Molecular mechanisms of shikonin and its derivatives in cancer therapy

The identification of molecular processes involved in cancer development and prognosis opened avenues for targeted therapies, which made treatment more tumor-specific and less toxic than conventional therapies. One important example is the epidermal growth factor receptor (EGFR) and EGFR-specific inhibitors (i.e. erlotinib). However, challenges such as drug resistance still remain in targeted therapies. Therefore, novel candidate compounds and new strategies are needed for improvement of therapy efficacy. Shikonin and its derivatives are cytotoxic constituents in traditional Chinese herbal medicine Zicao (Lithospermum erythrorhizin). In this study, we investigated the molecular mechanisms underlying the anti-cancer effects of shikonin and its derivatives in glioblastoma cells and leukemia cells. Most of shikonin derivatives showed strong cytotoxicity towards erlotinib-resistant glioblastoma cells, especially U87MG.ΔEGFR cells which overexpressed a deletion-activated EGFR (ΔEGFR). Moreover, shikonin and some derivatives worked synergistically with erlotinib in killing EGFR-overexpressing cells. Combination treatment with shikonin and erlotinib overcame the drug resistance of these cells to erlotinib. Western blotting analysis revealed that shikonin inhibited ΔEGFR phosphorylation and led to corresponding decreases in phosphorylation of EGFR downstream molecules. By means of Loewe additivity and Bliss independence drug interaction models, we found erlotinb and shikonin or its derivatives corporately suppressed ΔEGFR phosphorylation. We believed this to be a main mechanism responsible for their synergism in U87MG.ΔEGFR cells. In leukemia cells, which did not express EGFR, shikonin and its derivatives exhibited even greater cytotoxicity, suggesting the existence of other mechanisms. Microarray-based gene expression analysis uncovered the transcription factor c-MYC as the commonly deregulated molecule by shikonin and its derivatives. As validated by Western blotting analysis, DNA-binding assays and molecular docking, shikonin and its derivatives bound and inhibited c-MYC. Furthermore, the deregulation of ERK, JNK MAPK and AKT activity was closely associated with the reduction of c-MYC, indicating the involvement of these signaling molecules in shikonin-triggered c-MYC inactivation. In conclusion, the inhibition of EGFR signaling, synergism with erlotinib and targeting of c-MYC illustrate the multi-targeted feature of natural naphthoquinones such as shikonin and derivatives. This may open attractive possibilities for their use in a molecular targeted cancer therapy.

In vitro characterization of human AML-reactive CTL clones generated from the naive subset of healthy donors and adoptive transfer into leukemia-engrafted NSG mice

Acute myeloid leukemia (AML) is a very aggressive cancer of the hematopoietic system. Chemotherapy and immunotherapeutical approaches including hematopoietic stem cell transplantation (HSCT) and donor lymphocyte infusion (DLI) are the only curative options available. The beneficial graft-versus-leukemia (GVL) effect of cellular immunotherapy is mostly mediated by donor-derived CD8+ T lymphocytes that recognize minor histocompatibility antigens (mHags) and leukemia-associated antigens (LAAs) presented on the surface of AML blasts (Falkenburg et al. 2008; Kolb 2008). A main complication is graft-versus-host disease (GVHD) that can be induced when cytotoxic T lymphocytes (CTLs) recognize broadly expressed antigens. To reduce the risk of GVHD, specific allogeneic T-cell therapy inducing selective GVL responses could be an option (Barrett & Le Blanc 2010; Parmar et al. 2011; Smits et al. 2011). This requires efficient in vitro strategies to generate AML-reactive T cells with an early differentiation phenotype as well as vigorous effector functions and humanized mouse models to analyze the anti-leukemic potential of adoptively transferred T cells in vivo. In this study, AML-reactive CTL clones and oligoclonal T-cell lines could be reliably generated from the naive subset of healthy HLA-class I-identical donors by stimulation with primary AML blasts in mini-mixed-lymphocyte / leukemia cultures (MLLCs) in eight different patient / donor pairs. These CTLs were promising candidates for cellular immunotherapy because of their relatively early differentiation phenotype and strong proliferative and lytic capabilities. The addition of the common γ-chain cytokine IL-21 to the stimulation protocol enabled more precursors to develop into potent leukemia-reactive CTLs, presumably by its beneficial effects on cell survival and antigen-specific proliferation during the first weeks of cultures. It also strengthened the early-stage phenotype. Three long-term cultured CTLs exemplarily transferred into leukemia-engrafted immunodeficient NSG mice mediated a significant reduction of the leukemic burden after a single transfusion. These results demonstrate that CTL clones with reactivity to patient-derived AML blasts can be isolated from the naive compartment of healthy donors and show potent anti-leukemic effects in vivo. The herein described allo-MLLC approach with in vitro “programmed” naive CTL precursors independent of a HSCT setting is a valuable alternative to the conventional method of isolating in vivo primed donor CTLs out of patients after transplantation (Kloosterboer et al. 2004; Warren et al. 2010). This would make leukemia-reactive CTLs already available at the time point of HSCT, when residual leukemia disease is minimal and the chances for complete leukemia eradication are high. Furthermore, leukemia-reactive CTLs effectively expanded by this in vitro protocol can be used as screening populations to identify novel candidate LAAs and mHags for antigen-specific immunotherapy.

Influence of the chemokine CXCL12 on the progression and the signaling in colorectal cancer

Das Chemokin CXCL12 (auch bekannt als SDF-1) ist ein kleines Protein (8-14) KDa, das in sechs Isoformen exprimiert wird (SDF-1α, SDF-1β, SDF-1γ, SDF- 1δ, SDF-1ε und SDF-1θ) von einem einzigen Gen, dass die Leukozyten-Wanderung regelt und variabel in einer Reihe von normalen und Krebsgeweben exprimiert wird.rnCXCL12 spielt verschiedene Rollen in der Tumorpathogenese. Es wurde nachgewiesen, dass CXCL12 das Tumorwachstum und die Malignität fördert, die Tumorangiogenese stärkt, sich an der Metastasierung beteiligt und zu immunsuppressiven Netzwerken innerhalb des Tumormikromilieus beiträgt. Daher liegt es nahe, dass der CXCL12/CXCR4-Signalweg ein wichtiges Ziel ist für die Entwicklung von neuartigen Krebstherapien.rnUm Licht auf die Rolle der Chemokin CXCL12 Splicevarianten in der Entwicklung von Krebs zu werfen und die mögliche physiologische Relevanz und ihre möglichen funktionellen Unterschiede bei Darmkrebs zu verstehen, haben wir alle CXCL12 Splicevarianten (alpha, beta, gamma, delta, epsilon und theta) in die kolorektalen Zelllinie SW480 und die Melanomzellinie D05 transfiziert und exprimiert.rnrnDiese Arbeit wurde erstellt, um die folgenden Ziele zu erreichen. Untersuchung der Rolle von CXCL12 Splicevarianten bei der Vermittlung von Tumorprogression, Adhäsion, Migration, Invasion und Metastasierung von Darmkrebs. Untersuchung, ob die CXCL12 Variantenwege ein wichtiges Ziel für die Entwicklung von Krebstherapien darstellen.rn• Um eine in vivo Mausmodell zu entwickeln, um die Rolle der CXCL12 Varianten im Rahmen des Tumorwachstums zu verstehen.rnrnUnsere Ergebnisse zeigen, dass:Der CXCL12 G801A Polymorphismus ist ein Low-Penetranz Risikofaktor für die Entwicklung von Darmkrebs. Der CXCL12-Gen-Polymorphismus rs1801157 ist mit dem T-Status (Tumor-node-Metastasen) assoziiert. Es gab keine Beziehung zwischen CXCL12-Gen-Polymorphismus rs1801157 und Fernmetastisen oder LN metastasen. Alle sechs CXCL12 Splicevarianten werden im Darmkrebs und in gesunder Kolon mucosa exprimiert. Die höchste Expression wird bei SDF-1alpha, dann SDF-1 beta gefunden. Alle sechs CXCL12 Varianten zeigen erhöhte Tumorzellproliferation in vitro. SDF-1beta, gefolgt von SDF-1alpha zeigte die größte Aktivität im Proliferationsassay.rn• Alle sechs CXCL12 Varianten induzieren die Tumorzelladhäsion.SDF-1beta dann SDF-1alpha zeigte die größte Aktivität im Rahmen des Adhäsionsassay. Alle sechs CXCL12 Varianten erhöhten die Zellmigration und Invasion von Tumorzellen in vitro. SDF-1theta und SDF-1epsilon 1theta zeigten die größte Aktivität, während die schwächste Aktivität mit SDF-1alpha und SDF-1beta beobachtet wurde. Alle sechs CXCL12 Varianten aktivieren Akt und (MAPK) Mitogen- acktivatedierte Protein kinase Wege und damit die Regulierung viele essentieller Prozesse in Tumorzellen, wie Proliferation, Migration, Invasion und Adhäsion. Es ist interessant festzustellen, dass AMD3100 die CXCL12 Splicevarianten inhibriert, die AKT-MEK-1/2-Phosphorylierung induzieren.rnDer Inhibitor AMD3100 unterdrückt stark die CXCL12 Varianten -delta, -epsilon und theta-und unterdrückt schwach CXCL12-gamma. während es keine signifikante Wirkung auf CXCL12-alpha und beta hatte. Es hat möglicherweise Auswirkungen auf mehrere große Signalwage in Bezug auf Proliferation, Migration und Invasions.rn• Es ist wichtig anzumerken, dass die Hemmung von CXCL12-Varianten durch AMD3100 einen der möglichen Ansaätze in der Krebstherapie darstellen kann.Wir schlagen vor, dass weitere Studien erwogen werden, die wir brauchen, um die biologische Aktivität dieser neuen CXCL12 Varianten bei verschiedenen Arten von Krebs klar zu verstehen.

Safety and therapeutic efficacy of adoptive p53-specific T cell antigen receptor (TCR) gene transfer

Immunotherapy with T cells genetically modified by retroviral transfer of tumor-associated antigen (TAA)-specific T cell receptors (TCR) is a promising approach in targeting cancer. Therefore, using a universal TAA to target different tumor entities by only one therapeutic approach was the main criteria for our TAA-specific TCR. Here, an optimized (opt) αβ-chain p53(264-272)-specific and an opt single chain (sc) p53(264-272)-specific TCR were designed, to reduce mispairing reactions of endogenous and introduced TCR α and TCR β-chains, which might lead to off-target autoimmune reactions, similar to Graft-versus-host disease (GvHD). rnIn this study we evaluated the safety issues, which rise by the risk of p53TCR gene transfer-associated on/off-target toxicities as well as the anti-tumor response in vivo in a syngeneic HLA-A*0201 transgenic mouse model. We could successfully demonstrate that opt sc p53-specific TCR-redirected T cells prevent TCR mispairing-mediated lethal off-target autoimmunity in contrast to the parental opt αβ-chain p53-specific TCR. Since the sc p53-specific TCR proofed to be safe, all further studies were performed using sc p53-specific TCR redirected T cells only. Infusion of p53-specific TCR-redirected T cells in Human p53 knock-in (Hupki) mice after lymphodepletion-preconditioning regimen with either sublethal body irradiation (5Gy) or chemotherapy (fludarabine and cyclophosphamide) in combination with vaccination (anti-CD40, CpG1668 and p53(257-282) peptide) did not result in a depletion of hematopoietic cells. Moreover, adoptive transfer of high numbers of p53-specific TCR-redirected T cells in combination with Interleukin 2 (IL-2) also did not lead to toxic on-target reactions. The absence of host tissue damage was confirmed by histology and flow cytometry analysis. Furthermore, p53-specific TCR-redirected T cells were able to lyse p53+A2.1+ tumor cells in vitro. However, in vivo studies revealed the potent suppressive effect of the tumor microenvironment (TME) mediated by tumor-infiltrating myeloid-derived suppressor cells (MDSC). Accordingly, we could improve an insufficient anti-tumor response in vivo after injection of the sc p53-specific TCR-redirected T cells by additional depletion of immunosuppressive cells of the myeloid lineage.rnTogether, these data suggest that the optimized sc p53(264-272)-specific TCR may represent a safe and efficient approach for TCR-based gene therapy. However, combinations of immunotherapeutic strategies are needed to enhance the efficacy of adoptive cell therapy (ACT)-mediated anti-tumor responses.

Detrimental effects of exuberant and restrained immune responses against the central nervous system in the context of multiple sclerosis and glioblastoma multiforme

Glioblastoma multiforme (GBM) is the most common and most aggressive astrocytic tumor of the central nervous system (CNS) in adults. The standard treatment consisting of surgery, followed by a combinatorial radio- and chemotherapy, is only palliative and prolongs patient median survival to 12 to 15 months. The tumor subpopulation of stem cell-like glioma-initiating cells (GICs) shows resistance against radiation as well as chemotherapy, and has been suggested to be responsible for relapses of more aggressive tumors after therapy. The efficacy of immunotherapies, which exploit the immune system to specifically recognize and eliminate malignant cells, is limited due to strong immunosuppressive activities of the GICs and the generation of a specialized protective microenvironment. The molecular mechanisms underlying the therapy resistance of GICs are largely unknown. rnThe first aim of this study was to identify immune evasion mechanisms in GICs triggered by radiation. A model was used in which patient-derived GICs were treated in vitro with fractionated ionizing radiation (2.5 Gy in 7 consecutive passages) to select for a more radio-resistant phenotype. In the model cell line 1080, this selection process resulted in increased proliferative but diminished migratory capacities in comparison to untreated control GICs. Furthermore, radio-selected GICs downregulated various proteins involved in antigen processing and presentation, resulting in decreased expression of MHC class I molecules on the cellular surface and diminished recognition potential by cytotoxic CD8+ T cells. Thus, sub-lethal fractionated radiation can promote immune evasion and hamper the success of adjuvant immunotherapy. Among several immune-associated proteins, interferon-induced transmembrane protein 3 (IFITM3) was found to be upregulated in radio-selected GICs. While high expression of IFITM3 was associated with a worse overall survival of GBM patients (TCGA database) and increased proliferation and migration of differentiated glioma cell lines, a strong contribution of IFITM3 to proliferation in vitro as well as tumor growth and invasiveness in a xenograft model could not be observed. rnMultiple sclerosis (MS) is the most common autoimmune disease of the CNS in young adults of the Western World, which leads to progressive disability in genetically susceptible individuals, possibly triggered by environmental factors. It is assumed that self-reactive, myelin-specific T helper cell 1 (Th1) and Th17 cells, which have escaped the control mechanisms of the immune system, are critical in the pathogenesis of the human disease and its animal model experimental autoimmune encephalomyelitis (EAE). It was observed that in vitro differentiated interleukin 17 (IL-17) producing Th17 cells co-expressed the Th1-phenotypic cytokine Interferon-gamma (IFN-γ) in combination with the two respective lineage-associated transcription factors RORγt and T-bet after re-isolation from the CNS of diseased mice. Pathogenic molecular mechanisms that render a CD4+ T cell encephalitogenic have scarcely been investigated up to date. rnIn the second part of the thesis, whole transcriptional changes occurring in in vitro differentiated Th17 cells in the course of EAE were analyzed. Evaluation of signaling networks revealed an overrepresentation of genes involved in communication between the innate and adaptive immune system and metabolic alterations including cholesterol biosynthesis. The transcription factors Cebpa, Fos, Klf4, Nfatc1 and Spi1, associated with thymocyte development and naïve T cells were upregulated in encephalitogenic CNS-isolated CD4+ T cells, proposing a contribution to T cell plasticity. Correlation of the murine T-cell gene expression dataset to putative MS risk genes, which were selected based on their proximity (± 500 kb; ensembl database, release 75) to the MS risk single nucleotide polymorphisms (SNPs) proposed by the most recent multiple sclerosis GWAS in 2011, revealed that 67.3% of the MS risk genes were differentially expressed in EAE. Expression patterns of Bach2, Il2ra, Irf8, Mertk, Odf3b, Plek, Rgs1, Slc30a7, and Thada were confirmed in independent experiments, suggesting a contribution to T cell pathogenicity. Functional analysis of Nfatc1 revealed that Nfatc1-deficient CD4+ T cells were restrained in their ability to induce clinical signs of EAE. Nfatc1-deficiency allowed proper T cell activation, but diminished their potential to fully differentiate into Th17 cells and to express high amounts of lineage cytokines. As the inducible Nfatc1/αA transcript is distinct from the other family members, it could represent an interesting target for therapeutic intervention in MS.rn

Aspects of poriferan (Suberites domuncula) apoptosis and innate immune system and evolutionary implications

Survivin, a unique member of the family of inhibitors of apoptosis (IAP) proteins, orchestrates intracellular pathways during cell division and apoptosis. Its central regulatory function in vertebrate molecular pathways as mitotic regulator and inhibitor of apoptotic cell death has major implications for tumor cell proliferation and viability, and has inspired several approaches that target survivin for cancer therapy. Analyses in early-branching Metazoa so far propose an exclusive role of survivin as a chromosomal passenger protein, whereas only later during evolution the second, complementary antiapoptotic function might have arisen, concurrent with increased organismal complexity. To lift the veil on the ancestral function(s) of this key regulatory molecule, a survivin homologue of the phylogenetically oldest extant metazoan taxon (phylum Porifera) was identified and functionally characterized. SURVL of the demosponge Suberites domuncula shares significant similarities with its metazoan homologues, ranging from conserved exon/intron structures to the presence of localization signal and protein-interaction domains, characteristic of IAP proteins. Whereas sponge tissue displayed a very low steady-state level, SURVL expression was significantly up-regulated in rapidly proliferating primmorph cells. In addition, challenge of sponge tissue and primmorphs with cadmium and the lipopeptide Pam3Cys-Ser-(Lys)4 stimulated SURVL expression, concurrent with the expression of newly discovered poriferan caspases (CASL and CASL2). Complementary functional analyses in transfected HEK-293 revealed that heterologous expression of poriferan survivin in human cells not only promotes cell proliferation but also augments resistance to cadmium-induced cell death. Taken together, these results demonstrate both a deep evolutionary conserved and fundamental dual role of survivin, and an equally conserved central position of this key regulatory molecule in interconnected pathways of cell cycle and apoptosis. Additionally, SDCASL, SDCASL2, and SDTILRc (TIR-LRR containing protein) may represent new components of the innate defense sentinel in sponges. SDCASL and SDCASL2 are two new caspase-homolog proteins with a singular structure. In addition to their CASc domains, SDCASL and SDCASL2 feature a small prodomain NH2-terminal (effector caspases) and a remarkably long COOH-terminal domain containing one or several functional double stranded RNA binding domains (dsrm). This new caspase prototype can characterize a caspase specialization coupling pathogen sensing and apoptosis, and could represent a very efficient defense mechanism. SDTILRc encompasses also a unique combination of domains: several leucine rich repeats (LRR) and a Toll/IL-1 receptor (TIR) domain. This unusual domain association may correspond to a new family of intracellular sensing protein, forming a subclass of pattern recognition receptors (PRR).

DNA-Reparatur-assoziierte genetische und epigenetische Faktoren für die Zweittumorentstehung nach Tumoren im Kindes- und Jugendalter

Die Ursachen der Zweittumorentwicklung bei Personen, die eine Krebserkrankung in der Kindheit überlebten, sind weitgehend unklar. Strahlenexposition oder Chemotherapie führen in normalen somatischen Zellen zu DNA-Schäden, welche bei fehlerhafter Reparatur eine Karzinogenese auslösen können. Es ist denkbar, dass genetische Unterschiede z. B. in den Signalwegen der Zellzykluskontrolle und der DNA-Reparatur nach therapieinduzierten DNA-Schäden eine entscheidende Rolle bei der Zweittumorentwicklung spielen. Im Rahmen dieser Arbeit wurden 20 Personen, die eine Krebserkrankung in der Kindheit überlebten und einen unabhängigen Zweittumor entwickelten, mit 20 gematchten Kontrollpersonen ohne Zweittumorentwicklung verglichen. Die primären Fibroblasten der Patienten wurden auf somatische, genetische und/oder epigenetische Unterschiede in DNA-Reparaturnetzwerken untersucht. Die biologisch relevantesten Ergebnisse lieferten Proteinuntersuchungen mittels Antikörper-Microarrays. Hierbei wurde eine konstitutiv erniedrigte Menge an RAD9A und einigen anderen DNA-Reparatur-Proteinen (BRCA1, DDIT3, MSH6, p53, RAD51) in den Zweittumorpatienten im Vergleich zu den Eintumorpatienten festgestellt. Nach einer DNA-Schädigung durch 1 Gray Bestrahlung erhöhte sich die RAD9A-Proteinmenge, wobei die Zweittumorpatienten eine geringere Induktion als die Eintumorpatienten zeigten. Bei der Quantifizierung der mRNA-Expression mittels RTq-PCR wurde ein niedrigerer RAD9A-mRNA-Level sowohl in den unbehandelten und als auch in den 1 Gray bestrahlten Zellen der Zweittumorpatienten festgestellt. SNP-Array und Methylierungsanalysen konnten keine Auffälligkeiten im RAD9A-Lokus nachweisen. Diese Ergebnisse unterstützen die Hypothese, dass Modulationen von RAD9A und anderen Zellzyklusarrest- und DNA-Reparaturproteinen zum Risiko einer Zweittumorentwicklung in Kinderkrebspatienten beitragen. Bei einem diskordanten monozygoten Zwillingspaar wurde in ca. 20% der Zellen des Zweittumorzwillings eine Hypermethylierung des Tumorsuppressorgens BRCA1 festgestellt, die mit einer konstitutiv erniedrigten BRCA1-Proteinexpression einhergeht und einen möglichen Krebsrisikofaktor darstellt. Die partielle Deletion des Gens RSPO3, die wahrscheinlich als somatisches Zellmosaik beim Zweittumorzwilling vorliegt, korreliert mit einer niedrigeren RSPO3-mRNA-Expression und ist vermutlich auch mit einer erhöhten Krebsprädisposition assoziiert.

Mechanisms of resistance of tumor cells in response to treatment with the vacuolar H+-ATPase inhibitor archazolid B

Resistance of cancer cells towards chemotherapy is the major cause of therapy failure. Hence, the evaluation of cellular defense mechanisms is essential in the establishment of new chemotherapeutics. In this study, classical intrinsic and acquired as well as new resistance mechanisms relevant in the cellular response to the novel vacuolar H+-ATPase inhibitor archazolid B were investigated. Archazolid B, originally produced by the myxobacterium Archangium gephyra, displayed cytotoxicity in the low nanomolar range on a panel of cancer cell lines. The drug showed enhanced cytotoxic activity against nearly all cancerous cells compared to their non-cancerous pendants. With regards to ABC transporters, archazolid B was identified as a moderate substrate of ABCB1 (P-glycoprotein) and a weak substrate of ABCG2 (BCRP), whereas hypersensitivity was observed in ABCB5-expressing cells. The cytotoxic effect of archazolid B was shown to be independent of the cellular p53 status. However, cells expressing constitutively active EGFR displayed significantly increased resistance. Acquired drug resistance was studied by establishing an archazolid B-resistant MCF-7 cell line. Experiments showed that this secondary resistance was not conferred by aberrant expression or DNA mutations of the gene encoding vacuolar H+-ATPase subunit c, the direct target of archazolid B. Instead, a slight increase of ABCB1 and a significant overexpression of EGFR as well as reduced proliferation may contribute to acquired archazolid B resistance. For identification of new resistance strategies upon archazolid B treatment, omics data from bladder cancer and glioblastoma cells were analyzed, revealing drastic disturbances in cholesterol homeostasis, affecting cholesterol biosynthesis, uptake and transport. As shown by filipin staining, archazolid B led to accumulation of free cholesterol in lysosomes, which triggered sterol responses, mediated by SREBP-2 and LXR, including up-regulation of HMGCR, the key enzyme of cholesterol biosynthesis. Furthermore, inhibition of LDL uptake as well as impaired LDLR surface expression were observed, indicating newly synthesized cholesterol to be the main source of cholesterol in archazolid B-treated cells. This was proven by the fact that under archazolid B treatment, total free cholesterol levels as well as cell survival were significantly reduced by inhibiting HMGCR with fluvastatin. The combination of archazolid B with statins may therefore be an attractive strategy to circumvent cholesterol-mediated cell survival and in turn potentiate the promising anticancer effects of archazolid B.

Einfluss einer indirekten pharmazeutischen Betreuung auf klinische und soziale Ergebnisse bei ambulant mit Chemotherapie behandelten Tumorpatienten

Krebspatienten, die eine Chemotherapie erhalten, leiden häufig an schwerwiegenden unerwünschten Arzneimittelwirkungen, wie z.B. Übelkeit und Erbrechen, welche nachweislich durch eine geeignete Supportivmedikation und durch eine direkte pharmazeutische Betreuung gesenkt werden können.rnIn dieser Arbeit wurde in einer prospektiven, nicht-interventionellen multizentrischen Studie untersucht, ob ambulant behandelte Mamma- und Colon-Carcinom-Patienten während der Chemotherapie Vorteile durch eine indirekte pharmazeutische Betreuung (Mitgabe einer schriftlichen Patienteninformation und der Begleitmedikamente) haben. Primäres Ziel der Studie war eine Reduktion von Häufigkeit und Schweregrad ausgewählter UAW, sekundäre Ziele waren die Verbesserung der Lebensqualität, der Patientenzufriedenheit und des Patientenwissens zur Therapie und Begleitmedikation. Die Daten wurden mittels vier verschiedener Patienten-Fragebögen in Form von Telefoninterviews zu drei verschiedenen Zeitpunkten der Chemotherapie erhoben.rnInsgesamt konnten 106 Patienten vom St.-Johannes-Hospital in Dortmund und von der Universitätsmedizin Mainz in die Studie eingeschlossen werden. Die UAW nach Häufigkeit und Schweregrad gemäß CTC konnten durch eine indirekte pharmazeutische Betreuung zu allen drei Zeitpunkten der Datenerfassung z.T. signifikant gesenkt werden. Eine Verbesserung konnte auch bei allen humanistischen Ergebnisparametern (Patientenwissen, Lebensqualität, Patientenzufriedenheit) beobachtet werden. Auf Grund der relativ kleinen, nicht vollständig rekrutierten Kontrollgruppe und den unterschiedlichen Rahmenbedingungen an den teilnehmenden Kliniken, sind weitere vergleichende Untersuchungen erforderlich, um den Nutzen einer indirekten pharmazeutischen Betreuung weiter zu belegen. rn