Inhibition of Nuclear Factor Kappa-B Enhances the Antitumor Effect of Combination Treatment with Tumor Necrosis Factor-Alpha Gene Therapy and Gemcitabine for Pancreatic Cancer in Mice

BACKGROUND: Combination therapy with tumor necrosis factor-alpha (TNF-alpha) gene delivery and gemcitabine is a new therapeutic approach for pancreatic cancer. However, the efficacy of both TNF-alpha and gemcitabine is suppressed due to activation of nuclear factor-kappa B (NF-kappa B). We hypothesized that nafamostat mesilate (FUT175), an NF-kappa B inhibitor, enhances the antitumor effect of combination treatment with an adenoviral vector-expressing TNF-alpha (AxCAhTNF-alpha) and gemcitabine for pancreatic cancer in mice. STUDY DESIGN: In vitro, we assessed that FUT175 inhibited both TNF-alpha- and gemcitabine-induced NF-kappa B activation and enhanced apoptosis in human pancreatic cancer cell lines (MIAPaCa-2 and AsPC-1). In vivo, we established a xenograft pancreatic cancer model in mice by subcutaneous injection of MIAPaCa-2 and AsPC-1. The animals were treated with AxCAhTNF-alpha intratumorally and gemcitabine intraperitoneally once a week (combination group) or AxCAhTNF-alpha intratumorally and gemcitabine intraperitoneally once a week as well as FUT175 intraperitoneally 3 times a week (triple combination group). RESULTS: In vitro, FUT175 inhibited both TNF-alpha- and gemcitabine-induced NF-kappa B activation and enhanced induction of apoptosis. In the triple combination group, tumor growth in vivo was significantly slower and there were more apoptotic cells than in the combination group (p < 0.05). CONCLUSIONS: Inhibition of NF-kappa B by FUT175 enhances the antitumor effect of combined TNF-alpha gene therapy and gemcitabine for pancreatic cancer. (J Am Coll Surg 2013;216:320-332. (C) 2013 by the American College of Surgeons)