1
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Davids MS, O’Connor OA, Jurczak W, Samaniego F, Fenske TS, Zinzani PL, Patel MR, Ghosh N, Cheson BD, Derenzini E, Brander DM, Reeves JA, Knopińska-Posłuszny W, Allan JN, Phillips T, Caimi PF, Lech-Maranda E, Burke JM, Agajanian R, Pettengell R, Leslie LA, Cheah CY, Fonseca G, Essell J, Chavez JC, Pagel JM, Sharman JP, Hsu Y, Miskin HP, Sportelli P, Weiss MS, Flinn IW. Integrated safety analysis of umbralisib, a dual PI3Kδ/CK1ε inhibitor, in relapsed/refractory lymphoid malignancies. Blood Adv 2021; 5:5332-5343. [PMID: 34547767 PMCID: PMC9153017 DOI: 10.1182/bloodadvances.2021005132] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/12/2021] [Indexed: 11/20/2022] Open
Abstract
Phosphoinositide 3-kinase-δ (PI3Kδ) inhibitors are active in lymphoid malignancies, although associated toxicities can limit their use. Umbralisib is a dual inhibitor of PI3Kδ and casein kinase-1ε (CK1ε). This study analyzed integrated comprehensive toxicity data from 4 open-label, phase 1 and 2 studies that included 371 adult patients (median age, 67 years) with relapsed/refractory non-Hodgkin lymphoma (follicular lymphoma [n = 147]; marginal zone lymphoma [n = 82]; diffuse large B-cell lymphoma/mantle cell lymphoma [n = 74]; chronic lymphocytic leukemia [n = 43]; and other tumor types [n = 25]) who were treated with the recommended phase 2 dose of umbralisib 800 mg or higher once daily. At data cutoff, median duration of umbralisib treatment was 5.9 months (range, 0.1-75.1 months), and 107 patients (28.8%) received umbralisib for ≥12 months. Any-grade treatment-emergent adverse events (AEs) occurred in 366 (98.7%) of 371 patients, with the most frequent being diarrhea (52.3%), nausea (41.5%), and fatigue (31.8%). Grade 3 or higher treatment-emergent AEs occurred in 189 (50.9%) of 371 patients and included neutropenia (11.3%), diarrhea (7.3%), and increased aminotransferase levels (5.7%). Treatment-emergent serious AEs occurred in 95 (25.6%) of 371 patients. AEs of special interest were limited and included pneumonia (29 of 371 [7.8%]), noninfectious colitis (9 of 371 [2.4%]), and pneumonitis (4 of 371 [1.1%]). AEs led to discontinuation of umbralisib in 51 patients (13.7%). Four patients (1.1%) died of AEs, none of which was deemed related to umbralisib. No cumulative toxicities were reported. The favorable long-term tolerability profile and low rates of immune-mediated toxicities support the potential use of umbralisib for the benefit of a broad population of patients with lymphoid malignancies.
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Affiliation(s)
- Matthew S. Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Owen A. O’Connor
- Department of Medicine, University of Virginia Cancer Center, Charlottesville, VA
- TG Therapeutics, Inc, New York, NY
| | - Wojciech Jurczak
- Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Felipe Samaniego
- The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna, Italy
| | - Manish R. Patel
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL
| | | | | | - Enrico Derenzini
- Onco-Hematology Division, European Institute of Oncology IRCCS, Department of Health Sciences, University of Milan, Milan, Italy
| | | | - James A. Reeves
- Florida Cancer Specialists South/Sarah Cannon Research Institute, Fort Myers, FL
| | | | | | - Tycel Phillips
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Paolo F. Caimi
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Ewa Lech-Maranda
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - John M. Burke
- Rocky Mountain Cancer Centers/US Oncology Research, Aurora, CO
| | | | | | - Lori A. Leslie
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack, NJ
| | - Chan Y. Cheah
- Sir Charles Gairdner Hospital and University of Western Australia, Perth, Australia
| | - Gustavo Fonseca
- Florida Cancer Specialists North/Sarah Cannon Research Institute, St. Petersburg, FL
| | | | | | | | - Jeff P. Sharman
- Willamette Valley Cancer Institute/US Oncology Research, Eugene, OR; and
| | | | | | | | | | - Ian W. Flinn
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
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2
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Fowler NH, Samaniego F, Jurczak W, Ghosh N, Derenzini E, Reeves JA, Knopińska-Posłuszny W, Cheah CY, Phillips T, Lech-Maranda E, Cheson BD, Caimi PF, Grosicki S, Leslie LA, Chavez JC, Fonseca G, Babu S, Hodson DJ, Shao SH, Burke JM, Sharman JP, Law JY, Pagel JM, Miskin HP, Sportelli P, O'Connor OA, Weiss MS, Zinzani PL. Umbralisib, a Dual PI3Kδ/CK1ε Inhibitor in Patients With Relapsed or Refractory Indolent Lymphoma. J Clin Oncol 2021; 39:1609-1618. [PMID: 33683917 PMCID: PMC8148421 DOI: 10.1200/jco.20.03433] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Phosphatidylinositol-3-kinase (PI3K) inhibitors have shown activity in relapsed or refractory (R/R) indolent non-Hodgkin lymphoma (iNHL). PI3K inhibitors have been hampered by poor long-term tolerability and toxicity, which interfere with continuous use. Umbralisib, a dual inhibitor of PI3Kδ/casein kinase-1ε, exhibits improved selectivity for PI3Kδ compared with other PI3K inhibitors. This phase IIb trial was designed to evaluate the efficacy and safety of umbralisib in patients with R/R iNHL. PATIENTS AND METHODS In this multicohort, open-label, phase IIb study, 208 patients with R/R marginal zone, follicular, or small lymphocytic lymphoma (MZL, FL, or SLL) unresponsive to prior treatments (≥ 1 MZL; ≥ 2 FL/SLL), including ≥ 1 anti-CD20-based therapy, were administered umbralisib 800 mg orally once daily until disease progression, unacceptable toxicity, or study withdrawal. Primary end point is overall response rate; secondary end points include time to response, duration of response, progression-free survival, and safety. RESULTS The median follow-up is 27.7 months (efficacy) and 21.4 months (safety). The overall response rate was 47.1%, and tumor reduction occurred in 86.4% of patients. The median time to response was 2.7-4.6 months. The median duration of response was not reached for MZL, 11.1 months for FL, and 18.3 months for SLL. Median progression-free survival was not reached for MZL, 10.6 months for FL, and 20.9 months for SLL. At least one grade ≥ 3 treatment-emergent adverse event (TEAE) was reported in 53.4% of patients. TEAEs led to umbralisib discontinuation in 32 patients (15.4%). A total of 31 patients (14.9%) discontinued because of a treatment-related adverse event. Grade ≥ 3 TEAEs reported in ≥ 10% of patients: neutropenia (11.5%) and diarrhea (10.1%). Increased ALT/AST (grade ≥ 3) occurred in 6.7%/7.2% of patients. CONCLUSION Umbralisib achieved meaningful clinical activity in heavily pretreated patients with iNHL. The safety profile was manageable, with a relatively low incidence of immune-mediated toxicities and adverse event-related discontinuations.
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Affiliation(s)
- Nathan H Fowler
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Wojciech Jurczak
- Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | | | - Enrico Derenzini
- Onco-Hematology Division, European Institute of Oncology IRCCS, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - James A Reeves
- Florida Cancer Specialists South/Sarah Cannon Research Institute, Fort Myers, FL
| | | | - Chan Y Cheah
- Hollywood Private Hospital/Sir Charles Gairdner Hospital, Perth, Australia
| | - Tycel Phillips
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Ewa Lech-Maranda
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Bruce D Cheson
- Lymphoma Research Foundation, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Paolo F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | - Lori A Leslie
- John Theurer Cancer Center, Hackensack Meridian Health, Seton Hall School of Medicine, Hackensack, NJ
| | | | - Gustavo Fonseca
- Florida Cancer Specialists North/Sarah Cannon Research Institute, St Petersburg, FL
| | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wayne, IN
| | - Daniel J Hodson
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | | | - John M Burke
- Rocky Mountain Cancer Centers/US Oncology Research, Aurora, CO
| | - Jeff P Sharman
- Willamette Valley Cancer Institute/US Oncology Research, Eugene, OR
| | - Jennie Y Law
- The University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | - Owen A O'Connor
- TG Therapeutics, Inc, New York, NY.,Department of Medicine, University of Virginia Cancer Center, Charlottesville, VA
| | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli," Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
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3
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Herrera AF, Goy A, Mehta A, Ramchandren R, Pagel JM, Svoboda J, Guan S, Hill JS, Kwei K, Liu EA, Phillips T. Safety and activity of ibrutinib in combination with durvalumab in patients with relapsed or refractory follicular lymphoma or diffuse large B-cell lymphoma. Am J Hematol 2020; 95:18-27. [PMID: 31621094 PMCID: PMC6904508 DOI: 10.1002/ajh.25659] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/12/2019] [Accepted: 10/11/2019] [Indexed: 12/15/2022]
Abstract
This phase 1b/2, multicenter, open-label study evaluated ibrutinib plus durvalumab in relapsed/refractory follicular lymphoma (FL) or diffuse large B-cell lymphoma (DLBCL). Patients were treated with once-daily ibrutinib 560 mg plus durvalumab 10 mg/kg every 2 weeks in 28-day cycles in phase 1b without dose-limiting toxicities, confirming the phase 2 dosing. Sixty-one patients with FL (n = 27), germinal center B-cell (GCB) DLBCL (n = 16), non-GCB DLBCL (n = 16), and unspecified DLBCL (n = 2) were treated. Overall response rate (ORR) was 25% in all patients, 26% in patients with FL, 13% in patients with GCB DLBCL, and 38% in patients with non-GCB DLBCL. Overall, median progression-free survival was 4.6 months and median overall survival was 18.1 months; both were longer in patients with FL than in patients with DLBCL. The most frequent treatment-emergent adverse events (AEs) in patients with FL and DLBCL, respectively, were diarrhea (16 [59%]; 16 [47%]), fatigue (12 [44%]; 16 [47%]), nausea (9 [33%]; 12 [35%]), peripheral edema (7 [26%]; 13 [38%]), decreased appetite (8 [30%]; 11 [32%]), neutropenia (6 [22%]; 11 [32%]), and vomiting (5 [19%]; 12 [35%]). Investigator-defined immune-related AEs were reported in 12/61 (20%) patients. Correlative analyses were conducted but did not identify any conclusive biomarkers of response. In FL, GCB DLBCL, and non-GCB DLBCL, ibrutinib plus durvalumab demonstrated similar activity to single-agent ibrutinib with the added toxicity of the PD-L1 blockade; the combination resulted in a safety profile generally consistent with those known for each individual agent.
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Affiliation(s)
- Alex F. Herrera
- Department of Hematology/Hematopoietic Cell TransplantationCity of Hope National Medical Center Duarte California
| | - Andre Goy
- John Theurer Cancer Center Division of LymphomaHackensack University Medical Center Hackensack New Jersey
| | - Amitkumar Mehta
- Division of Hematology and OncologyUniversity of Alabama Birmingham Alabama
| | | | - John M. Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Division of OncologySwedish Cancer Institute Seattle Washington
| | - Jakub Svoboda
- Department of Medicine, Division of Hematology and OncologyUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Shanhong Guan
- Department of BiostatisticsPharmacyclics LLC, an AbbVie Company Sunnyvale California
| | - John S. Hill
- Department of Translational MedicinePharmacyclics LLC, an AbbVie Company Sunnyvale California
| | - Kevin Kwei
- Department of Translational MedicinePharmacyclics LLC, an AbbVie Company Sunnyvale California
| | - Emily A. Liu
- Department of Clinical SciencePharmacyclics LLC, an AbbVie Company Sunnyvale California
| | - Tycel Phillips
- Rogel Cancer Center, Division of Hematology and OncologyUniversity of Michigan Ann Arbor Michigan
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Enqvist M, Jacobs B, Junlén HR, Schaffer M, Melén CM, Friberg D, Wahlin BE, Malmberg KJ. Systemic and Intra-Nodal Activation of NK Cells After Rituximab Monotherapy for Follicular Lymphoma. Front Immunol 2019; 10:2085. [PMID: 31572357 PMCID: PMC6751265 DOI: 10.3389/fimmu.2019.02085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/19/2019] [Indexed: 01/22/2023] Open
Abstract
Monotherapy with the anti-CD20 monoclonal antibody rituximab can induce complete responses (CR) in patients with follicular lymphoma (FL). Resting FcRγIII+ (CD16+) natural killer (NK) cells respond strongly to rituximab-coated target cells in vitro. Yet, the contribution of NK cells in the therapeutic effect in vivo remains unknown. Here, we followed the NK cell repertoire dynamics in the lymph node and systemically during rituximab monotherapy in patients with FL. At baseline, NK cells in the tumor lymph node had a naïve phenotype albeit they were more differentiated than NK cells derived from control tonsils as determined by the frequency of CD56dim NK cells and the expression of killer cell immunoglobulin-like receptors (KIR), CD57 and CD16. Rituximab therapy induced a rapid drop in NK cell numbers coinciding with a relative increase in the frequency of Ki67+ NK cells both in the lymph node and peripheral blood. The Ki67+ NK cells had slightly increased expression of CD16, CD57 and higher levels of granzyme A and perforin. The in vivo activation of NK cells was paralleled by a temporary loss of in vitro functionality, primarily manifested as decreased IFNγ production in response to rituximab-coated targets. However, patients with pre-existing NKG2C+ adaptive NK cell subsets showed less Ki67 upregulation and were refractory to the loss of functionality. These data reveal variable imprints of rituximab monotherapy on the NK cell repertoire, which may depend on pre-existing repertoire diversity.
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Affiliation(s)
- Monika Enqvist
- Department of Medicine, Center for Infectious Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Benedikt Jacobs
- K.G. Jebsen Center for Cancer Immunotherapy, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Department of Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Henna R Junlén
- Division of Hematology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,Center for Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Schaffer
- Department of Medicine, Center for Infectious Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Christopher M Melén
- Center for Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oto-Rhino-Laryngology, Karolinska University Hospital and CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Danielle Friberg
- Department of Oto-Rhino-Laryngology, Karolinska University Hospital and CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Björn Engelbrekt Wahlin
- Division of Hematology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,Center for Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Karl-Johan Malmberg
- Department of Medicine, Center for Infectious Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,K.G. Jebsen Center for Cancer Immunotherapy, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Division of Hematology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.,Center for Hematology, Karolinska University Hospital, Stockholm, Sweden
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5
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Jurczak W, Gruszka AM, Sowa Staszczak A, Dlugosz-Danecka M, Szostek M, Zimowska-Curylo D, Giza A, Krawczyk K, Jakobczyk M, Hubalewska-Dydejczyk A, Szymczyk M, Wróbel T, Knopińska-Posłuszny W, Kisiel E, Skotnicki A, Zinzani PL. Consolidation with 90Y ibritumomab tiuxetan radioimmunotherapy in mantle cell lymphoma patients ineligible for high dose therapy: results of the phase II multicentre Polish Lymphoma Research Group trial, after 8-year long follow-up. Leuk Lymphoma 2019; 60:2689-2696. [PMID: 30961415 DOI: 10.1080/10428194.2019.1602261] [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
Polish Lymphoma Research Group performed a phase-II trial to test whether 90Y ibritumomab tiuxetan radioimmunotherapy (Y90) may constitute an alternative consolidation for mantle cell lymphoma patients unfit for high-dose therapy. Forty-six patients were consolidated with Y90 following response to the 1st (n = 34) or 2nd line (n = 12) (immuno)chemotherapy. Majority of the patients had advanced disease (stage IV and presence of B-symptoms in 85% and 70%, respectively) and high MIPI (5.8, range 4-7). Consolidation with Y90 increased the complete remission (CR) rate obtained by the 1st line therapy from 41% to 91% and allowed for median PFS of 3.3 and OS of 6.5 years. In the first relapse, CR rate increased from 16% to 75%, while median PFS and OS totaled 2.2 and 6.5 years, respectively. At 8 years, 30% of patients, consolidated in the 1st line CR were alive, without relapse. Toxicity associated with Y90 is manageable, more severe after fludarabine-based regimens.
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Affiliation(s)
- Wojciech Jurczak
- Department of Haematology, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Alicja M Gruszka
- Department of Experimental Oncology, Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Anna Sowa Staszczak
- Department of Endocrinology, Nuclear Medicine Unit, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Monika Dlugosz-Danecka
- Department of Haematology, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Marta Szostek
- Department of Haematology, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Dagmara Zimowska-Curylo
- Department of Haematology, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Agnieszka Giza
- Department of Haematology, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Katarzyna Krawczyk
- Department of Haematology, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Malgorzata Jakobczyk
- Department of Haematology, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Alicja Hubalewska-Dydejczyk
- Department of Endocrinology, Nuclear Medicine Unit, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Michal Szymczyk
- Department of Lymphoid Malignancies, Centrum Onkologii-Instytut im Marii Sklodowskiej-Curie w Warszawie, Warszawa, Poland
| | - Tomasz Wróbel
- Department of Haematology, Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, Wroclaw, Poland
| | - Wanda Knopińska-Posłuszny
- Department of Hematology, Independent Public Health Care of the Ministry of the Internal Affairs with the Oncology Centre, Olsztyn, Poland
| | | | - Aleksander Skotnicki
- Department of Haematology, Uniwersytet Jagiellonski w Krakowie Collegium Medicum, Krakow, Poland
| | - Pier Luigi Zinzani
- Policlinico "Sant'Orsola-Malpighi" - University of Bologna Institute of Hematology "Seràgnoli", Bologna, Italy
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Yuan T, Zhang F, Yao QM, Liu YX, Zhu XJ, Wang X. Weekly versus biweekly bortezomib given in patients with indolent non-Hodgkin lymphoma: A meta-analysis. PLoS One 2017; 12:e0177950. [PMID: 28531181 PMCID: PMC5439710 DOI: 10.1371/journal.pone.0177950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/05/2017] [Indexed: 01/11/2023] Open
Abstract
Background Bortezomib is recently studied as a novel agent in indolent lymphoma. The optimal schedule of bortezomib used in indolent lymphoma is still uncertain. Methods We did a systematic review and meta-analysis of the clinical trials comparing the efficacy and toxicity of the weekly and biweekly schedules of bortezomib in patients with indolent lymphoma. We searched Pubmed, Cochrane Library and Emabase from inception to July 29, 2016. The primary outcome was the overall response rate including the complete response rate and the partial response rate. The secondary outcomes were the proportions of patients in each group experiencing the adverse events including the neutropathy, fatigue, diarrhea, nausea and neutropenia. Findings After final screening, six trials were considered eligible for analysis. The results showed that the overall response rate of biweekly schedule was higher than that of weekly schedule in indolent lymphoma (OR 1.691;95%CI 1.02–2.80). Furthermore, there were no significant differences between the two schedules of bortezomib for the main adverse events. Interpretation The biweekly schedule of bortezomib was more effective than the weekly schedule in indolent lymphoma, with similar proportion of toxicities.
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Affiliation(s)
- Ting Yuan
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Feng Zhang
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Qing-min Yao
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Yan-xia Liu
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Xiao-juan Zhu
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
- * E-mail:
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Klinger M, Benjamin J, Kischel R, Stienen S, Zugmaier G. Harnessing T cells to fight cancer with BiTE® antibody constructs--past developments and future directions. Immunol Rev 2016; 270:193-208. [PMID: 26864113 DOI: 10.1111/imr.12393] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Bispecific T-cell engager (BiTE(®)) antibody constructs represent a novel immunotherapy that bridges cytotoxic T cells to tumor cells, thereby inducing target cell-dependent polyclonal T-cell activation and proliferation, and leading to apoptosis of bound tumor cells. Anti-CD19 BiTE(®) blinatumomab has demonstrated clinical activity in Philadelphia chromosome (Ph)-negative relapsed or refractory (r/r) acute lymphoblastic leukemia (ALL) eventually resulting in conditional approval by the U.S. Food and Drug Administration in 2014. This drug is currently further developed in pediatric and Ph(+) r/r, as well as in minimal residual disease-positive ALL, and might also offer clinical benefit for patients with non-Hodgkin's lymphoma, especially for those with aggressive forms like diffuse large B-cell lymphoma. Another BiTE(®) antibody construct in hemato-oncology designated AMG 330 targets CD33 on acute myeloid leukemia blast cells. After showing promising ex vivo activity, this drug candidate has recently entered phase 1 clinical development, and has further indicated potential for combination with checkpoint inhibitors. In solid tumor indications, three BiTE(®) antibody constructs have been tested in phase 1 studies so far: anti-EpCAM BiTE(®) AMG 110, anti-CEA BiTE(®) MEDI-565/AMG 211, and anti-PSMA BiTE(®) BAY2010112/AMG 212. Pertinent questions comprise how to maximize BiTE(®) penetration and T-cell infiltration of the tumor while simultaneously minimizing any adverse events, which is currently explored by a continuous intravenous infusion approach. Thus, BiTE(®) antibody constructs will hopefully provide new treatment options for patients in several indications with high unmet medical need.
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Abstract
INTRODUCTION B-cell Non-Hodgkin lymphomas (B-NHLs) include a number of disease subtypes, each defined by the tempo of disease progression and the identity of the cancerous cell. Idelalisib is a potent, selective inhibitor of the delta isoform of phosphatidylinositol-3-kinase (PI3K), a lipid kinase whose over-activity in B-NHL drives disease progression. Idelalisib has demonstrated activity in indolent B-NHL (iB-NHL) and is approved for use as monotherapy in patients with follicular lymphoma and small lymphocytic lymphoma and in combination with rituximab in patients with chronic lymphocytic leukemia. AREAS COVERED Herein we review the development and pharmacology of idelalisib, its safety and efficacy in clinical studies of iB-NHL, and its potential for inclusion in future applications in iB-NHL and in combination with other therapies. EXPERT OPINION Idelalisib adds to the growing arsenal of iB-NHL pharmacotherapeutics and to the progression of the field toward precision agents with good efficacy and reduced toxicities. Nevertheless, idelalisib carries important risks that require careful patient counseling and monitoring. The appropriate sequencing of idelalisib with other proven treatment options in addition to its potential for combination with established or novel drugs will be borne out in ongoing and planned investigations.
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Affiliation(s)
- Ajay Gopal
- University of Washington, Washington, United States
| | - Solomon Graf
- University of Washington, Washington, United States
- Fred Hutchinson Cancer Research Center, Seattle, United States
- Veterans Affairs Puget Sound Health Care System, Seattle, United States
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