in DNA repair capability in the cell, according to Duke University Medical Center researchers.

In a study reported in Cancer Research, Duke cancer and biochemistry specialists found that glioblastoma multiforme (GBM) tumors that had become resistant to chemotherapeutic agents showed defects in the cellular mismatch repair system, a key factor in quelling cancer cells. The findings reinforce researchers' beliefs that mismatch repair has broad impact on human tumor cell production.

"This study extends results that have been observed in tissue culture cells to human tumors in animals," said Paul Modrich, PhD, a Howard Hughes investigator in biochemistry at Duke and lead author of the study. "It renders it likely that this drug resistance is also a significant effect in cancer patients"

Dr. Henry Friedman, chief of pediatric neuro-oncology at Duke and primary investigator of the study funded by the National Institutes of Health, said the research may lead to more effective treatment of GBM.

The Major Problem

"The major problem in the treatment of cancer is drug resistance," Friedman said. "Tumor cells become resistant, or could be resistant at diagnosis. The cells escape the effects of the drug, repopulate, and the patient ultimately succumbs to the tumor. If we can determine the mechanisms of resistance to a drug, then we can opt for different therapy or, eventually, alter that mechanism of resistance."

While growing human GBM tumors on mouse models, the researchers treated the tumors with procarbazine. Though procarbazine is a frontline drug treatment, most patients ultimately develop resistance to it and it ceases to check tumor growth. The tumors growing on mice developed resistance to the drug after nine serial treatments, giving the researchers a way to study the resistance mechanism.

In the normal sequence of cell replication, the attached compounds alert the mismatch repair mechanism in the cell that a mutation has occurred, according to Friedman. That triggers a "toxic event," and ultimate destruction of the tumor cell.

"What we found was that the resistant tumor cells had a mutation in mismatch repair that was not present in the 'parent' tumor-the tumor graft that didn't seem to be resistant to drugs at first. We think the resulting deficiency led to the resistance to procarbazine and other methylators." Friedman said.

This summer, Friedman and Modrich are studying the mismatch repair activity in malignant GBM. If the findings from the xenograft tumors bear out, clinical application could begin in trials next year, Friedman said.

"It may soon be possible to analyze the patient's tumor at biopsy to determine the likelihood of resistance to the methylators, and to tailor treatment accordingly to reduce tumor progression, and that means faster, more effective treatment," Friedman said.