1
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Waldschmidt JM, Fruttiger SJ, Wider D, Jung J, Thomsen AR, Hartmann TN, Duyster J, Hug MJ, Azab KA, Jung M, Wäsch R, Engelhardt M. Ex vivo propagation in a novel 3D high-throughput co-culture system for multiple myeloma. J Cancer Res Clin Oncol 2022; 148:1045-1055. [PMID: 35072775 PMCID: PMC9016043 DOI: 10.1007/s00432-021-03854-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/04/2021] [Indexed: 12/28/2022]
Abstract
Purpose Multiple myeloma (MM) remains an incurable hematologic malignancy which ultimately develops drug resistance and evades treatment. Despite substantial therapeutic advances over the past years, the clinical failure rate of preclinically promising anti-MM drugs remains substantial. More realistic in vitro models are thus required to better predict clinical efficacy of a preclinically active compound. Methods Here, we report on the establishment of a conical agarose 3D co-culture platform for the preclinical propagation of primary MM cells ex vivo. Cell growth was compared to yet established 2D and liquid overlay systems. MM cell lines (MMCL: RPMI-8226, U266, OPM-2) and primary patient specimens were tested. Drug sensitivity was examined by exploring the cytotoxic effect of bortezomib and the deubiquitinase inhibitor auranofin under various conditions. Results In contrast to 2D and liquid overlay, cell proliferation in the 3D array followed a sigmoidal curve characterized by an initial growth delay but more durable proliferation of MMCL over 12 days of culture. Primary MM specimens did not expand in ex vivo monoculture, but required co-culture support by a human stromal cell line (HS-5, MSP-1). HS-5 induced a > fivefold increase in cluster volume and maintained long-term viability of primary MM cells for up to 21 days. Bortezomib and auranofin induced less cytotoxicity under 3D vs. 2D condition and in co- vs. monoculture, respectively. Conclusions This study introduces a novel model that is capable of long-term propagation and drug testing of primary MM specimens ex vivo overcoming some of the pitfalls of currently available in vitro models. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03854-6.
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Affiliation(s)
- Johannes M Waldschmidt
- Department of Internal Medicine I, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetterstr. 53, 79106, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg University Medical Center, Freiburg, Germany
| | - Stefan J Fruttiger
- Department of Internal Medicine I, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetterstr. 53, 79106, Freiburg, Germany
- Pharmacy, Freiburg University Medical Center, Freiburg, Germany
| | - Dagmar Wider
- Department of Internal Medicine I, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetterstr. 53, 79106, Freiburg, Germany
| | - Johannes Jung
- Department of Internal Medicine I, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetterstr. 53, 79106, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg University Medical Center, Freiburg, Germany
| | - Andreas R Thomsen
- Department of Radiation Oncology, Freiburg University Medical Center, Freiburg, Germany
| | - Tanja N Hartmann
- Department of Internal Medicine I, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetterstr. 53, 79106, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg University Medical Center, Freiburg, Germany
| | - Justus Duyster
- Department of Internal Medicine I, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetterstr. 53, 79106, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg University Medical Center, Freiburg, Germany
| | - Martin J Hug
- Pharmacy, Freiburg University Medical Center, Freiburg, Germany
| | - Kareem A Azab
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Manfred Jung
- Institute of Pharmaceutical Sciences, University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Internal Medicine I, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetterstr. 53, 79106, Freiburg, Germany
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg University Medical Center, Freiburg, Germany
| | - Monika Engelhardt
- Department of Internal Medicine I, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetterstr. 53, 79106, Freiburg, Germany.
- Comprehensive Cancer Center Freiburg (CCCF), Freiburg University Medical Center, Freiburg, Germany.
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2
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Abstract
Multiple myeloma (MM) is an incurable malignancy of plasma cells with a clinical course characterized by multiple relapses and treatment refractoriness. While recent treatment advancements have extended overall survival (OS), refractory MM has a poor prognosis, with a median OS of between 4 and 6 months. Nuclear export inhibition, specifically inhibition of CRM1/XPO1, is an emerging novel treatment modality that has shown promise in treatment-refractory MM. Initially discovered in yeast in 1983, early clinical applications were met with significant toxicities that limited their utility. The creation of small molecule inhibitors of nuclear export (SINE) has improved on toxicity limitations and has led to investigation in a number of malignancies at the preclinical and clinical stages. Preclinical studies of SINEs in MM have shown that these molecules are cytotoxic to myeloma cells, play a role in therapy resensitization, and suggest a role in limiting bone disease progression. In July 2019, selinexor became the first nuclear export inhibitor approved for use in relapsed/refractory MM based on the STORM trial. As of May 2020, there were eight ongoing trials combining selinexor with standard treatment regimens in relapsed/refractory MM. Eltanexor, a second-generation SINE, is also under investigation and has shown preliminary signs of efficacy in an early clinical trial while potentially having an improved toxicity profile compared with selinexor. Results in ongoing trials will help further define the role of SINEs in MM.
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Affiliation(s)
| | - Guido Lancman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1185, New York, NY, 10029, USA
| | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1185, New York, NY, 10029, USA.
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3
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Malek E, Saygin C, Ye R, Covut F, Kim BG, Welge J, Meropol NJ, De Lima M, Driscoll JJ. Predicting Successful Phase Advancement and Regulatory Approval in Multiple Myeloma From Phase I Overall Response Rates. JCO Clin Cancer Inform 2017; 1:1-14. [PMID: 30657399 PMCID: PMC9797233 DOI: 10.1200/cci.17.00055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Drug development in oncology is resource intensive, time consuming, and frequently unsuccessful. Here, we hypothesized that therapeutic benefit of published phase I studies of antimyeloma investigational agents was associated with advancement to phase II and future regulatory approval. PATIENTS AND METHODS Seventy four phase I trials that treated patients with multiple myeloma (n = 2,408) conducted from 2004 to 2015 were analyzed to assess drug safety, efficacy, phase advancement, and regulatory approval. RESULTS The median overall response rate (ORR) for all single-agent trials evaluated was 13.2%. However, the ORR in trials that advanced to phase II was 19%, whereas it was only 4% in trials that failed to advance. The median ORR was 23% for trials testing agents that were ultimately approved by the US Food and Drug Administration compared with only 8% for trials testing agents that were not approved (hazard ratio, 2.21; 95% CI, 2.01 to 2.61; P = .012). Importantly, the absolute number of phase I trials in multiple myeloma, but not the success rate, significantly increased over the period studied. The proportion of industry-sponsored trials also steadily increased over that same period. The ratio of initial dose to maximum tolerated dose was 0.29, suggesting that many patients were undertreated. CONCLUSION Investigational agents with higher ORRs in phase I trials were more likely to advance to phase II trials and achieve US Food and Drug Administration approval. Our results suggest that designing phase I trials to maximize the antimyeloma efficacy of a given compound may lead to more successful and cost-effective drug development.
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Affiliation(s)
- Ehsan Malek
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH.,Corresponding author: Ehsan Malek, MD, University
Hospitals Seidman Cancer Center and Case Western Reserve University, 11100
Euclid Ave, Cleveland, OH 44106; e-mail:
| | - Caner Saygin
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rebecca Ye
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Fahrettin Covut
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Byung-Gyu Kim
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jeffrey Welge
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Neal J. Meropol
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Marcos De Lima
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH
| | - James J. Driscoll
- Ehsan Malek, Fahrettin Covut, Neal J.
Meropol, and Marcos De Lima, University Hospitals
Seidman Cancer Center; Ehsan Malek, Byung-Gyu Kim, Fahrettin
Covut, Neal J. Meropol, and Marcos De Lima,
Case Western Reserve University Case Comprehensive Cancer Center; Caner
Saygin, Taussig Cancer Institute; Rebecca Ye, Case
Western Reserve University, Cleveland; Jeffrey Welge, University of
Cincinnati; and James J. Driscoll, The Vontz Center for Molecular
Studies, University of Cincinnati College of Medicine, Cincinnati, OH
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4
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Ríos-Tamayo R, Martín-García A, Alarcón-Payer C, Sánchez-Rodríguez D, de la Guardia AMDVD, García Collado CG, Jiménez Morales A, Jurado Chacón M, Cabeza Barrera J. Pomalidomide in the treatment of multiple myeloma: design, development and place in therapy. Drug Des Devel Ther 2017; 11:2399-2408. [PMID: 28860711 PMCID: PMC5574598 DOI: 10.2147/dddt.s115456] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Multiple myeloma is a very heterogeneous disease with variable survival. Despite recent progress and the widespread use of new agents, patients with relapsed and refractory disease have a poor outcome. Immunomodulatory drugs play a key role in both the front-line and the relapsed/refractory setting. The combination of pomalidomide (POM) and dexamethasone is safe and effective in relapsed and refractory patients, even in those with high-risk cytogenetic features. Furthermore, it can be used in most patients without the need to adjust according to the degree of renal failure. In order to further improve the results, POM-based triplet therapies are currently used. This article highlights the most relevant issues of POM and POM-based combinations in the relapsed/refractory multiple myeloma setting, from a pharmacological and clinical point of view.
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Affiliation(s)
- Rafael Ríos-Tamayo
- Monoclonal Gammopathies Unit
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Agustín Martín-García
- Department of Pharmacy
- Clinical Trials Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | | | | | - Manuel Jurado Chacón
- Monoclonal Gammopathies Unit
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - José Cabeza Barrera
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Department of Pharmacy
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5
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Jian Y, Gao W, Geng C, Zhou H, Leng Y, Li Y, Chen W. Arsenic trioxide potentiates sensitivity of multiple myeloma cells to lenalidomide by upregulating cereblon expression levels. Oncol Lett 2017; 14:3243-3248. [PMID: 28927072 DOI: 10.3892/ol.2017.6502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/11/2017] [Indexed: 11/05/2022] Open
Abstract
The mechanism of the anti-myeloma effect of the immunomodulatory drug lenalidomide relies upon the binding of lenalidomide or an analogue to cereblon (CRBN) ubiquitin ligase, which inhibits it and results in the degradation of Ikaros-family zinc finger proteins 1 and 3 (IKZF1 and IKZF3). To determine whether the traditional Chinese medicine arsenic trioxide, could potentiate sensitivity of multiple myeloma (MM) cells to lenalidomide and identify the mechanism by which this happens, the present study investigated how arsenic trioxide affected CRBN on MM cell lines and examined the anti-myeloma effect and mechanism in the combination of arsenic trioxide and lenalidomide. The present study revealed that arsenic trioxide upregulates the transcription and protein levels of CRBN, the anti-myeloma target of lenalidomide, thus potentiating the sensitivity of multiple myeloma cells to lenalidomide and enhancing the lenalidomide-dependent degradation of IKZF1 and IKZF3. The results of the present study indicate that clinical trials of this combination therapy could take place within the near future, with the aim of improving MM patient outcome.
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Affiliation(s)
- Yuan Jian
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China.,Multiple Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Wen Gao
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China.,Multiple Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Chuanying Geng
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China.,Multiple Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Huixing Zhou
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China.,Multiple Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yun Leng
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China.,Multiple Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yanchen Li
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China.,Multiple Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Wenming Chen
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China.,Multiple Myeloma Research Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
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6
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D’Agostino M, Salvini M, Palumbo A, Larocca A, Gay F. Novel investigational drugs active as single agents in multiple myeloma. Expert Opin Investig Drugs 2017; 26:699-711. [DOI: 10.1080/13543784.2017.1324571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Mattia D’Agostino
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Salvini
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
- Currently Takeda employee
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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7
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Lapa C, Herrmann K, Schirbel A, Hänscheid H, Lückerath K, Schottelius M, Kircher M, Werner RA, Schreder M, Samnick S, Kropf S, Knop S, Buck AK, Einsele H, Wester HJ, Kortüm KM. CXCR4-directed endoradiotherapy induces high response rates in extramedullary relapsed Multiple Myeloma. Theranostics 2017; 7:1589-1597. [PMID: 28529638 PMCID: PMC5436514 DOI: 10.7150/thno.19050] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/08/2017] [Indexed: 11/05/2022] Open
Abstract
C-X-C-motif chemokine receptor 4 (CXCR4) is a key factor for tumor growth and metastasis in several types of human cancer. We have recently reported promising first-in-man experience with CXCR4-directed endoradiotherapy (ERT) in multiple myeloma (MM). Eight heavily pretreated MM patients underwent a total of 10 ERT cycles (7 patients with 1 cycle and a single patient with 3 cycles). ERT was administered in combination with chemotherapy and autologous stem cell support. End points were occurrence and timing of adverse events, progression-free and overall survival. ERT was overall well tolerated without any unexpected acute adverse events or changes in vital signs. With absorbed tumor doses >30-70 Gy in intra- or extramedullary lesions, significant anti-myeloma activity was observed with 1 patient achieving complete remission and 5/8 partial remission. Directly after ERT major infectious complications were seen in one patient who died from sepsis 22 days after ERT, another patient with high tumor burden experienced lethal tumor lysis syndrome. Median progression-free survival was 54 days (range, 13-175), median overall survival was 223 days (range, 13-313). During follow-up (6 patients available), one patient died from infectious complications, 2/8 from disease progression, the remaining 3/8 patients are still alive. CXCR4-directed ERT was well-tolerated and exerted anti-myeloma activity even at very advanced stage MM with presence of extramedullary disease. Further assessment of this novel treatment option is highly warranted.
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8
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Rasche L, Weinhold N, Morgan GJ, van Rhee F, Davies FE. Immunologic approaches for the treatment of multiple myeloma. Cancer Treat Rev 2017; 55:190-199. [PMID: 28431262 DOI: 10.1016/j.ctrv.2017.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022]
Abstract
The FDA approval of two monoclonal antibodies in 2015has heralded a new era of targeted immunotherapies for multiple myeloma (MM). In this review we discuss the recent approaches using different immunological components to treat MM. In particular, we review current monoclonal antibody based therapies, engineered T- and NK cell products, 'off-target' immunomodulation, and strategies utilizing allogeneic cell transplantation in MM. We discuss how an immunologic approach offers promise for the treatment of this genetically heterogeneous disease, and how patients with acquired drug resistance may particularly benefit from these therapies. We also describe some of the limitations of the current strategies and speculate on the future of personalized immunotherapies for MM.
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Affiliation(s)
- Leo Rasche
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Niels Weinhold
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gareth J Morgan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Frits van Rhee
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Faith E Davies
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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9
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Jain T, Dueck AC, Kosiorek HE, Ginos BF, Mayo A, Reeder CB, Chesi M, Mikhael J, Keith Stewart A, Leif Bergsagel P, Fonseca R. Phase II trial of nab-paclitaxel in patients with relapsed or refractory multiple myeloma. Am J Hematol 2016; 91:E504-E505. [PMID: 27581088 DOI: 10.1002/ajh.24548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Tania Jain
- Division of Hematology and OncologyMayo ClinicPhoenix Arizona
| | | | | | | | - Angela Mayo
- Division of Hematology and OncologyMayo ClinicPhoenix Arizona
| | - Craig B. Reeder
- Division of Hematology and OncologyMayo ClinicPhoenix Arizona
| | - Marta Chesi
- Division of Hematology and OncologyMayo ClinicPhoenix Arizona
| | - Joseph Mikhael
- Division of Hematology and OncologyMayo ClinicPhoenix Arizona
| | | | | | - Rafael Fonseca
- Division of Hematology and OncologyMayo ClinicPhoenix Arizona
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10
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Le Ray E, Jagannath S, Palumbo A. Advances in targeted therapy for the treatment of patients with relapsed/refractory multiple myeloma. Expert Rev Hematol 2016; 9:91-105. [PMID: 26558304 DOI: 10.1586/17474086.2016.1119041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The development of proteasome inhibitors (PIs) and immunomodulatory drugs has significantly improved outcomes for patients with relapsed/refractory multiple myeloma (RRMM); however, not all patients benefit from treatment with these agents and some patients can become drug refractory over time. Due to the largely incurable nature of multiple myeloma, the development of newer agents is ongoing and includes new oral PIs (ixazomib), immunotherapies (e.g., CD38- or SLAMF7-targeted antibodies), and small molecules. This review provides an overview of the advances in targeted therapy for patients with RRMM, including recently approved agents, with a focus on monotherapy and combined targeted therapies.
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Affiliation(s)
- Emmanuelle Le Ray
- a Hematology Department , CHU Cochin, Paris V René Descartes University , Paris , France
| | - Sundar Jagannath
- b Tisch Cancer Institute/Multiple Myeloma Program , Mount Sinai Medical Center , New York , NY , USA
| | - Antonio Palumbo
- c Department of Haematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
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11
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Affiliation(s)
- Bruce Bostrom
- Cancer and Blood Disorders Program, Children’s Minnesota, Minneapolis, MN, USA
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12
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Rasche L, Menoret E, Dubljevic V, Menu E, Vanderkerken K, Lapa C, Steinbrunn T, Chatterjee M, Knop S, Düll J, Greenwood DL, Hensel F, Rosenwald A, Einsele H, Brändlein S. A GRP78-Directed Monoclonal Antibody Recaptures Response in Refractory Multiple Myeloma with Extramedullary Involvement. Clin Cancer Res 2016; 22:4341-9. [DOI: 10.1158/1078-0432.ccr-15-3111] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/16/2016] [Indexed: 11/16/2022]
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Kortüm KM, Zhu YX, Shi CX, Jedlowski P, Stewart AK. Cereblon binding molecules in multiple myeloma. Blood Rev 2015; 29:329-34. [PMID: 25843596 DOI: 10.1016/j.blre.2015.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/04/2015] [Accepted: 03/17/2015] [Indexed: 12/20/2022]
Abstract
Immunomodulation is an established treatment strategy in multiple myeloma with thalidomide and its derivatives lenalidomide and pomalidomide as its FDA approved representatives. Just recently the method of action of these cereblon binding molecules was deciphered and results from large phase 3 trials confirmed the backbone function of this drug family in various combination therapies. This review details the to-date knowledge concerning mechanism of IMiD action, clinical applications and plausible escape mechanisms in which cells may become resistant/refractory to cereblon binding molecule based treatment.
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Affiliation(s)
- K M Kortüm
- Mayo Clinic in AZ, Department of Hematology, USA
| | - Y X Zhu
- Mayo Clinic in AZ, Department of Hematology, USA
| | - C X Shi
- Mayo Clinic in AZ, Department of Hematology, USA
| | - P Jedlowski
- Mayo Clinic in AZ, Department of Hematology, USA
| | - A K Stewart
- Mayo Clinic in AZ, Department of Hematology, USA.
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Lien IC, Horng LY, Hsu PL, Wu CL, Sung HC, Wu RT. Internal ribosome entry site of bFGF is the target of thalidomide for IMiDs development in multiple myeloma. Genes Cancer 2014; 5:127-41. [PMID: 25053990 PMCID: PMC4091528 DOI: 10.18632/genesandcancer.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/20/2014] [Indexed: 01/20/2023] Open
Abstract
Although new analogues of immunomodulatory drugs (IMiDs) are being developed for MM, the molecular mechanism of these drugs remains unclear. In the current study, we used MM cell lines as a model to investigate the molecular mechanism of thalidomide and to compare its potency with IMiDs such as pomalidomide. We determined that thalidomide did not inhibit cell proliferation of RPMI8226 and U266 MM cells, whereas pomalidomide showed a significant inhibitory effect on these two MM cell lines. Interestingly, we further demonstrated that although thalidomide down-regulated bFGF translation through the inhibition of IRES even at 0.1 μg/ml, pomalidomide did not have a similar affect bFGF levels. A colony formation assay demonstrated that thalidomide and the bFGF knock-down clones caused a significant reduction in the clonogenic ability of MM cells, and treatment with exogenous bFGF can recover the clonogenic ability of thalidomide-treated cells and knock-down clones, but not that of pomalidomide-treated cells. This implies that thalidomide, but not pomalidomide, targets the IRES of FGF-2. In conclusion, our results highlight a non-cytotoxic anticancer drug target for thalidomide, the IRES of bFGF, and provide the mechanistic rationale for developing IMiDs as anti-cancer therapeutics in MM patients, with improved potency and fewer side effects.
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Affiliation(s)
- I-Chia Lien
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, ROC (Taiwan)
| | - Lin-Yea Horng
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, ROC (Taiwan) ; Research Centre for Drug Discovery, National Yang-Ming University, Taipei, ROC (Taiwan)
| | - Pei-Lun Hsu
- Research Centre for Drug Discovery, National Yang-Ming University, Taipei, ROC (Taiwan)
| | - Chia-Ling Wu
- Research Centre for Drug Discovery, National Yang-Ming University, Taipei, ROC (Taiwan)
| | - Hui-Ching Sung
- Research Centre for Drug Discovery, National Yang-Ming University, Taipei, ROC (Taiwan)
| | - Rong-Tsun Wu
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, ROC (Taiwan) ; Research Centre for Drug Discovery, National Yang-Ming University, Taipei, ROC (Taiwan)
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