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Richardson PG, Nagler A, Ben‐Yehuda D, Badros A, Hari PN, Hajek R, Spicka I, Kaya H, LeBlanc R, Yoon S, Kim K, Martinez‐Lopez J, Mittelman M, Shpilberg O, Blake P, Hideshima T, Colson K, Laubach JP, Ghobrial IM, Leiba M, Gatt ME, Sportelli P, Chen M, Anderson KC. Randomized, placebo‐controlled, phase 3 study of perifosine combined with bortezomib and dexamethasone in patients with relapsed, refractory multiple myeloma previously treated with bortezomib. EJHAEM 2020; 1:94-102. [PMID: 35847734 PMCID: PMC9175725 DOI: 10.1002/jha2.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022]
Abstract
Perifosine, an investigational, oral, synthetic alkylphospholipid, inhibits signal transduction pathways of relevance in multiple myeloma (MM) including PI3K/Akt. Perifosine demonstrated anti‐MM activity in preclinical studies and encouraging early‐phase clinical activity in combination with bortezomib. A randomized, double‐blind, placebo‐controlled phase 3 study was conducted to evaluate addition of perifosine to bortezomib‐dexamethasone in MM patients with one to four prior therapies who had relapsed following previous bortezomib‐based therapy. The primary endpoint was progression‐free survival (PFS). The study was discontinued at planned interim analysis, with 135 patients enrolled. Median PFS was 22.7 weeks (95% confidence interval 16·0–45·4) in the perifosine arm and 39.0 weeks (18.3–50.1) in the placebo arm (hazard ratio 1.269 [0.817–1.969]; P = .287); overall response rates were 20% and 27%, respectively. Conversely, median overall survival (OS) was 141.9 weeks and 83.3 weeks (hazard ratio 0.734 [0.380–1.419]; P = .356). Overall, 61% and 55% of patients in the perifosine and placebo arms reported grade 3/4 adverse events, including thrombocytopenia (26% vs 14%), anemia (7% vs 8%), hyponatremia (6% vs 8%), and pneumonia (9% vs 3%). These findings demonstrate no PFS benefit from the addition of perifosine to bortezomib‐dexamethasone in this study of relapsed/refractory MM, but comparable safety and OS.
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Affiliation(s)
- Paul G. Richardson
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | | | | | - Ashraf Badros
- Greenebaum Comprehensive Cancer Center University of Maryland Baltimore Maryland USA
| | - Parameswaran N. Hari
- Department of Hematology/Oncology Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Roman Hajek
- Department of Hematooncology University Hospital, Ostrava, and Faculty of Medicine University of Ostrava Ostrava Czech Republic
| | - Ivan Spicka
- First Department of Medicine, Department of Hematology First Faculty of Medicine Charles University and General Hospital in Prague Prague Czech Republic
| | - Hakan Kaya
- Cancer Care Northwest Spokane Washington USA
| | - Richard LeBlanc
- CIUSSS de l'est de l’île de Montréal University of Montreal Montreal Canada
| | - Sung‐Soo Yoon
- Department of Internal Medicine Seoul National University College of Medicine Seoul South Korea
| | - Kihyun Kim
- Sungkyunkwan University School of Medicine Samsung Medical Center Seoul South Korea
| | | | | | - Ofer Shpilberg
- Institute of Hematology Assuta Medical Centers Tel Aviv and Ariel University Ariel Israel
| | | | - Teru Hideshima
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Kathleen Colson
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Jacob P. Laubach
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Irene M. Ghobrial
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Merav Leiba
- Assuta Ashdod University Hospital Faculty of Health Sciences Ben‐Gurion University of the Negev Beer‐Sheba Israel
| | | | | | | | - Kenneth C. Anderson
- Jerome Lipper Center for Multiple Myeloma Research Dana‐Farber Cancer Institute Boston Massachusetts USA
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Preclinical efficacy of a novel dual PI3K/mTOR inhibitor, CMG002, alone and in combination with sorafenib in hepatocellular carcinoma. Cancer Chemother Pharmacol 2019; 84:809-817. [PMID: 31385002 DOI: 10.1007/s00280-019-03918-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/29/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Sorafenib has been the only first systemic drug that improves survival of patients with advanced hepatocellular carcinoma (HCC). However, because the response rate of sorafenib is relatively low, novel therapeutic strategies are needed to improve survival in patients with HCC. This study investigated the effect of CMG002 alone and in combination with sorafenib on HCC in vitro and vivo. METHODS The effect of a newly developed dual PI3K/mTOR inhibitor, CMG002, on the proliferation of Huh-7 and HepG2 HCC cells was investigated using the MTT assay. Western blotting was performed to assess phosphorylation of the key enzymes in the Ras/Raf/MAPK and PI3K/AKT/mTOR pathways. HepG2 cells were inoculated into mice, which were treated with vehicle, sorafenib, CMG002, and their combinations. Tumor cell proliferation and tumor angiogenesis were evaluated by immunohistochemical analysis of Ki-67 and CD31, respectively. Tumor cell apoptosis was detected by the terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Levels of key enzymes in the Ras/Raf/MAPK and PI3K/AKT/mTOR pathways were evaluated by western blot analysis. RESULTS The combination of sorafenib and CMG002 additively inhibited Huh-7 and HepG2 cell proliferation compared to single-agent treatment. Sorafenib and CMG002 as single agents differentially inhibited or activated key enzymes in the Ras/Raf/MAPK and PI3K/AKT/mTOR pathways. The combination of sorafenib and CMG002 inhibited all key enzymes in the two pathways. Treatment with CMG002 for 4 weeks alone and in combination with sorafenib strongly inhibited tumor growth. CMG002 inhibited HCC cell proliferation, induced apoptosis, and decreased tumor angiogenesis. Furthermore, these effects were enhanced when CMG002 was combined with sorafenib. CONCLUSIONS The combination of CMG002 and sorafenib significantly inhibited HCC cell proliferation and tumorigenesis by inhibiting the Ras/Raf/MAPK and PI3K/AKT/mTOR pathways. These findings suggest that CMG002 to be a potential novel candidate treatment for HCC.
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Llewellyn KJ, Nalbandian A, Weiss LN, Chang I, Yu H, Khatib B, Tan B, Scarfone V, Kimonis VE. Myogenic differentiation of VCP disease-induced pluripotent stem cells: A novel platform for drug discovery. PLoS One 2017; 12:e0176919. [PMID: 28575052 PMCID: PMC5456028 DOI: 10.1371/journal.pone.0176919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 04/19/2017] [Indexed: 02/07/2023] Open
Abstract
Valosin Containing Protein (VCP) disease is an autosomal dominant multisystem proteinopathy caused by mutations in the VCP gene, and is primarily associated with progressive muscle weakness, including atrophy of the pelvic and shoulder girdle muscles. Currently, no treatments are available and cardiac and respiratory failures can lead to mortality at an early age. VCP is an AAA ATPase multifunction complex protein and mutations in the VCP gene resulting in disrupted autophagic clearance. Due to the rarity of the disease, the myopathic nature of the disorder, ethical and practical considerations, VCP disease muscle biopsies are difficult to obtain. Thus, disease-specific human induced pluripotent stem cells (hiPSCs) now provide a valuable resource for the research owing to their renewable and pluripotent nature. In the present study, we report the differentiation and characterization of a VCP disease-specific hiPSCs into precursors expressing myogenic markers including desmin, myogenic factor 5 (MYF5), myosin and heavy chain 2 (MYH2). VCP disease phenotype is characterized by high expression of TAR DNA Binding Protein-43 (TDP-43), ubiquitin (Ub), Light Chain 3-I/II protein (LC3-I/II), and p62/SQSTM1 (p62) protein indicating disruption of the autophagy cascade. Treatment of hiPSC precursors with autophagy stimulators Rapamycin, Perifosine, or AT101 showed reduction in VCP pathology markers TDP-43, LC3-I/II and p62/SQSTM1. Conversely, autophagy inhibitors chloroquine had no beneficial effect, and Spautin-1 or MHY1485 had modest effects. Our results illustrate that hiPSC technology provide a useful platform for a rapid drug discovery and hence constitutes a bridge between clinical and bench research in VCP and related diseases.
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Affiliation(s)
- Katrina J. Llewellyn
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine School of Medicine, Irvine, California, United States of America
- Sue and Bill Gross Stem Cell Research Center, University of California-Irvine School of Medicine, Irvine, California, United States of America
| | - Angèle Nalbandian
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine School of Medicine, Irvine, California, United States of America
- Sue and Bill Gross Stem Cell Research Center, University of California-Irvine School of Medicine, Irvine, California, United States of America
| | - Lan N. Weiss
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine School of Medicine, Irvine, California, United States of America
- Sue and Bill Gross Stem Cell Research Center, University of California-Irvine School of Medicine, Irvine, California, United States of America
| | - Isabela Chang
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine School of Medicine, Irvine, California, United States of America
| | - Howard Yu
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine School of Medicine, Irvine, California, United States of America
| | - Bibo Khatib
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine School of Medicine, Irvine, California, United States of America
- Sue and Bill Gross Stem Cell Research Center, University of California-Irvine School of Medicine, Irvine, California, United States of America
| | - Baichang Tan
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine School of Medicine, Irvine, California, United States of America
| | - Vanessa Scarfone
- Sue and Bill Gross Stem Cell Research Center, University of California-Irvine School of Medicine, Irvine, California, United States of America
| | - Virginia E. Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California-Irvine School of Medicine, Irvine, California, United States of America
- Sue and Bill Gross Stem Cell Research Center, University of California-Irvine School of Medicine, Irvine, California, United States of America
- * E-mail:
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