1
|
Warner JL, Yang PC, Alterovitz G. Overcoming the Straw Man Effect in Oncology: Visualization and Ranking of Chemotherapy Regimens Using an Information Theoretic Approach. JCO Clin Cancer Inform 2017; 1:1-9. [PMID: 30657401 PMCID: PMC6874021 DOI: 10.1200/cci.17.00079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Despite the plethora of randomized controlled trial (RCT) data, most cancer treatment recommendations are formulated by experts. Alternatively, network meta-analysis (NMA) is one method of analyzing multiple indirect treatment comparisons. However, NMA does not account for mixed end points or temporality. Previously, we described a prototype information theoretical approach for the construction of ranked chemotherapy treatment regimen networks. Here, we propose modifications to overcome an apparent straw man effect, where the most studied regimens were the most negatively valued. METHODS RCTs from two scenarios-upfront treatment of chronic myelogenous leukemia and relapsed/refractory multiple myeloma-were assembled into ranked networks using an automated algorithm based on effect sizes, statistical significance, surrogacy of end points, and time since RCT publication. Vertex and edge color, transparency, and size were used to visually analyze the network. This analysis led to the additional incorporation of value propagation. RESULTS A total of 18 regimens with 42 connections (chronic myelogenous leukemia) and 28 regimens with 25 connections (relapsed/refractory multiple myeloma) were analyzed. An initial negative correlation between vertex value and size was ameliorated after value propagation, although not eliminated. Updated rankings were in close agreement with published guidelines and NMAs. CONCLUSION Straw man effects can distort the comparative efficacy of newer regimens at the expense of older regimens, which are often cheaper or less toxic. Using an automated method, we ameliorated this effect and produced rankings consistent with common practice and published guidelines in two distinct cancer settings. These findings are likely to be generalizable and suggest a new means of ranking efficacy in cancer trials.
Collapse
Affiliation(s)
- Jeremy L. Warner
- Jeremy L. Warner, Vanderbilt University, Nashville, TN; Peter C. Yang, Massachusetts General Hospital; and Gil Alterovitz, Harvard Medical School and Harvard-Massachusetts Institute of Technology Division of Health Science, Boston; and Massachusetts Institute of Technology, Cambridge, MA
| | - Peter C. Yang
- Jeremy L. Warner, Vanderbilt University, Nashville, TN; Peter C. Yang, Massachusetts General Hospital; and Gil Alterovitz, Harvard Medical School and Harvard-Massachusetts Institute of Technology Division of Health Science, Boston; and Massachusetts Institute of Technology, Cambridge, MA
| | - Gil Alterovitz
- Jeremy L. Warner, Vanderbilt University, Nashville, TN; Peter C. Yang, Massachusetts General Hospital; and Gil Alterovitz, Harvard Medical School and Harvard-Massachusetts Institute of Technology Division of Health Science, Boston; and Massachusetts Institute of Technology, Cambridge, MA
| |
Collapse
|
2
|
Banjar H, Adelson D, Brown F, Chaudhri N. Intelligent Techniques Using Molecular Data Analysis in Leukaemia: An Opportunity for Personalized Medicine Support System. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3587309. [PMID: 28812013 PMCID: PMC5547708 DOI: 10.1155/2017/3587309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/12/2017] [Accepted: 06/15/2017] [Indexed: 12/05/2022]
Abstract
The use of intelligent techniques in medicine has brought a ray of hope in terms of treating leukaemia patients. Personalized treatment uses patient's genetic profile to select a mode of treatment. This process makes use of molecular technology and machine learning, to determine the most suitable approach to treating a leukaemia patient. Until now, no reviews have been published from a computational perspective concerning the development of personalized medicine intelligent techniques for leukaemia patients using molecular data analysis. This review studies the published empirical research on personalized medicine in leukaemia and synthesizes findings across studies related to intelligence techniques in leukaemia, with specific attention to particular categories of these studies to help identify opportunities for further research into personalized medicine support systems in chronic myeloid leukaemia. A systematic search was carried out to identify studies using intelligence techniques in leukaemia and to categorize these studies based on leukaemia type and also the task, data source, and purpose of the studies. Most studies used molecular data analysis for personalized medicine, but future advancement for leukaemia patients requires molecular models that use advanced machine-learning methods to automate decision-making in treatment management to deliver supportive medical information to the patient in clinical practice.
Collapse
Affiliation(s)
- Haneen Banjar
- School of Computer Science, University of Adelaide, Adelaide, SA, Australia
- Department of Computer Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - David Adelson
- School of Molecular and Biomedical Science, University of Adelaide, Adelaide, SA, Australia
| | - Fred Brown
- School of Computer Science, University of Adelaide, Adelaide, SA, Australia
| | - Naeem Chaudhri
- Oncology Centre, Section of Hematology, HSCT, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Banjar H, Ranasinghe D, Brown F, Adelson D, Kroger T, Leclercq T, White D, Hughes T, Chaudhri N. Modelling Predictors of Molecular Response to Frontline Imatinib for Patients with Chronic Myeloid Leukaemia. PLoS One 2017; 12:e0168947. [PMID: 28045960 PMCID: PMC5207707 DOI: 10.1371/journal.pone.0168947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Treatment of patients with chronic myeloid leukaemia (CML) has become increasingly difficult in recent years due to the variety of treatment options available and challenge deciding on the most appropriate treatment strategy for an individual patient. To facilitate the treatment strategy decision, disease assessment should involve molecular response to initial treatment for an individual patient. Patients predicted not to achieve major molecular response (MMR) at 24 months to frontline imatinib may be better treated with alternative frontline therapies, such as nilotinib or dasatinib. The aims of this study were to i) understand the clinical prediction 'rules' for predicting MMR at 24 months for CML patients treated with imatinib using clinical, molecular, and cell count observations (predictive factors collected at diagnosis and categorised based on available knowledge) and ii) develop a predictive model for CML treatment management. This predictive model was developed, based on CML patients undergoing imatinib therapy enrolled in the TIDEL II clinical trial with an experimentally identified achieving MMR group and non-achieving MMR group, by addressing the challenge as a machine learning problem. The recommended model was validated externally using an independent data set from King Faisal Specialist Hospital and Research Centre, Saudi Arabia. PRINCIPLE FINDINGS The common prognostic scores yielded similar sensitivity performance in testing and validation datasets and are therefore good predictors of the positive group. The G-mean and F-score values in our models outperformed the common prognostic scores in testing and validation datasets and are therefore good predictors for both the positive and negative groups. Furthermore, a high PPV above 65% indicated that our models are appropriate for making decisions at diagnosis and pre-therapy. Study limitations include that prior knowledge may change based on varying expert opinions; hence, representing the category boundaries of each predictive factor could dramatically change performance of the models.
Collapse
Affiliation(s)
- Haneen Banjar
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
- The Department of Computer Science, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Damith Ranasinghe
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
- Auto-ID Lab, School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Fred Brown
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - David Adelson
- School of Molecular and Biomedical Science, The University of Adelaide, Adelaide, Australia
| | - Trent Kroger
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Tamara Leclercq
- Cancer Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide. South Australia, Australia
- University of Adelaide, Discipline of Medicine, Adelaide, South Australia, Australia
| | - Deborah White
- Cancer Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide. South Australia, Australia
- University of Adelaide, Discipline of Medicine, Adelaide, South Australia, Australia
- University of Adelaide, Discipline of Paediatrics, Adelaide, South Australia, Australia
- Centre for Cancer Biology, University of South Australia, Adelaide, South Australia, Australia
- Centre for Personalised Cancer Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy Hughes
- Cancer Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide. South Australia, Australia
- University of Adelaide, Discipline of Medicine, Adelaide, South Australia, Australia
- Centre for Cancer Biology, University of South Australia, Adelaide, South Australia, Australia
- Centre for Personalised Cancer Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Haematology Department, SA Pathology, Adelaide, South Australia, Australia
| | - Naeem Chaudhri
- King Faisal Specialist Hospital and Research Centre, Oncology Center, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Thiago F, Glauco V, Marla A. Possible involvement of tyrosine kinase inhibitors on the expression of CXCR4 in chronic myeloid leukemia. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.34.5] [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] Open
|
5
|
Inhibition of Aurora kinase B is important for biologic activity of the dual inhibitors of BCR-ABL and Aurora kinases R763/AS703569 and PHA-739358 in BCR-ABL transformed cells. PLoS One 2014; 9:e112318. [PMID: 25426931 PMCID: PMC4245092 DOI: 10.1371/journal.pone.0112318] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 10/06/2014] [Indexed: 12/21/2022] Open
Abstract
ABL tyrosine kinase inhibitors (TKI) like Imatinib, Dasatinib and Nilotinib are the gold standard in conventional treatment of CML. However, the emergence of resistance remains a major problem. Alternative therapeutic strategies of ABL TKI-resistant CML are urgently needed. We asked whether dual inhibition of BCR-ABL and Aurora kinases A-C could overcome resistance mediated by ABL kinase mutations. We therefore tested the dual ABL and Aurora kinase inhibitors PHA-739358 and R763/AS703569 in Ba/F3- cells ectopically expressing wild type (wt) or TKI-resistant BCR-ABL mutants. We show that both compounds exhibited strong anti-proliferative and pro-apoptotic activity in ABL TKI resistant cell lines including cells expressing the strongly resistant T315I mutation. Cell cycle analysis indicated polyploidisation, a consequence of continued cell cycle progression in the absence of cell division by Aurora kinase inhibition. Experiments using drug resistant variants of Aurora B indicated that PHA-739358 acts on both, BCR-ABL and Aurora Kinase B, whereas Aurora kinase B inhibition might be sufficient for the anti-proliferative activity observed with R763/AS703569. Taken together, our data demonstrate that dual ABL and Aurora kinase inhibition might be used to overcome ABL TKI resistant CML.
Collapse
|
6
|
Abstract
With the introduction of tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia, the course of the disease has been altered from an acute, rapidly progressive terminal disorder to a serious condition with high remission rates when patients are compliant with long-term treatment. The goal of therapy is to prevent transformation to the accelerated or blast crisis phases, which are associated with poor survival. Knowledge of the appropriate monitoring tests and treatment milestones, as well as the ability to interpret responses, allows advanced practitioners (APs) to effectively communicate key aspects of management to their patients. Monitoring patient responses to TKIs and identifying suboptimal responses early on offer APs the opportunity to reevaluate and adjust therapeutic treatment options. One of the causes of treatment failure is noncompliance; thus, educating patients on the importance of adhering to treatment and identifying reasons for noncompliance are of major importance. Because intolerance to TKIs may lead to discontinuation, frequent monitoring of side effects and response to treatment, open communication, patient education, and careful management are all essential in helping patients remain compliant with therapy. This review discusses the AP's role in helping patients achieve their best response to TKI therapy and optimize their long-term outcomes.
Collapse
|
7
|
Eyal E, Tohami T, Amir A, Cesarkas K, Jacob-Hirsch J, Volchek Y, Nagler A, Rechavi G, Amariglio N. Detection ofBCR-ABL1mutations in chronic myeloid leukaemia by massive parallel sequencing. Br J Haematol 2012; 160:477-86. [DOI: 10.1111/bjh.12171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 10/29/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Eran Eyal
- Cancer Research Centre; Chaim Sheba Medical Centre; Tel-Hashomer; Israel
| | - Tali Tohami
- Division of Haematology; Chaim Sheba Medical Centre; Tel-Hashomer; Israel
| | - Amnon Amir
- Cancer Research Centre; Chaim Sheba Medical Centre; Tel-Hashomer; Israel
| | - Karen Cesarkas
- Cancer Research Centre; Chaim Sheba Medical Centre; Tel-Hashomer; Israel
| | | | - Yuliya Volchek
- Division of Haematology; Chaim Sheba Medical Centre; Tel-Hashomer; Israel
| | | | | | - Ninette Amariglio
- Division of Haematology; Chaim Sheba Medical Centre; Tel-Hashomer; Israel
| |
Collapse
|
8
|
Katsumata R, Ishigaki S, Katsuno M, Kawai K, Sone J, Huang Z, Adachi H, Tanaka F, Urano F, Sobue G. c-Abl inhibition delays motor neuron degeneration in the G93A mouse, an animal model of amyotrophic lateral sclerosis. PLoS One 2012; 7:e46185. [PMID: 23049975 PMCID: PMC3458026 DOI: 10.1371/journal.pone.0046185] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 08/28/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive death of motor neurons. Although the pathogenesis of ALS remains unclear, several cellular processes are known to be involved, including apoptosis. A previous study revealed the apoptosis-related gene c-Abl to be upregulated in sporadic ALS motor neurons. METHODOLOGY/FINDINGS We investigated the possibility that c-Abl activation is involved in the progression of ALS and that c-Abl inhibition is potentially a therapeutic strategy for ALS. Using a mouse motor neuron cell line, we found that mutation of Cu/Zn-superoxide dismutase-1 (SOD1), which is one of the causative genes of familial ALS, induced the upregulation of c-Abl and decreased cell viability, and that the c-Abl inhibitor dasatinib inhibited cytotoxicity. Activation of c-Abl with a concomitant increase in activated caspase-3 was observed in the lumbar spine of G93A-SOD1 transgenic mice (G93A mice), a widely used model of ALS. The survival of G93A mice was improved by oral administration of dasatinib, which also decreased c-Abl phosphorylation, inactivated caspase-3, and improved the innervation status of neuromuscular junctions. In addition, c-Abl expression in postmortem spinal cord tissues from sporadic ALS patients was increased by 3-fold compared with non-ALS patients. CONCLUSIONS/SIGNIFICANCE The present results suggest that c-Abl is a potential therapeutic target for ALS and that the c-Abl inhibitor dasatinib has neuroprotective properties in vitro and in vivo.
Collapse
Affiliation(s)
- Ryu Katsumata
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Shinsuke Ishigaki
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
- Program in Gene Function and Expression, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Saitama, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Kaori Kawai
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Jun Sone
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Zhe Huang
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Hiroaki Adachi
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Fumiaki Tanaka
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Fumihiko Urano
- Program in Gene Function and Expression, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
- Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Saitama, Japan
| |
Collapse
|
9
|
Sancho P, Galeano E, Estañ MC, Gañán-Gómez I, Boyano-Adánez MDC, García-Pérez AI. Raf/MEK/ERK signaling inhibition enhances the ability of dequalinium to induce apoptosis in the human leukemic cell line K562. Exp Biol Med (Maywood) 2012; 237:933-42. [DOI: 10.1258/ebm.2012.011423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Delocalized lipophilic cations, such as dequalinium (DQA), selectively accumulate in mitochondria and display anticancer activity in cells from different malignancies. Previous studies in K562 human leukemic cells indicate that DQA causes cell damage as a consequence of an early disturbance in the mitochondrial function, inducing oxidative stress. These cells turned out to be resistant to apoptosis and died by necrosis when treated with high DQA concentrations (20 μmol/L) for long time periods (48 h). Resistance of K562 cells to DQA-induced apoptosis could be eliminated by inhibition of the kinase activity of the Bcr-Abl protein with imatinib. In this paper, we have studied the effect of DQA on the Raf/MEK/ERK1/2 and PI3K/Akt signal transduction pathways in K562 cells. Our data suggest a DQA downregulatory activity on both ERK1/2 and PI3K protein kinase activity supporting an interaction between both proteins. Moreover, inhibition of ERK1/2 with U0126 enhanced the ability of DQA to potentiate imatinib-induced apoptosis, suggesting a role of the Raf/MEK/ERK pathway and the Bcr-Abl tyrosine kinase in the K562 cell survival. This study contributes to a better understanding of the action mechanism of DQA on K562 cells and encourages the study of DQA in combination with other agents for improving the efficacy of targeted therapies and overcoming resistance to chemotherapeutic agents.
Collapse
Affiliation(s)
- Pilar Sancho
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Campus Universitario, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid
| | - Eva Galeano
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Campus Universitario, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid
- Centro de Investigación Médica Aplicada, Universidad de Navarra, Avda. Pío XII 55, 31008 Pamplona
| | - María Cristina Estañ
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Campus Universitario, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Irene Gañán-Gómez
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Campus Universitario, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid
| | - María del Carmen Boyano-Adánez
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Campus Universitario, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid
| | - Ana Isabel García-Pérez
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Campus Universitario, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid
| |
Collapse
|
10
|
|
11
|
Spunt SL, Vargas SO, Coffin CM, Skapek SX, Parham DM, Darling J, Hawkins DS, Keller C. The clinical, research, and social value of autopsy after any cancer death: a perspective from the Children's Oncology Group Soft Tissue Sarcoma Committee. Cancer 2011; 118:3002-9. [PMID: 22006470 DOI: 10.1002/cncr.26620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/21/2011] [Accepted: 09/13/2011] [Indexed: 01/04/2023]
Affiliation(s)
- Sheri L Spunt
- Department of Oncology, St Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, Tennessee 38105-3678, USA.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Martín-Palanco V, Martínez F, Arqueros V, Torres A, Román-Gómez J. Long-term durability of molecular and chimerism responses in patients treated with imatinib for chronic myeloid leukemia relapse after allogeneic transplantation. Eur J Haematol 2011; 87:182-5. [PMID: 21762210 DOI: 10.1111/j.1600-0609.2011.01628.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Bengió RM, Riva ME, Moiraghi B, Lanari E, Milone J, Ventriglia V, Bullorsky E, Tezanos pinto MD, Murro H, Bianchini M, Larripa I. Clinical outcome of chronic myeloid leukemia imatinib-resistant patients: do BCR–ABL kinase domain mutations affect patient survival? First multicenter Argentinean study. Leuk Lymphoma 2011; 52:1720-6. [DOI: 10.3109/10428194.2011.578310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Donato NJ, Peterson LF. Chronic myeloid leukemia stem cells and developing therapies. Leuk Lymphoma 2011; 52 Suppl 1:60-80. [PMID: 21299460 DOI: 10.3109/10428194.2010.546921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Chronic myeloid leukemia therapy has remarkably improved with the use of frontline BCR-ABL kinase inhibitors such that newly diagnosed patients have minimal disease manifestations or progression. Effective control of disease may also set the stage for eventual 'cure' of this leukemia. However, the existence of Philadelphia chromosome-positive leukemic cells that are unaffected by BCR-ABL inhibition represents a major barrier that may delay or prevent curative therapy with the current approaches. The most commonly reported mechanism of resistance to tyrosine kinase inhibitor-based therapies involves BCR-ABL gene mutations and amplification, but these changes may not be solely responsible for disease relapse when inhibitor-based therapies are curtailed. Therefore new targets may need to be defined before significant advancement in curative therapies is possible. Emerging evidence suggests that persistence of chronic myeloid leukemia stem cells or acquisition of stem cell-like characteristics prevents complete elimination of chronic myeloid leukemia by tyrosine kinase inhibition alone. This review focuses on several recently emerging concepts regarding the existence and characteristics of chronic myeloid leukemia stem cells. Definitions based on human primary cells and animal model studies are highlighted as are the potential signaling pathways associated with disease repopulating cells. Finally, several recently defined therapeutic targets and active compounds that have emerged from stem cell studies are described. Our goal is to provide an unbiased report on the current state of discovery within the chronic myeloid leukemia stem cell field and to orient the reader to emerging therapeutic targets and strategies that may lead to elimination of this leukemia.
Collapse
Affiliation(s)
- Nicholas J Donato
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109, USA.
| | | |
Collapse
|
15
|
Brózik A, Hegedüs C, Erdei Z, Hegedus T, Özvegy-Laczka C, Szakács G, Sarkadi B. Tyrosine kinase inhibitors as modulators of ATP binding cassette multidrug transporters: substrates, chemosensitizers or inducers of acquired multidrug resistance? Expert Opin Drug Metab Toxicol 2011; 7:623-42. [PMID: 21410427 DOI: 10.1517/17425255.2011.562892] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Anticancer tyrosine kinase inhibitors (TKIs) are small molecule hydrophobic compounds designed to arrest aberrant signaling pathways in malignant cells. Multidrug resistance (MDR) ATP binding cassette (ABC) transporters have recently been recognized as important determinants of the general ADME-Tox (absorption, distribution, metabolism, excretion, toxicity) properties of small molecule TKIs, as well as key factors of resistance against targeted anticancer therapeutics. AREAS COVERED The article summarizes MDR-related ABC transporter interactions with imatinib, nilotinib, dasatinib, gefitinib, erlotinib, lapatinib, sunitinib and sorafenib, including in vitro and in vivo observations. An array of methods developed to study such interactions is presented. Transporter-TKI interactions relevant to the ADME-Tox properties of TKI drugs, primary or acquired cancer TKI resistance, and drug-drug interactions are also reviewed. EXPERT OPINION Based on the concept presented in this review, TKI anticancer drugs are considered as compounds recognized by the cellular mechanisms handling xenobiotics. Accordingly, novel anticancer therapies should equally focus on the effectiveness of target inhibition and exploration of potential interactions of the designed molecules by membrane transporters. Thus, targeted hydrophobic small molecule compounds should also be screened to evade xenobiotic-sensing cellular mechanisms.
Collapse
Affiliation(s)
- Anna Brózik
- Hungarian Academy of Sciences and Semmelweis University, Membrane Biology, Budapest, Hungary
| | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
IFNα has been used to treat malignant and viral disorders for more than 25 years. Its efficacy is likely the consequence of its broad range of biologic activities, including direct effects on malignant cells, enhancement of anti-tumor immune responses, induction of proapoptotic genes, inhibition of angiogenesis, and promotion of the cycling of dormant malignant stem cells. Because of the recent development of "targeted" therapies, the use of IFN has been dramatically reduced over the last decade. The increasing awareness of the multistep pathogenesis of many malignancies has suggested, however, that such an approach using target-specific agents is not universally effective. These observations have resulted in a number of recent clinical trials utilizing IFNα in patients with chronic myeloid leukemia (CML), systemic mast cell disease, hypereosinophilic syndrome and the Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) with promising outcomes. These reports provide evidence that IFNα, alone or in combination with other agents, can induce surprisingly robust molecular response rates and possibly improve survival. Although IFNα at present remains an experimental form of therapy for patients with myeloid malignancies, these promising results suggest that it may become again an important component of the therapeutic arsenal for this group of hematologic malignancies.
Collapse
|
17
|
Wang BX, Rahbar R, Fish EN. Interferon: current status and future prospects in cancer therapy. J Interferon Cytokine Res 2011; 31:545-52. [PMID: 21323567 DOI: 10.1089/jir.2010.0158] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Type I interferons (IFNs) exhibit antiproliferative activity and apoptotic effects, and regulate an immune response by activating multiple cells types, including dendritic cells, cytotoxic T cells, and natural killer cells. Most recently, a report in the literature identified dysfunctional induction of a type I IFN response in cancer stem cells--specifically, breast cancer-initiating cells, implicating this defect in progression to breast cancer. Indeed, accumulating evidence suggests that cancer stem cells/cancer-initiating cells are prevalent in leukemias and solid tumors, are resistant to chemotherapy and radiation therapy, and therefore likely contribute to tumor recurrence. IFN-β treatment of human glioma xenografts leads to disruption of the vascular niche of glioma stem cells, in further support of a potential therapeutic effect of IFN treatment in limiting cancer stem cells. The implications are that restoring an IFN response, or enhancing an IFN response, may invoke a reduction, or elimination of both cancer stem cells and tumor cells. In this review, the clinical application of type I IFNs, mainly IFN-αs, will be reviewed.
Collapse
Affiliation(s)
- Ben X Wang
- Department of Immunology, University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
18
|
Wu YL, Zhou HC, Chen GQ. Molecular mechanisms of leukemia-associated protein degradation. ACTA ACUST UNITED AC 2010; 4:363-70. [PMID: 21104160 DOI: 10.1007/s11684-010-0210-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/12/2010] [Indexed: 11/25/2022]
Abstract
Chemical biology, using small molecules as probes to study the cellular signaling network, has developed rapidly in recent years. The interaction between chemistry and biology not only provides new insight into the understanding of cellular activities, but also generates new lead compounds for the treatment of diseases. Transcription factors and kinases such as retinoic acid receptor-alpha (RARα), acute myeloid leukemia 1 (AML1), CAAT/enhancer-binding protein α (C/EBPα), c-myc, and c-abl play important roles in the differentiation of hematopoietic stem/progenitor cells. Abnormalities in these proteins may cause the dysregulation of hematopoiesis and even the occurrence of leukemia. Ubiquitin-mediated protein degradation represents a critical mechanism in regulating the cellular levels and functions of these proteins. Thus, targeting protein degradation has been emerging as an important strategy to conquer malignant diseases. In this review, we will summarize the recent advances in the understanding of the roles of protein degradation in leukemia, with an emphasis on the mechanisms revealed by small molecules.
Collapse
MESH Headings
- CCAAT-Enhancer-Binding Protein-alpha/genetics
- CCAAT-Enhancer-Binding Protein-alpha/metabolism
- Core Binding Factor Alpha 2 Subunit/genetics
- Core Binding Factor Alpha 2 Subunit/metabolism
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression Regulation, Leukemic
- Humans
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/metabolism
- Leukemia, Myeloid/physiopathology
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Protein Kinases/genetics
- Protein Kinases/metabolism
- Proto-Oncogene Proteins c-myc/genetics
- Proto-Oncogene Proteins c-myc/metabolism
- RUNX1 Translocation Partner 1 Protein
- Receptors, Retinoic Acid/genetics
- Receptors, Retinoic Acid/metabolism
- Retinoic Acid Receptor alpha
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Ubiquitin/genetics
- Ubiquitin/metabolism
Collapse
Affiliation(s)
- Ying-Li Wu
- Department of Pathophysiology and Chemical Biology Division of Shanghai Universities E-Institutes, Key laboratory of Cell Differentiation and Apoptosis of the Ministry of Education of China, Shanghai JiaoTong University School of Medicine, Shanghai, 200025, China
| | | | | |
Collapse
|
19
|
Stankov K, Bogdanović G, Popović S. [Tyrosine kinases in etiopathogenesis and therapy of malignant diseases--C-kit activating mutations]. MEDICINSKI PREGLED 2010; 63:380-386. [PMID: 21186551 DOI: 10.2298/mpns1006380s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In the last 15 years, the introduction of molecular biology methods and techniques for identifying mutations and measuring gene expression levels of mutated genes since recently, have enabled precise molecular diagnostics, classification and assessment of prognosis and therapeutic response of malignant disease to specific therapies. The increased knowledge of the cancer genome and the introduction of multiple new technologies in cancer research have significantly improved the drug discovery process, leading to key success in targeted cancer therapeutics, including tyrosine kinase inhibitors. Tyrosine kinase inhibitors are the molecular targeted neoadjuvant and adjuvant therapy of various malignancies. Many more results which are expected from ongoing trials are necessary to specify the appropriate dosages, stages at which to start the treatment, and which therapeutic combinations to apply.
Collapse
|