PMC4623111_01
Timeline of drug administrations and CEA levels. Top panel represents the different drug combinations - including both chemotherapy, bevacizumab and metformin - received by the patient in 2012-2013. Bottom panel shows serum CEA levels in the same time window.
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Moreover, CEA levels sharply increased, compared to previous measurements (Fig. 1). Serum CEA slightly increased, compared to pre-treatment values (Fig. 1).
Timeline of morphologic changes in lung and liver metastasis by CT. Representative CT scans of lung (top panels) and liver metastasis (bottom panels) showing marked attenuation of radiologic density following combined administration of bevacizumab plus metformin in a patient with metastatic endometrial cancer.
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CT scans performed at the end of this window of clinical improvement showed reduced radiologic density of the lung and mediastinic lesions, as well as of the hepatic metastasis, compared with previous scans (Fig. 2).
Assessment of metabolic features of liver metastasis. Panel A shows IHC staining of monocarboxylate transporter 4 (MCT4) and liver kinase B1 (LKB1) in the liver metastasis of the patient. Magnifications x100 and x200 were used. This sample is strongly positive for the lactate transporter MCT4 and negative for LKB1. Panel B: PET imaging performed in May 2012 shows strong 18F-FDG uptake in the liver metastasis.
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Intriguingly, we found strong MCT4 expression in the liver metastases (Fig. 3A), suggesting presence of highly glycolytic tumor cells. In keeping with these findings, strong 18F-FDG uptake was observed in liver metastasis by PET imaging (Fig. 3B).   We found that liver metastasis of this patient lacked LKB1 expression (Fig. 3A).