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He X, Lan H, Jin K, Liu F. Can immunotherapy reinforce chemotherapy efficacy? a new perspective on colorectal cancer treatment. Front Immunol 2023; 14:1237764. [PMID: 37790928 PMCID: PMC10543914 DOI: 10.3389/fimmu.2023.1237764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
As one of the main threats to human life (the fourth most dangerous and prevalent cancer), colorectal cancer affects many people yearly, decreases patients' quality of life, and causes irreparable financial and social damages. In addition, this type of cancer can metastasize and involve the liver in advanced stages. However, current treatments can't completely eradicate this disease. Chemotherapy and subsequent surgery can be mentioned among the current main treatments for this disease. Chemotherapy has many side effects, and regarding the treatment of this type of tumor, chemotherapy can lead to liver damage, such as steatohepatitis, steatosis, and sinus damage. These damages can eventually lead to liver failure and loss of its functions. Therefore, it seems that other treatments can be used in addition to chemotherapy to increase its efficiency and reduce its side effects. Biological therapies and immunotherapy are one of the leading suggestions for combined treatment. Antibodies (immune checkpoint blockers) and cell therapy (DC and CAR-T cells) are among the immune system-based treatments used to treat tumors. Immunotherapy targets various aspects of the tumor that may lead to 1) the recruitment of immune cells, 2) increasing the immunogenicity of tumor cells, and 3) leading to the elimination of inhibitory mechanisms established by the tumor. Therefore, immunotherapy can be used as a complementary treatment along with chemotherapy. This review will discuss different chemotherapy and immunotherapy methods for colorectal cancer. Then we will talk about the studies that have dealt with combined treatment.
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Affiliation(s)
- Xing He
- Department of Gastroenterology, Jinhua Wenrong Hospital, Jinhua, Zhejiang, China
| | - Huanrong Lan
- Department of Surgical Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
| | - Ketao Jin
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Fanlong Liu
- Department of Colorectal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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2
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Letafati A, Soheili R, Norouzi M, Soleimani P, Mozhgani SH. Therapeutic approaches for HTLV-1-associated adult T-cell leukemia/lymphoma: a comprehensive review. Med Oncol 2023; 40:295. [PMID: 37689806 DOI: 10.1007/s12032-023-02166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/18/2023] [Indexed: 09/11/2023]
Abstract
Adult T-cell leukemia/lymphoma (ATLL), an infrequent malignancy resultant from human T-cell lymphotropic virus type I (HTLV-1), exhibits a spectrum of phenotypes, encompassing acute, smoldering, lymphomatous, and chronic variants, each bearing distinct clinical presentations. The preponderant acute manifestation is characterized by hypercalcemia, systemic manifestations, organomegaly, and dermatological eruptions. Conversely, the chronic phenotype is typified by lymphocytosis and/or cutaneous eruptions, while smoldering ATLL assumes an asymptomatic course. Immunocompromise afflicts ATLL patients, heightening their vulnerability to opportunistic infections that frequently intricately intertwine with disease progression. Therefore, an early diagnosis is crucial to manage the disease appropriately. While conventional chemotherapeutic regimens have shown limited success, especially in acute and lymphoma types, recent studies suggest that allogeneic stem cell transplantation might enhance treatment results because it has shown promising outcomes in some patients. Novel therapeutics, such as interferon and monoclonal antibodies, have also shown promise, but more research is needed to confirm their efficacy. Moreover, the identification of biomarkers for ATLL and genetic changes in HTLV-1 infected cells has led to the development of targeted therapies that have shown remarkable success in clinical trials. These targeted therapies have the potential to offer a more personalized approach to the treatment of ATLL. The aim of our review is to elaborate on conventional and novel therapies and the efficiency of mentioned treatments.
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Affiliation(s)
- Arash Letafati
- Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Roben Soheili
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Mehdi Norouzi
- Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran
| | - Parastoo Soleimani
- Advanced Science Faculty, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Sayed-Hamidreza Mozhgani
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
- Department of Microbiology and Virology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
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3
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Milano G, Innocenti F, Minami H. Liposomal irinotecan (Onivyde): Exemplifying the benefits of nanotherapeutic drugs. Cancer Sci 2022; 113:2224-2231. [PMID: 35445479 PMCID: PMC9277406 DOI: 10.1111/cas.15377] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Irinotecan is a topoisomerase inhibitor, widely used in treatment of malignancies including pancreatic ductal adenocarcinoma (PDAC) as part of the FOLFIRINOX regimen prescribed as a first-line treatment in several countries. However, irinotecan has not been successfully introduced as a second-line treatment for pancreatic cancer and few randomized clinical studies have evaluated its added value. Efficacy of liposomal irinotecan (nal-IRI) combined with 5-fluorouracil and leucovorin (5-FU/LV) was reported in the phase III NAPOLI-1 trial in metastatic PDAC following failure of gemcitabine-based therapy. Several features of nal-IRI pharmacokinetics (PK) could result in better outcomes versus nonliposomal irinotecan. Irinotecan is a prodrug that is converted to active SN-38 by carboxylesterase enzymes and inactivated by cytochrome P450 3A4/3A5. SN-38 is inactivated by UGT1A1 enzymes. Individual variations in their expression and activity could influence enhanced localized irinotecan activity and toxicity. Liposomal irinotecan exploits the enhanced permeability and retention effect in cancer, accumulating in tumor tissues. Liposomal irinotecan also has a longer half-life and higher area under the concentration-time curve (0-∞) than nonliposomal irinotecan, as the liposomal formulation protects cargo from premature metabolism in the plasma. This results in irinotecan activation in tumor tissue, leading to enhanced cytotoxicity. Importantly, despite the longer exposure, overall toxicity for nal-IRI is no worse than nonliposomal irinotecan. Liposomal irinotecan exemplifies how liposomal encapsulation of a chemotherapeutic agent can alter its PK properties, improving clinical outcomes for patients. Liposomal irinotecan is currently under investigation in other malignancies including biliary tract cancer (amongst other gastrointestinal cancers), brain tumors, and small-cell lung cancer.
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Affiliation(s)
- Gérard Milano
- UPR 7497Scientific Valorisation UnitCentre Antoine Lacassagne and Côte d’Azur UniversityNiceFrance
| | | | - Hironobu Minami
- Medical Oncology and HematologyKobe University Graduate School of Medicine and HospitalKobeJapan
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4
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Legrand N, McGregor S, Bull R, Bajis S, Valencia BM, Ronnachit A, Einsiedel L, Gessain A, Kaldor J, Martinello M. Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection. Clin Microbiol Rev 2022; 35:e0007821. [PMID: 35195446 PMCID: PMC8941934 DOI: 10.1128/cmr.00078-21] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.
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Affiliation(s)
- Nicolas Legrand
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Skye McGregor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rowena Bull
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sahar Bajis
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Amrita Ronnachit
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lloyd Einsiedel
- Central Australian Health Service, Alice Springs, Northern Territory, Australia
| | - Antoine Gessain
- Institut Pasteur, Epidemiology and Physiopathology of Oncogenic Viruses Unit, Paris, France
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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5
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Adult T-Cell Leukemia: a Comprehensive Overview on Current and Promising Treatment Modalities. Curr Oncol Rep 2021; 23:141. [PMID: 34735653 DOI: 10.1007/s11912-021-01138-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF THE REVIEW Adult T-cell leukemia (ATL) is an aggressive chemo-resistant malignancy secondary to HTLV-1 retrovirus. Prognosis of ATL remains dismal. Herein, we emphasized on the current ATL treatment modalities and their drawbacks, and opened up on promising targeted therapies with special focus on the HTLV-1 regulatory proteins Tax and HBZ. RECENT FINDINGS Indolent ATL and a fraction of acute ATL exhibit long-term survival following antiviral treatment with zidovudine and interferon-alpha. Monoclonal antibodies such as mogamulizumab improved response rates, but with little effect on survival. Allogeneic hematopoietic cell transplantation results in long-term survival in one third of transplanted patients, alas only few patients are transplanted. Salvage therapy with lenalidomide in relapsed/refractory patients leads to prolonged survival in some of them. ATL remains an unmet medical need. Targeted therapies focusing on the HTLV-1 viral replication and/or viral regulatory proteins, as well as on the host antiviral immunity, represent a promising approach for the treatment of ATL.
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Demir Y, Türkeş C, Beydemir Ş. Molecular Docking Studies and Inhibition Properties of Some Antineoplastic Agents against Paraoxonase-I. Anticancer Agents Med Chem 2020; 20:887-896. [DOI: 10.2174/1871520620666200218110645] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/15/2019] [Accepted: 01/27/2020] [Indexed: 01/28/2023]
Abstract
Background:
Currently, most of the drugs used in clinical applications show their pharmacological
influences by inhibiting or activating enzymes. Therefore, enzyme inhibitors have an essential place in the drug
design for many diseases.
Objective:
The current study aimed to contribute to this growing drug design field (i.e., medicine discovery and
development) by analyzing enzyme-drug interactions.
Methods:
For this reason, Paraoxonase-I (PON1) enzyme was purified from fresh human serum by using rapid
chromatographic techniques. Additionally, the inhibition effects of some antineoplastic agents were researched
on the PON1.
Results:
The enzyme was obtained with a specific activity of 2603.57 EU/mg protein. IC50 values for pemetrexed
disodium, irinotecan hydrochloride, dacarbazine, and azacitidine were determined to be 9.63μM,
30.13μM, 53.31μM, and 21.00mM, respectively. These agents found to strongly inhibit PON1, with Ki constants
ranging from 8.29±1.47μM to 23.34±2.71mM. Dacarbazine and azacitidine showed non-competitive inhibition,
while other drugs showed competitive inhibition. Furthermore, molecular docking was performed using maestro
for these agents. Among these, irinotecan hydrochloride and pemetrexed disodium possess the binding energy of
-5.46 and -8.43 kcal/mol, respectively.
Conclusion:
The interaction studies indicated that these agents with the PON1 possess binding affinity.
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Affiliation(s)
- Yeliz Demir
- Department of Pharmacy Services, Nihat Delibalta Gole Vocational High School, Ardahan University, 75700, Ardahan, Turkey
| | - Cüneyt Türkeş
- Department of Biochemistry, Faculty of Pharmacy, Erzincan Binali Yildirim University, 24100, Erzincan, Turkey
| | - Şükrü Beydemir
- Department of Biochemistry, Faculty of Pharmacy, Anadolu University, 26470, Eskisehir, Turkey
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El Hajj H, Tsukasaki K, Cheminant M, Bazarbachi A, Watanabe T, Hermine O. Novel Treatments of Adult T Cell Leukemia Lymphoma. Front Microbiol 2020; 11:1062. [PMID: 32547515 PMCID: PMC7270167 DOI: 10.3389/fmicb.2020.01062] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022] Open
Abstract
Adult T cell leukemia-lymphoma (ATL) is an aggressive malignancy secondary to chronic infection with the human T cell leukemia virus type I (HTLV-I) retrovirus. ATL carries a dismal prognosis. ATL classifies into four subtypes (acute, lymphoma, chronic, and smoldering) which display different clinical features, prognosis and response to therapy, hence requiring different clinical management. Smoldering and chronic subtypes respond well to antiretroviral therapy using the combination of zidovudine (AZT) and interferon-alpha (IFN) with a significant prolongation of survival. Conversely, the watch and wait strategy or chemotherapy for these indolent subtypes allies with a poor long-term outcome. Acute ATL is associated with chemo-resistance and dismal prognosis. Lymphoma subtypes respond better to intensive chemotherapy but survival remains poor. Allogeneic hematopoietic stem cell transplantation (HSCT) results in long-term survival in roughly one third of transplanted patients but only a small percentage of patients can make it to transplant. Overall, current treatments of aggressive ATL are not satisfactory. Prognosis of refractory or relapsed patients is dismal with some encouraging results when using lenalidomide or mogamulizumab. To overcome resistance and prevent relapse, preclinical or pilot clinical studies using targeted therapies such as arsenic/IFN, monoclonal antibodies, epigenetic therapies are promising but warrant further clinical investigation. Anti-ATL vaccines including Tax peptide-pulsed dendritic cells, induced Tax-specific CTL responses in ATL patients. Finally, based on the progress in understanding the pathophysiology of ATL, and the risk-adapted treatment approaches to different ATL subtypes, treatment strategies of ATL should take into account the host immune responses and the host microenvironment including HTLV-1 infected non-malignant cells. Herein, we will provide a summary of novel treatments of ATL in vitro, in vivo, and in early clinical trials.
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Affiliation(s)
- Hiba El Hajj
- Department of Experimental Pathology, Microbiology, and Immunology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Kunihiro Tsukasaki
- Department of Hematology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Morgane Cheminant
- INSERM UMR 1163 and CNRS URL 8254, Imagine Institute, Paris, France.,Department of Hematology, Necker-Enfants Malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Descartes University, Paris, France
| | - Ali Bazarbachi
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Toshiki Watanabe
- Department of Medical Genome Sciences, The University of Tokyo, Tokyo, Japan
| | - Olivier Hermine
- INSERM UMR 1163 and CNRS URL 8254, Imagine Institute, Paris, France.,Department of Hematology, Necker-Enfants Malades University Hospital, Assistance Publique Hôpitaux de Paris, Paris-Descartes University, Paris, France
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8
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Phillips AA, Fields PA, Hermine O, Ramos JC, Beltran BE, Pereira J, Wandroo F, Feldman T, Taylor GP, Sawas A, Humphrey J, Kurman M, Moriya J, Dwyer K, Leoni M, Conlon K, Cook L, Gonsky J, Horwitz SM. Mogamulizumab versus investigator's choice of chemotherapy regimen in relapsed/refractory adult T-cell leukemia/lymphoma. Haematologica 2019; 104:993-1003. [PMID: 30573506 PMCID: PMC6518882 DOI: 10.3324/haematol.2018.205096] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/18/2018] [Indexed: 12/30/2022] Open
Abstract
Mogamulizumab, a humanized defucosylated anti-C-C chemokine receptor 4 monoclonal antibody, has been approved in Japan for the treatment of C-C chemokine receptor 4-positive adult T-cell leukemia/lymphoma (ATL). This phase II study evaluated efficacy and safety of mogamulizumab in ATL patients with acute, lymphoma, and chronic subtypes with relapsed/refractory, aggressive disease in the US, Europe, and Latin America. With stratification by subtype, patients were randomized 2:1 to intravenous mogamulizumab 1.0 mg/kg once weekly for 4 weeks and biweekly thereafter (n=47) or investigator's choice of chemotherapy (n=24). The primary end point was confirmed overall response rate (cORR) confirmed on a subsequent assessment at 8 weeks by blinded independent review. ORR was 11% (95%CI: 4-23%) and 0% (95%CI: 0-14%) in the mogamulizumab and chemotherapy arms, respectively. Best response was 28% and 8% in the respective arms. The observed hazard ratio for progression-free survival was 0.71 (95%CI: 0.41-1.21) and, after post hoc adjustment for performance status imbalance, 0.57 (95%CI: 0.337-0.983). The most frequent treatment-related adverse (grade ≥3) events with mogamulizumab were infusion-related reaction and thrombocytopenia (each 9%). Relapsed/refractory ATL is an aggressive, poor prognosis disease with a high unmet need. Investigator's choice chemotherapy did not result in tumor response in this trial; however, mogamulizumab treatment resulted in 11% cORR, with a tolerable safety profile.
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Affiliation(s)
- Adrienne A Phillips
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Paul A Fields
- Department of Haematology Guy's and St Thomas' Hospitals NHS Trust Hospital, London, UK
| | - Olivier Hermine
- Department of Hematology, Necker University Hospital, Paris, France
| | - Juan C Ramos
- Division of Hematology/Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, FL, USA
| | - Brady E Beltran
- Hospital Nacional Edgardo Rebagliati Martins and Centro de Investigación de Medicina de Precision, Universidad de San Martin de Porres, Lima, Peru
| | | | - Farooq Wandroo
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, and University of Birmingham, UK
| | | | - Graham P Taylor
- National Centre for Human Retrovirology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ahmed Sawas
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | | | - Kevin Conlon
- Warren Grant Magnuson Clinical Center, National Cancer Institute, Bethesda, MD, USA
| | - Lucy Cook
- Department of Haematology and National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, UK
| | - Jason Gonsky
- Division of Hematology/Oncology, Department of Medicine, New York City Health + Hospitals/Kings County and SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Steven M Horwitz
- Hematology/Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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9
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Toriyama E, Imaizumi Y, Taniguchi H, Taguchi J, Nakashima J, Itonaga H, Sato S, Ando K, Sawayama Y, Hata T, Fukushima T, Miyazaki Y. EPOCH regimen as salvage therapy for adult T-cell leukemia–lymphoma. Int J Hematol 2018; 108:167-175. [DOI: 10.1007/s12185-018-2455-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 12/12/2022]
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Ishida T, Fujiwara H, Nosaka K, Taira N, Abe Y, Imaizumi Y, Moriuchi Y, Jo T, Ishizawa K, Tobinai K, Tsukasaki K, Ito S, Yoshimitsu M, Otsuka M, Ogura M, Midorikawa S, Ruiz W, Ohtsu T. Multicenter Phase II Study of Lenalidomide in Relapsed or Recurrent Adult T-Cell Leukemia/Lymphoma: ATLL-002. J Clin Oncol 2016; 34:4086-4093. [DOI: 10.1200/jco.2016.67.7732] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Few treatment options exist for adult T-cell leukemia/lymphoma (ATL), and the prognosis for this disease is poor. A phase I study of lenalidomide demonstrated preliminary antitumor activity in patients with relapsed ATL. The current phase II study evaluated the efficacy and safety of lenalidomide monotherapy in patients with relapsed or recurrent ATL. Patients and Methods Patients 20 years of age or older with acute, lymphoma, or unfavorable chronic subtype ATL, who had received one or more prior anti-ATL systemic chemotherapy and achieved stable disease or better on their last anti-ATL therapy with subsequent relapse or recurrence, were eligible. Patients received oral lenalidomide 25 mg/d continuously until disease progression or unacceptable toxicity. The primary end point was overall response rate; secondary end points included safety, tumor control rate (stable disease or better), time to response, duration of response, time to progression, progression-free survival, and overall survival. Results Objective responses were noted in 11 of 26 patients (overall response rate, 42%; 95% CI, 23% to 63%), including four complete responses and one unconfirmed complete response. The tumor control rate was 73%. The median time to response and duration of response were 1.9 months and not estimable, respectively, and the median time to progression was 3.8 months. The median progression-free survival and overall survival were 3.8 and 20.3 months, respectively. The most frequent grade ≥ 3 adverse events were neutropenia (65%), leukopenia (38%), lymphopenia (38%), and thrombocytopenia (23%), which were all manageable and reversible. Conclusion Lenalidomide demonstrated clinically meaningful antitumor activity and an acceptable toxicity profile in patients with relapsed or recurrent aggressive ATL, hinting at its potential to become a treatment option. Further investigations of lenalidomide in ATL and other mature T-cell neoplasms are warranted.
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Affiliation(s)
- Takashi Ishida
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Hiroshi Fujiwara
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Kisato Nosaka
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Naoya Taira
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Yasunobu Abe
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Yoshitaka Imaizumi
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Yukiyoshi Moriuchi
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Tatsuro Jo
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Kenichi Ishizawa
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Kensei Tobinai
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Kunihiro Tsukasaki
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Shigeki Ito
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Makoto Yoshimitsu
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Maki Otsuka
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Michinori Ogura
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Shuichi Midorikawa
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Wanda Ruiz
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
| | - Tomoko Ohtsu
- Takashi Ishida, Nagoya City University Graduate School of Medical Sciences, Aichi; Hiroshi Fujiwara, Ehime University Hospital, Ehime; Kisato Nosaka, Kumamoto University Hospital, Kumamoto; Naoya Taira, Heart Life Hospital, Okinawa; Yasunobu Abe, Kyushu Cancer Center, Fukuoka; Yoshitaka Imaizumi, Nagasaki University Hospital; Yukiyoshi Moriuchi, Sasebo City General Hospital; Tatsuro Jo, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki; Kenichi Ishizawa, Tohoku University Hospital, Miyagi; Kensei
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Abstract
Purpose. The primary objective of this article is to discuss the pharmacology, pharmacokinetics, clinical use, and adverse effects of the approved topoisomer ase I inhibitors. This is the second in a series of two articles and will focus on irinotecan. Data Sources. We reviewed the literature through a MEDLINE search of English language arti cles from 1985 through 1998. Relevant articles cited in the titles obtained from the MEDLINE search were also used. The following terms were used for purpose of conducting the MEDLINE search: topoisomerase inhibitors, irinotecan, topoisomerase I, camptosar, and CPT-11. Data Extraction. We have reviewed the current literature to discuss the pharmacology, pharmacokinet ics, clinical use, toxicity, drug interactions, indications, formulation, dosage and administration, and pharmaceu tical issues surrounding the use of irinotecan. Data Synthesis. The topoisomerase I inhibitors are new antineoplastic agents with a unique mechanism of action. Promising areas of application include colo rectal cancer, non-small-cell lung cancer, small-cell lung cancer, cervical cancer, and lymphomas. Clinical trials detailing the activity of topoisomerase I inhibitors in these areas are presented.
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Affiliation(s)
- J. Andrew Skirvin
- College of Pharmacy, St. John's University, Jamaica, New York, North Shore University Hospital, Manhasset, New York
| | - Valerie Relias
- New England Medical Center, Department of Pharmacy, Boston, Massachusetts
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12
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Abstract
Adult T-cell Leukemia (ATL) is an aggressive malignant disease of CD4+ T-cells associated with human T-cell leukemia virus type I (HTLV-I). Prognosis of ATL patients is directly correlated to the subtype of ATL. Treatment of the aggressive forms (acute and lymphoma types) of ATL remains inadequate, as most ATL patients receive conventional chemotherapy without stem cell rescue. At present, LSG15 is the standard chemotherapy for the treatment of aggressive ATL, but the efficacy of LSG15 in most patients is transient. To prolong median survival time, additional therapies for maintenance of complete response (CR) are needed after achieving CR by induction chemotherapy. Improved outcome after allogeneic stem cell transplantation (allo-SCT), despite a high incidence of graft-versus-host disease, has been reported. Thus, allogeneic bone marrow transplantation and allogeneic peripheral blood SCT may have great potential for eradication of HTLV-1 and cure of ATL. Recently, reduced-intensity conditioning stem cell transplantation was also reported to be effective for ATL. Although several issues, including selection criteria for patients and sources of stem cells remain to be resolved, allo-SCT may be considered as a treatment option for patients with aggressive ATL. To evaluate whether allo-SCT is more effective than the standard chemotherapy (LSG15) for aggressive ATL, an up front phase II clinical trial of JCOG-LSG is now being planned. Novel innovative targeted strategies, such as antiretroviral therapy, arsenic trioxide, nuclear factor-kappaB inhibitors, proteasome inhibitors, histone deacetylase inhibitors, several monoclonal antibodies including anti-CC chemokine receptor 4, anti-folate, purine nucleotide phosphorylase inhibitor, mTOR (mammalian target of rapamycin) inhibitor, bendamustine, small molecule Bcl-2 inhibitors and Tax-targeted immunotherapy, should be promptly studied in order to develop curative treatments for ATL in the near future.
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Affiliation(s)
- Kimiru Uozumi
- Department of Hematology and Immunology, Kagoshima University Hospital.
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13
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Ishitsuka K, Utsunomiya A, Katsuya H, Takeuchi S, Takatsuka Y, Hidaka M, Sakai T, Yoshimitsu M, Ishida T, Tamura K. A phase II study of bortezomib in patients with relapsed or refractory aggressive adult T-cell leukemia/lymphoma. Cancer Sci 2015; 106:1219-23. [PMID: 26179770 PMCID: PMC4582992 DOI: 10.1111/cas.12735] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/23/2015] [Accepted: 07/04/2015] [Indexed: 01/20/2023] Open
Abstract
Adult T-cell leukemia/lymphoma (ATL) is a malignancy of peripheral T-lymphocytes with a poor prognosis. This multicenter, two-stage, single-arm, phase II study assessed the efficacy and safety of bortezomib in patients with relapsed/refractory ATL who received at least one regimen of chemotherapy. The primary endpoint was the best overall response rate (ORR), and secondary endpoints included safety, the best response by lesions, and progression-free survival (PFS). Fifteen patients were enrolled in the first stage of this study. One partial remission (PR) and five stable disease (SD) were observed as the best overall responses, and ORR was 6.7% (95% confidence interval (C.I.) 0.17-31.95%). Responses according to disease sites were one complete remission (CR) in peripheral blood, two PR in measurable targeted lesions, and two PR in skin lesions. Progression-free survival (PFS) was 38 (95% CI; 18-106) days. All patients developed ≥1 adverse events (AEs), and 80% of patients had ≥1 grade 3/4 AEs; however, no new safety findings were obtained. Although these results fulfilled the planned settings to proceed to the second stage, the coordinating committee decided to terminate this study because single agent activity did not appear to be very promising for this cohort of patients.
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Affiliation(s)
- Kenji Ishitsuka
- Division of Oncology, Hematology and Infectious Diseases, Fukuoka University, Fukuoka, Japan
| | - Atae Utsunomiya
- Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
| | - Hiroo Katsuya
- Division of Oncology, Hematology and Infectious Diseases, Fukuoka University, Fukuoka, Japan
| | - Shogo Takeuchi
- Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
| | | | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Tatsunori Sakai
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Makoto Yoshimitsu
- Division of Hematology and Immunology, Center for Chronic Viral Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takashi Ishida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuo Tamura
- Division of Oncology, Hematology and Infectious Diseases, Fukuoka University, Fukuoka, Japan
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14
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Kobatake C, Mizutani M, Amou M, Yurimoto S. [Pharmacological and clinical profile of mogamulizumab (POTELIGEO(®) Injection)]. Nihon Yakurigaku Zasshi 2013; 141:100-5. [PMID: 23391551 DOI: 10.1254/fpj.141.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Ishida T, Joh T, Uike N, Yamamoto K, Utsunomiya A, Yoshida S, Saburi Y, Miyamoto T, Takemoto S, Suzushima H, Tsukasaki K, Nosaka K, Fujiwara H, Ishitsuka K, Inagaki H, Ogura M, Akinaga S, Tomonaga M, Tobinai K, Ueda R. Defucosylated Anti-CCR4 Monoclonal Antibody (KW-0761) for Relapsed Adult T-Cell Leukemia-Lymphoma: A Multicenter Phase II Study. J Clin Oncol 2012; 30:837-42. [DOI: 10.1200/jco.2011.37.3472] [Citation(s) in RCA: 494] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Adult T-cell leukemia-lymphoma (ATL) is usually resistant to conventional chemotherapies, and there are few other treatment options. Because CC chemokine receptor 4 (CCR4) is expressed on tumor cells from most patients with ATL, KW-0761, a humanized anti-CCR4 monoclonal antibody, which markedly enhances antibody-dependent cellular cytotoxicity, was evaluated in the treatment of patients with relapsed ATL. Patients and Methods A multicenter phase II study of KW-0761 for patients with relapsed, aggressive CCR4-positive ATL was conducted to evaluate efficacy, pharmacokinetic profile, and safety. The primary end point was overall response rate, and secondary end points included progression-free and overall survival from the first dose of KW-0761. Patients received intravenous infusions of KW-0761 once per week for 8 weeks at a dose of 1.0 mg/kg. Results Of 28 patients enrolled onto the study, 27 received at least one infusion of KW-0761. Objective responses were noted in 13 of 26 evaluable patients, including eight complete responses, with an overall response rate of 50% (95% CI, 30% to 70%). Median progression-free and overall survival were 5.2 and 13.7 months, respectively. The mean half-life period after the eighth infusion was 422 ± 147 hours (± standard deviation). The most common adverse events were infusion reactions (89%) and skin rashes (63%), which were manageable and reversible in all cases. Conclusion KW-0761 demonstrated clinically meaningful antitumor activity in patients with relapsed ATL, with an acceptable toxicity profile. Further investigation of KW-0761 for treatment of ATL and other T-cell neoplasms is warranted.
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Affiliation(s)
- Takashi Ishida
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Tatsuro Joh
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Naokuni Uike
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Kazuhito Yamamoto
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Atae Utsunomiya
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Shinichiro Yoshida
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Yoshio Saburi
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Toshihiro Miyamoto
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Shigeki Takemoto
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Hitoshi Suzushima
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Kunihiro Tsukasaki
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Kisato Nosaka
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Hiroshi Fujiwara
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Kenji Ishitsuka
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Hiroshi Inagaki
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Michinori Ogura
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Shiro Akinaga
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Masao Tomonaga
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Kensei Tobinai
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
| | - Ryuzo Ueda
- Takashi Ishida, Hiroshi Inagaki, and Ryuzo Ueda, Nagoya City University Graduate School of Medical Sciences; Kazuhito Yamamoto, Aichi Cancer Center; Michinori Ogura, Nagoya Daini Red Cross Hospital, Nagoya; Tatsuro Joh and Masao Tomonaga, Japanese Red Cross Nagasaki Genbaku Hospital; Shinichiro Yoshida, Nagasaki Medical Center; Kunihiro Tsukasaki, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Nagasaki; Naokuni Uike, National Kyushu Cancer Center; Toshihiro
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Sapra P, Kraft P, Mehlig M, Malaby J, Zhao H, Greenberger LM, Horak ID. Marked therapeutic efficacy of a novel polyethylene glycol-SN38 conjugate, EZN-2208, in xenograft models of B-cell non-Hodgkin's lymphoma. Haematologica 2011; 94:1456-9. [PMID: 19794091 DOI: 10.3324/haematol.2009.008276] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Examination of the clinical utility of SN38 (10-hydroxy-7-ethyl-camptothecin), the active metabolite of CPT-11, has not been possible to date due to poor solubility of SN38. Here we evaluated the activity of EZN-2208, a water-soluble polyethyleneglycol-SN38 conjugate, in pre-clinical models of Burkitt's non-Hodgkin's lymphoma (NHL) (Raji and Daudi), and follicular NHL (DoHH2). In vitro, the IC50 of EZN-2208 ranged from 3-24 nM, which was 30- to 45-fold lower than CPT-11 or 2.5- to 3.5-fold higher than SN38. In both an early-disease Raji model and an advanced-disease Daudi model, treatment with multiple doses of EZN-2208 resulted in 90% and 100% cures of animals, respectively (cure defined as no sign of tumors by gross observations at the termination of study). The activity of EZN-2208 was dramatically superior to that of CPT-11 in all three models. The excellent therapeutic efficacy of EZN-2208 in several B-cell NHL xenograft models merits its evaluation in the clinic for lymphoid malignancies.
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Affiliation(s)
- Puja Sapra
- Enzon Pharmaceuticals, Inc., 20 Kingsbridge Road, Piscataway, NJ 08854, USA.
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17
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Abstract
Adult T-cell leukemia/lymphoma (ATL) is an aggressive malignancy of mature activated T cells caused by human T-cell lymphotropic virus type I. ATL carries a bad prognosis because of intrinsic chemoresistance and severe immunosuppression. In acute ATL, Japanese trials demonstrated that although combinations of chemotherapy improved response rate, they failed to achieve a significant impact on survival. Patients with chronic and smoldering ATL have a better prognosis, but long-term survival is poor when these patients are managed with a watchful-waiting policy or with chemotherapy. Recently, a worldwide meta-analysis revealed that the combination of zidovudine and IFN-α is highly effective in the leukemic subtypes of ATL and should be considered as standard first-line therapy in that setting. This combination has changed the natural history of the disease through achievement of significantly improved long-term survival in patients with smoldering and chronic ATL as well as a subset of patients with acute ATL. ATL lymphoma patients still benefit from chemotherapy induction with concurrent or sequential antiretroviral therapy with zidovudine/IFN. To prevent relapse, clinical trials assessing consolidative targeted therapies such as arsenic/IFN combination or novel monoclonal antibodies are needed. Finally, allogeneic BM transplantation should be considered in suitable patients.
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Kirschbaum M. Comeback for the camptothecins? Leuk Lymphoma 2009; 50:1914-5. [PMID: 19860622 DOI: 10.3109/10428190903291088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mark Kirschbaum
- Department of Hematology & Hematopoetic Cell Transplantation, City of Hope National Cancer Center, Duarte, CA 91010, USA.
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19
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Inhibition of cell-to-cell transmission of human T-cell lymphotropic virus type 1 in vitro by carbohydrate-binding agents. Antimicrob Agents Chemother 2008; 52:2771-9. [PMID: 18505856 DOI: 10.1128/aac.01671-07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Peripheral blood mononuclear cells (PBMCs) from healthy individuals can be infected by human T-lymphotropic virus type 1 (HTLV-1) upon cocultivation of the PBMCs with irradiated HTLV-1-transformed human MT-2 cells. This model system closely mimics HTLV-1 transmission through cell-to-cell contact. Carbohydrate-binding agents (CBAs) such as the alpha(1,3)/alpha(1,6)mannose-specific Hippeastrum hybrid agglutinin and the GlcNAc-specific Urtica dioica agglutinin, and also the small, nonpeptidic alpha(1,2)-mannose-specific antibiotic pradimicin A, were able to efficiently prevent cell-to-cell HTLV-1 transmission at nontoxic concentrations, as evidenced by the lack of appearance of virus-specific mRNA and of the viral protein Tax in the acceptor cells. Consistently, antivirally active doses of CBAs fully prevented HTLV-1-induced stimulation of PBMC growth. The inhibitory effects of CBAs on HTLV-1 transmission were also evident when HTLV-1-infected C5MJ cells were used in place of MT-2 cells as a virus donor cell line. The anti-HTLV-1 properties of the CBAs highlight the importance of the envelope glycans in events underlying HTLV-1 passage from cell to cell and indicate that CBAs should be further investigated for their potential to prevent HTLV-1 infection, including mother-to-child virus transmission by cell-to-cell contact through breast milk feeding.
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Ishitsuka K, Tamura K. Treatment of adult T-cell leukemia/lymphoma: past, present, and future. Eur J Haematol 2007; 80:185-96. [PMID: 18081707 DOI: 10.1111/j.1600-0609.2007.01016.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is a peripheral T-cell malignancy caused by human T-cell lymphotrophic virus type I. Clinical manifestations of ATLL range from smoldering to chronic, lymphoma and acute. Patients with acute and lymphoma type ATLL require therapeutic intervention. Conventional chemotherapeutic regimens used against other malignant lymphoma have been administered to ATLL patients, but the therapeutic outcomes of acute and lymphoma type ATLL remain very poor. Promising results of allogeneic stem cell transplantation (SCT) for ATLL patients have recently been reported and the treatment outcome might be improved for some ATLL patients. Besides conventional chemotherapy and SCT, interferon, zidovudine, arsenic trioxide, targeted therapy against surface molecule on ATLL cells, retinoid derivatives, and bortezomib have been administered to ATLL patients in pilot or phase I/II studies. Further studies are required to confirm the clinical benefits of these novel therapeutics. This article reviews the current status and future directions of ATLL treatment.
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Affiliation(s)
- Kenji Ishitsuka
- Internal Medicine, Division of Hematology and Oncology, Fukuoka University, Fukuoka, Japan.
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Effect of phosphonated carbocyclic 2'-oxa-3'-aza-nucleoside on human T-cell leukemia virus type 1 infection in vitro. Antimicrob Agents Chemother 2007; 52:54-64. [PMID: 17967914 DOI: 10.1128/aac.00470-07] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is currently little research and development of new compounds with specific anti-human T-cell leukemia virus type 1 (HTLV-1) activity. The few antiretrovirals that have been tested against HTLV-1 in vitro have already been developed into anti-human immunodeficiency virus (HIV) drugs. Here, we show the effects of a newly synthesized family of phosphonated nucleoside compounds, phosphonated carbocyclic 2'-oxa-3'-aza-nucleosides (PCOANs), on HTLV-1 infection in vitro. To ascertain the anti-HTLV-1 activity of PCOANs, peripheral blood mononuclear cells from healthy donors were infected in vitro by coculture with an HTLV-1 donor cell line in the presence of three prototype PCOAN compounds. PCOANs were able to completely inhibit HTLV-1 infection in vitro at a concentration of 1 microM, similar to what has been observed for tenofovir and azidothymidine. Treatment with PCOANs was associated with inhibited growth of HTLV-1-infected cells, and their effects were 100 to 200 times more potent than that of tenofovir. The mechanisms involved in the anti-HTLV-1 effects of PCOANs can mainly be ascribed to their capacity to inhibit HTLV-1 reverse transcriptase activity, as ascertained by means of a cell-free assay. PCOANs caused little reduction in proliferation or induction of apoptotic cell death of uninfected cells, showing toxicity levels similar to tenofovir and lower than azidothymidine. Overall, these results indicate that the family of PCOANs includes potential candidate compounds for long-lasting control of HTLV-1 infection.
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Irinotecan plus cisplatin and dexamethasone (ICD) combination chemotherapy for patients with diffuse large B-cell lymphoma previously treated with Rituximab plus CHOP. Cancer Chemother Pharmacol 2007; 62:299-304. [DOI: 10.1007/s00280-007-0607-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 09/14/2007] [Indexed: 11/26/2022]
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Ratner L, Grant C, Zimmerman B, Fritz J, Weil G, Denes A, Suresh R, Campbell N, Jacobson S, Lairmore M. Effect of treatment of Strongyloides infection on HTLV-1 expression in a patient with adult T-cell leukemia. Am J Hematol 2007; 82:929-31. [PMID: 17617788 PMCID: PMC2652703 DOI: 10.1002/ajh.20929] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Human T-cell leukemia virus type 1 (HTLV-1) is associated with adult T-cell leukemia-lymphoma (ATLL) in about 5% of infected individuals. Coinfection by Strongyloides stercoralis has been suggested to be a cofactor for development of ATLL. We describe a patient who presented with HTLV-1-associated chronic ATLL and Strongyloides infection. Studies of this patient's viral RNA levels demonstrated stimulation of HTLV-1 replication by Strongyloides, which resolved with anti-helminthic therapy. This case provides support for the hypothesis that Strongyloides is a cofactor for ATLL via T-cell stimulation.
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Affiliation(s)
- Lee Ratner
- Division of Oncology, Washington University, St. Louis, Missouri 63110, USA.
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Brown M, Bellon M, Nicot C. Emodin and DHA potently increase arsenic trioxide interferon-alpha-induced cell death of HTLV-I-transformed cells by generation of reactive oxygen species and inhibition of Akt and AP-1. Blood 2006; 109:1653-9. [PMID: 17077332 PMCID: PMC1794054 DOI: 10.1182/blood-2006-04-015537] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adult T-cell leukemia (ATL) is an aggressive lymphoproliferative disease of poor clinical prognosis associated with infection by the human T-cell leukemia virus type I (HTLV-I). The use of arsenic trioxide (As2O3) has been shown to effectively treat acute promyelocytic leukemia (APL) with greater than 80% of patients achieving complete remission. The combination of arsenic and interferon has also shown promising results in the treatment of ATL. The requirement for slow dosage increases of arsenic and the time required to achieve a pharmacologic active dose in patients is a major obstacle because median survival of patients with ATL is about 6 months. In this study we report a potent synergistic effect of the combination of arsenic trioxide and interferon alpha (As/IFN-alpha) with emodin and DHA on cell-cycle arrest and cell death of HTLV-I-infected cells. Importantly, we found that clinically achievable doses of DHA and emodin allowed for reduced arsenic concentrations by 100-fold while still remaining highly toxic to tumor cells. Our data provide a rationale for combined use of As/IFN-alpha with emodin and DHA in patients with ATL refractory to conventional therapy.
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Affiliation(s)
- Megan Brown
- Department of Microbiology, Immunology, and Molecular Genetics, University of Kansas Medical Center, Kansas City 66160, USA
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Abstract
PURPOSE OF REVIEW This article summarizes the current pathophysiologic basis for human T cell lymphotropic virus-associated leukemia/lymphoma as well as past, present, and future therapeutic options. RECENT FINDINGS New studies have been published on allogeneic stem cell transplantation, arsenic trioxide, and bortezomib for this condition. SUMMARY Studies of the molecular biology of human T cell lymphotropic virus-1-induced T cell leukemia/lymphoma have defined a critical role for oncoprotein, Tax, and activation of nuclear factor kappaB transcription pathways, which have provided rational approaches to improved therapy for T cell leukemia/lymphoma as well as a model for other hematopoietic malignancies characterized by nuclear factor kappaB activation.
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Affiliation(s)
- Lee Ratner
- Division of Molecular Oncology, Washington University, 660 South Euclid Avenue, Saint Louis, MO 63110, USA.
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Minderman H, O'Loughlin KL, Smith PF, Pendyala L, Greco WR, Sweeney KG, Ford LA, Wetzler M, Baer MR. Sequential administration of irinotecan and cytarabine in the treatment of relapsed and refractory acute myeloid leukemia. Cancer Chemother Pharmacol 2005; 57:73-83. [PMID: 16010591 DOI: 10.1007/s00280-005-0017-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 04/04/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE Based on reported synergy of the topoisomerase-I (topo-I) inhibitor irinotecan with antimetabolites, irinotecan and cytarabine (Ara-C) were administered sequentially to patients with acute myeloid leukemia (AML) refractory to or relapsed following high-dose Ara-C and anthracycline therapy. Pharmacokinetic and pharmacodynamic studies were performed with the first irinotecan dose. EXPERIMENTAL DESIGN In vitro synergy of irinotecan followed by Ara-C was confirmed in a human AML cell line as a basis for the clinical trial. Irinotecan was administered daily for 5 days, with Ara-C 1 g/m2 12 h after each irinotecan dose. Irinotecan was initiated at 5 mg/m2, and the dose was escalated by 5 mg/m2 increments in cohorts of three patients and in individual patients. Pre-treatment samples were studied for topo-I activity and serial samples after the first irinotecan dose were analyzed for pharmacokinetics and for pharmacodynamic effects, including DNA damage and DNA synthesis rate. RESULTS The irinotecan dose reached 15 mg/m2 in three-patient cohorts without reaching the maximum tolerated dose, and reached 30 mg/m2 in individual patients. The AUC and Cmax of both irinotecan and its active metabolite SN38 increased linearly in proportion to dose, and the mean half-lives of irinotecan conversion to SN38 and SN38 elimination were 6.2 h (CV 171%) and 7.2 h (CV 48%). Irinotecan rapidly induced DNA damage, and DNA synthesis inhibition varied among patients and treatment cycles. All courses resulted in rapid cytoreduction, and two patients achieved complete remission. Topo-I activity did not predict response. CONCLUSION Irinotecan can be safely administered with Ara-C. This combination is active in refractory AML and warrants further study.
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Affiliation(s)
- Hans Minderman
- Leukemia Section, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Yokote T, Akioka T, Oka S, Yamano T, Hara S, Higashi K, Enomoto U, Kusakabe H, Kiyokane K, Tsuji M, Hanafusa T. Irinotecan (CPT-11) in the treatment of mycosis fungoides. Br J Dermatol 2005; 153:1086-8. [PMID: 16225643 DOI: 10.1111/j.1365-2133.2005.06930.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Taylor GP, Matsuoka M. Natural history of adult T-cell leukemia/lymphoma and approaches to therapy. Oncogene 2005; 24:6047-57. [PMID: 16155611 DOI: 10.1038/sj.onc.1208979] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
After cell-to-cell transmission, HTLV-I increases its viral genome by de novo infection and proliferation of infected cells. Proliferation of infected cells is clonal and persistent in vivo. During the carrier state, infected cells are selected in vivo by the host's immune system, the genetic and epigenetic environment of proviral integration sites, and other factors. In leukemic cells, tax gene expression is frequently impaired by genetic and epigenetic mechanisms. Such loss of Tax expression enables ATL cells to escape the host immune system. On the other hand, ATL cells acquire the ability to proliferate without Tax by intracellular genetic and epigenetic changes. Despite advances in support and the development of novel treatment agents, the prognosis for ATLL remains poor. A number of therapies, however, do appear to improve prognosis compared to CHOP (VEPA). These include interferon-alpha plus zidovudine (probably after 1-2 cycles of CHOP), intensive chemotherapy as in LSG-15 with G-CSF support and Allo-SCT (which includes the potential for cure). Emerging novel approaches include HDAC inhibitors, monoclonal antibodies, and proteasome inhibitors. Comparison between different therapeutic approaches is complicated by the range of natural history of ATLL, different recruitments of naïve-to-therapy, refractory or relapsed patients, and variations in the reporting of outcome that frequently excludes difficult-to-evaluate patients. Moreover, results from relatively small proof-of-principle studies have not been extended with randomized, controlled trials. As a result, currently, there is no clear evidence to support the value of any particular treatment approach over others. To avoid further unnecessary patient suffering and to identify optimal therapy as rapidly as possible, large randomized, controlled trials encompassing multicenter, international collaborations will be necessary.
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Affiliation(s)
- Graham P Taylor
- Department of GU Medicine & Communicable Diseases, Faculty of Medicine, Imperial College, Norfolk Place, London W2 1PG, UK
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Abstract
Adult T-cell leukaemia or lymphoma is an aggressive malignant disease of mature activated T cells caused by human T-cell lymphotropic virus type I. Patients with this disease have a very poor outlook because of intrinsic chemoresistance and severe immunosuppression. In acute adult T-cell leukaemia, clinical trials in Japan show that although non-targeted combinations of chemotherapy improve response, they do not have a significant effect on complete remission and survival. Antiretroviral therapy with combination zidovudine and interferon alfa, which induces a high rate of complete remission and lengthens survival, should be the first treatment option in acute adult T-cell leukaemia. Patients with adult T-cell lymphoma might benefit from initial aggressive chemotherapy followed by antiretroviral therapy. To prevent relapse in all patients allogeneic bone-marrow transplantation when feasible, or additional targeted therapy, should be mandatory. Based on current pathophysiology, we discuss promising new drugs such as arsenic trioxide, proteasome inhibitors, retinoids, and angiogenesis inhibitors, as well as cellular immunotherapy.
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Abstract
The results of the clinical trials by the Lymphoma Study Group of the Japan Clinical Oncology Group (JCOG-LSG) and those of the industry-supported trials mainly conducted by the members of JCOG-LSG are summarized. In the treatment of advanced aggressive non-Hodgkin's lymphoma (NHL), we investigated the efficacy of granulocyte colony-stimulating factor (G-CSF)-supported, dose-intensified strategies. Based on the results of a randomized phase II study (JCOG9505), we conducted a phase III study, JCOG9809, comparing CHOP and biweekly CHOP. However, JCOG9809 was terminated early based on the results of a planned interim analysis, because it was deemed highly unlikely that biweekly CHOP would be superior to standard CHOP. For aggressive ATL, a G-CSF-supported, dose-intensified, multi-agent regimen (JCOG9303; LSG15) showed superior efficacy to our historical controls. To establish a new standard for ATL, we conducted a phase III study, JCOG9801, comparing LSG15 and biweekly CHOP. To develop new agents for lymphoid malignancies, we focused on irinotecan hydrochloride, interferon-alpha, cladribine and oral fludarabine. Among them, cladribine and oral fludarabine are promising for indolent B-cell malignancies. The Japanese phase I and II studies of rituximab, a chimeric anti-CD20 monoclonal antibody, in relapsed indolent and aggressive B-NHL showed high efficacy with minimal toxicities, which led us to conduct combination studies with chemotherapy for B-NHL. In addition, a phase I study of a radiolabeled anti-CD20 antibody (ibritumomab tiuxetan) was completed in 2003, and a phase II study for indolent B-NHL will be initiated. The multicenter trials by the JCOG-LSG and industry-supported new agent studies will contribute to further improvement in the treatment of malignant lymphoma.
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Affiliation(s)
- Kensei Tobinai
- Hematology Division, National Cancer Center Hospital, Tokyo 104-0045, Japan.
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Suzumiya J, Suzushima H, Maeda K, Okamura S, Utsunomiya A, Shibuya T, Tamura K. Phase I Study of the Combination of Irinotecan Hydrochloride, Carboplatin, and Dexamethasone for the Treatment of Relapsed or Refractory Malignant Lymphoma. Int J Hematol 2004; 79:266-70. [PMID: 15168596 DOI: 10.1532/ijh97.03071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A phase I study of irinotecan hydrochloride (CPT-11), carboplatin, and dexamethasone treatment in 7 patients with relapsed lymphoma and 7 patients with refractory lymphoma was conducted to evaluate the maximal tolerated dose. The 6 female and 8 male patients had a median age of 63 years (range, 45-73 years), a median performance status of 0 (range, 0-2), and a median disease stage of IV. This study included patients with diffuse large B-cell lymphoma (n = 5), adult T-cell leukemia/lymphoma (n = 2), mantle cell lymphoma (n = 2), follicular lymphoma (n = 2), angioimmunoblastic T-cell lymphoma (n = 1), anaplastic large cell lymphoma (n = 1), and Hodgkin's lymphoma (n = 1). All patients had received anthracycline-containing combination chemotherapy prior to this therapy. The starting dosage of CPT-11 was 15 mg/m2 per day (days 1-3 and 8-10), and dosage-escalation increments of 5 mg/m2 per day were planned, with fixed dosages of carboplatin (250 mg/m2 per day, day 1) and dexamethasone (40 mg/body, days 1-3 and days 8-10). Five patients were enrolled at level 1, 3 at level 2, 4 at level 3, and 2 at level 4. Ten patients (71%) and 11 patients (79%) experienced grade 3 or 4 hematologic toxicities of leukocytopenia and neutropenia, respectively. Three patients (29%) and 9 patients (64%) experienced grade 3 or 4 thrombocytopenia and anemia, respectively. Two patients who received 30 mg/m2 (level 4) of CPT-11 developed sepsis. We concluded that the recommended dose of CPT-11 with carboplatin and dexamethasone is 25 mg/m2. No deaths were related to this chemotherapy, and no patient developed liver dysfunction. The overall response rate was 36%. We conclude that the combination therapy of CPT-11, carboplatin, and dexamthasone is effective as salvage therapy but that the duration of response is too short.
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Affiliation(s)
- Junji Suzumiya
- Department of Internal Medicine, Fukuoka University, School of Medicine, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan.
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Abstract
More than 2 decades have elapsed since the proposal of adult T-cell leukemia (ATL). Since then, the discovery of the etiologic virus, human T-cell leukemia virus type I (HTLV-I), and the establishment of the diagnostic steps of serum test and molecular study have clearly defined ATL as a distinct disease entity. Because conventional chemotherapy, which is active against other lymphoid malignancies, was proven to be ineffective for treating aggressive forms of ATL, ATL has become the target of several clinical studies for the purpose of improving therapeutic outcomes. Combination chemotherapy exclusively designed for ATL has considerably elevated the treatment response rate in ATL patients, but it has not sufficiently extended the median survival time. The introduction of antiviral agents has led to surprising effects for patients with acute ATL. Monoclonal antibodies seem to be promising, especially for patients with chemotherapy-resistant disease. Unfortunately, these approaches did not prove to be sufficient for most patients with ATL to obtain long-term survival. Recent promising reports on allogeneic stem cell transplantation (allo-SCT) for ATL have suggested that allo-SCT could overcome the limitations that other treatment modalities have not surmounted. More efforts are clearly needed to clarify the usefulness of allo-SCT, especially with reduced-intensity conditioning regimens, for ATL patients.
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Affiliation(s)
- Takayuki Ishikawa
- Department of Hematology/Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Abstract
The primate T-cell lymphoma/leukemia viruses belong to an oncogenic genus of complex retroviruses. Members of this genus have been shown to be pathogenic in man. The human T-cell lymphoma/leukemia virus (HTLV) type I has been linked in the etiology of T-cell malignancies and "autoimmune-like" neurologic and rheumatic disorders; a related virus, HTLV-II, is becoming increasingly associated with similar disorders. Cell transformation is thought to be caused predominantly by the effects of the viral regulatory protein, Tax. An additional induced host cell molecule, adult T-cell lymphoma-derived factor, may contribute to cell immortalization. Like the DNA tumor viruses, HTLV activates transcription of cellular proto-oncogenes and inhibits cellular mechanisms of tumor suppression, cell cycle arrest, and apoptosis. However, individuals who are able to mount a strong cell-mediated immune response and limit viral entry into uninfected cells do not develop associated malignancies. Unfortunately, HTLV-induced malignancies are difficult to treat with conventional chemotherapy, and disease progression is often rapid with a median survival of less than 2 years. There are, however, some novel approaches that have yet to be fully tested that may have greater efficacy in the treatment of HTLV-induced diseases. In the future, better screening and detection methods, along with new vaccines and therapies, may contribute to the increased prevention and control of HTLV infection and its associated diseases.
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Affiliation(s)
- Bernard J Poiesz
- Department of Medicine, Upstate Medical University, SUNY Syracuse, New York 13120, USA.
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Silva KL, Vasconcelos FC, Marques-Santos LF, Kwee JK, Maia RC. CPT-11-induced cell death in leukemic cells is not affected by the MDR phenotype. Leuk Res 2003; 27:243-51. [PMID: 12537977 DOI: 10.1016/s0145-2126(02)00094-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CPT-11 is a topoisomerase I (Topo I) inhibitor which was initially described as active in multi-drug resistance (MDR) tumors. The MDR phenomenon is characterized by the overexpression of efflux pumps which are able to extrude a range of drugs non-related chemical or functionally. In this work, we treated leukemic cells with CPT-11 300 microM at 24h and compared its cytotoxicity with the activity of efflux pumps and with cell cycle phase. Our findings show that CPT-11 has a potent anti-tumor activity in leukemic cells regardless MDR phenotype and the cell cycle phase, suggesting new avenues to be explored in leukemia treatment.
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Affiliation(s)
- Karina L Silva
- Laboratório de Hematologia Celular e Molecular, Serviço de Hematologia, Hospital do Câncer (HC-I), Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
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Ribrag V, Suzan F, Ravoet C, Feremans W, Guerci A, Dreyfus F, Damaj G, Vantelon JM, Bourhis JH, Fenaux P. Phase II trial of CPT-11 in myelodysplastic syndromes with excess of marrow blasts. Leukemia 2003; 17:319-22. [PMID: 12592329 DOI: 10.1038/sj.leu.2402726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2002] [Accepted: 07/03/2002] [Indexed: 11/09/2022]
Abstract
CPT-11 is an antineoplastic agent which acts as a specific inhibitor of DNA topisomerase 1 and has a broad spectrum of activity in solid tumors. Very few studies have evaluated the activity of CPT-11 in hematological malignancies. We conducted a phase II trial of CPT-11 in 26 patients with high-risk MDS (RAEB 1: n = 4; RAEB 2: n = 9; MDS having progressed to AML: n = 10; CMML: n = 3) who could not receive anthracycline/cytarabine intensive chemotherapy. Induction therapy consisted of four courses of CPT-11 given intravenously at 200 mg/m(2) every 2 weeks. Patient characteristics were: median age, 71 (range 51-77); sex, (M/F), 21/5, median % marrow blasts cells, 13.5 (range 7-52). Cytogenetics according to IPSS were: low-risk n = 13, intermediate-risk n = 6, high-risk n = 3, failure or not done n = 4. Six patients stopped treatment after only one or two courses of CPT-11 due to severe infection (n = 2), progressive disease (n = 3), acute lysis syndrome with renal failure (n = 1). In the 20 patients who received at least three cycles of CPT-11, complete remission was achieved in one case, partial remission in four cases, and hematological improvement in three cases with an overall response rate of 33% in the 26 patients. Duration of response was short (median 4 months, range 1-6 months) and median survival was 8 months (range 1-23 months). Digestive toxicity (diarrhea) occurred in 26/89 (29%) courses, but was mild (grade 1, 20% courses; grade 2 or 3, 9% courses). Hematological toxicity was difficult to assess in non-responders because of initial pancytopenia, but all the patients who responded had grade 3/4 hematological toxicity associated with grade >/=2 infection requiring hospitalization in 18% of the courses. No other major toxicity was observed. Thus CPT-11 has an interesting activity in MDS with excess of blasts; toxicity is easily managed and most patients can be treated in the out-clinic setting. These results suggest that further evaluation of CPT-11 in MDS is warranted.
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Affiliation(s)
- V Ribrag
- Institut Gustave Roussy, Villejuif, France
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Abstract
Camptothecin analogues and derivatives appear to exert their antitumour activity by binding to topoisomerase I and have shown significant activity against a broad range of tumours. In general, camptothecins are not substrates for either the multidrug-resistance P-glycoprotein or the multidrug-resistance-associated protein (MRP). Because of manageable toxicity and encouraging activity against solid tumours, camptothecins offer promise in the clinical management of human tumours. This review illustrates the proposed mechanism(s) of action of camptothecins and presents a concise overview of current camptothecin therapy, including irinotecan and topotecan, and novel analogues undergoing clinical trails, such as exatecan (DX-8951f), IDEC-132 (9-aminocamptothecin), rubitecan (9-nitrocamptothecin), lurtotecan (GI-147211C), and the recently developed homocamptothecins diflomotecan (BN-80915) and BN-80927.
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Affiliation(s)
- Hulya Ulukan
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, Ohio 43210-1291, USA
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Bazarbachi A, Hermine O. Treatment of adult T-cell leukaemia/lymphoma: current strategy and future perspectives. Virus Res 2001; 78:79-92. [PMID: 11520582 DOI: 10.1016/s0168-1702(01)00286-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human T-cell leukaemia virus type I (HTLV-I) associated adult T-cell leukaemia/lymphoma (ATL) carries a very poor prognosis due to an intrinsic resistance of leukaemic cells to conventional or even high doses of chemotherapy and to an associated severe immunosuppression. Therefore, the potential role of conventional chemotherapy, high dose chemotherapy with autologous or allogeneic bone marrow transplantation remains to be defined. Important progress was achieved in the treatment of ATL with the combination of zidovudine (AZT) and interferon-alpha (IFN) which produces a high response rate in ATL patients with minimal side effects. This treatment seems to prolong the survival of patients much more than intensive chemotherapy. The success of this potentially anti-retroviral approach in the treatment of ATL suggests the existence of continuous HTLV-I replication in vivo. These encouraging results may be improved by the use of higher doses of AZT and IFN combined with other anti-retroviral agents. However, since cure seems still elusive, new therapeutic approaches or new combinations are required. For example, biological mediators such as retinoid acid, which induces apoptosis of ATL cells in vitro, may reduce drug resistance and stimulates immunity to restore anti-tumour activity against ATL cells. Alternatively, immunotherapy with anti-interleukin-2 receptor monoclonal antibodies or injection of cytotoxic T-cells directed against virus antigens could be interesting approaches which may merit further investigations in the near future. Finally, the recent demonstration that the combination of arsenic trioxide (As) and IFN induces a specific degradation of the viral transactivator Tax followed by cell cycle arrest and apoptosis of HTLV-I positive cells may constitute a valuable addition to ATL treatment.
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Affiliation(s)
- A Bazarbachi
- Department of Internal Medicine, American University of Beirut, PO Box 113, 6044, Beirut, Lebanon.
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Siegel RS, Gartenhaus RB, Kuzel TM. Human T-cell lymphotropic-I-associated leukemia/lymphoma. Curr Treat Options Oncol 2001; 2:291-300. [PMID: 12057109 DOI: 10.1007/s11864-001-0022-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Human T-cell lymphotropic virus-I (HTLV-I)-related adult T-cell leukemia/lymphoma (ATL) is a model disease for proof of viral oncogenesis. HTLV-I infection is endemic in southern Japan and the Caribbean basin, and occurs sporadically in Africa, Central and South America, the Middle East, and the southeastern United States. ATL occurs in only 2% to 4% of HTLV-I-infected people [1-3]. When it does occur, it is usually aggressive and difficult to treat; most people survive for less than 1 year [1-3]. Combination chemotherapy with cytotoxic agents has yielded complete response rates of 20% to 45%, but responses usually last only a few months [3]. Recently, novel treatments, such as monoclonal antibodies directed at the interleukin-2 receptor and the combination of interferon alfa and zidovudine, have been shown to be active in the treatment of patients with ATL. A small percentage of patients achieve long-lasting remissions [2,3].
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Affiliation(s)
- R S Siegel
- Division of Hematology/Oncology, Department of Medicine, Northwestern University Medical School, and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 676 N. St. Clair, Suite 850, Chicago, IL 60611, USA
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Takagi T, Saotome T. Chemotherapy with irinotecan (CPT-11), a topoisomerase-I inhibitor, for refractory and relapsed non-Hodgkin's lymphoma. Leuk Lymphoma 2001; 42:577-86. [PMID: 11697485 DOI: 10.3109/10428190109099317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Irinotecan hydrochloride (CPT-11), a DNA topoisomerase-I inhibitor, is now widely used in the treatment of various solid tumors, including colorectal, gastric, breast, lung, and ovarian cancer. Despite the good response shown in the late phase-II study, CPT-11 was not often employed in the treatment of malignant lymphoma, mainly because of severe leukopenia and diarrhea caused by the recommended schedule: 40 mg/m2 of CPT-11 on days 1 to 3, 8 to 10, 15 to 17, then discontinued for at least 2 weeks. In clinical use, administration of CPT-11 had to be ceased on days 15 to 17 in almost all cases, and on days 8 to 10 in a considerable number of patients. Subsequently, a lower dose schedule (less than 40 mg/m2) was developed. Our phase II trial employing a reduced dose of CPT-11 on days 1 and 2, plus ADM on day 3 with 3-week interval in patients with refractory and relapsed NHL showed a fairly good response of relapsed B-cell lymphoma and a substantial response of T-cell lymphoma with acceptable toxicity. The combination of a topoisomerase-I inhibitor (CPT-11) and a topoisomerase-II inhibitor is an interesting concept for the treatment of NHL. Another phase II trial in combination with CPT-11 and other anti-cancer drugs, particularly cisplatin or topoisomerase-II inhibitors, is warranted. A superior salvage chemotherapy regimen could be found in the future by investigating combinations of low-dose CPT-11 and cisplatin or topoisomerase-II inhibitors.
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Affiliation(s)
- T Takagi
- Division of Laboratory Medicine, Chiba Cancer Center Hospital, Japan.
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Yamada Y, Tomonaga M, Fukuda H, Hanada S, Utsunomiya A, Tara M, Sano M, Ikeda S, Takatsuki K, Kozuru M, Araki K, Kawano F, Niimi M, Tobinai K, Hotta T, Shimoyama M. A new G-CSF-supported combination chemotherapy, LSG15, for adult T-cell leukaemia-lymphoma: Japan Clinical Oncology Group Study 9303. Br J Haematol 2001; 113:375-82. [PMID: 11380402 DOI: 10.1046/j.1365-2141.2001.02737.x] [Citation(s) in RCA: 258] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This phase II trial was performed to evaluate the efficacy of a new granulocyte colony-stimulating factor (G-CSF)-supported multi-agent chemotherapy protocol, LSG15, for aggressive adult T-cell leukaemia-lymphoma (ATL). Ninety-six previously untreated patients with aggressive ATL were enrolled and grouped as: acute type (58), lymphoma type (28) and unfavourable chronic type (10). Therapy consisted of seven cycles of VCAP (vincristine, cyclophosphamide, doxorubicin and prednisone), AMP (doxorubicin, ranimustine and prednisone) and VECP (vindesine, etoposide, carboplatin and prednisone). G-CSF was administered during the intervals between chemotherapy until neutrophil reconstitution was achieved. Eighty-one per cent of the 93 eligible patients responded [95% confidence interval (CI), 71.1-88.1%], with 33 patients obtaining complete response (35.5%) and 42 obtaining partial response (45.2%). The median survival time (MST) after registration was 13 months and the median follow-up duration of the 20 surviving patients was 4.2 years (range 2.8-5.6). Overall survival at 2 years was estimated to be 31.3% (95% CI, 22.0-40.5%). Grade 4 haematological toxicity of neutropenia and thrombocytopenia were observed in 65.3% and 52.6% of the patients respectively, but grade 4 non-haematological toxicity was observed in only one patient. LSG15 is feasible with mild non-haematological toxicity and improved the clinical outcome of ATL patients. MST and overall survival at 2 years were superior to those obtained by our previous trials.
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Affiliation(s)
- Y Yamada
- Department of Laboratory Medicine, Nagasaki University, Nagasaki, Japan.
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41
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Siegel R, Gartenhaus R, Kuzel T. HTLV-I associated leukemia/lymphoma: epidemiology, biology, and treatment. Cancer Treat Res 2001; 104:75-88. [PMID: 11191136 DOI: 10.1007/978-1-4615-1601-9_3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- R Siegel
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, USA
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42
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Abstract
Abstract
This review covers the diagnosis and management of natural killer and peripheral T-cell lymphomas (PTCL). Problems with PTCL include their rarity, representing usually 10-15% of non-Hodgkin's lymphomas in the Western Hemisphere, morphologic heterogeneity, and lack of immunophenotypic markers for clonality. Additionally, their clinical behavior is variable and may not correlate with morphology.
Dr. Kinney gives a general overview of the diagnosis of PTCL and NK cell neoplasms. Emphasis will be placed on extranodal T cell and natural killer (NK) cell lymphomas such as hepatosplenic lymphoma, subcutaneous panniculitis-like lymphoma and nasal/nasal type T/NK-cell lymphoma. The use of ALK gene regulation in the classification of anaplastic large cell lymphoma is also reviewed.
Dr. Loughran describes current understanding of the pathogenesis of large granular lymphocyte (LGL) leukemia. The discussion focuses on LGL leukemia as an instructive model of dysregulated apoptosis causing both malignant and autoimmune disease. Current management options and mechanisms of therapeutic response are also described.
Dr. Greer addresses whether PTCL should be treated differently from the more common diffuse large B cell lymphomas. He discusses the therapeutic options for anaplastic large cell lymphoma (ALCL), from a conservative approach for primary cutaneous ALCL to combination chemotherapy for the highly chemosensitive ALCL expressing anaplastic lymphoma kinase. He reviews therapy options for the extranodal subtypes of PTCL by drawing from series in adults, pediatrics, dermatology, and the Far East.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Humans
- Killer Cells, Natural/pathology
- Leukemia, T-Cell/etiology
- Leukemia, T-Cell/pathology
- Leukemia, T-Cell/therapy
- Lymphoma, T-Cell, Peripheral/etiology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Lymphoproliferative Disorders/etiology
- Lymphoproliferative Disorders/pathology
- Lymphoproliferative Disorders/therapy
- T-Lymphocytes/pathology
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Affiliation(s)
- J P Greer
- H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
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White JD, Wharfe G, Stewart DM, Maher VE, Eicher D, Herring B, Derby M, Jackson-Booth PG, Marshall M, Lucy D, Jain A, Cranston B, Hanchard B, Lee CC, Top LE, Fleisher TA, Nelson DL, Waldmann TA. The combination of zidovudine and interferon alpha-2B in the treatment of adult T-cell leukemia/lymphoma. Leuk Lymphoma 2001; 40:287-94. [PMID: 11426550 DOI: 10.3109/10428190109057927] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adult T-cell leukemia/lymphoma (ATL) is frequently a very aggressive malignancy with a poor survival despite aggressive multiagent chemotherapy. The combination of the antiretroviral drug zidovudine (AZT) and interferon alpha (IFNalpha) has been reported to induce remissions in patients with ATL. The purpose of this study was to evaluate the clinical response and toxicity following administration of a combination of IFNalpha-2b and AZT in patients with human T-cell lymphotropic virus type I (HTLV-I)-associated ATL. Eighteen patients with ATL (chronic. crisis, acute or lymphoma type) were treated with the combination of AZT (50 - 200 mg orally 5 times a day) and IFNalpha-2b (2.5 - 10 million units subcutaneously daily). Three patients had objective responses lasting more than one month. One patient had a clinical complete remission, lasting 21.6 months and two patients had partial remissions lasting 3.7 and 26.5 months. Six patients were not considered evaluable for response due to short and/or interrupted periods of treatment. Seventeen patients have died with a median survival time after initiation of therapy of 6 months. Neutropenia and thrombocytopenia were the dose limiting toxicities. In conclusion, the response rate in this study was lower than noted in the two previous published series. This may be due to the amount and type of prior treatment our patients had received.
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Affiliation(s)
- J D White
- Metabolism Branch, National Cancer Institute, University of the West Indies, Kingston, Jamaica
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Masuda N, Negoro S, Kudoh S, Sugiura T, Nakagawa K, Saka H, Takada M, Niitani H, Fukuoka M. Phase I and pharmacologic study of docetaxel and irinotecan in advanced non-small-cell lung cancer. J Clin Oncol 2000; 18:2996-3003. [PMID: 10944133 DOI: 10.1200/jco.2000.18.16.2996] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We conducted a phase I trial of docetaxel, a new antimicrotubule agent, combined with irinotecan (CPT-11), a topoisomerase I inhibitor. The aim was to determine the maximum-tolerated dose (MTD) of docetaxel combined with CPT-11, as well as the dose-limiting toxicities (DLTs) of this combination in advanced non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS Thirty-two patients with stage IIIB or IV NSCLC were treated at 4-week intervals with docetaxel (60 minutes, day 2) plus CPT-11 (90 minutes, days 1, 8, and 15). The starting doses of docetaxel/CPT-11 were 30/40 mg/m(2), and doses were escalated in 10-mg/m(2) increments until the MTD was reached. RESULTS The MTD of docetaxel/CPT-11 was 50/60 mg/m(2) (level 5A), or 60/50 mg/m(2) (level 5B). Neutropenia and diarrhea were the DLTs. CPT-11 did not affect the pharmacokinetics of docetaxel. There were 11 (37%) partial responses among 30 patients. The median survival time was 48 weeks, and the 1-year survival rate was 44.9%. CONCLUSION The combination of docetaxel and CPT-11 seems to be active against NSCLC, with acceptable toxicity. The recommended dose for phase II studies is 50 mg/m(2) of CPT-11 (days 1, 8, and 15) and 50 mg/m(2) of docetaxel (day 2) administered every 28 days.
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Affiliation(s)
- N Masuda
- Departments of Internal Medicine, Osaka Prefectural Habikino Hospital and Kinki University School of Medicine, Osaka, Japan
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DeVore RF, Johnson DH, Crawford J, Garst J, Dimery IW, Eckardt J, Eckhardt SG, Elfring GL, Schaaf LJ, Hanover CK, Miller LL. Phase II study of irinotecan plus cisplatin in patients with advanced non-small-cell lung cancer. J Clin Oncol 1999; 17:2710-20. [PMID: 10561345 DOI: 10.1200/jco.1999.17.9.2710] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the antitumor efficacy and safety of a combination of irinotecan (CPT-11) and cisplatin in patients with inoperable non-small-cell lung cancer (NSCLC). A secondary objective was to characterize the pharmacokinetics and pharmacodynamics of CPT-11 and its active metabolite, SN-38. PATIENTS AND METHODS Patients with stage IIIB or IV NSCLC were treated with repeated 4-week courses comprising CPT-11 (60 mg/m(2)) administered on days 1, 8, and 15, and a single dose of cisplatin (80 mg/m(2)) after CPT-11 administration on day 1. RESULTS Fifty-two patients were enrolled, including 33 men and 19 women. The median age was 61 years (range, 29 to 79 years). Southwest Oncology Group performance status was 0 in 12 patients, 1 in 32 patients, and 2 in eight patients. Eleven and 41 patients had stage IIIB and IV disease, respectively. Objective responses occurred in 28.8% of patients (15 of 52; 95% confidence interval, 16.5% to 41.2%). The median survival duration was 9.9 months (range, 1.6 to 30.8 months). The 1-year survival rate was 37%. Grade 3/4 adverse events consisted primarily of nausea (32. 7% ) or vomiting (13.5%), late-onset diarrhea (17.3%), and neutropenia (46.1%). The study design led to preferential modification of CPT-11 doses, resulting in CPT-11 dose attenuations to < or = 40 mg/m(2) in the majority of patients (31 of 52; 60%), whereas dose reductions of cisplatin were uncommon. CPT-11 pharmacokinetic parameters were comparable to those reported previously in single-agent studies. CONCLUSION CPT-11/cisplatin is an active combination regimen with manageable toxicity in the therapy of stage IIIB/IV NSCLC. Future studies should be designed with schedules and dose modification provisions that avoid unnecessary CPT-11 dose reductions to exploit more directly the therapeutic synergy of these agents.
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Affiliation(s)
- R F DeVore
- Vanderbilt University, Nashville, TN 37232, USA.
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Furman WL, Stewart CF, Poquette CA, Pratt CB, Santana VM, Zamboni WC, Bowman LC, Ma MK, Hoffer FA, Meyer WH, Pappo AS, Walter AW, Houghton PJ. Direct translation of a protracted irinotecan schedule from a xenograft model to a phase I trial in children. J Clin Oncol 1999; 17:1815-24. [PMID: 10561220 DOI: 10.1200/jco.1999.17.6.1815] [Citation(s) in RCA: 189] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In a preclinical model of neuroblastoma, administration of irinotecan daily 5 days per week for 2 consecutive weeks ([qd x 5] x 2) resulted in greater antitumor activity than did a single 5-day course with the same total dose. We evaluated this protracted schedule in children. PATIENTS AND METHODS Twenty-three children with refractory solid tumors were enrolled onto a phase I study. Cohorts received irinotecan by 1-hour intravenous infusion at 20, 24, or 29 mg/m(2) (qd x 5) x 2 every 21 days. RESULTS The 23 children (median age, 14.1 years; median prior regimens, two) received 84 courses. Predominant diagnoses were neuroblastoma (n = 5), osteosarcoma (n = 5), and rhabdomyosarcoma (n = 4). The dose-limiting toxicity was grade 3/4 diarrhea and/or abdominal cramps in six of 12 patients treated at 24 mg/m(2), despite aggressive use of loperamide. The maximum-tolerated dose (MTD) on this schedule was 20 mg/m(2)/d. Five patients had partial responses and 16 had disease stabilization. On day 1, the median systemic exposure to SN-38 (the active metabolite of irinotecan) at the MTD was 106 ng-h/mL (range, 41 to 421 ng-h/mL). CONCLUSION This protracted schedule is well tolerated in children. The absence of significant myelosuppression and encouraging clinical responses suggest compellingly that irinotecan be further evaluated in children using the (qd x 5) x 2 schedule, beginning at a dose of 20 mg/m(2). These results imply that data obtained from xenograft models can be effectively integrated into the design of clinical trials.
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Affiliation(s)
- W L Furman
- Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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Takimoto CH, Wright J, Arbuck SG. Clinical applications of the camptothecins. BIOCHIMICA ET BIOPHYSICA ACTA 1998; 1400:107-19. [PMID: 9748525 DOI: 10.1016/s0167-4781(98)00130-4] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The camptothecin topoisomerase I-targeting agents are new class of antitumor drugs with demonstrated clinical activity in human malignancies, such as colorectal cancer and ovarian cancer. Currently, irinotecan and topotecan are the most widely used camptothecin analogs in clinical use and clinical trials are ongoing to better characterize their spectra of clinical activity, to determine their optimal schedules of administration and to define their use in combination with other chemotherapeutic agents. Newer camptothecin analogs in clinical development, such as 9-aminocamptothecin, 9-nitrocamptothecin, GI147211 and DX-8951f, are also being studied to determine if they have improved toxicity and efficacy profiles compared with existing analogs. Other potential clinical applications include the use of camptothecin derivatives as radiation sensitizers or as antiviral agents. The successful development of the camptothecins as antitumor agents highlights the importance of topoisomerase I as a target for cancer chemotherapy.
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Affiliation(s)
- C H Takimoto
- Developmental Therapeutics Department, Medicine Branch, Division of Clinical Sciences, National Cancer Institute, Building 8, Room 5101, Bethesda Naval Hospital, Bethesda, MD 20892, USA.
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Affiliation(s)
- R Pawson
- Department of Haematology, Royal Free Hospital, London
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Ravandi-Kashani F, Sriswasdi C, Lynott A, Giles FJ. HTLV-1 and Adult T-Cell Leukemia/Lymphoma: A Review. Hematology 1998; 3:429-41. [PMID: 27420330 DOI: 10.1080/10245332.1998.11746417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Infection with the human T-lymphotropic virus type 1 (HTLV-1) has been shown to be fundamental to the etiology of Adult T-cell Leukemia/Lymphoma (ATL). The disease is endemic in specific geographic areas but is increasingly reported from non-endemic regions. With increasing number of patients with this entity, the diversity in the clinical features has become apparent. In the past treatment strategies using combination chemotherapy have been unsatisfactory, but more recent trials using adenosine analouges, interferons, and combination of interferons and AZT have shown promise. With increased understanding of the etiology and molecular basis of the disease more effective therapies can be anticipated.
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Affiliation(s)
- F Ravandi-Kashani
- a Department of Leukemia , University of Texas , M.D. Anderson Cancer Center , Houston , Texas
| | - C Sriswasdi
- a Department of Leukemia , University of Texas , M.D. Anderson Cancer Center , Houston , Texas
| | - A Lynott
- b International Oncology Study Group , Houston , Texas
| | - F J Giles
- a Department of Leukemia , University of Texas , M.D. Anderson Cancer Center , Houston , Texas
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Saijo N. New chemotherapeutic agents for the treatment of non-small cell lung cancer: the Japanese experience. Chest 1998; 113:17S-23S. [PMID: 9438685 DOI: 10.1378/chest.113.1_supplement.17s] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is refractory to systemic chemotherapy, compared with small cell lung cancer. Until recently, only five drugs--cisplatin, vindesine, mitomycin, ifosfamide, and vinblastine--could produce overall response rates of 15% against NSCLC. However, recent efforts have contributed to the development of new drugs with activity against NSCLC, including irinotecan hydrochloride (CPT-11), paclitaxel, docetaxel, vinorelbine, and gemcitabine. Combination chemotherapy against NSCLC using these agents has demonstrated high response rates. In Japan, various combination chemotherapy and combined-modality regimens employing CPT-11 have been evaluated for their efficacy. Randomized controlled trials to establish new state-of-the-art treatments for NSCLC are ongoing.
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Affiliation(s)
- N Saijo
- Pharmacology Division, National Cancer Center Research Institute and Hospital, Tokyo, Japan
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