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Fineschi S, Bongiovanni M, Donati Y, Djaafar S, Naso F, Goffin L, Argiroffo CB, Pache JC, Dayer JM, Ferrari-Lacraz S, Chizzolini C. In vivo investigations on anti-fibrotic potential of proteasome inhibition in lung and skin fibrosis. Am J Respir Cell Mol Biol 2008; 39:458-65. [PMID: 18458239 DOI: 10.1165/rcmb.2007-0320oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In systemic sclerosis (SSc), a disease characterized by fibrosis of the skin and internal organs, the occurrence of interstitial lung disease is responsible for high morbidity and mortality. We previously demonstrated that proteasome inhibitors (PI) show anti-fibrotic properties in vitro by reducing collagen production and favoring collagen degradation in a c-jun N-terminal kinase (JNK)-dependent manner in human fibroblasts. Therefore, we tested whether PI could control fibrosis development in bleomycin-induced lung injury, which is preceded by massive inflammation. We extended the study to test PI in TSK-1/+ mice, where skin fibrosis develops in the absence of overt inflammation. C57Bl/6 mice received bleomycin intratracheally and were treated or not with PI. Lung inflammation and fibrosis were assessed by histology and quantification of hydroxyproline content, type I collagen mRNA, and TGF-beta at Days 7, 15, and 21, respectively. Histology was used to detect skin fibrosis in TSK-1/+mice. The chymotryptic activity of 20S proteasome was assessed in mice blood. JNK and Smad2 phosphorylation were evaluated by Western blot on lung protein extracts. PI reduced collagen mRNA levels in murine lung fibroblasts, without affecting their viability in vitro. In addition, PI inhibited the chymotryptic activity of proteasome and enhanced JNK and TGF-beta signaling in vivo. PI failed to prevent bleomycin-induced lung inflammation and fibrosis and to attenuate skin fibrosis in TSK-1/+mice. In conclusion, our results provide direct evidence that, despite promising in vitro results, proteasome blockade may not be a strategy easily applicable to control fibrosis development in diseases such as lung fibrosis and scleroderma.
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Affiliation(s)
- Serena Fineschi
- Immunology and Allergy, Department of Internal Medicine, School of Medicine and University Hospital, Geneva, Switzerland
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102
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Vahid B, Marik PE. Infiltrative lung diseases: complications of novel antineoplastic agents in patients with hematological malignancies. Can Respir J 2008; 15:211-6. [PMID: 18551203 PMCID: PMC2677954 DOI: 10.1155/2008/305234] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Infiltrative lung disease is a well-known complication of antineoplastic agents in patients with hematological malignancies. Novel agents are constantly being added to available treatments. The present review discusses different pulmonary syndromes, pathogenesis and management of these novel agents.
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Affiliation(s)
- Bobbak Vahid
- Dominican Hospital, Santa Cruz Pulmonary Medical Group, Santa Cruz, CA, USA.
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103
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Miyakoshi S, Kusumi E, Kodama Y, Narimatsu H, Hamaki T, Matsumura T, Kami M. Adverse events of unapproved drugs in Japan. Lancet Oncol 2008; 9:414-5. [DOI: 10.1016/s1470-2045(08)70116-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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104
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Hernández-Espinosa D, Miñano A, Martínez C, Ordoñez A, Pérez-Ceballos E, de Arriba F, Mota RA, Ferrer F, González M, Vicente V, Corral J. Inhibition of proteasome by bortezomib causes intracellular aggregation of hepatic serpins and increases the latent circulating form of antithrombin. J Transl Med 2008; 88:306-17. [PMID: 18195690 DOI: 10.1038/labinvest.3700717] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Conformational diseases include heterogeneous disorders sharing a similar pathological mechanism, leading to intracellular aggregation of proteins with toxic effects. Serpins are commonly involved in these diseases. These are structurally sensitive molecules that modify their folding under even minor genetic or environmental variations. Indeed, under normal conditions, the rate of misfolding of serpins is high and unfolded serpins must be degraded by the proteasome system. Our aim was to study the effects of bortezomib, a proteasome inhibitor, on conformationally sensitive serpins. The effects of bortezomib were analysed in patients with multiple myeloma, HepG2 cells, and Swiss mice, as well as in vitro. Levels, anti-FXa activity, heparin affinity, and conformational features of antithrombin, a relevant anticoagulant serpin, were analysed. Histological, ultrastructural features and immunohistological distribution of antithrombin and alpha1-antitrypsin (another hepatic serpin) were evaluated. We also studied the intracellular accumulation of conformationally sensitive (fibrinogen) or non-sensitive (prothrombin) hepatic proteins. The inhibition of the proteasome caused intracellular accumulation and aggregation of serpins within the endoplasmic reticulum that was associated with confronting cisternae and Mallory body formation. These effects were accompanied by a heat stress response. Bortezomib also increased the levels of intracellular fibrinogen, but has no significant effect on prothrombin. Finally, bortezomib had only minor effects on the mature circulating antithrombin, with increased amounts of latent antithrombin in plasma. These results suggest that the impairment of proteasomal activities leads to an intracellular accumulation of conformationally sensitive proteins and might facilitate the release of misfolded serpins into circulation where they adopt more stable conformations.
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105
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Kane RC, Dagher R, Farrell A, Ko CW, Sridhara R, Justice R, Pazdur R. Bortezomib for the treatment of mantle cell lymphoma. Clin Cancer Res 2007; 13:5291-4. [PMID: 17875757 DOI: 10.1158/1078-0432.ccr-07-0871] [Citation(s) in RCA: 276] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To describe the Food and Drug Administration review and marketing approval considerations for bortezomib (Velcade) for the treatment of patients with mantle cell lymphoma. EXPERIMENTAL DESIGN Food and Drug Administration reviewed a multicenter study of bortezomib in 155 patients with progressive mantle cell lymphoma after at least one prior therapy. RESULTS Seventy-seven percent were stage IV, and 75% had one or more extranodal sites of disease. Prior therapy included an anthracycline or mitoxantrone, cyclophosphamide, and rituximab. Median age was 65 years. All received bortezomib 1.3 mg/m(2) i.v. on days 1, 4, 8, and 11 of each 3-week cycle. The primary end point was response. Response and progression were determined by independent review of serial computed tomography scans using International Lymphoma Workshop Response Criteria. The overall response rate was 31%, including complete response (CR) plus CR unconfirmed (CRu) plus partial response; median response duration was 9.3 months. The CR plus CRu response rate was 8% with a median duration of 15.4 months. Adverse events were similar to those observed previously for bortezomib. The most commonly reported treatment-emergent adverse events were asthenia (72%), peripheral neuropathies (55%), constipation (50%), diarrhea (47%), nausea (44%), and anorexia (39%). The most common adverse event leading to discontinuation was neuropathy. CONCLUSIONS Bortezomib received regular approval for the treatment of patients with mantle cell lymphoma in relapse after prior therapy.
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Affiliation(s)
- Robert C Kane
- Division of Drug Oncology Products, Office of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20993-0002, USA.
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106
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Ozaki S, Tanaka O, Fujii S, Shigekiyo Y, Miki H, Choraku M, Kagawa K, Asano J, Takeuchi K, Kitazoe KI, Hashimoto T, Abe M, Matsumoto T. Therapy with bortezomib plus dexamethasone induces osteoblast activation in responsive patients with multiple myeloma. Int J Hematol 2007; 86:180-5. [PMID: 17875535 DOI: 10.1532/ijh97.07030] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bortezomib is a novel proteasome inhibitor that has shown marked antitumor effects in patients with multiple myeloma (MM). We evaluated the feasibility and efficacy of bortezomib plus dexamethasone (BD) therapy and assessed bone metabolism in relapsed or refractory MM. Fourteen patients received 1.3 mg/m2 bortezomib on days 1, 4, 8, and 11 along with 20 mg/dose of dexamethasone on days 1, 2, 4, 5, 8, 9, 11, and 12 in a 21-day cycle. After 1 to 3 cycles of BD therapy, 9 patients (64%) achieved an objective response (5 very good partial responses and 4 partial responses). Notably, a rapid increase in the serum concentration of alkaline phosphatase (ALP) was observed in 6 of the treatment-responsive patients. Moreover, serum levels of bone-formation markers (bone-specific ALP and osteocalcin) significantly increased in 5 and 2 responsive patients, respectively. Radiographic examination showed improvement in bone lesions, suggesting that BD therapy induces osteoblast activation in responders. Adverse events included thrombocytopenia of grades 1 to 3, peripheral neuropathy of grades 1 to 2, and grade 3 ileus and were transient and manageable. Although severe lung injury has been reported among Japanese patients treated with bortezomib, no pulmonary complications were observed during BD therapy. Our results suggest that BD therapy is a safe and promising therapeutic approach for Japanese patients with MM.
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Affiliation(s)
- Shuji Ozaki
- Department of Medicine and Bioregulatory Sciences, The University of Tokushima Graduate School of Health Biosciences, Kuramoto, Tokushima, Japan.
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107
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Abstract
The advent of new therapies for multiple myeloma brings new hope for patients but also new side effects. Emerging information about the risks of supportive care therapies, including long-term, high-intensity bisphosphonate use and erythropoiesis-stimulating agents, is examined. As the number of drugs in the myeloma armamentarium grows, so does the list of possible side effects and interactions. With current progress, not only are there more complications to consider but patients are also living longer and the risk for delayed complications is becoming more relevant. The author provides perspective about the risks for the most active and commonly used single-agent and combination myeloma therapies.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
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108
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Tobinai K. Proteasome inhibitor, bortezomib, for myeloma and lymphoma. Int J Clin Oncol 2007; 12:318-26. [PMID: 17929113 DOI: 10.1007/s10147-007-0695-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Indexed: 12/22/2022]
Abstract
Bortezomib, a boronic acid, is a potent and selective proteasome inhibitor. The 20S proteasome is an enzyme complex present in cells, and it degrades many cell-cycle control factors, signal transduction factors, transcription factors, and oncogene and anti-oncogene products, thus controlling cell proliferation, differentiation, and apoptosis. Bortezomib is a novel molecular targeting agent which was designed to exhibit an antitumor effect by selectively inhibiting the 20S proteasome. Multiple myeloma is one of the incurable B-cell malignancies that continues to relapse with current treatment modalities, and the duration to progression becomes shorter in patients who repeatedly receive chemotherapy. There are no available treatment options in which durable efficacy can be expected after relapse; therefore, an effective therapy with a novel mechanism of action has been desired. In this review article, the results of clinical trials of bortezomib for multiple myeloma, including a Japanese phase I/II and pharmacokinetic/pharmacodynamic study, and those for non-Hodgkin lymphoma, especially for mantle cell lymphoma, are summarized. In the Japanese phase I/II study of bortezomib for relapsed multiple myeloma, this agent showed remarkable efficacy, with acceptable toxicities and unique pharmacokinetic/pharmacodynamic profiles, warranting further investigations, including more relevant administration schedules.
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Affiliation(s)
- Kensei Tobinai
- Hematology and Stem Cell Transplantation Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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109
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Zappasodi P, Dore R, Castagnola C, Astori C, Varettoni M, Mangiacavalli S, Lazzarino M, Corso A. Rapid Response to High-Dose Steroids of Severe Bortezomib-Related Pulmonary Complication in Multiple Myeloma. J Clin Oncol 2007; 25:3380-1. [PMID: 17664489 DOI: 10.1200/jco.2006.10.0164] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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110
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Pitini V, Arrigo C, Altavilla G, Naro C. Severe pulmonary complications after bortezomib treatment for multiple myeloma: An unrecognized pulmonary vasculitis? Leuk Res 2007; 31:1027-8. [PMID: 17134751 DOI: 10.1016/j.leukres.2006.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 09/13/2006] [Accepted: 09/17/2006] [Indexed: 10/23/2022]
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111
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Thornburg A, Abonour R, Smith P, Knox K, Twigg HL. Hypersensitivity pneumonitis-like syndrome associated with the use of lenalidomide. Chest 2007; 131:1572-4. [PMID: 17494808 DOI: 10.1378/chest.06-1734] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Lenalidomide is an immunomodulatory agent approved for use in patients with myelodysplastic syndrome, and in combination with dexamethasone for refractory or relapsed multiple myeloma. Pulmonary toxicity is believed to be uncommon. In this report, we describe a patient receiving lenalidomide in whom dyspnea, fever, hypoxia, and diffuse pulmonary infiltrates developed. BAL demonstrated a significant lymphocytic alveolitis typical for hypersensitivity pneumonitis. Extensive workup for other causes, including infections, was negative. Finally, the patient had improvement in symptoms and oxygenation after withdrawing lenalidomide and recurrence of symptoms when the drug was restarted. Thus, the patient's clinical course and workup strongly support a diagnosis of lenalidomide-induced hypersensitivity pneumonitis-like syndrome. Physicians should be cognizant of this potential complication in patients receiving thalidomide or thalidomide-like drugs who present with fever and pulmonary infiltrates and fail to improve despite treatment with broad-spectrum antibiotics.
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Affiliation(s)
- Aaron Thornburg
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University Medical Center, 1481 W Tenth Street, VA 111P-IU, Indianapolis, IN 46202, USA
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112
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Duek A, Feldberg E, Haran M, Berrebi A. Pulmonary fibrosis in a myeloma patient on bortezomib treatment. A new severe adverse effect of a new drug. Am J Hematol 2007; 82:502-3. [PMID: 17301973 DOI: 10.1002/ajh.20891] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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113
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Chew E, Filshie R, Wei A. Development of fatal bortezomib induced acute lung injury despite concurrent therapy with high-dose dexamethasone. Leuk Lymphoma 2007; 48:212-3. [PMID: 17325874 DOI: 10.1080/10428190600988010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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114
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Abstract
Bortezomib is a proteosome inhibitor with good clinical activity in multiple myeloma. Frequently described side effects are gastrointestinal symptoms, neuropathy, and thrombocytopenia. Even though pneumonia is listed as an infrequent toxicity, severe pneumonitis leading to respiratory distress had not been described until recently. This report was from a single institution in Japan. All these patients had received bone marrow transplant before therapy with bortezomib. To the authors knowledge, this is the first report of life-threatening pulmonary toxicity after bortezomib in a non-Japanese patient and without history of prior autologous peripheral stem cell transplant.
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Affiliation(s)
- Anju Ohri
- Arena Oncology Associates, Lake Success, New York 11042, USA.
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115
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Hemeryck A, Geerts R, Monbaliu J, Hassler S, Verhaeghe T, Diels L, Verluyten W, van Beijsterveldt L, Mamidi RNVS, Janssen C, De Coster R. Tissue distribution and depletion kinetics of bortezomib and bortezomib-related radioactivity in male rats after single and repeated intravenous injection of 14 C-bortezomib. Cancer Chemother Pharmacol 2007; 60:777-87. [PMID: 17285316 DOI: 10.1007/s00280-007-0424-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE The body distribution of total radioactivity (TR) and bortezomib was investigated in male Sprague-Dawley rats after single and repeated i.v. (bolus) administration with (14)C-labelled bortezomib (VELCADE) (0.2 mg/kg; 0.28 MBq./kg). METHODS Bortezomib was dosed on days 1, 4, 8, and 11 (i.e. a clinical dosing cycle) and the animals were sacrificed at selected time points following single and repeated dose administration for the quantification of TR in blood, plasma, and various tissues by liquid scintillation counting following organ dissection or by quantitative whole body autoradiography. In selected tissues, bortezomib levels were determined by LC-MS/MS. RESULTS In general, plasma TR levels were less than 10% of the corresponding blood concentrations. TR was rapidly and widely distributed to the tissues with only limited penetration into the central nervous system (CNS). In the tissues, highest levels of TR were measured in bortezomib-eliminating organs (liver and kidney), lymphoid tissues, and regions of rapidly dividing cells (e.g. the bone marrow, intestinal mucosa). Low TR concentrations were found in the CNS (tissue-to-blood ratio of approximately 0.05 after repeated dosing). With the exception of the liver, TR consisted almost exclusively of the parent drug. Tissue concentrations of TR and bortezomib increased up to about threefold from the first to the third dose administration, after which they remained constant. CONCLUSION No undue tissue accumulation of TR and of bortezomib was observed in rats following a full clinical dosing cycle of bortezomib.
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Affiliation(s)
- Alex Hemeryck
- Global Preclinical Development, Johnson & Johnson Pharmaceutical Research & Development, A Division of Janssen Pharmaceutica N.V., Beerse, Belgium.
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116
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117
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Yamada Y, Shiga T, Matsuda N, Hagiwara N, Kasanuki H. Incidence and Predictors of Pulmonary Toxicity in Japanese Patients Receiving Low-Dose Amiodarone. Circ J 2007; 71:1610-6. [PMID: 17895560 DOI: 10.1253/circj.71.1610] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Amiodarone-induced pulmonary toxicity (APT) is the most serious side-effect of amiodarone, and its detection and prevention are extremely important. This study was designed to evaluate the incidence and clinical risk factors of APT, and the utility of a pulmonary function test or serum KL-6 assay to predict pulmonary toxicity in Japanese patients receiving low-dose amiodarone. METHODS AND RESULTS Five hundred consecutive patients receiving amiodarone were retrospectively evaluated. Mean follow-up period was 48 months and mean maintenance dose was 141 mg daily. Cumulative incidence of APT was 4.2%, 7.8%, and 10.6% at 1, 3, and 5 years, respectively. On multivariate analysis, age at the start (hazard ratio (HR) =1.48, 95% confidence interval (CI) 1.13 to 1.93) was a significant pretreatment risk factor. Age (HR =1.64, 95% CI 1.29 to 2.09), maintenance dose (HR =1.90, 95% CI 1.45 to 2.49) and plasma monodesethylamiodarone concentration (HR =1.30, 95%CI 1.08 to 1.58) were risk factors. Sensitivity and specificity in screening with measurement of percent predicted diffusion capacity of carbon monoxide, > or =15% individual decrease, were 68% and 69%, and for > or =20% individual decrease, were 59% and 74%, whereas those in screening with serum KL-6 assay, > or =500 U/ml, were 25% and 91%, respectively. CONCLUSIONS Even at low dose, amiodarone shows substantial pulmonary toxicity. Higher age and higher maintenance dose are risk factors. Further decreasing the maintenance dose of amiodarone should be considered in order to reduce the incidence of pulmonary toxicity, at least in Japanese patients.
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Affiliation(s)
- Yuichiro Yamada
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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118
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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119
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Boyer JE, Batra RB, Ascensao JL, Schechter GP. Severe pulmonary complication after bortezomib treatment for multiple myeloma. Blood 2006; 108:1113. [PMID: 16861361 DOI: 10.1182/blood-2006-03-011494] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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120
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Shimazaki C, Kobayashi Y, Inaba T, Taniwaki M. Dexamethasone reduces the risk of bortezomib-induced pulmonary complications in Japanese myeloma patients. Int J Hematol 2006; 84:90-1. [PMID: 16867910 DOI: 10.1532/ijh97.06062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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121
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Okamoto S. [Recent progress in diagnosis of and therapy for multiple myeloma]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2006; 95:1922-31. [PMID: 17037337 DOI: 10.2169/naika.95.1922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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122
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Kropff M, Bisping G, Wenning D, Berdel WE, Kienast J. Proteasome inhibition in multiple myeloma. Eur J Cancer 2006; 42:1623-39. [PMID: 16820291 DOI: 10.1016/j.ejca.2006.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 02/22/2006] [Indexed: 11/18/2022]
Abstract
The ubiquitin-proteasome pathway is the major cellular degradative system for various proteins critical for proliferation, survival and homing of myeloma cells. Bortezomib is the first specific and reversible proteasome inhibitor for clinical application in humans. Phase I studies have defined the maximum tolerated dose and suggested activity against multiple myeloma. From single agent phase II studies, a rate of at least partial responses ranging from 27% for relapsed and refractory to 38% for second-line patients was derived. In comparison with pulsed dexamethasone, bortezomib enabled a higher response rate, a longer time to myeloma progression and a longer survival for patients after one to three prior lines of therapy. Preclinical and clinical phase I studies as well as initial phase II studies combining bortezomib with conventional chemotherapy or thalidomide support the assumption that bortezomib sensitizes myeloma cells to these drugs resulting in additive or synergistic activity.
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Affiliation(s)
- Martin Kropff
- Department of Medicine/Haematology and Oncology, University of Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany
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123
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Abstract
The ubquitin-proteasome pathway is a key regulator of homeostasis within cells, degrading misfolded or redundant proteins, and also those involved in mediating transcription, cell-cycle progression and apoptosis. Inhibition of the 26S proteasome results in accumulation of such proteins and ultimately leads to cell death. Malignant cells are more susceptible to proteasome inhibition due to their higher proliferation rates, protein production and their dependence on anti-apoptotic molecules for cell survival. Bortezomib has recently gained European Commission approval for the treatment of relapsed multiple myeloma on the basis of clinical trials demonstrating its efficacy, tolerability and superiority to high-dose dexamethasone. Preclinical data demonstrates the ability to synergise with other chemotherapeutic agents and overcome drug resistance, and hence combination studies are underway. This review describes the pharmacology, toxicity, preclinical and clinical activity of bortezomib, predominantly in the setting of multiple myeloma.
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Affiliation(s)
- Rakesh Popat
- Department of Haematology, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
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