AccScience Publishing / TD / Online First / DOI: 10.36922/td.4346
REVIEW

Hypoxia-inducible factor-1α inhibition in renal cell carcinoma

Kinsey Morey1 Santosh Nimkar1 Samir Dalia2*
Show Less
1 College of Osteopathic Medicine, Joplin Campus, Kansas City University, Joplin, Missouri, United States of America
2 Department of Medical Oncology, Mercy Hospital, Joplin, Missouri, United States of America
Tumor Discovery, 4346 https://doi.org/10.36922/td.4346
Submitted: 27 July 2024 | Accepted: 10 September 2024 | Published: 8 October 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

The tumorigenesis of clear cell renal cell carcinoma (ccRCC), an aggressive variant of renal cell carcinoma (RCC), is primarily attributable to the mutational inactivation of the Von Hippel–Lindau (VHL) gene. This mutation causes VHL syndrome, which is associated with tumor growth in various body parts, including the brain, spinal cord, eyes, adrenal glands, pancreas, kidney, and reproductive tract. RCC is the leading cause of death in patients with VHL syndrome. The VHL gene acts as a tumor suppressor that prevents the proliferation of various oncogenes by controlling the hypoxia-inducible factor (HIF). The HIF pathway is directly linked to the control of metabolic adaptation, cell proliferation, migration, angiogenesis, and apoptosis, which, in turn, is linked to ccRCC tumorigenesis. Consequently, many treatments have been developed to directly or indirectly inhibit HIF1α. Direct inhibition of HIF-1α was briefly explored but has not yet resulted in any treatment strategy approved by the Food and Drug Administration. Most prevalent are the indirect inhibitors targeting vascular endothelial growth factor receptors (VEGFR), the mammalian target of rapamycin (mTOR), and heat shock protein 90 (Hsp90). The VEGFR inhibitor category has the most FDA-approved drugs as they have been proven to be the most efficacious and safe early on. Thus, VEGFR inhibitors, along with mTOR inhibitors, have become the mainstay in RCC treatment. Most recently, therapies targeting HIF-2α inhibition have gained traction with FDA approval, whereas emerging therapies targeting direct inhibition of hsp90 have shown promise.

Keywords
Renal cell carcinoma
HIF-1α
HIF-2α
HIF-1α inhibitor
HIF-2α inhibitor
VEGF inhibitor
mTOR inhibitor
Funding
None.
Conflict of interest
The authors declare no conflicts of interest.
References
  1. Bahadoram S, Davoodi M, Hassanzadeh S, Bahadoram M, Barahman M, Mafakher L. Renal cell carcinoma: An overview of the epidemiology, diagnosis, and treatment. G Ital Nefrol. 2022;39:2022-vol3.

 

  1. Cohen HT, McGovern FJ. Renal-cell carcinoma. N Engl J Med. 2005;353(23):2477-2490. doi: 10.1056/NEJMra043172

 

  1. Motzer RJ, Bander NH, Nanus DM. Renal-cell carcinoma. N Engl J Med. 1996;335(12):865-875. doi: 10.1056/NEJM199609193351207

 

  1. Chen S, Wang Y, Xiong Y, et al. Wild-type IDH1 inhibits the tumor growth through degrading HIF-α in renal cell carcinoma. Int J Biol Sci. 2021;17(5):1250-1262. doi: 10.7150/ijbs.54401

 

  1. Masoud GN, Li W. HIF-1α pathway: Role, regulation and intervention for cancer therapy. Acta Pharma Sin B. 2015;5(5):378-389. doi: 10.1016/j.apsb.2015.05.007

 

  1. Weidemann A, Johnson RS. Biology of HIF-1alpha. Cell Death Differ. 2008;15(4):621-627. doi: 10.1038/cdd.2008.12

 

  1. Toledo RA, Jimenez C, Armaiz-Pena G, Arenillas C, Capdevila J, Dahia PLM. Hypoxia-inducible factor 2 alpha (HIF2α) inhibitors: Targeting genetically driven tumor hypoxia. Endocr Rev. 2023;44(2):312-322. doi: 10.1210/endrev/bnac025

 

  1. Chittiboina P, Lonser RR. Von Hippel-lindau disease. Handb Clin Neurol. 2015;132:139-156. doi: 10.1016/B978-0-444-62702-5.00010-X

 

  1. Maher ER, Sandford RN. Von Hippel-lindau disease: An update. Curr Genet Med Rep. 2019;7(4):227-235.doi: 10.1007/s40142-019-00180-9

 

  1. Medina Villaamil V, Aparicio Gallego G, Santamarina Caínzos I, Valladares-Ayerbes M, Antón Aparicio LM. Searching for Hif1-α interacting proteins in renal cell carcinoma. Clin Transl Oncol. 2012;14(9):698-708. doi: 10.1007/s12094-012-0857-4

 

  1. Klatte T, Seligson DB, Riggs SB, et al. Hypoxia-inducible factor 1 alpha in clear cell renal cell carcinoma. Clin Cancer Res. 2007;13(24):7388-7393. doi: 10.1158/1078-0432.CCR-07-0411

 

  1. Shen C, Beroukhim R, Schumacher SE, et al. Genetic and functional studies implicate HIF1α as a 14q kidney cancer suppressor gene. Cancer Discov. 2011;1(3):222-235. doi: 10.1158/2159-8290.CD-11-0098

 

  1. Xu K, Ding Q, Fang Z, et al. Silencing of HIF-1α suppresses tumorigenicity of renal cell carcinoma through induction of apoptosis. Cancer Gene Ther. 2010;17(3):212-222. doi: 10.1038/cgt.2009.66

 

  1. Tassoudi A, Stefanidis I, Eleftheriadis T, Tzortzis V, Tassoudis V, Ioannou M. Study of hypoxia induced factor- 1alpha (HIF-1A) and carbonic anhydrase 9 (CAIX) in Clear Cell Renal Cell Carcinoma (ccRCC). Arch Nephrol Urol. 2021;4(2):50-62. doi: 10.26502/anu.2644-2833036

 

  1. Fallah J, Rini BI. HIF inhibitors: Status of current clinical development. Curr Oncol Rep. 2019;21(1):6. doi: 10.1007/s11912-019-0752-z

 

  1. Greenberger LM, Horak ID, Filpula D, et al. A RNA antagonist of hypoxia-inducible factor-1α, EZN-2968, inhibits tumor cell growth. Mol Cancer Ther. 2008;7(11):3598-3608. doi: 10.1158/1535-7163.MCT-08-0510

 

  1. Costa LJ, Drabkin HA. Renal cell carcinoma: New developments in molecular biology and potential for targeted therapies. Oncologist. 2007;12(12):1404-1415. doi: 10.1634/theoncologist.12-12-1404

 

  1. Drugs.com. Nexavar FDA Approval History. Available from: https://www.drugs.com/history/nexavar. html # : ~ : te x t = fda%20approved%3a%20yes%20 %28first%20approved%20december%2020%2c%20 2005%29,for%3a%20renal%20cell%20carcinoma%2c%20 hepatocellular%20carcinoma%2c%20thyroid%20cancer [Last accessed on 2024 Jul 14].

 

  1. Escudier B, Eisen T, Stadler WM, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007;356(2):125-134. doi: 10.1056/NEJMoa060655

 

  1. Kathuria-Prakash N, Drolen C, Hannigan CA, Drakaki A. Immunotherapy and metastatic renal cell carcinoma: A review of new treatment approaches. Life (Basel). 2021;12(1):24. doi: 10.3390/life12010024

 

  1. Wiechno P, Kucharz J, Sadowska M, et al. Contemporary treatment of metastatic renal cell carcinoma. Med Oncol. 2018;35(12):156. doi: 10.1007/s12032-018-1217-1

 

  1. Drugs.com. Sutent (Sunitinib Malate) FDA Approval History. Available from: https://www.drugs.com/history/sutent.html [Last accessed on 2024 Jul 14].

 

  1. Motzer RJ, Hutson TE, Tomczak P, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. 2007;356(2):115-124. doi: 10.1056/NEJMoa065044

 

  1. Summers J, Cohen MH, Keegan P, Pazdur R. FDA drug approval summary: Bevacizumab plus interferon for advanced renal cell carcinoma. Oncologist. 2010;15(1):104-111. doi: 10.1634/theoncologist.2009-0250

 

  1. Rini BI, Halabi S, Rosenberg JE, et al. Bevacizumab Plus interferon alfa compared with interferon alfa monotherapy in patients with metastatic renal cell carcinoma: CALGB 90206. J Clin Oncol. 2008;26(33):5422-5428. doi: 10.1200/JCO.2008.16.9847

 

  1. Gupta S, Spiess PE. The prospects of pazopanib in advanced renal cell carcinoma. Ther Adv Urol. 2013;5(5):223-232. doi: 10.1177/1756287213495099

 

  1. Kim JH, Park I, Lee JL. Pazopanib versus sunitinib for the treatment of metastatic renal cell carcinoma patients with poor-risk features. Cancer Chemother Pharmacol. 2016;78(2):325-332. doi: 10.1007/s00280-016-3093-8

 

  1. Tyler T. Axitinib: Newly approved for renal cell carcinoma. J Adv Pract Oncol. 2012;3(5):333-335. doi: 10.6004/jadpro.2012.3.5.7

 

  1. Motzer RJ, Penkov K, Haanen J, et al. Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019;380(12):1103-1115. doi: 10.1056/NEJMoa1816047

 

  1. Center for Drug Evaluation and Research. FDA Grants Regular Approval to Cabometyx for First-Line Treatment of Advanced Renal Cell Carcinoma. U.S. Food and Drug Administration, FDA. Available from: https://www. fda.gov/drugs/resources-information-approved-drugs/ fda-grants-regular-approval-cabometyx-first-line-treatment-advanced-renal-cell-carcinoma#:~:text=on%20 december%2019%2c%202017%2c%20the,renal%20cell%20 carcinoma%20(rcc) [Last accessed on 2024 Jul 14].

 

  1. Choueiri TK, Halabi S, Sanford BL, et al. Cabozantinib versus sunitinib as initial targeted therapy for patients with metastatic renal cell carcinoma of poor or intermediate risk: The alliance A031203 CABOSUN trial. J Clin Oncol. 2017;35(6):591-597. doi: 10.1200/JCO.2016.70.7398

 

  1. Center for Drug Evaluation and Research. FDA D.I.S.C.O. Burst Edition: FDA Approval of Fotivda (Tivozanib) for Adult Patients with Relapsed or Refractory Advanced Renal Cell Carcinoma Following Two or More Prior Systemic Therapies. U.S. Food and Drug Administration, FDA. Available from: https://www.fda.gov/drugs/ resources-information-approved-drugs/fda-disco-burst-edition-fda-approval-fotivda-tivozanib-adult-patients-relapsed-or-refractor y#:~:text=on%20march%20 10%2c%202021%2c%20the,or%20more%20prior%20 systemic%20therapies [Last accessed on 2024 Jul 14].

 

  1. Motzer RJ, Nosov D, Eisen T, et al. Tivozanib versus sorafenib as initial targeted therapy for patients with metastatic renal cell carcinoma: Results from a Phase III trial. J Clin Oncol. 2013;31(30):3791-3799. doi: 10.1200/JCO.2012.47.4940

 

  1. Center for Drug Evaluation and Research. FDA Approves Lenvatinib plus Pembrolizumab for Advanced Renal Cell Car. U.S. Food and Drug Administration, FDA. Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-lenvatinib-plus-pembrolizumab-advanced-renal-cell-carcinoma [Last accessed on 2024 Jul 14].

 

  1. Motzer R, Alekseev B, Rha SY, et al. Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. N Engl J Med. 2021;384(14):1289-1300. doi: 10.1056/NEJMoa2035716

 

  1. Semenza GL. Evaluation of HIF-1 inhibitors as anticancer agents. Drug Discov Today. 2007;12(19-20):853-859. doi: 10.1016/j.drudis.2007.08.006

 

  1. Motzer RJ, Escudier B, Oudard S, et al. Efficacy of everolimus in advanced renal cell carcinoma: A double-blind, randomised, placebo-controlled phase III trial. Lancet. 2008;372(9637):449-456. doi: 10.1016/S0140-6736(08)61039-9

 

  1. Kuroshima K, Yoshino H, Okamura S, et al. Potential new therapy of Rapalink‐1, a new generation mammalian target of rapamycin inhibitor, against sunitinib‐resistant renal cell carcinoma. Cancer Sci. 2020;111(5):1607-1618. doi: 10.1111/cas.14395

 

  1. Faes S, Demartines N, Dormond O. Mechanistic target of rapamycin inhibitors in renal cell carcinoma: Potential, limitations, and perspectives. Front Cell Dev Biol. 2021;9:636037. doi: 10.3389/fcell.2021.636037

 

  1. Diaz-Gonzalez JA, Russell J, Rouzaut A, Gil-Bazo I, Montuenga L. Targeting hypoxia and angiogenesis through HIF-1alpha inhibition. Cancer Biol Ther. 2005;4(10):1055-1062. doi: 10.4161/cbt.4.10.2195

 

  1. Onnis B, Rapisarda A, Melillo G. Development of HIF‐1 inhibitors for cancer therapy. J Cell Mol Med. 2009;13(9A):2780-2786. doi: 10.1111/j.1582-4934.2009.00876.x

 

  1. Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356(22):2271-2281. doi: 10.1056/NEJMoa066838

 

  1. Motzer RJ, Hutson TE, Glen H, et al. Lenvatinib, everolimus, and the combination in patients with metastatic renal cell carcinoma: A randomised, phase 2, open-label, multicentre trial. Lancet Oncol. 2015;16(15):1473-1482. doi: 10.1016/S1470-2045(15)00290-9

 

  1. Bohonowych JE, Peng S, Gopal U, et al. Comparative analysis of novel and conventional Hsp90 inhibitors on HIF activity and angiogenic potential in clear cell renal cell carcinoma: Implications for clinical evaluation. BMC Cancer. 2011;11(1):520. doi: 10.1186/1471-2407-11-520

 

  1. Isaacs JS, Jung YJ, Mimnaugh EG, Martinez A, Cuttitta F, Neckers LM. Hsp90 regulates a von Hippel lindau-independent hypoxia-inducible factor-1α-degradative pathway. J Biol Chem. 2002;277(33):29936-29944. doi: 10.1074/jbc.M204733200

 

  1. Albadari N, Deng S, Li W. The transcriptional factors HIF-1 and HIF-2 and their novel inhibitors in cancer therapy. Expert Opin Drug Discov. 2019;14(7):667-682. doi: 10.1080/17460441.2019.1613370

 

  1. Deeks ED. Belzutifan: First approval. Drugs. 2021;81(16):1921-1927. doi: 10.1007/s40265-021-01606-x

 

  1. Jonasch E, Donskov F, Iliopoulos O, et al. Belzutifan for renal cell carcinoma in von Hippel-lindau disease. N Engl J Med. 2021;385(22):2036-2046. doi: 10.1056/NEJMoa2103425
Share
Back to top
Tumor Discovery, Electronic ISSN: 2810-9775 Print ISSN: 3060-8597, Published by AccScience Publishing