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Podar K, Pecherstorfer M. Current and developing synthetic pharmacotherapy for treating relapsed/refractory multiple myeloma. Expert Opin Pharmacother 2017; 18:1061-1079. [PMID: 28604120 DOI: 10.1080/14656566.2017.1340942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The introduction of novel agents has significantly improved multiple myeloma (MM) patient outcome during the last two decades. MM received the most drug approvals for any one malignancy during this time period, both in the United States as well as in Europe. Areas covered: Proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies are prototype drug classes, which target both specific MM cell functions, as well as the tumor supportive bone marrow microenvironment, and represent current cornerstones of MM therapy. Importantly, the unprecedented extent and frequency of durable responses, in relapsed/refractory multiple myeloma (RRMM), in particular, is predominantly based on the combinatorial use of these agents with conventional chemotherapeutics or representatives of other drug classes. This article will summarize past landmark discoveries in MM that led to the dramatic progress of today's clinical practice. Moreover, developing strategies will be discussed that are likely to yet improve patient outcome even further. Expert opinion: Despite significant therapeutic advancements, MM remains an incurable disease. With several novel agents in the preclinical and early clinical pipeline, among those novel CD38 and BCMA mAbs, immune checkpoint inhibitors, as well as ricolinostat, selinexor, venetoclax, CAR-T cells, and vaccines, further advances in MM patient outcome are expected in the near future.
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Affiliation(s)
- Klaus Podar
- a Department of Internal Medicine , Karl Landsteiner University of Health Sciences, University Hospital , Krems , Austria
| | - Martin Pecherstorfer
- a Department of Internal Medicine , Karl Landsteiner University of Health Sciences, University Hospital , Krems , Austria
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102
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Identification of precision treatment strategies for relapsed/refractory multiple myeloma by functional drug sensitivity testing. Oncotarget 2017; 8:56338-56350. [PMID: 28915594 PMCID: PMC5593565 DOI: 10.18632/oncotarget.17630] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/20/2017] [Indexed: 02/07/2023] Open
Abstract
Novel agents have increased survival of multiple myeloma (MM) patients, however high-risk and relapsed/refractory patients remain challenging to treat and their outcome is poor. To identify novel therapies and aid treatment selection for MM, we assessed the ex vivo sensitivity of 50 MM patient samples to 308 approved and investigational drugs. With the results we i) classified patients based on their ex vivo drug response profile; ii) identified and matched potential drug candidates to recurrent cytogenetic alterations; and iii) correlated ex vivo drug sensitivity to patient outcome. Based on their drug sensitivity profiles, MM patients were stratified into four distinct subgroups with varied survival outcomes. Patients with progressive disease and poor survival clustered in a drug response group exhibiting high sensitivity to signal transduction inhibitors. Del(17p) positive samples were resistant to most drugs tested with the exception of histone deacetylase and BCL2 inhibitors. Samples positive for t(4;14) were highly sensitive to immunomodulatory drugs, proteasome inhibitors and several targeted drugs. Three patients treated based on the ex vivo results showed good response to the selected treatments. Our results demonstrate that ex vivo drug testing may potentially be applied to optimize treatment selection and achieve therapeutic benefit for relapsed/refractory MM.
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Abstract
B-cell lymphoma-2 (BCL-2) family dysfunction and impairment of apoptosis are common in most B-cell lymphoid malignancies. Venetoclax (Venclexta™, formerly ABT-199, GDC-0199) is a highly selective BCL-2 inhibitor, which mimics its BCL-2 homology 3-domain to induce apoptosis. It was approved for treatment of previously treated chronic lymphocytic leukemia (CLL) patients with 17p deletion early in 2016. It has also been in clinical trials for other B-cell lymphoid malignancies. Unlike the other recently approved targeted agents idelalisib and ibrutinib, so far there has been no relapse reported in some patients. Also, unlike the other targeted agents, it is effective against tumor cells that reside in the blood marrow. Despite its promising outcome in CLL, preclinical data have already uncovered mechanistic insights underlying venetoclax resistance, such as upregulation of MCL-1 or BCL-xL expression and protective signaling from the microenvironment. In this review, we describe the role of the BCL-2 family in the pathogenesis of B-cell lymphoid malignancies, the development of venetoclax, and its current clinical outcome in CLL and other B-cell malignancies. We also discuss the resistance mechanisms that develop following venetoclax therapy, potential strategies to overcome them, and how this knowledge can be translated into clinical applications.
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Affiliation(s)
- Huayuan Zhu
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, People’s Republic of China
| | - Alexandru Almasan
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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104
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Affiliation(s)
- Anthony Letai
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02215
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105
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Barile E, Marconi GD, De SK, Baggio C, Gambini L, Salem AF, Kashyap MK, Castro JE, Kipps TJ, Pellecchia M. hBfl-1/hNOXA Interaction Studies Provide New Insights on the Role of Bfl-1 in Cancer Cell Resistance and for the Design of Novel Anticancer Agents. ACS Chem Biol 2017; 12:444-455. [PMID: 28026162 PMCID: PMC5320539 DOI: 10.1021/acschembio.6b00962] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Upregulation of antiapoptotic Bcl-2 proteins in certain tumors confers cancer cell resistance to chemotherapy or radiations. Members of the antiapoptotic Bcl-2 proteins, including Bcl-2, Mcl-1, Bcl-xL, Bcl-w, and Bfl-1, inhibit apoptosis by selectively binding to conserved α-helical regions, named BH3 domains, of pro-apoptotic proteins such as Bim, tBid, Bad, or NOXA. Five antiapoptotic proteins have been identified that interact with various selectivity with BH3 containing pro-apoptotic counterparts. Cancer cells present various and variable levels of these proteins, making the design of effective apoptosis based therapeutics challenging. Recently, BH3 profiling was introduced as a method to classify cancer cells based on their ability to resist apoptosis following exposure to selected BH3 peptides. However, these studies were based on binding affinities measured with model BH3 peptides and Bcl-2-proteins taken from mouse sequences. While the majority of these interactions are conserved between mice and humans, we found surprisingly that human NOXA binds to human Bfl-1 potently and covalently via conserved Cys residues, with over 2 orders of magnitude increased affinity over hMcl-1. Our data suggest that some assumptions of the original BH3 profiling need to be revisited and that perhaps further targeting efforts should be redirected toward Bfl-1, for which no suitable specific inhibitors or pharmacological tools have been reported. In this regard, we also describe the initial design and characterizations of novel covalent BH3-based agents that potently target Bfl-1. These molecules could provide a novel platform on which to design effective Bfl-1 targeting therapeutics.
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Affiliation(s)
- Elisa Barile
- Division of Biomedical
Sciences, School of Medicine, University
of California, Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Guya D. Marconi
- Division of Biomedical
Sciences, School of Medicine, University
of California, Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Surya K. De
- Division of Biomedical
Sciences, School of Medicine, University
of California, Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Carlo Baggio
- Division of Biomedical
Sciences, School of Medicine, University
of California, Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Luca Gambini
- Division of Biomedical
Sciences, School of Medicine, University
of California, Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Ahmed F. Salem
- Division of Biomedical
Sciences, School of Medicine, University
of California, Riverside, 900 University Avenue, Riverside, California 92521, United States
| | - Manoj K. Kashyap
- Moores Cancer Center, University of California, San Diego, La Jolla, California 92093, United States
- CLL Research
Consortium, and Department of Medicine, University of California, San Diego, La Jolla, California 92093, United States
| | - Januario E. Castro
- Moores Cancer Center, University of California, San Diego, La Jolla, California 92093, United States
- CLL Research
Consortium, and Department of Medicine, University of California, San Diego, La Jolla, California 92093, United States
| | - Thomas J. Kipps
- Moores Cancer Center, University of California, San Diego, La Jolla, California 92093, United States
- CLL Research
Consortium, and Department of Medicine, University of California, San Diego, La Jolla, California 92093, United States
| | - Maurizio Pellecchia
- Division of Biomedical
Sciences, School of Medicine, University
of California, Riverside, 900 University Avenue, Riverside, California 92521, United States
- Phone: (951)-827-7829. E-mail:
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106
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Bone marrow microenvironment-derived signals induce Mcl-1 dependence in multiple myeloma. Blood 2017; 129:1969-1979. [PMID: 28151428 DOI: 10.1182/blood-2016-10-745059] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/30/2017] [Indexed: 01/25/2023] Open
Abstract
Multiple myeloma is highly dependent on the bone marrow microenvironment until progressing to very advanced extramedullary stages of the disease such as plasma cell leukemia. Stromal cells in the bone marrow secrete a variety of cytokines that promote plasma cell survival by regulating antiapoptotic members of the Bcl-2 family including Mcl-1, Bcl-xL, and Bcl-2. Although the antiapoptotic protein on which a cell depends is typically consistent among normal cells of a particular phenotype, Bcl-2 family dependence is highly heterogeneous in multiple myeloma. Although normal plasma cells and most multiple myeloma cells require Mcl-1 for survival, a subset of myeloma is codependent on Bcl-2 and/or Bcl-xL We investigated the role of the bone marrow microenvironment in determining Bcl-2 family dependence in multiple myeloma. We used the Bcl-2/Bcl-xL inhibitor ABT-737 to study the factors regulating whether myeloma is Mcl-1 dependent, and thus resistant to ABT-737-induced apoptosis, or Bcl-2/Bcl-xL codependent, and thus sensitive to ABT-737. We demonstrate that bone marrow stroma is capable of inducing Mcl-1 dependence through the production of the plasma cell survival cytokine interleukin-6 (IL-6). IL-6 upregulates Mcl-1 transcription in a STAT3-dependent manner, although this occurred in a minority of the cells tested. In all cells, IL-6 treatment results in posttranslational modification of the proapoptotic protein Bim. Phosphorylation of Bim shifts its binding from Bcl-2 and Bcl-xL to Mcl-1, an effect reversed by MEK inhibition. Blocking IL-6 or downstream signaling restored Bcl-2/Bcl-xL dependence and may therefore represent a clinically useful strategy to enhance the activity of Bcl-2 inhibitors.
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107
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Touzeau C, Le Gouill S, Mahé B, Boudreault JS, Gastinne T, Blin N, Caillon H, Dousset C, Amiot M, Moreau P. Deep and sustained response after venetoclax therapy in a patient with very advanced refractory myeloma with translocation t(11;14). Haematologica 2017; 102:e112-e114. [PMID: 28057737 DOI: 10.3324/haematol.2016.160408] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Cyrille Touzeau
- Department of Hematology, University Hospital, Nantes, France.,CRCNA, INSERM, CNRS, University of Nantes, Nantes, France
| | - Steven Le Gouill
- Department of Hematology, University Hospital, Nantes, France.,CRCNA, INSERM, CNRS, University of Nantes, Nantes, France
| | - Béatrice Mahé
- Department of Hematology, University Hospital, Nantes, France
| | | | - Thomas Gastinne
- Department of Hematology, University Hospital, Nantes, France
| | - Nicolas Blin
- Department of Hematology, University Hospital, Nantes, France
| | - Hélène Caillon
- Biochemistry Laboratory, University Hospital, Nantes, France
| | - Christelle Dousset
- Department of Hematology, University Hospital, Nantes, France.,CRCNA, INSERM, CNRS, University of Nantes, Nantes, France
| | - Martine Amiot
- Department of Hematology, University Hospital, Nantes, France.,CRCNA, INSERM, CNRS, University of Nantes, Nantes, France
| | - Philippe Moreau
- Department of Hematology, University Hospital, Nantes, France .,CRCNA, INSERM, CNRS, University of Nantes, Nantes, France
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108
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Deng J. How to unleash mitochondrial apoptotic blockades to kill cancers? Acta Pharm Sin B 2017; 7:18-26. [PMID: 28119805 PMCID: PMC5237704 DOI: 10.1016/j.apsb.2016.08.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/27/2016] [Indexed: 01/28/2023] Open
Abstract
Apoptosis, especially the intrinsic mitochondrial cell death pathway, is regulated by the BCL-2 family of proteins. Defects in apoptotic machinery are one of the main mechanisms that cells employ to evade cell death and become cancerous. Targeting the apoptotic defects, either by direct inhibition of BCL-2 family proteins or through modulation of regulatory pathways, can restore cell sensitivity to cell death. This review will focus on the aspects of BCL-2 family proteins, their interactions with kinase pathways, and how novel targeted agents can help overcome the apoptotic blockades. Furthermore, functional assays, such as BH3 profiling, may help in predicting responses to chemotherapies and aid in the selection of combination therapies by determining the mitochondrial threshold for initiating cell death.
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Key Words
- ASH, American Society of Hematology
- ATAP, amphipathic tail-anchoring peptide
- Apoptosis
- BAD, BCL-2-associated death promoter protein
- BAK, BCL-2 homologous antagonist killer
- BAX, BCL-2-associated X protein
- BCL-2 family
- BCL-2, B-cell lymphoma 2
- BCL-w (BCL2L2), BCL-2-like protein 2
- BCL-xL, B-cell lymphoma X long
- BCR, B-cell receptor
- BFL-1 (BCL2A1), BCL-2-related protein A1
- BH3 profiling
- BH3, BCL-2 homology 3
- BID, BH3 interacting domain death agonist
- BIK, BCL-2-interacting killer
- BIM, BCL-2-interacting mediator of cell death
- BOK, BCL-2 related ovarian killer
- BTK, Bruton׳s tyrosine kinase
- CDK, cyclin-dependent kinase
- CHOP, cyclophosphamide, hydroxydaunorubicin, oncovin-vincristine and prednisone
- CLL, chronic lymphocytic leukemia
- CML, chronic myelogenous leukemia
- CR, complete response;EGFR, epidermal growth factor receptor
- Combination therapy
- ER, endoplasmic reticulum
- ERK, extracellular signal-regulated kinase
- FDA, U. S. Food and Drug Administration
- GSK-3, glycogen synthase kinase-3
- ITK, interleukin-2-inducible T-cell kinase
- MCL, myeloid cell leukemia
- MOMP, mitochondrial outer membrane permeabilization
- Mitochondrial priming
- NHL, non-Hodgkin lymphoma
- NIH, National Institutes of Health
- NSCLC, non-small cell lung cancer
- PI3K, phosphatidylinositol-3-kinase
- PUMA, p53 up-regulated modulator of apoptosis
- SLL, small lymphocytic lymphoma
- T-ALL, T-acute lymphocytic leukemia
- Targeted therapy
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109
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Taylor-Weiner A, Zack T, O'Donnell E, Guerriero JL, Bernard B, Reddy A, Han GC, AlDubayan S, Amin-Mansour A, Schumacher SE, Litchfield K, Turnbull C, Gabriel S, Beroukhim R, Getz G, Carter SL, Hirsch MS, Letai A, Sweeney C, Van Allen EM. Genomic evolution and chemoresistance in germ-cell tumours. Nature 2016; 540:114-118. [PMID: 27905446 PMCID: PMC5553306 DOI: 10.1038/nature20596] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/02/2016] [Indexed: 01/04/2023]
Abstract
Germ-cell tumours (GCTs) are derived from germ cells and occur most frequently in the testes. GCTs are histologically heterogeneous and distinctly curable with chemotherapy. Gains of chromosome arm 12p and aneuploidy are nearly universal in GCTs, but specific somatic genomic features driving tumour initiation, chemosensitivity and progression are incompletely characterized. Here, using clinical whole-exome and transcriptome sequencing of precursor, primary (testicular and mediastinal) and chemoresistant metastatic human GCTs, we show that the primary somatic feature of GCTs is highly recurrent chromosome arm level amplifications and reciprocal deletions (reciprocal loss of heterozygosity), variations that are significantly enriched in GCTs compared to 19 other cancer types. These tumours also acquire KRAS mutations during the development from precursor to primary disease, and primary testicular GCTs (TGCTs) are uniformly wild type for TP53. In addition, by functional measurement of apoptotic signalling (BH3 profiling) of fresh tumour and adjacent tissue, we find that primary TGCTs have high mitochondrial priming that facilitates chemotherapy-induced apoptosis. Finally, by phylogenetic analysis of serial TGCTs that emerge with chemotherapy resistance, we show how TGCTs gain additional reciprocal loss of heterozygosity and that this is associated with loss of pluripotency markers (NANOG and POU5F1) in chemoresistant teratomas or transformed carcinomas. Our results demonstrate the distinct genomic features underlying the origins of this disease and associated with the chemosensitivity phenotype, as well as the rare progression to chemoresistance. These results identify the convergence of cancer genomics, mitochondrial priming and GCT evolution, and may provide insights into chemosensitivity and resistance in other cancers.
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Affiliation(s)
- Amaro Taylor-Weiner
- Division of Medical Sciences, Harvard University, Boston, Massachusetts 02115, USA
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Travis Zack
- Division of Medical Sciences, Harvard University, Boston, Massachusetts 02115, USA
- Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Elizabeth O'Donnell
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Jennifer L Guerriero
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Brandon Bernard
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Anita Reddy
- Department of Cell Biology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - G Celine Han
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Saud AlDubayan
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Massachusetts 02115, USA
- Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia
| | - Ali Amin-Mansour
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Steven E Schumacher
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Kevin Litchfield
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- William Harvey Research Institute, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Fulham Road, London SW3 6JB, UK
- William Harvey Research Institute, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
| | - Stacey Gabriel
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Rameen Beroukhim
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Gad Getz
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Cancer Center and Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Scott L Carter
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215 , USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Anthony Letai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Eliezer M Van Allen
- Cancer Program, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
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110
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Roberts AW, Huang D. Targeting BCL2 With BH3 Mimetics: Basic Science and Clinical Application of Venetoclax in Chronic Lymphocytic Leukemia and Related B Cell Malignancies. Clin Pharmacol Ther 2016; 101:89-98. [PMID: 27806433 PMCID: PMC5657403 DOI: 10.1002/cpt.553] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 10/28/2016] [Accepted: 10/30/2016] [Indexed: 12/17/2022]
Abstract
The intracellular protein B‐cell‐lymphoma‐2 (BCL2) has been considered an attractive target for cancer therapy since the discovery of its function as a major promoter of cell survival (an anti‐apoptotic) in the late 1980s. However, the challenges of targeting a protein‐protein interaction delayed the discovery of fit‐for‐purpose molecules until the mid‐2000s. Since then, a series of high affinity small organic molecules that inhibits the interaction of BCL2 with the apoptotic machinery, the so‐called BH3‐mimetics, have been developed. Venetoclax (formerly ABT‐199) is the first to achieve US Food and Drug Administration approval, with an indication for treatment of patients with previously treated chronic lymphocytic leukemia (CLL) bearing deletion of the long arm of chromosome 17. Here, we review key aspects of the science underpinning the clinical application of BCL2 inhibitors and explore both our current knowledge and unresolved questions about its clinical utility, both in CLL and in other B‐cell malignancies that highly express BCL2.
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Affiliation(s)
- A W Roberts
- Integrated Department of Clinical Hematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, Australia.,Cancer and Haematology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Parkville, Australia.,Victorian Comprehensive Cancer Centre, Parkville, Australia
| | - Dcs Huang
- Cancer and Haematology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.,Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Parkville, Australia
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111
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Bcl-2 protein family expression pattern determines synergistic pro-apoptotic effects of BH3 mimetics with hemisynthetic cardiac glycoside UNBS1450 in acute myeloid leukemia. Leukemia 2016; 31:755-759. [PMID: 27872497 PMCID: PMC5339427 DOI: 10.1038/leu.2016.341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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112
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Abstract
INTRODUCTION The myeloid cell leukemia-1 (MCL-1) protein is one of the key anti-apoptotic members of the B-cell lymphoma-2 (BCL-2) protein family. Over-expression of MCL-1 has been closely related to tumor progression as well as to resistance, not only to traditional chemotherapies but also to targeted therapeutics including BCL-2 inhibitors such as ABT-263. Therefore, there has been extensive research and development in the last decade in both academic and industrial settings to address this unmet medical need. Areas covered: This review covers the research and patent literature of the past 10 years in the field of discovery and development of small-molecule inhibitors of the MCL-1 anti-apoptotic protein. Expert opinion: Small-molecule strategies to disrupt the protein-protein interactions between MCL-1 and its pro-apoptotic counterparts, such as BAK and BIM, have recently emerged. Several small-molecules based on different scaffolds describe promising in vitro data as MCL-1 selective inhibitors. While many lead compounds remain at the in vitro preclinical development stage, the two most recent patent applications describe promising in vivo data, and one small molecule inhibitor has recently entered into clinical development. It is such an exciting moment that the long awaited clinical studies will generate some insight into the therapeutic potential of this anti-cancer approach, and possibly facilitate the further development of other early stage inhibitors.
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Affiliation(s)
- Lijia Chen
- a Department of Pharmaceutical Sciences , University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Steven Fletcher
- a Department of Pharmaceutical Sciences , University of Maryland School of Pharmacy , Baltimore , MD , USA
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113
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Hanf M, Chiron D, de Visme S, Touzeau C, Maisonneuve H, Jardel H, Pellat-Deceunynck C, Amiot M, le Gouill S. The REFRACT-LYMA cohort study: a French observational prospective cohort study of patients with mantle cell lymphoma. BMC Cancer 2016; 16:802. [PMID: 27737650 PMCID: PMC5064959 DOI: 10.1186/s12885-016-2844-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 10/06/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mantle Cell Lymphoma (MCL) is often associated with progression, temporary response to therapy and a high relapse rate over time resulting in a poor long-term prognosis. Because MCL is classified as an incurable disease, therapeutic resistance is of great interest. However, knowledge about the biological mechanisms underlying resistance associated with MCL therapies and about associated predictors remains poor. The REFRACT-LYMA Cohort, a multicenter prospective cohort of patients with MCL, is set up to address this limitation. We here describe the study background, design and methods used for this cohort. METHODS/DESIGN The REFRACT-LYMA Cohort Study aims at including all patients (>18 years old) who are diagnosed with MCL in any stage of the disease and treated in specialized oncology centers in three public hospitals in Northwestern France. Any such patient providing a signed informed consent is included. All subjects are followed up indefinitely, until refusal to participate in the study, emigration or death. The REFRACT-LYMA follow-up is continuous and collects data on socio-economic status, medical status, MCL therapies and associated events (resistance, side effects). Participants also complete standardized quality of life (QOL) questionnaires. In addition, participants are asked to donate blood samples that will support ex vivo analysis of expression and functional assays required to uncover predictive biomarkers and companion diagnostics. If diagnostic biopsies are performed during the course of the disease, extracted biological samples are kept in a dedicated biobank. DISCUSSION To our knowledge, the REFRACT-LYMA Cohort Study is the first prospective cohort of patients with MCL for whom "real-life" medical, epidemiological and QOL data is repeatedly collected together with biological samples during the course of the disease. The integrative cohort at mid-term will be unique at producing a large variety of data that can be used to conceive the most effective personalized therapy for MCL patients. Additionally, the REFRACT-LYMA Cohort puts the medical care of MCL patients in a health and pharmacoeconomic perspective.
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Affiliation(s)
- Matthieu Hanf
- INSERM CIC 1413, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - David Chiron
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, Nantes, France
| | - Sophie de Visme
- INSERM CIC 1413, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Cyrille Touzeau
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Hervé Maisonneuve
- Service de Médecine Onco-hématologie, Centre Hospitalier Départemental de La Roche sur Yon, La Roche sur Yon, France
| | - Henry Jardel
- Service de Médecine interne - Maladies hématologiques - Maladies infectieuses, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Catherine Pellat-Deceunynck
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Martine Amiot
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Steven le Gouill
- INSERM CIC 1413, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, Nantes, France. .,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France.
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114
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Inhibition of Mcl-1 through covalent modification of a noncatalytic lysine side chain. Nat Chem Biol 2016; 12:931-936. [DOI: 10.1038/nchembio.2174] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 06/23/2016] [Indexed: 01/06/2023]
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115
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Dousset C, Maïga S, Gomez-Bougie P, Le Coq J, Touzeau C, Moreau P, Le Gouill S, Chiron D, Pellat-Deceunynck C, Moreau-Aubry A, Amiot M. BH3 profiling as a tool to identify acquired resistance to venetoclax in multiple myeloma. Br J Haematol 2016; 179:684-688. [DOI: 10.1111/bjh.14251] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Christelle Dousset
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Sophie Maïga
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Patricia Gomez-Bougie
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Joy Le Coq
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Cyrille Touzeau
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Philippe Moreau
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Steven Le Gouill
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - David Chiron
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Catherine Pellat-Deceunynck
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Agnès Moreau-Aubry
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
| | - Martine Amiot
- CRCNA; CNRS; INSERM; Centre Hospitalier Universitaire de Nantes; Université d'Angers; Université de Nantes; Nantes France
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116
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Hierarchy for targeting prosurvival BCL2 family proteins in multiple myeloma: pivotal role of MCL1. Blood 2016; 128:1834-1844. [PMID: 27465916 DOI: 10.1182/blood-2016-03-704908] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/13/2016] [Indexed: 11/20/2022] Open
Abstract
New therapeutic targets are needed to address the poor prognosis of patients with high-risk multiple myeloma. Myeloma cells usually express a range of the prosurvival BCL2 proteins. To define the hierarchy of their relative importance for maintaining the survival of myeloma cells, we targeted each of them in a large panel of cell lines, using pharmacological inhibitors or gene editing or by peptide-based approaches, alone or in combination. The majority of well-established immortalized cell lines (17/25) or low-passage myeloma cell lines (5/7) are readily killed when MCL1 is targeted, even including those cell lines sensitive to BCL2 inhibition. Targeting MCL1 also constrained the growth of myeloma in vivo. We also identified a previously unrecognized subset of myeloma that is highly BCLXL-dependent, and has the potential for cotargeting MCL1 and BCLXL. As MCL1 is pivotal for maintaining survival of most myelomas, it should be prioritized for targeting in the clinic once high-quality, validated inhibitors become available.
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117
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Punnoose EA, Leverson JD, Peale F, Boghaert ER, Belmont LD, Tan N, Young A, Mitten M, Ingalla E, Darbonne WC, Oleksijew A, Tapang P, Yue P, Oeh J, Lee L, Maiga S, Fairbrother WJ, Amiot M, Souers AJ, Sampath D. Expression Profile of BCL-2, BCL-XL, and MCL-1 Predicts Pharmacological Response to the BCL-2 Selective Antagonist Venetoclax in Multiple Myeloma Models. Mol Cancer Ther 2016; 15:1132-44. [DOI: 10.1158/1535-7163.mct-15-0730] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/15/2016] [Indexed: 11/16/2022]
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118
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Dexamethasone treatment promotes Bcl-2 dependence in multiple myeloma resulting in sensitivity to venetoclax. Leukemia 2015; 30:1086-93. [PMID: 26707935 PMCID: PMC4874660 DOI: 10.1038/leu.2015.350] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 12/22/2022]
Abstract
Venetoclax (ABT-199), a specific inhibitor of the anti-apoptotic protein Bcl-2, is currently in phase I clinical trials for multiple myeloma. Results suggest that venetoclax is only active in a small cohort of patients therefore we wanted to determine its efficacy when used in combination. Combining venetoclax with melphalan or carfilzomib produced additive or better cell death in 4 of the 5 cell lines tested. The most striking results were seen with dexamethasone. Co-treatment of human myeloma cell lines and primary patient samples, with dexamethasone and venetoclax significantly increased cell death over venetoclax alone in 4 of the 5 cell lines, and in all patient samples tested. The mechanism by which this occurs is an increase in the expression of both Bcl-2 and Bim upon addition of dexamethasone. This results in alterations in Bim binding to anti-apoptotic proteins. Dexamethasone shifts Bim binding towards Bcl-2 resulting in increased sensitivity to venetoclax. These data suggest that knowledge of drug-induced alterations of Bim binding patterns may help inform better combination drug regimens. Furthermore, the data indicate combining this novel therapeutic with dexamethasone could be an effective therapy for a broader range of patients than would be predicted by single agent activity.
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