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Obrist F, Manic G, Kroemer G, Vitale I, Galluzzi L. Trial Watch: Proteasomal inhibitors for anticancer therapy. Mol Cell Oncol 2015; 2:e974463. [PMID: 27308423 PMCID: PMC4904962 DOI: 10.4161/23723556.2014.974463] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 09/15/2014] [Accepted: 09/17/2014] [Indexed: 01/12/2023]
Abstract
The so-called "ubiquitin-proteasome system" (UPS) is a multicomponent molecular apparatus that catalyzes the covalent attachment of several copies of the small protein ubiquitin to other proteins that are generally (but not always) destined to proteasomal degradation. This enzymatic cascade is crucial for the maintenance of intracellular protein homeostasis (both in physiological conditions and in the course of adaptive stress responses), and regulates a wide array of signaling pathways. In line with this notion, defects in the UPS have been associated with aging as well as with several pathological conditions including cardiac, neurodegenerative, and neoplastic disorders. As transformed cells often experience a constant state of stress (as a result of the hyperactivation of oncogenic signaling pathways and/or adverse microenvironmental conditions), their survival and proliferation are highly dependent on the integrity of the UPS. This rationale has driven an intense wave of preclinical and clinical investigation culminating in 2003 with the approval of the proteasomal inhibitor bortezomib by the US Food and Drug Administration for use in multiple myeloma patients. Another proteasomal inhibitor, carfilzomib, is now licensed by international regulatory agencies for use in multiple myeloma patients, and the approved indications for bortezomib have been extended to mantle cell lymphoma. This said, the clinical activity of bortezomib and carfilzomib is often limited by off-target effects, innate/acquired resistance, and the absence of validated predictive biomarkers. Moreover, the antineoplastic activity of proteasome inhibitors against solid tumors is poor. In this Trial Watch we discuss the contribution of the UPS to oncogenesis and tumor progression and summarize the design and/or results of recent clinical studies evaluating the therapeutic profile of proteasome inhibitors in cancer patients.
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Affiliation(s)
- Florine Obrist
- Université Paris-Sud/Paris XI; Le Kremlin-Bicêtre, France
- INSERM, U1138; Paris, France
- Equipe 11 labelisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers; Paris, France
- Gustave Roussy Cancer Campus; Villejuif, France
| | | | - Guido Kroemer
- INSERM, U1138; Paris, France
- Equipe 11 labelisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers; Paris, France
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
- Pôle de Biologie, Hôpital Européen Georges Pompidou; Paris, France
- Metabolomics and Cell Biology Platforms; Gustave Roussy Cancer Campus; Villejuif, France
| | - Ilio Vitale
- Regina Elena National Cancer Institute; Rome, Italy
- Department of Biology, University of Rome “Tor Vergata”
| | - Lorenzo Galluzzi
- INSERM, U1138; Paris, France
- Equipe 11 labelisée par la Ligue Nationale contre le Cancer, Center de Recherche des Cordeliers; Paris, France
- Gustave Roussy Cancer Campus; Villejuif, France
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
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Awan FT, Flynn JM, Jones JA, Andritsos LA, Maddocks KJ, Sass EJ, Lucas MS, Chase W, Waymer S, Ling Y, Jiang Y, Phelps MA, Byrd JC, Lucas DM, Woyach JA. Phase I dose escalation trial of the novel proteasome inhibitor carfilzomib in patients with relapsed chronic lymphocytic leukemia and small lymphocytic lymphoma. Leuk Lymphoma 2015; 56:2834-40. [PMID: 25669927 DOI: 10.3109/10428194.2015.1014368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The proteasome complex degrades proteins involved in a variety of cellular processes and is a powerful therapeutic target in several malignancies. Carfilzomib is a potent proteasome inhibitor which induces rapid chronic lymphocytic leukemia (CLL) cell apoptosis in vitro. We conducted a phase I dose-escalation trial to determine the safety and tolerability of carfilzomib in relapsed/refractory CLL or small lymphocytic lymphoma (SLL). Nineteen patients were treated with carfilzomib initially at 20 mg/m(2), then escalated in four cohorts (27, 36, 45 and 56 mg/m(2)) on days 1, 2, 8, 9, 15 and 16 of 28-day cycles. Therapy was generally well tolerated, and no dose limiting toxicities were observed. The most common hematologic toxicities were thrombocytopenia and neutropenia. All patients evaluable for response had stable disease, including patients with del17p13 and fludarabine-resistant disease. This trial shows acceptable tolerability and limited preliminary efficacy of carfilzomib in CLL and SLL.
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Affiliation(s)
- Farrukh T Awan
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Joseph M Flynn
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Jeffrey A Jones
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Leslie A Andritsos
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Kami J Maddocks
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Ellen J Sass
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Margaret S Lucas
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Weihong Chase
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Sharon Waymer
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Yonghua Ling
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Yao Jiang
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Mitch A Phelps
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - John C Byrd
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - David M Lucas
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
| | - Jennifer A Woyach
- a The Ohio State University Comprehensive Cancer Center , Columbus , OH , USA
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Papadopoulos KP, Siegel DS, Vesole DH, Lee P, Rosen ST, Zojwalla N, Holahan JR, Lee S, Wang Z, Badros A. Phase I study of 30-minute infusion of carfilzomib as single agent or in combination with low-dose dexamethasone in patients with relapsed and/or refractory multiple myeloma. J Clin Oncol 2014; 33:732-9. [PMID: 25225420 DOI: 10.1200/jco.2013.52.3522] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Carfilzomib is an irreversible inhibitor of the constitutive proteasome and immunoproteasome. This phase I study evaluated the maximum-tolerated dose (MTD), pharmacokinetics, and pharmacodynamics of carfilzomib administered as a 30-minute intravenous (IV) infusion. Safety and efficacy of carfilzomib as a single agent or in combination with low-dose dexamethasone were assessed. PATIENTS AND METHODS Patients with relapsed and/or refractory multiple myeloma (MM) were administered single-agent carfilzomib on days 1, 2, 8, 9, 15, and 16 of a 28-day cycle. Cycle one day 1 and 2 doses were 20 mg/m(2), followed thereafter by dose escalation to 36, 45, 56, or 70 mg/m(2). Additionally, carfilzomib was combined with low-dose dexamethasone (40 mg/wk). RESULTS Thirty-three patients were treated with single-agent carfilzomib. Dose-limiting toxicities in two patients at 70 mg/m(2) were renal tubular necrosis and proteinuria (both grade 3). The MTD was 56 mg/m(2). Nausea (51.5%), fatigue (51.5%), pyrexia (42.4%), and dyspnea and thrombocytopenia (each 39.4%) were the most common treatment-related toxicities. Overall response rate (ORR) was 50% (56-mg/m(2) cohort). Increasing carfilzomib dosing from 20 to 56 mg/m(2) resulted in higher area under the plasma concentration-time curve from time zero to last sampling and maximum plasma concentration exposure with short half-life (range, 0.837 to 1.21 hours) and dose-dependent inhibition of proteasome chymotrypsin-like activity. In 22 patients treated with 45 or 56 mg/m(2) of carfilzomib plus low-dose dexamethasone, the ORR was 55% with a safety profile comparable to that of single-agent carfilzomib. CONCLUSION Carfilzomib administered as a 30-minute IV infusion at 56 mg/m(2) (as single agent or with low-dose dexamethasone) was generally well tolerated and highly active in patients with relapsed and/or refractory MM. These data have provided the basis for the phase III randomized, multicenter trial ENDEAVOR.
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Affiliation(s)
- Kyriakos P Papadopoulos
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD.
| | - David S Siegel
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - David H Vesole
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Peter Lee
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Steven T Rosen
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Naseem Zojwalla
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Joseph R Holahan
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Susan Lee
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Zhengping Wang
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
| | - Ashraf Badros
- Kyriakos P. Papadopoulos and Joseph R. Holahan, South Texas Accelerated Research Therapeutics, San Antonio, TX; David S. Siegel and David H. Vesole, John Theurer Cancer Center, Hackensack, NJ; Peter Lee, Tower Cancer Research Foundation, Beverly Hills; Naseem Zojwalla, Susan Lee, and Zhengping Wang, Onyx Pharmaceuticals, South San Francisco, CA; Steven T. Rosen, Northwestern Medical Center, Chicago, IL; and Ashraf Badros, Greenebaum Cancer Center, University of Maryland, Baltimore, MD
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