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The BTK inhibitor ibrutinib may protect against pulmonary injury in COVID-19-infected patients. Blood 2020; 135:1912-1915. [PMID: 32302379 PMCID: PMC7243149 DOI: 10.1182/blood.2020006288] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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52
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New Insights on the Emerging Genomic Landscape of CXCR4 in Cancer: A Lesson from WHIM. Vaccines (Basel) 2020; 8:vaccines8020164. [PMID: 32260318 PMCID: PMC7349554 DOI: 10.3390/vaccines8020164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
Deciphering the molecular alterations leading to disease initiation and progression is currently crucial to identify the most relevant targets for precision therapy in cancer patients. Cancers express a complex chemokine network influencing leucocyte infiltration and angiogenesis. Moreover, malignant cells also express a selective repertoire of chemokine receptors that sustain their growth and spread. At present, different cancer types have been shown to overexpress C-X-C chemokine receptor type 4 (CXCR4) and to respond to its ligand C-X-C motif chemokine 12 (CXCL12). The CXCL12/CXCR4 axis influences cancer biology, promoting survival, proliferation, and angiogenesis, and plays a pivotal role in directing migration of cancer cells to sites of metastases, making it a prognostic marker and a therapeutic target. More recently, mutations in the C-terminus of CXCR4 have been identified in the genomic landscape of patients affected by Waldenstrom's macroglobulinemia, a rare B cell neoplasm. These mutations closely resemble those occurring in Warts, Hypogammaglobulinemia, Immunodeficiency, and Myelokathexis (WHIM) syndrome, an immunodeficiency associated with CXCR4 aberrant expression and activity and with chemotherapy resistance in clinical trials. In this review, we summarize the current knowledge on the relevance of CXCR4 mutations in cancer biology, focusing on its importance as predictors of clinical presentation and response to therapy.
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Treon SP, Xu L, Guerrera ML, Jimenez C, Hunter ZR, Liu X, Demos M, Gustine J, Chan G, Munshi M, Tsakmaklis N, Chen JG, Kofides A, Sklavenitis-Pistofidis R, Bustoros M, Keezer A, Meid K, Patterson CJ, Sacco A, Roccaro A, Branagan AR, Yang G, Ghobrial IM, Castillo JJ. Genomic Landscape of Waldenström Macroglobulinemia and Its Impact on Treatment Strategies. J Clin Oncol 2020; 38:1198-1208. [PMID: 32083995 DOI: 10.1200/jco.19.02314] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Next-generation sequencing has revealed recurring somatic mutations in Waldenström macroglobulinemia (WM), including MYD88 (95%-97%), CXCR4 (30%-40%), ARID1A (17%), and CD79B (8%-15%). Deletions involving chromosome 6q are common in patients with mutated MYD88 and include genes that modulate NFKB, BCL2, Bruton tyrosine kinase (BTK), and apoptosis. Patients with wild-type MYD88 WM show an increased risk of transformation and death and exhibit many mutations found in diffuse large B-cell lymphoma. The discovery of MYD88 and CXCR4 mutations in WM has facilitated rational drug development, including the development of BTK and CXCR4 inhibitors. Responses to many agents commonly used to treat WM, including the BTK inhibitor ibrutinib, are affected by MYD88 and/or CXCR4 mutation status. The mutation status of both MYD88 and CXCR4 can be used for a precision-guided treatment approach to WM.
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Affiliation(s)
- Steven P Treon
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Lian Xu
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Maria Luisa Guerrera
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Cristina Jimenez
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Zachary R Hunter
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Xia Liu
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Maria Demos
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Joshua Gustine
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Gloria Chan
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Manit Munshi
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Jiaji G Chen
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Amanda Kofides
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Romanos Sklavenitis-Pistofidis
- Department of Medicine, Harvard Medical School, Boston, MA.,Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA.,Clinical Research Development and Phase I Unit, CREA Laboratory, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Mark Bustoros
- Department of Medicine, Harvard Medical School, Boston, MA.,Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA
| | - Andrew Keezer
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Kirsten Meid
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | | | - Antonio Sacco
- Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA.,Clinical Research Development and Phase I Unit, CREA Laboratory, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Aldo Roccaro
- Clinical Research Development and Phase I Unit, CREA Laboratory, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Andrew R Branagan
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Guang Yang
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Irene M Ghobrial
- Department of Medicine, Harvard Medical School, Boston, MA.,Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA
| | - Jorge J Castillo
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
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Munshi M, Liu X, Chen JG, Xu L, Tsakmaklis N, Demos MG, Kofides A, Guerrera ML, Jimenez C, Chan GG, Hunter ZR, Palomba ML, Argyropoulos KV, Meid K, Keezer A, Gustine J, Dubeau T, Castillo JJ, Patterson CJ, Wang J, Buhrlage SJ, Gray NS, Treon SP, Yang G. SYK is activated by mutated MYD88 and drives pro-survival signaling in MYD88 driven B-cell lymphomas. Blood Cancer J 2020; 10:12. [PMID: 32005797 PMCID: PMC6994488 DOI: 10.1038/s41408-020-0277-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/30/2019] [Accepted: 01/13/2020] [Indexed: 12/27/2022] Open
Abstract
Activating MYD88 mutations promote pro-survival signaling through BTK and HCK, both targets of ibrutinib. Despite high response rates, complete responses to ibrutinib are lacking, and other MYD88 triggered pro-survival pathways may contribute to primary drug resistance. B-cell receptor (BCR) signaling has been observed in lymphomas driven by mutated MYD88, even without activating the BCR pathway mutations. We identified activated SYK (p-SYK), a component of BCR in complex with MYD88 in MYD88-mutated WM and ABC DLBCL lymphoma cells. Confocal microscopy confirmed co-localization of MYD88 with SYK in MYD88-mutated cells. Knockdown of MYD88 or use of a MYD88 signaling inhibitor abrogated SYK activation, while expression of mutated but not wild-type MYD88 amplified p-SYK in MYD88-mutated and wild-type lymphoma cells. Knockdown of SYK or use of inhibitors targeting SYK blocked p-STAT3 and p-AKT signaling in MYD88-mutated cells. Cell viability analysis showed that combining ibrutinib and SYK inhibitors triggered synthetic killing of MYD88-mutated lymphoma cells. Our findings extend the spectrum of mutated MYD88 pro-survival signaling to include SYK directed BCR cross talk in MYD88-mutated lymphomas. Targeting SYK in combination with ibrutinib produces synthetic lethality, providing a framework for the clinical investigation of ibrutinib with SYK inhibitors in MYD88-mutated lymphomas.
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Affiliation(s)
- Manit Munshi
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Xia Liu
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jiaji G Chen
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Lian Xu
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Nickolas Tsakmaklis
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Maria G Demos
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Amanda Kofides
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Maria Luisa Guerrera
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Cristina Jimenez
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Gloria G Chan
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Zachary R Hunter
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - M Lia Palomba
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Kirsten Meid
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Andrew Keezer
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Joshua Gustine
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Toni Dubeau
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jorge J Castillo
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Christopher J Patterson
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jinhua Wang
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Sara J Buhrlage
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Nathanael S Gray
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Steven P Treon
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
- Department of Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
| | - Guang Yang
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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55
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de Groen RAL, Schrader AMR, Kersten MJ, Pals ST, Vermaat JSP. MYD88 in the driver's seat of B-cell lymphomagenesis: from molecular mechanisms to clinical implications. Haematologica 2019; 104:2337-2348. [PMID: 31699794 PMCID: PMC6959184 DOI: 10.3324/haematol.2019.227272] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022] Open
Abstract
More than 50 subtypes of B-cell non-Hodgkin lymphoma (B-NHL) are recognized in the most recent World Health Organization classification of 2016. The current treatment paradigm, however, is largely based on 'one-size-fits-all' immune-chemotherapy. Unfortunately, this therapeutic strategy is inadequate for a significant number of patients. As such, there is an indisputable need for novel, preferably targeted, therapies based on a biologically driven classification and risk stratification. Sequencing studies identified mutations in the MYD88 gene as an important oncogenic driver in B-cell lymphomas. MYD88 mutations constitutively activate NF-κB and its associated signaling pathways, thereby promoting B-cell proliferation and survival. High frequencies of the hotspot MYD88(L265P) mutation are observed in extranodal diffuse large B-cell lymphoma and Waldenström macroglobulinemia, thereby demonstrating this mutation's potential as a disease marker. In addition, the presence of mutant MYD88 predicts survival outcome in B-NHL subtypes and it provides a therapeutic target. Early clinical trials targeting MYD88 have shown encouraging results in relapsed/refractory B-NHL. Patients with these disorders can benefit from analysis for the MYD88 hotspot mutation in liquid biopsies, as a minimally invasive method to demonstrate treatment response or resistance. Given these clear clinical implications and the crucial role of MYD88 in lymphomagenesis, we expect that analysis of this gene will increasingly be used in routine clinical practice, not only as a diagnostic classifier, but also as a prognostic and therapeutic biomarker directing precision medicine. This review focuses on the pivotal mechanistic role of mutated MYD88 and its clinical implications in B-NHL.
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Affiliation(s)
| | | | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.,Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam.,Cancer Center Amsterdam, Amsterdam
| | - Steven T Pals
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.,Cancer Center Amsterdam, Amsterdam.,Department of Pathology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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56
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Castillo JJ, Treon SP. What is new in the treatment of Waldenstrom macroglobulinemia? Leukemia 2019; 33:2555-2562. [PMID: 31591468 DOI: 10.1038/s41375-019-0592-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 01/12/2023]
Abstract
Waldenstrom macroglobulinemia (WM) is a rare type of non-Hodgkin lymphoma. The diagnosis of WM is established by the presence of lymphoplasmacytic lymphoma in the bone marrow or other organs, a monoclonal IgM paraproteinemia and the recurrent MYD88 L265P somatic mutation. Some patients with WM can be asymptomatic, in which case treatment is not indicated. However, most patients with WM will become symptomatic during the course of the disease, due to anemia, hyperviscosity, neuropathy, or other processes, necessitating therapy. Current treatment options for symptomatic WM patients include alkylating agents, proteasome inhibitors and anti-CD20 monoclonal antibodies. The approval of the oral Bruton tyrosine kinase (BTK) inhibitor ibrutinib alone and in combination with rituximab has expanded the treatment options for WM patients. The present Perspective would focus on exciting treatment strategies under development for WM patients, such as proteasome inhibitors (e.g., ixazomib), BTK inhibitors (e.g., acalabrutinib, zanubrutinib, vecabrutinib), BCL2 inhibitors (e.g., venetoclax), and anti-CXCR4 antibodies (e.g., ulocuplumab), among others. It is certainly an exciting time for WM therapy development with novel and promising treatment options in the horizon.
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Affiliation(s)
- Jorge J Castillo
- Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Steven P Treon
- Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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57
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Insights into the genomic landscape of MYD88 wild-type Waldenström macroglobulinemia. Blood Adv 2019; 2:2937-2946. [PMID: 30401751 DOI: 10.1182/bloodadvances.2018022962] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/05/2018] [Indexed: 01/20/2023] Open
Abstract
Activating MYD88 mutations are present in 95% of Waldenström macroglobulinemia (WM) patients, and trigger NF-κB through BTK and IRAK. The BTK inhibitor ibrutinib is active in MYD88-mutated (MYD88 MUT ) WM patients, but shows lower activity in MYD88 wild-type (MYD88 WT ) disease. MYD88 WT patients also show shorter overall survival, and increased risk of disease transformation in some series. The genomic basis for these findings remains to be clarified. We performed whole exome and transcriptome sequencing of sorted tumor samples from 18 MYD88 WT patients and compared findings with WM patients with MYD88 MUT disease. We identified somatic mutations predicted to activate NF-κB (TBL1XR1, PTPN13, MALT1, BCL10, NFKB2, NFKBIB, NFKBIZ, and UDRL1F), impart epigenomic dysregulation (KMT2D, KMT2C, and KDM6A), or impair DNA damage repair (TP53, ATM, and TRRAP). Predicted NF-κB activating mutations were downstream of BTK and IRAK, and many overlapped with somatic mutations found in diffuse large B-cell lymphoma. A distinctive transcriptional profile in MYD88 WT WM was identified, although most differentially expressed genes overlapped with MYD88 MUT WM consistent with the many clinical and morphological characteristics that are shared by these WM subgroups. Overall survival was adversely affected by mutations in DNA damage response in MYD88 WT WM patients. The findings depict genomic and transcriptional events associated with MYD88 WT WM and provide mechanistic insights for disease transformation, decreased ibrutinib activity, and novel drug approaches for this population.
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58
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Papanota AM, Ntanasis-Stathopoulos I, Kastritis E, Dimopoulos MA, Gavriatopoulou M. Evaluating ibrutinib in the treatment of symptomatic Waldenstrom's macroglobulinemia. J Blood Med 2019; 10:291-300. [PMID: 31695539 PMCID: PMC6717707 DOI: 10.2147/jbm.s183997] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 08/06/2019] [Indexed: 12/11/2022] Open
Abstract
Waldenstrom's macroglobulinemia (WM) is a rare lymphoplasmacytic lymphoma with indolent course and prolonged disease course. The first-in-class Bruton's tyrosine kinase inhibitor, ibrutinib, has shown significant activity and a distinct adverse event profile among both newly diagnosed and relapsed/refractory WM patients. Interestingly, clinical responses to ibrutinib have been shown to be dependent on patients' MYD88 and CXCR4 mutational status. The recent outcomes of the Phase III iNNOVATE trial showed that the combination of ibrutinib with rituximab resulted in a significantly prolonged progression-free survival compared with rituximab monotherapy, which provides a novel therapeutic option in the clinical practice especially for the rituximab-refractory WM patients. However, the need for continuous drug administration along with the unique toxicity manifestations may render the patient management challenging. Furthermore, our understanding of the underlying resistant mechanisms to ibrutinib is currently being evolved.
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Affiliation(s)
- Aristea-Maria Papanota
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
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Genomic landscape of Waldenström's macroglobulinemia. Hemasphere 2019; 3:HEMASPHERE-2019-0044. [PMID: 35309816 PMCID: PMC8925683 DOI: 10.1097/hs9.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/09/2022] Open
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60
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Feng Y, Duan W, Cu X, Liang C, Xin M. Bruton's tyrosine kinase (BTK) inhibitors in treating cancer: a patent review (2010-2018). Expert Opin Ther Pat 2019; 29:217-241. [PMID: 30888232 DOI: 10.1080/13543776.2019.1594777] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Bruton's tyrosine kinase (BTK) plays a critical role in the regulation of survival, proliferation, activation and differentiation of B-lineage cells. It participates by regulating multiple cellular signaling pathways, including B cell receptor and FcR signaling cascades. BTK is abundantly expressed and constitutively active in the pathogenesis of B cell hematological malignancies, as well as several autoimmune diseases. Therefore, BTK is considered as an attractive target for treatment of B-lineage lymphomas, leukemias, and some autoimmune diseases. Many industry and academia efforts have been made to explore small molecular BTK inhibitors. AREAS COVERED This review aims to provide an overview of the patented BTK inhibitors for the treatment of cancer from 2010 to 2018. EXPERT OPINION BTK inhibitors attract much interest for their therapeutic potential in the treatment of cancers and autoimmune diseases, especially for B cell hematological malignancies. In 2013, ibrutinib was approved by the FDA as the first-in-class BTK inhibitors for the treatment of mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL), and now it is also undergoing clinical evaluation for other indications in either single or combined therapy. It is clear that BTK inhibitors can provide a promising clinical benefit in treating B-lineage lymphomas and leukemias.
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Affiliation(s)
- Yifan Feng
- a Department of Medicinal Chemistry, School of Pharmacy, Health Science Center , Xi'an Jiaotong University , Xi'an , Shaanxi P.R. China
| | - Weiming Duan
- a Department of Medicinal Chemistry, School of Pharmacy, Health Science Center , Xi'an Jiaotong University , Xi'an , Shaanxi P.R. China
| | - Xiaochuan Cu
- b Department of Orthopedics , People's Hospital of Fufeng County in Shaanxi Province , Baoji , Shaanxi P.R. China
| | - Chengyuan Liang
- c Department of Pharmacy , Shaanxi University of Science & Technology , Xi'an , Shaanxi P.R. China
| | - Minhang Xin
- a Department of Medicinal Chemistry, School of Pharmacy, Health Science Center , Xi'an Jiaotong University , Xi'an , Shaanxi P.R. China
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61
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Lu L, Zhu F, Li Y, Kimpara S, Hoang NM, Pourdashti S, Rui L. Inhibition of the STAT3 target SGK1 sensitizes diffuse large B cell lymphoma cells to AKT inhibitors. Blood Cancer J 2019; 9:43. [PMID: 30926771 PMCID: PMC6441016 DOI: 10.1038/s41408-019-0203-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/07/2019] [Accepted: 03/15/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Li Lu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Fen Zhu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Yangguang Li
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Shuichi Kimpara
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Nguyet Minh Hoang
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA.,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Sheida Pourdashti
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Lixin Rui
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA. .,Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA.
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62
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Rao S, Du G, Hafner M, Subramanian K, Sorger PK, Gray NS. A multitargeted probe-based strategy to identify signaling vulnerabilities in cancers. J Biol Chem 2019; 294:8664-8673. [PMID: 30858179 DOI: 10.1074/jbc.ra118.006805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/01/2019] [Indexed: 12/31/2022] Open
Abstract
Most cancer cells are dependent on a network of deregulated signaling pathways for survival and are insensitive, or rapidly evolve resistance, to selective inhibitors aimed at a single target. For these reasons, drugs that target more than one protein (polypharmacology) can be clinically advantageous. The discovery of useful polypharmacology remains serendipitous and is challenging to characterize and validate. In this study, we developed a non-genetic strategy for the identification of pathways that drive cancer cell proliferation and represent exploitable signaling vulnerabilities. Our approach is based on using a multitargeted kinase inhibitor, SM1-71, as a tool compound to identify combinations of targets whose simultaneous inhibition elicits a potent cytotoxic effect. As a proof of concept, we applied this approach to a KRAS-dependent non-small cell lung cancer (NSCLC) cell line, H23-KRASG12C Using a combination of phenotypic screens, signaling analyses, and kinase inhibitors, we found that dual inhibition of MEK1/2 and insulin-like growth factor 1 receptor (IGF1R)/insulin receptor (INSR) is critical for blocking proliferation in cells. Our work supports the value of multitargeted tool compounds with well-validated polypharmacology and target space as tools to discover kinase dependences in cancer. We propose that the strategy described here is complementary to existing genetics-based approaches, generalizable to other systems, and enabling for future mechanistic and translational studies of polypharmacology in the context of signaling vulnerabilities in cancers.
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Affiliation(s)
- Suman Rao
- Laboratory of Systems Pharmacology, Boston, Massachusetts 02115; Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts 02115
| | - Guangyan Du
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts 02115
| | - Marc Hafner
- Laboratory of Systems Pharmacology, Boston, Massachusetts 02115
| | | | - Peter K Sorger
- Laboratory of Systems Pharmacology, Boston, Massachusetts 02115
| | - Nathanael S Gray
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115; Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts 02115.
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Baron M, Simon L, Poulain S, Leblond V. How Recent Advances in Biology of Waldenström's Macroglobulinemia May Affect Therapy Strategy. Curr Oncol Rep 2019; 21:27. [PMID: 30806816 DOI: 10.1007/s11912-019-0768-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Waldenström macroglobulinemia (WM) is a rare lymphoproliferative disorder. Up to now, therapeutic choice was not influenced by the biological characteristics of the disease. Here, we will review how recent advances in biology in WM may affect therapy strategy. RECENT FINDINGS Recently, WM has been described as a new oncogenic model. MyD88 mutation has been described as a key driver mutation and has functional consequences which could be targeted. Other mutations, such as CXCR4 or TP53, have been reported. These mutations are associated with different clinical presentation, prognosis, and treatment response. Mutational status may influence therapeutic choice in some patients but additional data are required. New targeted therapies are on development.
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Affiliation(s)
- Marine Baron
- Department of Hematology, Pitié-Salpétrière Hospital APHP, Sorbonne Université, Boulevard de l'hôpital, 75013, Paris, France.
| | - Laurence Simon
- Department of Hematology, Centre-Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Stéphanie Poulain
- Department of Cellular Hematology, CHU de Lille, Lille, France.,INSERM UMRX 1172, IRCL, Lille, France
| | - Véronique Leblond
- Department of Hematology, Pitié-Salpétrière Hospital APHP, Sorbonne Université, Boulevard de l'hôpital, 75013, Paris, France
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Kalogeropoulos D, Vartholomatos G, Mitra A, Elaraoud I, Ch'ng SW, Zikou A, Papoudou-Bai A, Moschos MM, Kanavaros P, Kalogeropoulos C. Primary vitreoretinal lymphoma. Saudi J Ophthalmol 2019; 33:66-80. [PMID: 30930667 PMCID: PMC6424706 DOI: 10.1016/j.sjopt.2018.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/03/2018] [Accepted: 12/30/2018] [Indexed: 11/30/2022] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, which consists a subset of primary central system lymphoma (PCNSL) and the most common type of intraocular lymphoma. The involvement of eyes is estimated to be approximately 20% of PCNSL, but the brain involvement may be up to 80% of PVRL. Typically, PVRL is a high grade B-cell malignancy of the retina and needs to be assorted from choroidal low-grade B-cell lymphomas. Very often PVRL masquerades and can be erroneously diagnosed as chronic uveitis, white dot syndromes or other neoplasms. Establishing an accurate diagnosis may involve cytology/pathology, immunohistochemistry, flow cytometry, molecular pathology and cytokine profile analysis. There is inadequate information about PVRL’s true incidence, ethnic/geographical variation and pathogenetic mechanisms. The therapeutic approach of PVRL involves aggressive chemotherapy and radiation therapy. Although PVRL tends to have a good response to the initial treatment, the prognosis is poor and the survival restricted due to the high relapse rates and CNS involvement.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom.,Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Arijit Mitra
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | | | - Soon Wai Ch'ng
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Anastasia Zikou
- Department of Radiology, Faculty of Medicine, School of Health Science, University of Ioannina, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Greece
| | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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65
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Bruton tyrosine kinase degradation as a therapeutic strategy for cancer. Blood 2018; 133:952-961. [PMID: 30545835 DOI: 10.1182/blood-2018-07-862953] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/04/2018] [Indexed: 01/08/2023] Open
Abstract
The covalent Bruton tyrosine kinase (BTK) inhibitor ibrutinib is highly efficacious against multiple B-cell malignancies. However, it is not selective for BTK, and multiple mechanisms of resistance, including the C481S-BTK mutation, can compromise its efficacy. We hypothesized that small-molecule-induced BTK degradation may overcome some of the limitations of traditional enzymatic inhibitors. Here, we demonstrate that BTK degradation results in potent suppression of signaling and proliferation in cancer cells and that BTK degraders efficiently degrade C481S-BTK. Moreover, we discovered DD-03-171, an optimized lead compound that exhibits enhanced antiproliferative effects on mantle cell lymphoma (MCL) cells in vitro by degrading BTK, IKFZ1, and IKFZ3 as well as efficacy against patient-derived xenografts in vivo. Thus, "triple degradation" may be an effective therapeutic approach for treating MCL and overcoming ibrutinib resistance, thereby addressing a major unmet need in the treatment of MCL and other B-cell lymphomas.
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Wenzl K, Manske MK, Sarangi V, Asmann YW, Greipp PT, Schoon HR, Braggio E, Maurer MJ, Feldman AL, Witzig TE, Slager SL, Ansell SM, Cerhan JR, Novak AJ. Loss of TNFAIP3 enhances MYD88 L265P-driven signaling in non-Hodgkin lymphoma. Blood Cancer J 2018; 8:97. [PMID: 30301877 PMCID: PMC6177394 DOI: 10.1038/s41408-018-0130-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/04/2018] [Accepted: 08/09/2018] [Indexed: 01/04/2023] Open
Abstract
MYD88 mutations are one of the most recurrent mutations in hematologic malignancies. However, recent mouse models suggest that MYD88L265P alone may not be sufficient to induce tumor formation. Interplay between MYD88L265P and other genetic events is further supported by the fact that TNFAIP3 (A20) inactivation often accompanies MYD88L265P. However, we are still lacking information about the consequence of MYD88L265P in combination with TNFAIP3 loss in human B cell lymphoma. Review of our genetic data on diffuse large B cell lymphoma (DLBCL) and Waldenstrom macroglobulinemia (WM), found that a large percentage of DLBCL and WM cases that have a MYD88 mutation also harbor a TNFAIP3 loss, 55% DLBCL and 28% of WM, respectively. To mimic this combination of genetic events, we used genomic editing technology to knock out TNFAIP3 in MYD88L265P non-Hodgkin's lymphoma (NHL) cell lines. Loss of A20 expression resulted in increased NF-κB and p38 activity leading to upregulation of the NF-κB target genes BCL2 and MYC. Furthermore, we detected the increased production of IL-6 and CXCL10 which led to an upregulation of the JAK/STAT pathway. Overall, these results suggest that MYD88L265P signaling can be enhanced by a second genetic alteration in TNFAIP3 and highlights a potential opportunity for therapeutic targeting.
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Affiliation(s)
- Kerstin Wenzl
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Yan W Asmann
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Patricia T Greipp
- Genomics Laboratory, Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Anne J Novak
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Hao M, Barlogie B, Tricot G, Liu L, Qiu L, Shaughnessy JD, Zhan F. Gene Expression Profiling Reveals Aberrant T-cell Marker Expression on Tumor Cells of Waldenström's Macroglobulinemia. Clin Cancer Res 2018; 25:201-209. [PMID: 30279229 DOI: 10.1158/1078-0432.ccr-18-1435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/01/2018] [Accepted: 09/27/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE That the malignant clone of Waldenström's macroglobulinemia (WM) demonstrates significant intraclonal heterogeneity with respect to plasmacytoid differentiation indicates the mechanistic complexity of tumorigenesis and progression. Identification of WM genes by comparing different stages of B cells may provide novel druggable targets. EXPERIMENTAL DESIGN The gene expression signatures of CD19+ B cells (BC) and CD138+ plasma cells (PC) from 19 patients with WM were compared with those of BCs from peripheral blood and tonsil and to those of PCs from the marrow of healthy (N-PC) and multiple myeloma donors (MM-PC), as well as tonsil (T-PC). Flow cytometry and immunofluorescence were used to examine T-cell marker expression on WM tumor cells. RESULTS Consistent with defective differentiation, both BCs and PCs from WM cases expressed abnormal differentiation markers. Sets of 55 and 46 genes were differentially expressed in WM-BC and WM-PC, respectively; and 40 genes uniquely dysregulated in WM samples were identified. Dysregulated genes included cytokines, growth factor receptors, and oncogenes not previously implicated in WM or other plasma cell dyscrasias. Interestingly, strong upregulation of both IL6 and IL6R was confirmed. Supervised cluster analysis of PC revealed that marrow-derived WM-PC was either MM-PC-like or T-PC-like, but not N-PC-like. The aberrant expression of T-cell markers was confirmed at the protein level in WM-BC. CONCLUSIONS We showed that comparative microarray profiles allowed gaining more comprehensive insights into the biology of WM. The data presented here have implications for the development of novel therapies, such as targeting aberrant T-cell markers in WM.
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Affiliation(s)
- Mu Hao
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, China.,Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Bart Barlogie
- Hematology-Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Guido Tricot
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Lanting Liu
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, China
| | - Lugui Qiu
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Tianjin, China
| | - John D Shaughnessy
- Hematology-Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Fenghuang Zhan
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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Treon SP, Xu L, Liu X, Hunter ZR, Yang G, Castillo JJ. Genomic Landscape of Waldenström Macroglobulinemia. Hematol Oncol Clin North Am 2018; 32:745-752. [DOI: 10.1016/j.hoc.2018.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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69
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Treon SP, Gustine J, Meid K, Yang G, Xu L, Liu X, Demos M, Kofides A, Tsakmaklis N, Chen JG, Munshi M, Chan G, Dubeau T, Raje N, Yee A, O’Donnell E, Hunter ZR, Castillo JJ. Ibrutinib Monotherapy in Symptomatic, Treatment-Naïve Patients With Waldenström Macroglobulinemia. J Clin Oncol 2018; 36:2755-2761. [DOI: 10.1200/jco.2018.78.6426] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose Ibrutinib is active in previously treated Waldenström macroglobulinemia (WM). MYD88 mutations ( MYD88MUT) and CXCR4 mutations ( CXCR4MUT) affect ibrutinib response. We report on a prospective study of ibrutinib monotherapy in symptomatic, untreated patients with WM, and the effect of CXCR4MUT status on outcome. Patients and Methods Symptomatic, treatment-naïve patients with WM were eligible. Ibrutinib (420 mg) was administered daily until progression or unacceptable toxicity. All tumors were genotyped for MYD88MUT and CXCR4MUT. Results A total of 30 patients with WM received ibrutinib. All carried MYD88MUT, and 14 (47%) carried a CXCR4MUT. After ibrutinib treatment, median serum IgM levels declined from 4,370 to 1,513 mg/dL, bone marrow involvement declined from 65% to 20%, and hemoglobin level rose from 10.3 to 13.9 g/dL ( P < .001 for all comparisons). Overall (minor or more than minor) and major (partial or greater than partial) responses for all patients were 100% and 83%, respectively. Rates of major (94% v 71%) and very good partial (31 v 7%) responses were higher and time to major responses more rapid (1.8 v 7.3 months; P = 0.01) in patients with wild-type CXCR4 versus those with CXCR4MUT, respectively. With a median follow-up of 14.6 months, disease in two patients (both with CXCR4MUT) progressed. The 18-month, estimated progression-free survival is 92% (95% CI, 73% to 98%). All patients are alive. Grade 2/3 treatment-related toxicities in > 5% of patients included arthralgia (7%), bruising (7%), neutropenia (7%), upper respiratory tract infection (7%), urinary tract infection (7%), atrial fibrillation (10%), and hypertension (13%). There were no grade 4 or unexpected toxicities. Conclusion Ibrutinib is highly active, produces durable responses, and is safe as primary therapy in patients with symptomatic WM. CXCR4MUT status affects responses to ibrutinib.
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Affiliation(s)
- Steven P. Treon
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Joshua Gustine
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Kirsten Meid
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Guang Yang
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Lian Xu
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Xia Liu
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Maria Demos
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Amanda Kofides
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Nicholas Tsakmaklis
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Jiaji G. Chen
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Manit Munshi
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Gloria Chan
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Toni Dubeau
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Noopur Raje
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Andrew Yee
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Elizabeth O’Donnell
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Zachary R. Hunter
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
| | - Jorge J. Castillo
- Steven P. Treon, Joshua Gustine, Kirsten Meid, Guang Yang, Lian Xu, Xia Liu, Maria Demos, Amanda Kofides, Nicholas Tsakmaklis, Jiaji G. Chen, Manit Munshi, Gloria Chan, Toni Dubeau, Zachary R. Hunter, and Jorge J. Castillo, Dana-Farber Cancer Institute; Steven P. Treon, Guang Yang, Xia Liu, Noopur Raje, Andrew Yee, Elizabeth O’Donnell, Zachary R. Hunter, and Jorge J. Castillo, Harvard Medical School; and Noopur Raje, Andrew Yee, and Elizabeth O’Donnell, Massachusetts General Hospital, Boston, MA
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Tam CS, LeBlond V, Novotny W, Owen RG, Tedeschi A, Atwal S, Cohen A, Huang J, Buske C. A head-to-head Phase III study comparing zanubrutinib versus ibrutinib in patients with Waldenström macroglobulinemia. Future Oncol 2018; 14:2229-2237. [DOI: 10.2217/fon-2018-0163] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Waldenström macroglobulinemia (WM), an incurable B-cell malignancy, is sensitive to Bruton tyrosine kinase (BTK) inhibition with ibrutinib, a first-generation BTK inhibitor. Off-target effects of ibrutinib against TEC- and EGFR-family kinases are implicated in some adverse events. Patients with CXCR4WHIM and MYD88L265P mutations or who are MYD88WT have less sensitivity to ibrutinib than those with MYD88L265P and CXCR4WT disease. Zanubrutinib, a next-generation BTK inhibitor with potent preclinical activity in WM and minimal off-target effects, showed sustained BTK occupancy in peripheral blood mononuclear cells from patients with B-cell malignancies and promising responses in advanced WM. Described here is a head-to-head Phase III study comparing efficacy and safety of zanubrutinib and ibrutinib in WM patients. Effect of MYD88 and CXCR4 mutation status will be assessed.
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Affiliation(s)
- Constantine S Tam
- Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- St Vincent's Hospital, Fitzroy, Victoria, Australia
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | | | | | | | | | | | - Jane Huang
- BeiGene Company Ltd, San Mateo, CA 94403, USA
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Yosef A, Touloukian EZ, Nambudiri VE. Ibrutinib in the management of Waldenstrom macroglobulinemia. J Oncol Pharm Pract 2018; 25:434-441. [PMID: 29996737 DOI: 10.1177/1078155218786037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bruton tyrosine kinase plays a critical role in hastening cell proliferation. Bruton tyrosine kinase inhibitors are a class of immunotheraputic agents that disrupt this signaling pathway. Ibrutinib, a novel Bruton tyrosine kinase inhibitor approved by the Food and Drug Administration (FDA) for the treatment of Waldenstrom macroglobulinemia in patients who have failed treatment with other agents, has emerged as an important therapeutic agent in the management of Waldenstrom macroglobulinemia and other plasma cell dyscrasias. Ibrutinib has shown to increase progression free survival and improve overall mortality. We present a review of ibrutinib, beginning with an overview of the Bruton tyrosine kinase pathway and clinically relevant gene mutations impacting treatment and prognosis for patients with Waldenstrom macroglobulinemia, followed by evidence supporting therapeutic indications for ibrutinib, and detailing its safety and efficacy evidence, current clinical guidelines, adverse effects and their management, and finally challenges of drug resistance. We also present findings on newly developed Bruton tyrosine kinase inhibitors in the therapeutic pipeline to provide readers insight into this rapidly evolving corner of oncology pharmacy practice.
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Affiliation(s)
- Amir Yosef
- Grand Strand Regional Medical Center, Myrtle Beach, USA
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Pulido JS, Johnston PB, Nowakowski GS, Castellino A, Raja H. The diagnosis and treatment of primary vitreoretinal lymphoma: a review. Int J Retina Vitreous 2018; 4:18. [PMID: 29760948 PMCID: PMC5937042 DOI: 10.1186/s40942-018-0120-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/16/2018] [Indexed: 11/12/2022] Open
Abstract
Background To describe the recent diagnostic and treatment options for the most predominant form of primary vitreoretinal lymphoma (PVRL), namely diffuse large B cell lymphoma. This is mainly based on the experience at the Mayo Clinic as well as a partial review of the literature. MYD88 L265P mutation is seen in about 80% of cases; therefore, a polymerase chain reaction for this mutation helps in making the diagnosis that has been notoriously difficult to make. Local therapy using intravitreal methotrexate and rituximab has been very helpful in the treatment of the local disease. Systemic high-dose intravenous methotrexate is helpful in treating bilateral disease in conjunction with intravitreal therapy. Whether it is helpful in preventing or delaying the development of central nervous system lymphoma (CNSL) is still in dispute. If there is development of CNSL or recurrent ocular disease, alternatives to high-dose methotrexate under investigation include pomalidomide, stem cell transplantation, or ibrutinib, with or without local therapy. Vitrectomy alone might be helpful as a debulking procedure. Because of the risks of redevelopment of disease, local radiation should be given if other options are not possible. Aqueous levels of IL10 are helpful in following the redevelopment of local disease. Conclusion Although PVRL is still a difficult disease to diagnose and treat, new advances are helping to make these easier. Larger collaborative studies will be helpful in determining better treatments.
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Affiliation(s)
- Jose S Pulido
- 1Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA.,3Department of Molecular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | | | | | | | - Harish Raja
- 1Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
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73
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Yu X, Li W, Deng Q, Li L, Hsi ED, Young KH, Zhang M, Li Y. MYD88 L265P Mutation in Lymphoid Malignancies. Cancer Res 2018; 78:2457-2462. [PMID: 29703722 DOI: 10.1158/0008-5472.can-18-0215] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/13/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022]
Abstract
Next-generation sequencing has revealed cancer genomic landscapes, in which over 100 driver genes that, when altered by intragenic mutations, can promote oncogenesis. MYD88 is a driver gene found in hematologic B-cell malignancies. A missense mutation (L265P) changing leucine at position 265 to proline in MYD88 is found in ∼90% of Waldenström macroglobulinemia (WM) cases and in significant portions of activated B-cell diffuse large B-cell lymphomas and IgM monoclonal gammopathy of undetermined significance. Few cancers such as WM have a single amino acid substitution in one gene like MYD88 L265P that occurs in ∼90% of cases, making WM paradigmatic for study of a single causative mutation in oncogenesis. In this review, we summarize the frequency and cancer spectrum of MYD88 L265P and its downstream effects in lymphoid cancers. Malignant B cells with MYD88 L265P are likely transformed from IgM-producing B cells either in response to T-cell-independent antigens or in response to protein antigens before class switching. We also discuss therapeutic strategies that include targeting Bruton tyrosine kinase and other kinases, interfering with the assembly of MYD88 and its interacting partners, and MYD88 L265P-specific peptide-based immunotherapy. Cancer Res; 78(10); 2457-62. ©2018 AACR.
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Affiliation(s)
- Xinfang Yu
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan Province, China
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wei Li
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Qipan Deng
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ling Li
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan Province, China
| | - Eric D Hsi
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mingzhi Zhang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan Province, China.
| | - Yong Li
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
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74
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BTK Cys481Ser drives ibrutinib resistance via ERK1/2 and protects BTK wild-type MYD88-mutated cells by a paracrine mechanism. Blood 2018; 131:2047-2059. [PMID: 29496671 DOI: 10.1182/blood-2017-10-811752] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/27/2018] [Indexed: 12/27/2022] Open
Abstract
Acquired ibrutinib resistance due to BTKCys481 mutations occurs in B-cell malignancies, including those with MYD88 mutations. BTKCys481 mutations are usually subclonal, and their relevance to clinical progression remains unclear. Moreover, the signaling pathways that promote ibrutinib resistance remain to be clarified. We therefore engineered BTKCys481Ser and BTKWT expressing MYD88-mutated Waldenström macroglobulinemia (WM) and activated B-cell (ABC) diffuse large B-cell lymphoma (DLBCL) cells and observed reactivation of BTK-PLCγ2-ERK1/2 signaling in the presence of ibrutinib in only the former. Use of ERK1/2 inhibitors triggered apoptosis in BTKCys481Ser-expressing cells and showed synergistic cytotoxicity with ibrutinib. ERK1/2 reactivation in ibrutinib-treated BTKCys481Ser cells was accompanied by release of many prosurvival and inflammatory cytokines, including interleukin-6 (IL-6) and IL-10 that were also blocked by ERK1/2 inhibition. To clarify if cytokine release by ibrutinib-treated BTKCys481Ser cells could protect BTKWT MYD88-mutated malignant cells, we used a Transwell coculture system and showed that nontransduced BTKWT MYD88-mutated WM or ABC DLBCL cells were rescued from ibrutinib-induced killing when cocultured with BTKCys481Ser but not their BTKWT-expressing counterparts. Use of IL-6 and/or IL-10 blocking antibodies abolished the protective effect conferred on nontransduced BTKWT by coculture with BTKCys481Ser expressing WM or ABC DLBCL cell counterparts. Rebound of IL-6 and IL-10 serum levels also accompanied disease progression in WM patients with acquired BTKCys481 mutations. Our findings show that the BTKCys481Ser mutation drives ibrutinib resistance in MYD88-mutated WM and ABC DLBCL cells through reactivation of ERK1/2 and can confer a protective effect on BTKWT cells through a paracrine mechanism.
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75
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76
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Abeykoon JP, Paludo J, King RL, Ansell SM, Gertz MA, LaPlant BR, Halvorson AE, Gonsalves WI, Dingli D, Fang H, Rajkumar SV, Lacy MQ, He R, Kourelis T, Reeder CB, Novak AJ, McPhail ED, Viswanatha DS, Witzig TE, Go RS, Habermann TM, Buadi FK, Dispenzieri A, Leung N, Lin Y, Thompson CA, Hayman SR, Kyle RA, Kumar SK, Kapoor P. MYD88 mutation status does not impact overall survival in Waldenström macroglobulinemia. Am J Hematol 2018; 93:187-194. [PMID: 29080258 DOI: 10.1002/ajh.24955] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 10/25/2017] [Indexed: 12/22/2022]
Abstract
Waldenström macroglobulinemia (WM) is an immunoglobulin M-associated lymphoma, with majority of cases demonstrating MYD88 locus alteration, most commonly, MYD88L265P . Owing to low prevalence of the wild-type (WT) MYD88 genotype in WM, clinically relevant data in this patient population are sparse, with one study showing nearly a 10-fold increased risk of mortality in this subgroup compared to patients with MYD88L265P mutation. We studied a large cohort of patients with MYD88L265P and MYD88WT WM, evaluated at Mayo Clinic, Rochester, between 1995 and 2016, to specifically assess the impact of these genotypes on clinical course. Of 557 patients, MYD88L265P mutation status, as determined by allele-specific polymerase chain reaction, was known in 219, and 174 (79%) of those exhibited MYD88L265P , 157 of 174 patients had active disease. Of 45 (21%) patients with MYD88WT genotype, 44 had active disease. The estimated median follow-up was 7.0 years; median overall survival was 10.2 years (95% CI: 8.4-16.5) for MYD88L265P versus 13.9 years (95% CI: 6.4-29.3) for the MYD88WT (P = 0.86). The time-to-next therapy from frontline treatment and the presenting features were similar in the two patient populations. For patients with smoldering WM at diagnosis, the median time-to-progression to active disease was 2.8 years (95% CI: 2.2-3.8) in the MYD88L265P cohort and 1.9 years (95% CI: 0.7-3.1) in the MYD88WT cohort (P = 0.21). The frequency of transformation to high-grade lymphoma, or the development of therapy-elated myelodysplastic syndrome was higher in the MYD88WT cohort (16% versus 4% in the MYD88L265P , P = 0.009). In conclusion, MYD88L265P mutation does not appear to be a determinant of outcome, and its presence may not be a disease-defining feature in WM. Our findings warrant external validation, preferably through prospective studies.
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77
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Treon SP, Gustine J, Xu L, Manning RJ, Tsakmaklis N, Demos M, Meid K, Guerrera ML, Munshi M, Chan G, Chen J, Kofides A, Patterson CJ, Yang G, Liu X, Severns P, Dubeau T, Hunter ZR, Castillo JJ. MYD88
wild-type Waldenstrom Macroglobulinaemia: differential diagnosis, risk of histological transformation, and overall survival. Br J Haematol 2017; 180:374-380. [DOI: 10.1111/bjh.15049] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/09/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Steven P. Treon
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Joshua Gustine
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Lian Xu
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Robert J. Manning
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Maria Demos
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Kirsten Meid
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Maria L. Guerrera
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Manit Munshi
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Gloria Chan
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Jiaji Chen
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Amanda Kofides
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Christopher J. Patterson
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Guang Yang
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Xia Liu
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Patricia Severns
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Toni Dubeau
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Zachary R. Hunter
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - Jorge J. Castillo
- Bing Center for Waldenstrom's Macroglobulinemia; Dana Farber Cancer Institute; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
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78
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Zamò A, Pischimarov J, Schlesner M, Rosenstiel P, Bomben R, Horn H, Grieb T, Nedeva T, López C, Haake A, Richter J, Trümper L, Lawerenz C, Klapper W, Möller P, Hummel M, Lenze D, Szczepanowski M, Flossbach L, Schreder M, Gattei V, Ott G, Siebert R, Rosenwald A, Leich E. Differences between BCL2-break positive and negative follicular lymphoma unraveled by whole-exome sequencing. Leukemia 2017; 32:685-693. [PMID: 28824170 DOI: 10.1038/leu.2017.270] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 12/25/2022]
Abstract
Depending on disease stage follicular lymphoma (FL) lack the t(14;18) in ~15-~50% of cases. Nevertheless, most of these cases express BCL2. To elucidate mechanisms triggering BCL2 expression and promoting pathogenesis in t(14;18)-negative FL, exonic single-nucleotide variant (SNV) profiles of 28 t(14;18)-positive and 13 t(14;18)-negative FL were analyzed, followed by the integration of copy-number changes, copy-neutral LOH and published gene-expression data as well as the assessment of immunoglobulin N-glycosylation sites. Typical FL mutations also affected t(14;18)-negative FL. Curated gene set/pathway annotation of genes mutated in either t(14;18)-positive or t(14;18)-negative FL revealed a strong enrichment of same or similar gene sets but also a more prominent or exclusive enrichment of immune response and N-glycosylation signatures in t(14;18)-negative FL. Mutated genes showed high BCL2 association in both subgroups. Among the genes mutated in t(14;18)-negative FL 555 were affected by copy-number alterations and/or copy-neutral LOH and 96 were differently expressed between t(14;18)-positive and t(14;18)-negative FL (P<0.01). N-glycosylation sites were detected considerably less frequently in t(14;18)-negative FL. These results suggest a diverse portfolio of genetic alterations that may induce or regulate BCL2 expression or promote pathogenesis of t(14;18)-negative FL as well as a less specific but increased crosstalk with the microenvironment that may compensate for the lack of N-glycosylation.
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Affiliation(s)
- A Zamò
- Institute of Pathology, University of Würzburg, Würzburg, Würzburg, Germany.,Department of Diagnostic and Public Health, University of Verona, Verona, Italy.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - J Pischimarov
- Institute of Pathology, University of Würzburg, Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - M Schlesner
- Theoretical Bioinformatics (B080), Computational Oncology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Rosenstiel
- Institute for Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - R Bomben
- Department of Translational Research, CRO, Aviano, Italy
| | - H Horn
- Dr Margarete Fischer-Bosch-Institute for Clinical Pharmacology, Stuttgart, Germany
| | - T Grieb
- Institute of Pathology, University of Würzburg, Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - T Nedeva
- Institute of Pathology, University of Würzburg, Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - C López
- Institute for Human Genetics, University Hospital Ulm, Ulm, Germany.,Institute for Human Genetics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Haake
- Institute for Human Genetics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Richter
- Institute for Human Genetics, University Hospital Schleswig-Holstein, Kiel, Germany.,Institute of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L Trümper
- Department of Hematology and Medical Oncology, University Hospital, Göttingen, Germany
| | - C Lawerenz
- Theoretical Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - W Klapper
- Institute of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - P Möller
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | - M Hummel
- Institute of Pathology, Charité-University Hospital Berlin, Germany
| | - D Lenze
- Institute of Pathology, Charité-University Hospital Berlin, Germany
| | - M Szczepanowski
- Institute of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L Flossbach
- Institute of Pathology, University of Würzburg, Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - M Schreder
- Medizinische Klinik und Poliklinik II, University Hospital Würzburg, Würzburg, Germany
| | - V Gattei
- Department of Translational Research, CRO, Aviano, Italy
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - R Siebert
- Institute for Human Genetics, University Hospital Ulm, Ulm, Germany.,Institute for Human Genetics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - E Leich
- Institute of Pathology, University of Würzburg, Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, Würzburg, Germany
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79
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Castillo JJ, Hunter ZR, Yang G, Treon SP. Novel approaches to targeting MYD88 in Waldenström macroglobulinemia. Expert Rev Hematol 2017; 10:739-744. [PMID: 28617062 DOI: 10.1080/17474086.2017.1343661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Waldenström macroglobulinemia (WM) is an incurable lymphoma characterized by the accumulation of IgM-producing lymphoplasmacytic cells in the bone marrow and other organs. Although WM patients can experience prolonged remissions, the disease invariably recurs advocating for the need of novel treatments in order to achieve higher response and survival rates. The discovery of a recurrent mutation in the MYD88 gene and an increased understanding behind the biology of MYD88 signaling have provided the opportunity to developing novel agents targeting the MYD88 pathway. Areas covered: The present review focuses on potential therapies that could change the landscape of treatment of patients with WM, specifically focusing on inhibitors of the Bruton tyrosine kinase (BTK), phosphatidylinositol-3 kinase, hematopoietic cell kinase, interleukin-1 receptor associated kinase and MYD88 assembly. Expert commentary: Novel agents such as the BTK inhibitor ibrutinib has shown to be safe and highly effective in the treatment of WM. Ibrutinib has been approved in Europe and the United States for its use in patients with symptomatic WM. Prospective studies are ongoing and/or planned to study many other novel agents alone and in combination with aims at improving response, survival and quality of life in patients with WM.
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Affiliation(s)
- Jorge J Castillo
- a Bing Center for Waldenström Macroglobulinemia , Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA
| | - Zachary R Hunter
- a Bing Center for Waldenström Macroglobulinemia , Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA
| | - Guang Yang
- a Bing Center for Waldenström Macroglobulinemia , Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA
| | - Steven P Treon
- a Bing Center for Waldenström Macroglobulinemia , Dana-Farber Cancer Institute, Harvard Medical School , Boston , MA , USA
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80
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Islam S, Qi W, Morales C, Cooke L, Spier C, Weterings E, Mahadevan D. Disruption of Aneuploidy and Senescence Induced by Aurora Inhibition Promotes Intrinsic Apoptosis in Double Hit or Double Expressor Diffuse Large B-cell Lymphomas. Mol Cancer Ther 2017; 16:2083-2093. [PMID: 28615297 DOI: 10.1158/1535-7163.mct-17-0089] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/05/2017] [Accepted: 06/06/2017] [Indexed: 11/16/2022]
Abstract
Double hit (DH) or double expressor (DE) diffuse large B-cell lymphomas (DLBCL) are aggressive non-Hodgkin's lymphomas (NHL) with translocations and/or overexpressions of MYC and BCL-2, which are difficult to treat. Aurora kinase (AK) inhibition with alisertib in DH/DE-DLBCL induces cell death in ∼30%, while ∼70% are aneuploid and senescent cells (AASC), a mitotic escape mechanism contributing to drug resistance. These AASCs elaborated a high metabolic rate by increased AKT/mTOR and ERK/MAPK activity via BTK signaling through the chronic active B-cell receptor (BCR) pathway. Combinations of alisertib + ibrutinib or alisertib + ibrutinib + rituximab significantly reduced AASCs with enhanced intrinsic cell death. Inhibition of AK + BTK reduced phosphorylation of AKT/mTOR and ERK-1/2, upregulated phospho-H2A-X and Chk-2 (DNA damage), reduced Bcl-6, and decreased Bcl-2 and Bcl-xL and induced apoptosis by PARP cleavage. In a DE-DLBCL SCID mouse xenograft model, ibrutinib alone was inactive, while alisertib + ibrutinib was additive with a tumor growth inhibition (TGI) rate of ∼25%. However, TGI for ibrutinib + rituximab was ∼50% to 60%. In contrast, triple therapy showed a TGI rate of >90%. Kaplan-Meier survival analysis showed that 67% of mice were alive at day 89 with triple therapy versus 20% with ibrutinib + rituximab. All treatments were well tolerated with no changes in body weights. A novel triple therapy consisting of alisertib + ibrutinib + rituximab inhibits AASCs induced by AK inhibition in DH/DE-DLBCL leading to a significant antiproliferative signal, enhanced intrinsic apoptosis and may be of therapeutic potential in these lymphomas. Mol Cancer Ther; 16(10); 2083-93. ©2017 AACR.
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Affiliation(s)
- Shariful Islam
- University of Arizona Cancer Center, Cancer Biology Graduate Interdisciplinary Program, Tucson, Arizona
| | - Wenqing Qi
- West Cancer Center and University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Carla Morales
- West Cancer Center and University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Laurence Cooke
- University of Arizona Cancer Center, Department of Medicine, Tucson, Arizona
| | - Catherine Spier
- University of Arizona, Department of Pathology, Tucson, Arizona
| | - Eric Weterings
- University of Arizona, Department of Radiation Oncology, Tucson, Arizona
| | - Daruka Mahadevan
- University of Arizona Cancer Center, Department of Medicine, Tucson, Arizona.
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81
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Cai ZX, Chen G, Zeng YY, Dong XQ, Lin MJ, Huang XH, Zhang D, Liu XL, Liu JF. Circulating tumor DNA profiling reveals clonal evolution and real-time disease progression in advanced hepatocellular carcinoma. Int J Cancer 2017; 141:977-985. [PMID: 28543104 DOI: 10.1002/ijc.30798] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/12/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
Circulating tumor DNA (ctDNA) provides a potential non-invasive biomarker for cancer diagnosis and prognosis, but whether it could reflect tumor heterogeneity and monitor therapeutic responses in hepatocellular carcinoma (HCC) is unclear. Focusing on 574 cancer genes known to harbor actionable mutations, we identified the mutation repertoire of HCC tissues, and monitored the corresponding ctDNA features in blood samples to evaluate its clinical significance. Analysis of 3 HCC patients' mutation profiles revealed that ctDNA could overcome tumor heterogeneity and provide information of tumor burden and prognosis. Further analysis was conducted on the 4th HCC case with multiple lesion samples and sequential plasma samples. We identified 160 subclonal SNVs in tumor tissues as well as matched peritumor tissues with PBMC as control. 96.9% of this patient's tissue mutations could be also detected in plasma samples. These subclonal SNVs were grouped into 9 clusters according to their trends of cellular prevalence shift in tumor tissues. Two clusters constituted of tumor stem somatic mutations showed circulating levels relating with cancer progression. Analysis of tumor somatic mutations revealed that circulating level of such tumor stem somatic mutations could reflect tumor burden and even predict prognosis earlier than traditional strategies. Furthermore, HCK (p.V174M), identified as a recurrent/metastatic related mutation site, could promote migration and invasion of HCC cells. Taken together, study of mutation profiles in biopsy and plasma samples in HCC patients showed that ctDNA could overcome tumor heterogeneity and real-time track the therapeutic responses in the longitudinal monitoring.
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Affiliation(s)
- Zhi-Xiong Cai
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China
| | - Geng Chen
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China
| | - Yong-Yi Zeng
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China.,Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350025, China
| | - Xiu-Qing Dong
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China
| | - Min-Jie Lin
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China
| | - Xin-Hui Huang
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China
| | - Da Zhang
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China
| | - Xiao-Long Liu
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China
| | - Jing-Feng Liu
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, China.,The Liver Center of Fujian Province, Fujian Medical University, Fuzhou, 350025, China.,Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350025, China
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82
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Smith CIE. From identification of the BTK kinase to effective management of leukemia. Oncogene 2017; 36:2045-2053. [PMID: 27669440 PMCID: PMC5395699 DOI: 10.1038/onc.2016.343] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/11/2022]
Abstract
BTK is a cytoplasmic protein-tyrosine kinase, whose corresponding gene was isolated in the early 1990s. BTK was initially identified by positional cloning of the gene causing X-linked agammaglobulinemia and independently in a search for new kinases. Given the phenotype of affected patients, namely lack of B-lymphocytes and plasma cells with the ensuing inability to mount humoral immune responses, BTK inhibitors were anticipated to have beneficial effects on antibody-mediated pathologies, such as autoimmunity. In contrast to, for example, the SRC-family of cytoplasmic kinases, there was no obvious way in which structural alterations would yield constitutively active forms of BTK, and such mutations were also not found in leukemias or lymphomas. In 2007, the first efficient inhibitor, ibrutinib, was reported and soon became approved both in the United States and in Europe for the treatment of three B-cell malignancies, mantle cell lymphoma, chronic lymphocytic leukemia and Waldenström's macroglobulinemia. Over the past few years, additional inhibitors have been developed, with acalabrutinib being more selective, and recently demonstrating fewer clinical adverse effects. The antitumor mechanism is also not related to mutations in BTK. Instead tumor residency in lymphoid organs is inhibited, making these drugs highly versatile. BTK is one of the only 10 human kinases that carry a cysteine in the adenosine triphosphate-binding cleft. As this allows for covalent, irreversible inhibitor binding, it provides these compounds with a highly advantageous character. This quality may be crucial and bodes well for the future of BTK-modifying medicines, which have been estimated to reach annual multi-billion dollar sales in the future.
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Affiliation(s)
- C I E Smith
- Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
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83
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Abeykoon JP, Yanamandra U, Kapoor P. New developments in the management of Waldenström macroglobulinemia. Cancer Manag Res 2017; 9:73-83. [PMID: 28331368 PMCID: PMC5354523 DOI: 10.2147/cmar.s94059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Waldenström macroglobulinemia (WM) is a rare, immunoglobulin M -associated lymphoplasmacytic lymphoma. With the recent discoveries of CXCR warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) and MYD88 mutations, our understanding of the biology of WM has expanded substantially. While WM still remains incurable, the field is rapidly evolving, and a number of promising agents with significant activity in this malignancy are being evaluated currently. In this review, we discuss the new developments that have occurred in WM over the past 15 years, with a focus on the role of ibrutinib, an oral Bruton's tyrosine kinase inhibitor that has recently been approved for WM in the United States, Europe, and Canada.
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Affiliation(s)
| | - Uday Yanamandra
- Department of Hematology and Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Prashant Kapoor
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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84
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Hunter ZR, Yang G, Xu L, Liu X, Castillo JJ, Treon SP. Genomics, Signaling, and Treatment of Waldenström Macroglobulinemia. J Clin Oncol 2017; 35:994-1001. [PMID: 28294689 DOI: 10.1200/jco.2016.71.0814] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Next-generation sequencing has revealed recurring somatic mutations in Waldenström macroglobulinemia (WM). Commonly recurring mutations include MYD88 (95% to 97%), CXCR4 (30% to 40%), ARID1A (17%), and CD79B (8% to 15%). Diagnostic discrimination of WM from overlapping B-cell malignancies is aided by MYD88 mutation status. Transcription is affected by MYD88 and CXCR4 mutations and includes overexpression of genes involved in VDJ recombination, CXCR4 pathway signaling, and BCL2 family members. Among patients with MYD88 mutations, those with CXCR4 mutations show transcriptional silencing of tumor suppressors associated with acquisition of mutated MYD88. Deletions involving chromosome 6q are common and include genes that modulate nuclear factor-κB, BCL2, BTK, apoptosis, differentiation, and ARID1B. Non-chromosome 6q genes are also frequently deleted and include LYN, a regulator of B-cell receptor signaling. MYD88 and CXCR4 mutations affect WM disease presentation and treatment outcome. Patients with wild-type MYD88 show lower bone marrow disease burden and serum immunoglobulin M levels but show an increased risk of death. Patients with CXCR4 mutations have higher bone marrow disease burden, and those with nonsense CXCR4 mutations have higher serum immunoglobulin M levels and incidence of symptomatic hyperviscosity. Mutated MYD88 triggers BTK, IRAK1/IRAK4, and HCK growth and survival signaling, whereas CXCR4 mutations promote AKT and extracellular regulated kinase-1/2 signaling and drug resistance in the presence of its ligand CXCL12. Ibrutinib is active in patients with WM and is affected by MYD88 and CXCR4 mutation status. Patients with mutated MYD88 and wild-type CXCR4 mutation status exhibit best responses to ibrutinib. Lower response rates and delayed responses to ibrutinib are associated with mutated CXCR4 in patients with WM. MYD88 and CXCR4 mutation status may be helpful in treatment selection for symptomatic patients. Novel therapeutic approaches under investigation include therapeutics targeting MYD88, CXCR4, and BCL2 signaling.
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Affiliation(s)
- Zachary R Hunter
- All authors: Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Guang Yang
- All authors: Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Lian Xu
- All authors: Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Xia Liu
- All authors: Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Jorge J Castillo
- All authors: Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
| | - Steven P Treon
- All authors: Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA
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85
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Dimopoulos MA, Trotman J, Tedeschi A, Matous JV, Macdonald D, Tam C, Tournilhac O, Ma S, Oriol A, Heffner LT, Shustik C, García-Sanz R, Cornell RF, de Larrea CF, Castillo JJ, Granell M, Kyrtsonis MC, Leblond V, Symeonidis A, Kastritis E, Singh P, Li J, Graef T, Bilotti E, Treon S, Buske C. Ibrutinib for patients with rituximab-refractory Waldenström's macroglobulinaemia (iNNOVATE): an open-label substudy of an international, multicentre, phase 3 trial. Lancet Oncol 2017; 18:241-250. [DOI: 10.1016/s1470-2045(16)30632-5] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/30/2016] [Accepted: 10/13/2016] [Indexed: 12/16/2022]
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86
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Treon SP, Meid K, Tripsas C, Heffner LT, Eradat H, Badros AZ, Xu L, Hunter ZR, Yang G, Patterson CJ, Gustine J, Castillo JJ, Matous J, Ghobrial IM. Prospective, Multicenter Clinical Trial of Everolimus as Primary Therapy in Waldenstrom Macroglobulinemia (WMCTG 09-214). Clin Cancer Res 2016; 23:2400-2404. [PMID: 27836860 DOI: 10.1158/1078-0432.ccr-16-1918] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/05/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
Purpose: Everolimus inhibits mTOR, a component of PI3K/AKT prosurvival signaling triggered by MYD88 and CXCR4-activating mutations in Waldenstrom macroglobulinemia.Experimental design: We evaluated everolimus in a prospective, multicenter study of 33 symptomatic, previously untreated Waldenstrom macroglobulinemia patients. Intended therapy consisted of everolimus (10 mg/day) until progression or unacceptable toxicity. Dose deescalation was permitted. The study was registered at www.clinicaltrials.gov (NCT00976248).Results: At best response, median serum IgM levels declined from 4,440 to 1,360 mg/dL (P < 0.0001), median hemoglobin rose from 10.8 to 12 g/dL (P = 0.001), and median bone marrow disease burden declined from 75% to 52.5% in serially biopsied patients. The ORR and major response rates were 72.7% and 60.6%, respectively. Among genotyped patients, nonresponders associated with wild-type MYD88 and mutated CXCR4 status. Median time to response was 4 weeks. Discordance between serum IgM levels and bone marrow disease burden was remarkable. With a median follow-up of 13.1 (range, 1.6-64.6 months), the median time to progression was 21 months for all patients and 33 months for major responders. Discontinuation of everolimus led to rapid serum IgM rebound in 7 patients and symptomatic hyperviscosity in 2 patients. Toxicity led to treatment discontinuation in 27% of patients, including 18% for pneumonitis.Conclusions: Everolimus is active in previously untreated Waldenstrom macroglobulinemia. IgM discordance is common, and treatment cessation can often lead to rapid serum IgM rebound. Pneumonitis also appears more pronounced in untreated versus previously treated Waldenstrom macroglobulinemia patients. The risks and benefits of everolimus should be carefully weighed against other primary Waldenstrom macroglobulinemia therapy options. Clin Cancer Res; 23(10); 2400-4. ©2016 AACR.
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Affiliation(s)
- Steven P Treon
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts.
| | - Kirsten Meid
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
| | - Christina Tripsas
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
| | - Leonard T Heffner
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Herbert Eradat
- Jonsson Comprehensive Cancer Center, UCLA School of Medicine, Los Angeles, California
| | - Ashraf Z Badros
- Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Lian Xu
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
| | - Zachary R Hunter
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
| | - Guang Yang
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
| | - Christopher J Patterson
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
| | - Joshua Gustine
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
| | - Jorge J Castillo
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
| | | | - Irene M Ghobrial
- Bing Center for Waldenstrom's Macroglobulinemia at the Dana-Farber Cancer Institute; and Harvard Medical School, Boston, Massachusetts
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87
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Castillo JJ, Hunter ZR, Yang G, Argyropoulos K, Palomba ML, Treon SP. Future therapeutic options for patients with Waldenström macroglobulinemia. Best Pract Res Clin Haematol 2016; 29:206-215. [PMID: 27825467 DOI: 10.1016/j.beha.2016.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Abstract
Waldenström macroglobulinemia (WM) is a rare lymphoma characterized by the accumulation of IgM-producing lymphoplasmacytic cells. Although WM patients can experience prolonged remissions, the disease invariably recurs. Therefore, novel treatments associated with higher success rates and lower toxicity profiles are needed. The discovery of recurrent mutations in the MYD88 and CXCR4 genes has unraveled potential therapeutic targets in WM patients. As a result of these findings and based on the design and execution of a prospective clinical trial, the FDA granted approval to ibrutinib, an oral Bruton tyrosine kinase (BTK) inhibitor, to treat patients with symptomatic WM. The present review focuses on potential therapies that could change the landscape of treatment of patients with WM, specifically focusing on inhibitors or antagonists or the proteasome, BTK, CD38, BCL2 and the CXCR4 and MYD88 genes themselves. Novel agents with novel mechanisms of action should be evaluated in the context of carefully designed clinical trials.
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Affiliation(s)
- Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Zachary R Hunter
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Guang Yang
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kimon Argyropoulos
- Division of Hematology and Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M Lia Palomba
- Division of Hematology and Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Steven P Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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