Dissertations / Theses on the topic 'Cancer colorectal – Chimiothérapie'
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Jonchère, Barbara. "Echappement à la chimiothérapie et émergence de cellules plus agressives : Importance de l’hétérogénéité tumorale." Thesis, Angers, 2014. http://www.theses.fr/2014ANGE0008/document.
Full textActivated by chemotherapy, senescence is a suppressive response which prevents cell cycle progress through activation of the p53-p21 and p16-Rb signaling pathways. However, despite the efficiency of this suppression, cancer cells can emerge to induce clinical relapse. In this study, we analyzed senescence escape in response to irinotecan, one of the first line treatment used in colorectal cancer. After treatment, senescence is induced in LS174T cell but a subpopulation of cells finally resume proliferation. Persistent cells (PLCs) are composed of an heterogenous mixture of senescent (PLS) and dividing cells (PLD). In spite of PLS, PLCs are able to grow in vivo as efficiently as parental LS174T cells. Importantly, persistence induced the emergence of more transformed cells characterized by the ability to grow in low adhesion conditions. PLD emergence and anoikis resistance depend on Mcl-1, Bcl-xL and p21. PLD and PLS enrichment, by flow cytometry, allowed us to identify PLS as essential for anoikis resistance. Our results suggest that PLS establish a favorable environment for the transformation of unaffected cells. Mcl-1 and Bcl-xL role in each population remains to be determined, but inhibitors of these protein used in combination with irinotecan should restrict the heterogeneity of the response and tumoral aggressiveness
Weinling, Estelle. "Pharmacocinétique de l'irinotécan (CPT-11) en monothérapie et en combinaison dans le traitement du cancer colorectal." Paris 5, 1998. http://www.theses.fr/1998PA05P247.
Full textBélanger, Audrey. "NF-KB2, régulateur de l'autophagie dans le cancer colorectal : implication dans la sénescence induite par RAS et la chimiothérapie." Angers, 2014. http://tel.archives-ouvertes.fr/tel-01080402.
Full textOncogene-induced senescence (OIS) is a tumor suppressor mechanism leading to cell cycle arrest. In response to oncogene Ras expression, we have observed that NF-κB2 is activated and regulates transcriptionally the autophagy, a degradation pathway responsible for the recycling of damaged organelles and necessary for senescence establishment. Moreover, the regulation of autophagy by NF-κB2 occurs also during sn38-induced senescence, a chemotherapy for colorectal cancer treatment. Interestingly, we have demonstrated that cells that escape from OIS still present an activation of NF-κB2. During the OIS escape, the phosphorylation of NF-κB2 on serine 222 is lost and could be responsible for an autophagy defect allowing a decrease of senescence in favor of proliferation recovery. Colorectal cancer is the third leading cause of cancer death in France. It is important to diagnose cancer at early stages in order to increase the probabilities of recovery. Through a proteomic study, we have identified OLFM4 as new marker of the early stages of colorectal tumor. We have showed that the expression of OLFM4 is correlated with Ras mutation in tumors, and is regulated by the Ras-NF-κB2 pathway. All together, these results suggest a major role of NF-κB2 in colorectal cancer. The activation of NF- κB2 could represent a marker of tumoral aggressiveness through the regulation of the senescence-dependent autophagy phenotype and OLFM4 expression
Pagès, Pierre-Benoît. "Technique de perfusion pulmonaire isolée de chimiothérapie chez le porc." Thesis, Dijon, 2014. http://www.theses.fr/2014DIJOMU01/document.
Full textIntroduction: The isolated lung perfusion (ILP) is an experimental technique which main objective is to deliver high dose of cytotoxic agent to the lung tissue without systemic exposure. The thesis took place in three stages: first stage, setting in vitro the chemotherapy the most efficient against colorectal cancer (CCR) cells in 30 min. Second stage, develop the ILP technique in a pig model. Third stage, lead a dose escalation study with chemotherapy by ILP.Methods: First stage, efficacy of various cytotoxic molecules against a panel of human CCR cell lines was tested in vitro after a 30-minute exposure. Second stage, pigs were treated with chemotherapy delivered by ILP during 30 minutes and kept alive during a month. Third stage, chemotherapy doses were increase in order to obtain acute toxicity or death of animals.Results: Gemcitabine (GEM) was the most efficient drug against CCR cells in 30 minutes. ILP with GEM permit to maintain high concentration in the lung parenchyma and pigs survival during one month. No systemic leaks were detected. Dose increase of GEM conduct to determine the maximal tolerated dose of GEM by ILP to 320 mg. Conclusions: ILP with GEM is a safety and reproducible technique allowing high GEM concentrations in the lung tissue
Baussard, Louise. "Déterminants psychosociaux des trajectoires de fatigue chez des patients traités en chimiothérapie pour un cancer colorectal métastatique." Thesis, Montpellier 3, 2018. http://www.theses.fr/2018MON30040/document.
Full textCancer-related fatigue is a subjective and pervasive symptom, related to the disease and its treatments, and has a significant impact on patients' quality of life. This study has two fundamental goals: (1) to identify different fatigue trajectories in metastatic colorectal cancer patients undergoing chemotherapy; (2) to identify psychosocial determinants of these fatigue trajectories. A total of 169 patients were assessed for their level of fatigue at the beginning of a new chemotherapy cycle, and were subsequently followed every two weeks. Psychosocial variables such as anxiety, depression, perceived control, coping strategies, and social support were measured from the start. Four trajectories of physical fatigue were identified: 1) a trajectory of "intense fatigue" (6.51%), 2) a trajectory of "average fatigue" (48.52%), 3) an "increasing fatigue" trajectory over time characterized by non-fatigued patients at the inclusion (11.83%); finally, 4) a trajectory of resilient patients who report "no fatigue" during treatment (33.14%). While it appears that physical fatigue and depression are strongly associated, the results also show that poor adaptation (emotionally-focused coping) and little control over the evolution of the disease contribute to the intensity and the increase of fatigue over time.The identification of transactional variables in the explanation of this symptom makes it possible to envisage adapted psychosocial care, turned towards personalized medicine
Granci, Virginie. "Mécanismes de résistance au 5-FU dans le cancer colorectal : implication des récepteurs de TRAIL." Montpellier 2, 2007. http://www.theses.fr/2007MON20008.
Full textGagnon, Jean-François. "Régulation de l'inactivation intratumorale de l'agent antinéoplasique irinotécan par un mécanisme épigénétique." Master's thesis, Université Laval, 2006. http://hdl.handle.net/20.500.11794/18848.
Full textUGT1A1 is the main enzyme involved in the hepatic and tumoral inactivation of SN-38, an anticancer agent used in first line treatment of metastasic colorectal cancer. UGT1A1 genetic factors determine response to irinotecan therapy. We hypothesised that an epigenetic mechanism, more specifically methylation, is involved in tumoral regulation of UGT1A1 levels. Specific CpG islands in the UGT1A1 gene are hypermethylated and linked to the repression of gene expression and to lower levels of SN-38 glucuronidation in colon tumor cells in vitro. In addition, methylation of specific CpG was linked to lower expression of UGT1A1 gene in primary colon tumors from patients. Our data support that methylation profile of the UGT1A1 gene determine SN-38 tumoral concentration and may help to predict tumoral response to irinotecan.
Raynal, Caroline. "Etude du rôle du récepteur des xénobiotiques PXR dans la réponse à la chimiothérapie du cancer colorectal." Montpellier 1, 2009. http://www.theses.fr/2009MON13523.
Full textDespite numerous pharmacogenetic studies, clinical efficacy of chemotherapy in colorectal cancer is subjected to broad inter-individual variations leading to the inability to predict outcome and toxicity. Fluoropyrimidines, oxaliplatine and irinotecan are worldwide approved for the treatment of metastatic colorectal cancer and undergoe extensive peripheral and tumoral metabolism. Considering their metabolic profiles and the tissue distribution of Pregnane X Receptor (PXR), we hypothesized that PXR could play a key role in colon cancer cell response to those cytotoxic agents. PXR is a xenoreceptor activated by many drugs and environmental compounds regulating the expression of drug metabolism and transport genes in detoxification organs such as liver and gastrointestinal tract. Stable transfection of hPXR cDNA in human colorectal cancer cells LS174T, SW480 and SW620 led to a marked chemoresistance to the active metabolite SN38 correlated with PXR expression level. Metabolic profile of SN38 showed a strong enhancement of SN38 glucuronidation to the inactive SN38G metabolite in PXR-expressing cells, related to an increase of UDP-glucuronosyl transferases UGT1A1, UGT1A9 and UGT1A10 mRNAs. Inhibition of PXR expression by lentivirus-mediated shRNA, led to SN38 chemoresistance reversion concomitantly to a decrease of UGT1A1 expression and SN38 glucuronidation. We also showed that PXR was expressed with a strong variability in both normal and neoplastic human colon tissues and highlighted a strong correlation between PXR and UGT1A1 in tumors. Our results suggest that tumoral metabolism of SN38 is affected by PXR and that this should be taken into account in the prediction of irinotecan response as environmental compounds, nutrition and diet affect PXR expression and/or activity
Demontoux, Lucie. "Rôle de l’hypotonie dans la réponse à la chimiothérapie intra-péritonéale : étude des effets sur les cellules cancéreuses et la mort immunogène induite." Thesis, Bourgogne Franche-Comté, 2018. http://www.theses.fr/2018UBFCI012/document.
Full textIntraPeritoneal Chemotherapy (IPEC) is commonly used to treat colorectal cancer metastases. However there is no standardized protocol.The aim of this work was to model this chemotherapy in vitro and to understand the role of hypotonic conditions in this model and its impact on cell death.We determined that the optimal treatment parameters on HCT116 human colon cancer cells, were an exposure of the cells for 30 minutes to 400μM of oxaliplatin under hypotonic conditions (G2.5%) at 37 °C. These results have been validated on various human and murine colic cancer cell lines. We have also shown that these treatment conditions are also able to increase the cytotoxicity of other platinum derivatives such as cisplatin and carboplatin.The cell death induced by this treatment in hypotonia is apoptosis, and can be explained by an increase in the intracellular incorporation of oxaliplatin, partly due to the activation and trimerization of the CTR1 copper transporter.Treatment with oxaliplatin and cisplatin (but not carboplatin) in hypotonia also leads to the stigmata of immunogenic death, e.i. exposure of calreticulin at the membrane, release of ATP and HMGB1 in the supernatant, suggesting that hypotonia would entail immunogenic death and an immune system response during this IPEC modeling.Finally, we have been able to demonstrate in vivo that the treatment of intraperitoneal metastases of Balb/c mice by an intraperitoneal injection of oxaliplatin in hypotonia slowed down tumor nodules appearance and increased survival of the mice.Thus, in this work we highlighted that hypotonia is one of the fundamental parameters of IPEC which suggests that its use could make it possible to increase the efficacy of IPEC and maybe to prolong the survival of patients
Bash, Imam Zeina. "Effect of 5-Fluorouracil on translational regulation in colorectal cancer cells." Thesis, Lyon 1, 2015. http://www.theses.fr/2015LYO10014/document.
Full text5-Fluorouracil (5-FU) is an anti-metabolite intensely used in chemotherapeutic treatments in various cancers. The cellular and molecular mechanisms of action of this anti-cancer agent still remain to be determined. Because 5-FU is incorporated within all classes of RNA, knowledge of the different levels of gene expression regulation affected by 5-FU will help to decipher its mode of action. We hypothesized that the translational control is altered by 5-FU treatment as a consequence of disrupted RNA metabolism. In this study, the colorectal cancer cell line HCT116 has been treated or not by different doses of 5-FU for different periods of time to determine the time and dose window that induces modifications of cell behavior without leading to an extensive cell death. Translational reprogramming was then analyzed during this time and dose window. For this, cytoplasmic fractions were purified and separated through sucrose gradients to distinguish the actively translated mRNAs that are associated with polysomes from the inactive mRNAs associated with monosomes or free mRNAs. A microarray analysis was then performed to identify the mRNAs presented in monosome and polysome fractions with and without treatment. This polysome profiling approach reveals that 5-FU treatment did not turn-off the global translation efficiency, but rather modulates translation efficiency of specific mRNAs. Secondly, more than 640 mRNAs were found to be up-translated following 5-FU treatment. Finally, we have demonstrated that 5-FU induced up-regulation of HIVEP2 by a molecular mechanism involving an action of 5-FU on miR-155
Gouju, Julien. "Importance de la voie Cdk4-EZH2 dans l'échappement à la sénescence induite par la chimiothérapie." Thesis, Angers, 2016. http://www.theses.fr/2016ANGE0056/document.
Full textChemotherapy-induced senescence enables to trigger a durable division arrest of tumor cells. However, this tumor suppressor mechanism is neutralized in some treated cells leading mostly to cancer relapse in patients. Recently, we have described a MCL1-dependent mechanism of escape in SN-38-induced senescence from colorectal cell lines. In this study, we showed that senescent cells (PLS cells) promoted the non senescent cells (PLD cells) proliferation through mitogenic signals stimulating Cdk4 kinase activity and subsequently the cell cycle. We demonstrated that Cdk4 phosphorylated Rb on the serine 780 to inhibit its activity, allowing E2F- family transcriptional functions activation on cell cycle targets. Loss of Cdk4 expression or activity induced by RNA interference or Palbociclib reduced the emergence of proliferating clones. TheEZH2-methyltransferase, a E2F transcriptional target, is only expressed by PLD cells and this expression depends on Cdk4 activity. Moreover, loss of EZH2 expression or activity, by RNA interference or by DZNepA and GSK343 inhibitors, reduced the emergence of proliferating cells. Finally, EZH2 inhibition promotes both cell division arrest and senescence in response to Palbociclibin the SN-38-escaped cells. To conclude, this study enabled to highlight a major role of EZH2 as effector of Cdk4 in the escape mechanism induced by SN-38 a signaling pathway offering newtargeted cancer therapies
Sellier, Hélène. "RÉPONSE À LA CHIMIOTHÉRAPIE ET PROGRESSION DU CYCLE CELLULAIRE : RÔLE DE L'ONCOGÈNE STAT3 DANS LE CANCER COLORECTAL." Phd thesis, Université d'Angers, 2011. http://tel.archives-ouvertes.fr/tel-00979247.
Full textLièvre, Astrid. "Facteurs moléculaires pronostiques et prédictifs de la réponse aux traitements du cancer colorectal." Paris 5, 2008. http://www.theses.fr/2008PA05S014.
Full textWe showed that mutations in the non-coding region (D-Loop) of the mitochondrial DNA were frequent in colorectal tumors, that they occured at an early step (adenoma) of the carcinogenesis and that they were a prognostic factor and associated with resistance to 5-fluorouracil-based adjuvant chemotherapy. Moreover, we showed that KRAS gene mutations were associated with a resistance to cetuximab, an anti-EGFR antibody used in the treatment of metastatic colorectal cancer, and that they were a poor prognostic factor in patients treated by this antibody, independently of skin toxicity. The expression of the phosphoproteins pP70S6K and pMEKl also seems to be predictive of response to anti-EGFR antibodies and a prognostic factor in patients treated by them, independantly of KRAS mutation status
Roberge, Joannie. "Modulation de la réponse pharmacologique à un agent anticancéreux par les isoformes I2 dérivées de l'épissage alternatif du gène UGT1A." Master's thesis, Université Laval, 2012. http://hdl.handle.net/20.500.11794/25969.
Full textPoujol, Sylvain. "Pharmacocinétique et pharmacogénétique de l’irinotécan chez le patient atteint de cancer colorectal métastatique." Montpellier 1, 2009. http://www.theses.fr/2009MON13511.
Full textGirard, Hugo. "Rôle de la voie de glucuronidation dans la susceptibilité et le traitement du cancer colorectal." Thesis, Université Laval, 2008. http://www.theses.ulaval.ca/2008/25719/25719_1.pdf.
Full textCherradi, Sara. "Les claudines dans le cancer colorectal : ciblage thérapeutique de la claudine-1." Thesis, Montpellier, 2018. http://www.theses.fr/2018MONTT082.
Full textColorectal cancer (CRC) is one of the major causes of cancer-related deaths in the Western world. When localized, CRC is often curable by surgery. However, 50% of patients are diagnosed at a metastatic stage, these patients are then treated with chemotherapy (FOLFOX / FOLFIRI), often in combination with targeted therapies including antibodies such as Cetuximab (anti-EGFR) or Bevacizumab (anti -VEGF). Despite these treatment, almost 40% of patients develop resistance. One of the most known resistance mechanisms of resistance is due to the RAS pathway downstream of the EGF receptor in response to Cetuximab. Therefore, more therapeutic options are required particularly by identifying new molecular targets that can be reached by antibodies. Recently, Claudines have generated interest as targets in cancer, such as claudin-4 in endometrial or prostate cancer. More recently, the results of a clinical study demonstrated that the combination of an anti-Claudin-18.2 antibody, IMAB362 mAb, with chemotherapy significantly prolonged survival in patients with advanced gastric cancer.Therefore, one of our aims was to focus on claudins in CCR. First, by studying their expression in metastatic CRC patient samples. We demonstrated the prognostic value of some claudins, after analyzing their gene expression in the new molecular subtype of CRC. Beside, we identified some claudins as potential therapeutic targets in CCR, among them claudin-1 (CLDN1). Indeed, we showed that the membrane form of CLDN1 is overexpressed in primary tumors and metastases of CRC. Therefore, we developed a monoclonal antibody (mAb) targeting the extracellular parts of CLDN1. We showed that therapeutic targeting of CLDN1 by mAb significantly decreased tumor cell growth, migration and invasion both in vitro and in vivo. In order to improve the efficiency of targeting CLDN1 by mAb, we conjugated it with a toxin, thus generating an Antibody Drug Conjugate (ADC). We showed that CLDN1 targeting by an ADC decreased cell survival in vitro in 2D cell culture, but also spheroids growth via a cytotoxic effect.This work demonstrated the proof of concept of CLDN1 targeting by both mAb and ADC. In order to achieve this work, the next steps remains on testing ADC affect in vivo models. CLDN1 is a good therapeutic target in the CCR. In the long term, we hope that its targeting can find its place within the therapeutic arsenal of metastatic CRC, particularly in treatment of resistant patients
Terret, Catherine. "Optimisation de la chimiothérapie du cancer colorectal métastatique par 5-FU et CPT-11 : données de pharmacocinétique, de chimiosensibilité." Toulouse 3, 2000. http://www.theses.fr/2000TOU30166.
Full textRemy, Stéphane. "Chimiothérapie du cancer colorectal métastatique : étude rétrospective d'une série de 69 patients traités par une perfusion continue de 5-fluorouracile." Bordeaux 2, 1999. http://www.theses.fr/1999BOR23030.
Full textHendlisz, Alain. "Multimodality imaging for treatment response prediction in colorectal cancer." Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209109.
Full text1) Le premier projet explore l’imagerie multimodale comme un outil d’individualisation pour la radio-embolisation (microsphères chargées en 90Yttrium) chez des patients porteurs d’un CCR métastatique au niveau du foie, pour laquelle l’imagerie morphologique classique est incapable de mesurer l’effet thérapeutique. Nous montrons que l’usage non sélectif de la radio-embolisation améliore l’histoire clinique de ces patients, bien que certains d’entre eux ne semblent pas en bénéficier. Ensuite, par une analyse multimodale lésion par lésion intégrant angiographie-CT Scan, FDG-PET/CT et scintigraphie aux macro-agrégats d’albumine marqués au 99mTechnetium, nous démontrons que la distribution pré-thérapeutique des macro-agrégats d’albumine est hétérogène entre les différentes lésions des patients et prédictive de la réponse métabolique au sein de ces lésions, permettant le développement d’un outil de prédiction et de planification pour la radio-embolisation.
2) Le deuxième projet explore le domaine du CCR métastatique traité par chimiothérapie palliative. (i) Nous démontrons d’abord que la réponse métabolique (RM) tumorale après une cure de chimiothérapie cytolytique prédit plus vite et plus adéquatement que l’imagerie morphologique basée sur les critères RECIST les bénéfices cliniques du traitement. La RM précoce a une excellente valeur prédictive négative sur l’absence de réponse morphologique et met en évidence une variabilité de réponse inter-lésionnelle chez une proportion importante des patients. (ii) L’étude SoMore explore ensuite des patients présentant un CCR avancé et réfractaire, traités par capecitabine et sorafenib, et confirme l’importance pronostique des RM mixtes, suggérant une méthodologie de classification clinique basée sur la consistance de la RM. (iii) Cette classification cherche confirmation dans l’étude RegARd-C, encore en cours, évaluant les effets du regorafenib, et explorant également la signification génomique et épigénétique de la variabilité de RM.
3) Le troisième projet cherche à utiliser les propriétés de l’imagerie métabolique pour modifier l’algorithme de traitement adjuvant des patients porteurs d’un cancer du côlon de stade III. Ce projet, encore en cours, fait l’hypothèse que l’absence de RM de la lésion primitive après une cure de chimiothérapie prédit l’absence de bénéfice du traitement adjuvant complet. Une analyse intérimaire en démontre la faisabilité et confirme la présence de 40% de tumeurs présentant des caractéristiques métaboliques de chimio-résistance.
En conclusion, pour des patients porteurs d’un CCR, l’imagerie multimodale comprenant une évaluation du métabolisme tumoral permet une évaluation plus précoce et plus adéquate du bénéfice au traitement anticancéreux pour différentes modalités thérapeutiques comme la radio-embolisation, la chimiothérapie cytotoxique et les agents biologiques. L’imagerie multimodale permet de prédire et planifier les radio-embolisations et se révèle très prometteuse pour les traitements chimiothérapiques cytotoxiques ou combinés à des biologiques en situation adjuvante ou métastatique. Elle démontre par ailleurs une importante variabilité de réponse métabolique inter-lésionnelle qui représente un axe de recherche majeur sur les mécanismes moléculaires d’hétérogénéité génomique tumorale et de résistance aux traitements anti-cancéreux.
Doctorat en Sciences médicales
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Chen, Siwen Sylvialin. "Novel pharmacogenomic markers of irinotecan-induced severe toxicity in metastatic colorectal cancer patients." Doctoral thesis, Université Laval, 2015. http://hdl.handle.net/20.500.11794/26976.
Full textIrinotecan is a cytotoxic agent widely used for the treatment of solid tumors, most particularly for metastatic colorectal cancers (mCRC). Treatment with this drug frequently results in severe neutropenia and diarrhea that can seriously impact the course of treatment and patients’ quality of life. Pharmacogenomic tailoring of irinotecan-based chemotherapy has been the subject of several investigations, especially for the UGT1A1 gene, but with limited data regarding transporter genes. In this study, we sought to discover toxicity-associated markers using a haplotype-tagging SNP (htSNP) strategy to maximize gene coverage. We examined the genetic association across the UGT1 locus, and in seven transporter genes participating in irinotecan pharmacokinetics involving the ABC transporter genes ABCB1, ABCC1, ABCC2, ABCC5, ABCG1, ABCG2 and the solute carrier organic anion transporter gene SLCO1B1. The profiles of 167 mCRC Canadian patients treated with FOLFIRI-based regimens were examined and findings were replicated in an independent cohort of 250 Italian patients. We found rs11563250G, located in the intergenic region downstream of UGT1, to be significantly associated with reduced risk of severe neutropenia (odds ratio (OR)=0.21; p=0.043 and OR=0.27; p=0.036, respectively, and OR=0.31 when combined; p=0.001), which remained significant upon correction for multiple testing in the combined cohort (p=0.041). For the two-marker haplotype rs11563250G and UGT1A1*1 (rs8175347 TA6), the OR was of 0.17 (p=0.0004). Genetic testing of this marker may identify patients who might benefit from increased irinotecan dosing. In combined cohorts, a two-marker ABCC5 rs3749438 and rs10937158 haplotype (T–C) predicted a lower risk of severe diarrhea (odds ratio (OR) of 0.43; p=0.001). The co-occurrence of ABCG1 rs225440T and ABCC5 rs2292997A predicted an increased risk of severe neutropenia (OR=5.93; p=0.0002), which was further improved when incorporating the well-known risk marker UGT1A1*28 rs8175347 (OR=7.68; p< 0.0001). In contrast, carriers of one protective marker (UGT1 rs11563250G) but none of these risk alleles experienced significantly less severe neutropenia (8.2% vs. 34.0%; p< 0.0001). This combination of predictive genetic markers could lead to better risk assessment and may thus enhance personalized treatment.
Very, Ninon. "O-GlcNAcylation de la Thymidylate Synthase : un mécanisme de sensibilisation au 5-fluorouracile dans le cancer colorectal." Thesis, Lille, 2020. http://www.theses.fr/2020LILUS113.
Full textO-GlcNAcylation (O-N-acetylglucosaminylation) is a dynamic and reversible PTM (post-translational modification) controlled by a couple of unique antagonist enzymes : OGT (O-GlcNAc transferase) and OGA (O-GlcNAcase). O GlcNAcylation is considered as a nutritional sensor and regulates a plethora of fundamental cellular mechanisms. By targeting oncoproteins and tumor suppressors, dysregulation of O-GlcNAcylation is associated with carcinogenesis and tumor progression. However, its role in the anti-cancer therapy response has been poorly investigated. Recently, hyper O-GlcNAcylation has been shown to impact the response of some cancers to drugs such as tamoxifen, cisplatin, bortezomib and 5-FU (5-fluorouracil). 5-FU is the CRC (colorectal cancer) gold standard chemotherapy and TS (Thymidylate synthase) is its main target. Overexpression of TS is a biomarker of 5-FU resistance already used clinically. TS has been shown to be O-GlcNAcylated but the role of this PTM has not been elucidated. We therefore analyzed the « cross-talk » between O-GlcNAcylation and 5-FU response based on the hypothesis that O-GlcNAcylation impacts the sensitivity to 5-FU by regulating TS. In vivo mouse model of human CRC and colon non-cancerous and cancerous cells were used to analyze the effect of 5 FU on total O-GlcNAcylation and, reciprocally, the impact of O-GlcNAcylation on TS level/activity and 5-FU response. Our in vitro data corroborate our in vivo results and support that 5-FU decreases O-GlcNAcylation and, reciprocally, that O-GlcNAcylation increases TS level and sensitizes CRC to 5-FU. We deciphered the underlying molecular mechanism which highlights the role of O-GlcNAcylation towards TS stability and protection against proteasomal degradation. Two TS O-GlcNAcylated sites have been identified: at Thr251 within the dimerization interface and at Thr306 within the carboxy-terminal degron sequence known to control TS degradation. Together, our results propose a new therapeutic approach combining 5-FU-based therapy with an OGA inhibitor to improve the CRC drug response
El, Ouadrani Belkhiria Karima. "L'exposition prolongée de cellules de cancer colorectal aux agents chimiothérapeutiques induit une Transition Epithélio-Mésenchymateuse (EMT) et une augmentation de l'invasivité tumorale." Paris 6, 2011. http://www.theses.fr/2011PA066709.
Full textViguier, Jérôme. "Identification de facteurs moléculaires prédictifs de la chimiosensibilité des cancers colorectaux." Paris 6, 2006. http://www.theses.fr/2006PA066324.
Full textVetillard, Alexandra. "Rôle de la kinase Akt dans la chimiorésistance : Régulation de l’équilibre Apoptose-Sénescence." Thesis, Angers, 2015. http://www.theses.fr/2015ANGE0078.
Full textActivated by chemotherapy, senescence is a tumor suppressive mechanism that prevents tumor progression. However, some cancer cells can emerge to induce clinical relapse. The mechanisms set up by cells to escape senescence are not yet clearly known. We have recently described that cells that escape senescence are more transformed than non treated parental cells ; they resist anoikis and depend on Mcl-1. In this study, we further characterize this emergence in response to irinotecan, a first line treatment used in colorectal cancer. Our results indicate that the Akt kinase was activated as a feedback pathway during the early step of senescence and also during emergence. Inhibition of the kinase with GSK690693 prevented cell emergence and improved treatment efficacy, both in vitro and in vivo. This improvement was correlated with senescence inhibition, p21waf1 down regulation and a concomitant activation of apoptosis due to Noxa upregulation and Mcl-1 inactivation. Indeed, Noxa inactivation prevented apoptosis and increased the number of emergent cells. Moreover, using p21waf1-deficient cells, we further confirmed that an intact p53-p21-senescence pathway favored cell emergence and that its down regulation improved treatment efficacy through apoptosis induction. These results highlight that Akt inhibition improves irinotecan treatment and prevent cell emergence by switching the senescence response to apoptosis. Therefore, we propose that use of Akt inhibitors in sequential therapies should be considered in future to improve the treatment of irinotecan-refractory colorectal cancers
Graudens, Esther. "Réseaux fonctionnels associés à la résistance innée du cancer colorectal à la chimiothérapie : analyse du transcriptome, annotation fonctionnelle, modélisation systémique." Paris 11, 2006. http://www.theses.fr/2006PA112039.
Full textColorectal cancer is a major cause of death in western countries. In spite of the use of new molecules, resistance to the treatments is important upon first exposure to chemotherapy. The objective of my thesis was to identify functional networks contributing to innate resistance of the tumours. Expression profiles of tumor and metastasis samples from 13 patients with advanced colorectal cancer were collected using cdna microarrays before exposure of the patients to a combined chemotherapy. Experimental and analytical procedures were established to obtain precise and highly documented data. A careful experimental design allowed limiting falsely positive or negative differential hybridization results. A list of 679 genes differentially expressed in relation with responses to chemotherapy was established. The results have been verified and validated by quantitative rt-pcr on the samples investigated and two novel samples whose phenotype was correctly characterized. Functional annotation of the selected genes made it possible to determine the biological processes and cellular components associated with them. A map of functional networks was constructed using a systems biology language. It allowed formulation of hypotheses on underlying mechanisms. A resistant cell would divide poorly, would rapidly repair damages caused to its dna, and would present an increased drug efflux and a frozen extracellular matrix. Two groups of genes predictors of response to chemotherapy were selected, which will have to be validated on new samples. These results could be used as a basis to facilitate resistance bypass through diagnostics and implementation of novel therapeutic strategies
Boige, Valérie. "Impact des polymorphismes constitutionnels et des altérations génétiques somatiques sur l'efficacité et la toxicité des chimiothérapies anti-tumorales dans le cancer colorectal." Paris 5, 2009. http://www.theses.fr/2009PA05S003.
Full textDesurmont, Thibault. "Etude de l'implication des chimiokines et de leurs récepteurs dans la survenue d'une rechute métastatique chez des patients atteints d'un cancer du côlon métastatique et traités par chirurgie hépatique avec ou sans chimiothérapie néoadjuvante." Thesis, Lille 2, 2015. http://www.theses.fr/2015LIL2S042/document.
Full textOur aim was to analyze the potential role of chemokine receptors CXCR2 and CXCR4 signalling pathways in liver metastatic colorectal cancer (CRC) relapse. Expression levels of CXCR2, CXCR4, and their chemokine ligands were evaluated in liver metastases of colorectal cancer in order to study their correlation with overall and disease-free survival of patients having received, or not received, a neoadjuvant chemotherapy regimen.Quantitative RT-PCR and CXCR2 immunohistochemical staining were carried out using human CRC liver metastasis samples. Expression levels of CXCR2, CXCR4, and their ligands were statistically analyzed according to treatment with neoadjuvant chemotherapy and patients ' outcome. Murine models of subcutaneous and orthotopic intracaecal xenografts have been developed and used to study the expression of CXCR2, CXCR4 and CXCL7 in connection with the treatment of mice with chemotherapy.We showed that CXCR2 and CXCL7 overexpression are correlated to patient’s shorter overall and disease-free survival. By multivariate analysis, CXCR2 and CXCL7 expressions are independent factors of overall and disease-free survival. Neoadjuvant chemotherapy increases significantly the expression of CXCR2 and CXCL7 was overexpressed close to significance. Results of our mouse models have shown a trend over-expression of our interest genes in tumor tissues of the treated mice.In conclusion, we show the involvement of CXCL7/CXCR2 signalling pathways as a predictive factor of poor outcome in metastatic CRC. 5-Fluorouracil-based chemotherapy regimens increase the expression of these genes in liver metastasis, providing one explanation for aggressiveness of relapsed drug-resistant tumors. Selective blockage of CXCR2/CXCL7 signalling pathways could provide new potential therapeutic opportunities
Rajabi, Fatemeh. "Role of the xenoreceptor PXR (NR1I2) in colon cancer stem cells drug resistance and tumor relapse." Thesis, Montpellier, 2015. http://www.theses.fr/2015MONTT027.
Full textTumor recurrence is one of the major obstacles to overcome in the future to improve overall survival of patients with colon cancer. High rates and patterns of therapeutic failure seen in patients are consistent with a steady accumulation of drug-resistant cancer stem cells (CSCs). Here, we demonstrate that the nuclear receptor PXR (NR1I2) acts as a key regulator of colon CSC chemoresistance and of their ability to generate post-treatment tumor relapse. We first determined that the enrichment of PXR paralleled that of CSC markers upon treatment of colon cancer cells with standard of care chemotherapy. We found that PXR was highly expressed in colorectal cancer cells displaying CSC markers and function and that it was instrumental for the emergence of CSCs following chemotherapy in vitro and in vivo. mRNA profiling experiments in colon CSCs indicated that PXR transcriptionally controls a large network of genes including markers of stemness, genes involved in resistance to drug/apoptosis or migration/invasion. Finally, PXR down-regulation altered the survival and self-renewal of colon CSCs in vitro and hampered their capacity to resist chemotherapy in vivo, leading to significant delays of post-chemotherapy tumor relapse. This study strongly suggests that targeting PXR may represent a novel treatment strategy to prevent drug resistance and recurrence through the sensitization of CSCs to standard chemotherapy. Taken together, our data strongly suggest that PXR plays an instrumental role in the so-called "intrinsic" pan-resistance of CSCs against therapy
Leguelinel, Géraldine. "Rôle des récepteurs des xénobiotiques CAR (Constitutive Androstane Receptor, NR1I3) et PXR (Pregnane X receptor, NR1I2) dans le métabolisme des chimiothérapies conventionnelles du cancer colorectal." Thesis, Montpellier 1, 2011. http://www.theses.fr/2011MON13512.
Full textColorectal cancer is characterized by high mortality in advanced stages due to the high rate of tumor recurrence after chemotherapy. The prediction of the efficacy and toxicity of cytotoxic drugs represents a major challenge in the coming years. Because the majority of cancer drugs are supported by the enzymes and transporters whose expression is controlled by the level of expression and activation of the xenosensors CAR (NR1I3) and PXR (NR1I2), it is likely that they may represent predictive factors in the management of cancer. Our team has recently shown that xenobiotic receptors PXR (Raynal et al, 2010) and CAR are expressed in cell lines and human colon tissues. Their overexpression in colon cancer cell lines LS174T and T84 leads to resistance to irinotecan and to its active metabolite SN38, while their inhibition reverse this resistance. Irinotecan metabolites detection assays of SN38 and SN38G, and the quantification of UGT1As and MDR1 mRNA, show that CAR and PXR increase the detoxifying metabolism and the efflux of SN38. The impact of overexpression of these xenosensors on LS174T cell viability to different classes of cytotoxic agents (anti-metabolites, DNA intercalators, topoisomerase inhibitors, antimitotic agents) was then evaluated. We observed that the expression of CAR or PXR results in a significant drug resistance to paclitaxel, docetaxel and 4-hydroxy-cyclophosphamide whereas PXR leads to a marked sensitization to cisplatin and carboplatin by increasing the amount of platinum adducts the DNA. Microarray studies of our cell models allowed us to identify the target genes potentially involved in these changes in cytotoxicity. Further studies by pharmacological modulation or interfering RNAs of these target genes are in progress and will allow us to clarify the mechanisms involved in the changes in chemosensitivity. This work should help us to understand the impact of CAR and PXR xenosensors on the intratumoral metabolism of cytotoxic drugs and potentially on the response to various chemotherapies
Moreau, Marie. "Les cellules sénecentes comme niche de survie : rôle de la voie TSP1-CD47." Thesis, Angers, 2017. http://www.theses.fr/2017ANGE0078.
Full textActivated by chemotherapy, senescence is a suppressive mechanism that prevents tumor progression. However some cancer cells can emerge and induce clinical relapse. We have recently described that emergent cells resist toanoikis and depend on Mcl-1. This survival pathway is activated by Akt kinase that inhibits Noxa and apoptosis. One of the caracteristics of senescence is the appearance of the secretory phenotype called SASP that can induce deleterious effects to neighboring cells. In this study, we observed that the secretome of persistant cells induces anoïkis resistance, migration and invasion of parental cells. Proteomics analysis performed at laboratory showed that TSP-1 is over expressed in advanced stages of colon and breast tumors. During persistance, TSP-1 and its receptor CD47 are more expressed by senescent cells. Blockade of TSP-1 or its binding on CD47 increases persistence and induces spheroïds generation showing an increase in the proportion of stem cells. Self-renewal factors Nanog and Klf4 are early expressed following treatment. Following CD47 inactivation or stimulation withTSP-1, the expression of Nanog is blocked. The inhibition of Nanog or Klf4 reduces emergence. So, in senescent cells, CD47 could activate self-renewal and could promote emergence. By linking to its receptor, TSP-1 could block these processes et coud act as a tumor suppressor
Corvaisier, Matthieu. "Implication des co-activateurs transcriptionnels YAP/TAZ dans la régulation entre la croissance et la dormance tumorale des cellules du cancer colorectal : mécanismes moléculaires et perspectives thérapeutiques." Thesis, Lille 2, 2016. http://www.theses.fr/2016LIL2S028/document.
Full textColorectal cancer is the most frequent and lethal cancerous pathology from the digestive system. Each year in France, 41 000 new cases are diagnosed and 17 000 patients die due to this pathology. This high mortality is mainly due to the rate of patients with liver metastatic lesions and the early relapse of those metastases after treatment. The use of chemotherapy prior to surgery induces a decrease of early relapse, however 2 years after resection this advantage is lost. Thus, understanding the mechanisms underlying escape to treatment is required to try to delay or prevent tumor recurrence.The aim of this doctoral work was to analyze clonal chemoresistant subpopulations derived from the colorectal cancer cell line HT29 after chronic exposure to 5-Fluorouracil (5FU) and molecular mechanisms associated with chemoresistance. The most chemoresistant clonal subpopulation, 5F31, stops its proliferation after treatment with high dose of 5FU, this behavior being associated with the modulation of the c-Yes/YAP axis. After treatment, 5F31 cells enter quiescence, interaction between c-Yes and YAP is lost and total and nuclear YAP protein expression reduces significantly (Igoudjil, Touil, Corvaisier et al. 2014, Clinical Cancer Research). The next step was to study functions of YAP protein in this chemotherapy- induced quiescence.Pharmacological or transient inhibition of YAP and its homolog TAZ, induces quiescence and reduces cellular growth in several colorectal cancer cell lines. On the other hand, overexpression of a constitutively active form of YAP in 5F31 cells forces cells to remain proliferative under 5FU treatment, enhancing 5F31 cell chemosensitivity to 5FU.Regarding proteic effectors, quiescence (either induced by 5FU or YAP/TAZ inhibition) is associated with loss of expression of the transcription factor c-Myc and Cyclin E1. In 5F31 cells expressing the active mutant form of YAP, Cyclin E1 expression is sustained after 5FU treatment through the activation of the transcription factor CREB. Cyclin E1 inhibition is sufficient to induce quiescence, therefore introducing this protein as one of the final effectors of YAP/TAZ co-activators in the regulation of the proliferation/quiescence switch in colorectal cancer cells (Corvaisier et al. 2016, Oncotarget).To conclude, our work reveals the importance of YAP/TAZ proteins for the maintenance of colorectal cancer cells proliferation through Cyclin E1 expression. Our work on liver metastases from patients with colorectal cancer shows that high expression of YAP/TAZ is connected to a higher proliferative index in metastatic lesions. Moreover, high YAP/TAZ expression is associated with shorter patient progression-free survival and shorter overall survival. Studying the expression and level of YAP/TAZ activation could be an interesting prognosis marker to anticipate metastatic relapse and potent druggable target to delay tumoral recurrence
Janouskova, Hana. "Caractérisation de la voie de signalisation intégrine α5β1/protéine p53 dans la résistance à la chimiothérapie des gliomes et cancers du colon." Thesis, Strasbourg, 2013. http://www.theses.fr/2013STRAJ065/document.
Full textIntegrins seem to be attractive anti-cancer targets. In this work we investigated the role of integrin α5β1 in glioma brain tumors and colon cancer. We were particularly interested in the role of integrin α5β1/p53 pathway in resistance to therapy. We first focused on gliomas and found that α5β1 integrin was overexpressed in aggressive malignant glioma tumors. Moreover, we showed that α5β1 integrin upregulation was associated with a shorter patient survival. We also demonstrated that α5β1 integrin expression in glioblastomas participates to the resistance to the chemotherapeutic agent Temozolomide, through a negative regulation of the tumor suppressor p53. A direct p53-activation by the non-genotoxic agent Nutlin-3a down-regulated α5 integrin subunit and thus sensitized glioblastoma cells to Nutlin-3a. Furthermore, we demonstrated that the inhibition of α5β1 integrin with a concomitant p53-activation enhanced the effects of p53-based therapy. We also confirmed the existence of a negative cross-talk between α5β1 integrin and p53 in colon cancer
Lagrange, Anais. "Mutation de la chaperonne HSP110 et cancers MSI : étude de ses conséquences moléculaires, fonctionelles, physiopathologiques et cliniques." Thesis, Paris 6, 2014. http://www.theses.fr/2014PA066684/document.
Full textMSI cancers (MicroSatellite Instability) are characterized by widespread instability of DNA repeated sequences, known as microsatellites, due to MMR system (Mismatch Repair) deficiency. Since the detection of this tumor phenotype, most of the oncogenic events reported in these tumors are somatic mutations (1-2 bp insertions or deletions) that affect coding DNA repeats, resulting in frameshifts and inactivation of the corresponding proteins. They accumulate in tumor cells due to positive selection during the MSI-driven tumorigenic process when they promote tumor development by inactivating genes with tumor suppressor-related functions. This work reports the first somatic mutation of a chaperone protein in a cancer so far, i.e. HSP110 (Heat Shock Protein) in MSI colorectal cancer. This mutational event consists in the somatic deletion of the intronic microsatellite, located in the splice acceptor site of HSP110. We demonstrate that it is almost systematic and bi-allelic in these cancers, leading to inactivation of the oncogenic functions of the HSP110 chaperone (pro-apoptotic and anti-proliferative impact leading to chemosensitization of tumor cells and tumor growth decrease). Our findings support an unexpected and paradoxical anticancer impact of the microsatellite instability-driven pathway in mismatch repair-deficient colon cancer. From a pathophysiological and clinical point of view, they highlight HSP110 as a putative relevant prognostic marker (improvement of patients’ response to chemotherapy) and therapeutic target. According to these findings, I propose a therapeutic strategy targeting HSP110 and its mutant for personalized medicine of MSI colon cancer patients
Reita, Damien. "Evaluation préclinique d'une nouvelle combinaison thérapeutique associant l'irinotécan à un inhibiteur de mTOR pour le traitement des tumeurs coliques." Thesis, Strasbourg, 2017. http://www.theses.fr/2017STRAJ071.
Full textDownstream of the PI3K/AKT and RAS/MAPK pathways, mTOR protein kinase plays a decisive role in the development and tumor progression of colorectal cancers. Furthermore, the microenvironment of colorectal cancers is hypoxic. The adaptation of the tumor cells to hypoxia is regulated by the PI3K/AKT /mTOR pathway as well as by the HIFs transcription factors whose protein expression and transcriptional activity is partially regulated by mTOR. In this study, we showed that the vertical and complete inhibition of the PI3K / AKT / mTOR /HIF-1α axis by the combined use of low-dose irinotecan and mTOR catalytic inhibitors significantly inhibits human colon cancer cell proliferation, as well as the growth and metastatic development of xenografted human colon tumors. In parallel, a Tissue Micro Array study on a cohort of stage III human colic tumors shows that the HIFs are strongly expressed in the epithelium and stroma of the tumors and a low nuclear expression of HIF-1α in epithelial cells provides with poor survival to patients and has a predictive value of worse response to 5-FU treatment
Courapied, Sandy. "Implication de l'oncogène STAT3 dans la réponse aux traitements de chimiothérapies : Application au cancer colorectal." Phd thesis, Université d'Angers, 2010. http://tel.archives-ouvertes.fr/tel-00576728.
Full textPavillard, Valérie. "Etude des déterminants de l'activité de l'Irinotécan sur les cancers colorectaux." Bordeaux 2, 2001. http://www.theses.fr/2001BOR28829.
Full textAnticancer drugs of the camptothecin series are able to stabilise DNA-topoisomerase I cleavable complexes which lead double strand DNA breaks which are toxis to the target cells. Irinotecan is a semi-synthetic derivative of the camptothecin which is active in colorectal cancer ; it is in fact a pro-drug which needs to be transformed into an active metabolite. SN-38, by microsomal carboxylesterases. We studied several cellular parameters potentially involved in irinotecan activity in order to link them to tumor response : DNA topoisomerase I, the target of irinotecan ; carboxylesterases, which activate irinotecan ; BCRP membrane protein (Breast Cancer Resistance Protein) which is expected to expell irinotecan out of the cells ; and p53 which is able to activate topoisomerase I and is commonly mutated in cancers. In the first part of our work, we studied these parameters on two colorectal cancer cell lines which present different irinotecan sensitivity. We showed that intracellular accumulation of irinotecan and p53 status could explain this difference in sensitivity. In the second part of our work, we optimized a subcellular fractionation technique with normal and tumoral rat organs in order to apply it to human biopsies. In the third part of our work, we studied the cellular parameters previously described in normal and tumoral human biopsies obtained from patients treated for a colorectal cancer by irinotecan. We observed that topoisomerase I expression, quantity and activity, were related to clinical response : partial responders present higher values of these parameters than non responders ; carboxylesterase activity seems to be less directly related to tumor response. A prospective study would allow to verify the results obtained in our retrospective study. The challenge of our work is to guide clinicians to choose irinotecan containing treatment for those patients who present cellular parameters favoring to tumor response
Jante, Corbin Sandrine. "Traitement palliatif des cancers colorectaux évolués par une chimiothérapie associant acide folinique à forte dose, 5-Fluoro-Uracile (5FU) en bolus et en perfusion continue : à propos de 91 cas." Bordeaux 2, 1994. http://www.theses.fr/1995BOR2M094.
Full textGourdier, Isabelle. "Exploration de la résistance à l'oxaliplatine dans les cancers colorectaux : implication de la voie apoptotique mitochondriale." Montpellier 1, 2002. http://www.theses.fr/2002MON13520.
Full textTumor resistance to chemotherapy limits considerably the efficacy of colorectal cancer treatment. The aim of this thesis was to identify major cellular mechanisms leading to oxaliplatin resistance of colorectal cancers. For this purpose, we developed cellular models to study resistance, submitting several human colorectal cell lines to increasing concentrations of oxaliplatin. In this study, oxaliplatin resistance was found to be associated with a mitochondrial apoptosis defect, first in the HCT116 cellular model and then in a second cellular model: SW620. Indeed, oxaliplatin resistance was found to be associated with functional alterations in the mitochondrial apoptotic pathway (cross-resistance to apoptosis inducers acting directly on the mitochondria). In some cases, apoptosis alterations were found to be associated with a dysregulation of the pro-apoptotic protein Bax at several levels: genetic (Bax mutation), transcriptional (over-expression of Bax transcripts) and/or proteomic ( dawn-expression or complete loss of expression of Bax protein). Identification of these alterations in the mitochondrial apoptotic pathway in relation to acquisition of oxaliplatin resistance opens new clinical horizons among which are:(i) the development of a method to predict oxaliplatin resistance, based on the identification of tumor markers of mitochondrial apoptosis defects, and (ii) the conception of a therapeutic strategy designed to increase oxaliplatin efficacy by addition of a substance able to modulate phenomena of mitochondria-mediated apoptosis resistance
Lignet, Floriane. "Approches mathématiques multi-niveaux pour l'étude de la croissance des tumeurs : Application à la morphogenèse du cancer du sein et ciblage thérapeutique de l'angiogenèse du cancer du côlon." Phd thesis, Ecole normale supérieure de lyon - ENS LYON, 2012. http://tel.archives-ouvertes.fr/tel-00844807.
Full textBalin-Gauthier, Diane. "Etude des interactions "Cetuximab/oxaliplatine" dans des modèles de tumeurs coliques humaines." Toulouse 3, 2006. http://www.theses.fr/2006TOU30166.
Full textThe effects of cetuximab, a chimeric monoclonal antibody anti-EGFR, combined with oxaliplatin were assessed in a panel of 4 colorectal cancer cell lines expressing different level of EGFR. Results show that cetuximab exosure induces, in vivo and in vitro, synergistic interaction with oxaliplatin in HT-29 and HCT-8 cell lines. Synergistic effect of the oxaliplatin/cetuximab combination in HCT-8 cells involves multiple interaction between oxaliplatin pharmacology and EGFR signaling transduction pathway. First, cetuximab inhibits NER activity through the down-regulation of ERCC1 expression which results in the stabilization of platinum-DNA adducts level. Oxaliplatin/cetuximab combination accelerates apoptotic effect of oxaliplatin concomitantly with an inhibition of AKT activation. The analysis of cell cycle distribution and modulation of various gene expression highlight the inhibition of the initiation of DNA replication as a signature of oxaliplatin/cetuximab synergistic interaction