1
|
Gutiérrez-Diez PJ, López-Marcos MÁ, Martínez-Rodríguez J, Russo J. The effects of time valuation in cancer optimal therapies: a study of chronic myeloid leukemia. Theor Biol Med Model 2019; 16:10. [PMID: 31138288 PMCID: PMC6540446 DOI: 10.1186/s12976-019-0106-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/07/2019] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND The mathematical design of optimal therapies to fight cancer is an important research field in today's Biomathematics and Biomedicine given its relevance to formulate patient-specific treatments. Until now, however, cancer optimal therapies have considered that malignancy exclusively depends on the drug concentration and the number of cancer cells, ignoring that the faster the cancer grows the worse the cancer is, and that early drug doses are more prejudicial. Here, we analyze how optimal therapies are affected when the time evolution of treated cancer is envisaged as an additional element determining malignancy, analyzing in detail the implications for imatinib-treated Chronic Myeloid Leukemia. METHODS Taking as reference a mathematical model describing Chronic Myeloid Leukemia dynamics, we design an optimal therapy problem by modifying the usual malignancy objective function, unaware of any temporal dimension of cancer malignance. In particular, we introduce a time valuation factor capturing the increase of malignancy associated to the quick development of the disease and the persistent negative effects of initial drug doses. After assigning values to the parameters involved, we solve and simulate the model with and without the new time valuation factor, comparing the results for the drug doses and the evolution of the disease. RESULTS Our computational simulations unequivocally show that the consideration of a time valuation factor capturing the higher malignancy associated with early growth of cancer and drug administration allows more efficient therapies to be designed. More specifically, when this time valuation factor is incorporated into the objective function, the optimal drug doses are lower, and do not involve medically relevant increases in the number of cancer cells or in the disease duration. CONCLUSIONS In the light of our simulations and as biomedical evidence strongly suggests, the existence of a time valuation factor affecting malignancy in treated cancer cannot be ignored when designing cancer optimal therapies. Indeed, the consideration of a time valuation factor modulating malignancy results in significant gains of efficiency in the optimal therapy with relevant implications from the biomedical perspective, specially when designing patient-specific treatments.
Collapse
Affiliation(s)
- Pedro José Gutiérrez-Diez
- Department of Economic Theory and IMUVA, Faculty of Economics, Avda. Valle Esgueva 6, University of Valladolid, Valladolid, 47011 Spain
| | - Miguel Ángel López-Marcos
- Department of Applied Mathematics and IMUVA, Faculty of Science, University of Valladolid, Paseo de Belén 7, Valladolid, 47011 Spain
| | - Julia Martínez-Rodríguez
- Department of Applied Economics and IMUVA, Faculty of Economics, University of Valladolid, Avda. Valle Esgueva 6, Valladolid, 47011 Spain
| | - Jose Russo
- Director of the Breast Cancer Research Laboratory, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, 19111-2497 PA USA
| |
Collapse
|
2
|
Harivenkatesh N, Kumar L, Bakhshi S, Sharma A, Kabra M, Velpandian T, Gogia A, Shastri SS, Gupta YK. Do polymorphisms inMDR1andCYP3A5genes influence the risk of cytogenetic relapse in patients with chronic myeloid leukemia on imatinib therapy? Leuk Lymphoma 2017; 58:1-9. [DOI: 10.1080/10428194.2017.1287359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Lalit Kumar
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Madhulika Kabra
- Pediatrics (Genetics Unit), All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Gogia
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Shivaram S. Shastri
- Pediatrics (Genetics Unit), All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Klaewsongkram J, Thantiworasit P, Sodsai P, Buranapraditkun S, Mongkolpathumrat P. Slow desensitization of imatinib-induced nonimmediate reactions and dynamic changes of drug-specific CD4 +CD25 +CD134 + lymphocytes. Ann Allergy Asthma Immunol 2016; 117:514-519. [PMID: 27788881 DOI: 10.1016/j.anai.2016.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/22/2016] [Accepted: 08/30/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Imatinib is a tyrosine kinase inhibitor indicated for the treatment of gastrointestinal stromal tumors (GISTs) and certain neoplastic diseases; however, nonimmediate adverse reactions are common. OBJECTIVE To describe the process of imatinib slow desensitization in patients who experienced nonimmediate reactions to imatinib and the dynamic change in drug-specific CD4+CD25+CD134+ T-lymphocyte percentages. METHODS Five patients diagnosed as having GISTs and with a recent history of imatinib-induced nonimmediate reactions (maculopapular exanthema with eosinophilia, exfoliative dermatitis, palmar-plantar erythrodysesthesia, and drug rash with eosinophilia and systemic symptoms) were desensitized using a slow desensitization protocol. The reintroduced imatinib dosage was stepped up every week starting from 10 mg/d and increasing to 25, 50, 75, 100, 150, 200, and 300 mg/d until the target dose of 400 mg/d was achieved. Prednisolone of up to 30 mg/d was allowed if allergic reactions recurred. The percentages of CD4+CD25+CD134+ T cells present after incubating peripheral blood mononuclear cells with imatinib, at baseline and after successful desensitization, were analyzed using flow cytometric analysis. RESULTS By using a slow desensitization technique, all patients were able to receive 400 mg/d of imatinib, and prednisolone was gradually tapered off. The percentages of imatinib-induced CD4+CD25+CD134+ T cells decreased from a mean (SD) of 11.3% (6.5%) and 13.4% (7.3%) at baseline to 3.2% (0.7%) and 3.0% (1.1%) after successful desensitization, when stimulating peripheral blood mononuclear cells with 1 and 2 μM of imatinib, respectively. CONCLUSION Slow desensitization is a helpful procedure in treating patients with imatinib-induced nonimmediate reactions other than simple maculopapular exanthema. The reduced percentages of imatinib-induced CD4+CD25+CD134+ T cells in these patients may be associated with immune tolerance.
Collapse
Affiliation(s)
- Jettanong Klaewsongkram
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, and Chulalongkorn Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| | - Pattarawat Thantiworasit
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, and Chulalongkorn Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, Thailand
| | - Pimpayao Sodsai
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supranee Buranapraditkun
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, and Chulalongkorn Allergy and Clinical Immunology Research Group, Chulalongkorn University, Bangkok, Thailand
| | | |
Collapse
|
4
|
Abstract
In chronic myeloid leukemia (CML), the presence of a specific chromosome marker (Ph-chromosome) as well as of the corresponding molecular marker (BCR-ABL fusion transcripts) provides suitable and precise tools to monitor the burden of the disease present at diagnosis and that of the residual disease present at specific time points during treatment. A huge number of studies have clearly demonstrated that in CML cytogenetic and molecular responses are strictly correlated to the final outcome of the patients and the correct use of standardized methods to assess the achievement of specific degrees of disease reduction at specific time points during treatment has become an essential part of proper clinical management of CML. The target to be achieved and the corresponding "optimal response" definition are however evolving, and at least for some patients, they may be represented not only by best possible overall survival (OS) but also by the possibility to discontinue the tyrosine-kinase inhibitor (TKI) treatment and therefore to live in a treatment-free remission (TFR) status. Therefore, at least for some patients, deep degrees of molecular response, as MR(4) and MR(4.5), whose precise definition has been recently introduced and that are prerequisites to try to discontinuation, are becoming the target to be achieved even in common clinical practice. As a fast initial decline of the disease burden after therapy start may be highly predictive for the final outcome of patients not only in terms of progression-free survival (PFS) and of PS but also in terms of possibility of achieving deep molecular responses, a more intense and punctual monitoring of the response of CML patients during the first 6 months of TKI therapy is now recommended by the more recent versions of the European Leukemia Net (ELN) and National Comprehensive Cancer Network (NCCN) guidelines, as this represents the major driver to decide therapy.
Collapse
|
5
|
Khorashad JS, Eiring AM, Mason CC, Gantz KC, Bowler AD, Redwine HM, Yu F, Kraft IL, Pomicter AD, Reynolds KR, Iovino AJ, Zabriskie MS, Heaton WL, Tantravahi SK, Kauffman M, Shacham S, Chenchik A, Bonneau K, Ullman KS, O'Hare T, Deininger MW. shRNA library screening identifies nucleocytoplasmic transport as a mediator of BCR-ABL1 kinase-independent resistance. Blood 2015; 125:1772-81. [PMID: 25573989 PMCID: PMC4357584 DOI: 10.1182/blood-2014-08-588855] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/23/2014] [Indexed: 12/26/2022] Open
Abstract
The mechanisms underlying tyrosine kinase inhibitor (TKI) resistance in chronic myeloid leukemia (CML) patients lacking explanatory BCR-ABL1 kinase domain mutations are incompletely understood. To identify mechanisms of TKI resistance that are independent of BCR-ABL1 kinase activity, we introduced a lentiviral short hairpin RNA (shRNA) library targeting ∼5000 cell signaling genes into K562(R), a CML cell line with BCR-ABL1 kinase-independent TKI resistance expressing exclusively native BCR-ABL1. A customized algorithm identified genes whose shRNA-mediated knockdown markedly impaired growth of K562(R) cells compared with TKI-sensitive controls. Among the top candidates were 2 components of the nucleocytoplasmic transport complex, RAN and XPO1 (CRM1). shRNA-mediated RAN inhibition or treatment of cells with the XPO1 inhibitor, KPT-330 (Selinexor), increased the imatinib sensitivity of CML cell lines with kinase-independent TKI resistance. Inhibition of either RAN or XPO1 impaired colony formation of CD34(+) cells from newly diagnosed and TKI-resistant CML patients in the presence of imatinib, without effects on CD34(+) cells from normal cord blood or from a patient harboring the BCR-ABL1(T315I) mutant. These data implicate RAN in BCR-ABL1 kinase-independent imatinib resistance and show that shRNA library screens are useful to identify alternative pathways critical to drug resistance in CML.
Collapse
MESH Headings
- Active Transport, Cell Nucleus/genetics
- Benzamides/pharmacology
- Cell Line, Tumor
- Cell Survival
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Knockdown Techniques
- Gene Library
- Humans
- Hydrazines/pharmacology
- Imatinib Mesylate
- K562 Cells
- Karyopherins/antagonists & inhibitors
- Karyopherins/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Mutation
- Piperazines/pharmacology
- Protein Kinase Inhibitors/pharmacology
- Pyrimidines/pharmacology
- RNA, Small Interfering/genetics
- Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors
- Receptors, Cytoplasmic and Nuclear/genetics
- Signal Transduction
- Triazoles/pharmacology
- Tumor Stem Cell Assay
- ran GTP-Binding Protein/antagonists & inhibitors
- ran GTP-Binding Protein/genetics
- Exportin 1 Protein
Collapse
Affiliation(s)
| | - Anna M Eiring
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Clinton C Mason
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Kevin C Gantz
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Amber D Bowler
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Hannah M Redwine
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Fan Yu
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT; Beijing Tsinghua Chang Gung Hospital, Tsinghua University, Beijing, China
| | - Ira L Kraft
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | | | | | - Anthony J Iovino
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | | | - William L Heaton
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT
| | - Srinivas K Tantravahi
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT; Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | | | | | | | | | | | - Thomas O'Hare
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT; Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | - Michael W Deininger
- Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT; Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| |
Collapse
|
6
|
Chronic myeloid leukemia: imatinib and next-generation ABL inhibitors. Mol Oncol 2013. [DOI: 10.1017/cbo9781139046947.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
7
|
Bitencourt R, Zalcberg I, Louro ID. Imatinib resistance: a review of alternative inhibitors in chronic myeloid leukemia. Rev Bras Hematol Hemoter 2013; 33:470-5. [PMID: 23049365 PMCID: PMC3459369 DOI: 10.5581/1516-8484.20110124] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 10/21/2011] [Indexed: 12/15/2022] Open
Abstract
The development of point mutations in the BCR-ABL kinase domain is the main reason for imatinib resistance in chronic myeloid leukemia. Different detection methods are used in chronic myeloid leukemia monitoring, such as direct sequencing, denaturing high performance liquid chromatography and allele specific polymerase chain reaction. Mutation analysis has become mandatory during patient workup of chronic myeloid leukemia in order for the physician to choose the most suitable tyrosine kinase inhibitor. This article, a review of possible therapies used to overcome imatinib resistance, investigates the current position by searching the PubMed electronic database using the following keywords: imatinib, dasatinib, nilotinib, aurora kinase, SRC kinase, mutation, treatment, drugs and resistance. New tyrosine kinase inhibitors include BCR-ABL kinase selective inhibitors, dual ABL/SRC kinase inhibitors and aurora kinase inhibitors. Awareness of the spectrum of new drugs against mutations, in particular the T315I mutation, makes it possible to properly select the best therapy for each patient.
Collapse
Affiliation(s)
- Roberta Bitencourt
- Master Program in Biotechnology, Universidade Federal do Espírito Santo - UFES, Vitória, ES, Brazil
| | | | | |
Collapse
|
8
|
Khorashad JS, Deininger MWN. Selection of therapy: rational decisions based on molecular events. Hematol Oncol Clin North Am 2012; 25:1009-23, vi. [PMID: 22054732 DOI: 10.1016/j.hoc.2011.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article reviews to what extent molecular data can be used to rationalize therapeutic choices in the treatment of chronic myeloid leukemia. Two categories of data are discussed: markers that globally measure risk but do not provide a molecular rationale for therapy selection; and biomarkers with a causal link to a clinical phenotype, such as certain mutations of the BCR-ABL kinase domain. As therapy selection is still mainly based on clinical criteria, molecular biomarkers are discussed in the context of available clinical prognostication tools, focusing on biomarkers that do not reflect disease burden as a surrogate of responsiveness to treatment.
Collapse
Affiliation(s)
- Jamshid S Khorashad
- Deininger Lab, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4270, Salt Lake City, UT 84112-5550, USA
| | | |
Collapse
|
9
|
CML: Defining the efficacy of targeted therapy with the TARGET system. Leuk Res 2011; 35:575-6. [DOI: 10.1016/j.leukres.2010.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 11/14/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
|
10
|
Donato NJ, Peterson LF. Chronic myeloid leukemia stem cells and developing therapies. Leuk Lymphoma 2011; 52 Suppl 1:60-80. [PMID: 21299460 DOI: 10.3109/10428194.2010.546921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Chronic myeloid leukemia therapy has remarkably improved with the use of frontline BCR-ABL kinase inhibitors such that newly diagnosed patients have minimal disease manifestations or progression. Effective control of disease may also set the stage for eventual 'cure' of this leukemia. However, the existence of Philadelphia chromosome-positive leukemic cells that are unaffected by BCR-ABL inhibition represents a major barrier that may delay or prevent curative therapy with the current approaches. The most commonly reported mechanism of resistance to tyrosine kinase inhibitor-based therapies involves BCR-ABL gene mutations and amplification, but these changes may not be solely responsible for disease relapse when inhibitor-based therapies are curtailed. Therefore new targets may need to be defined before significant advancement in curative therapies is possible. Emerging evidence suggests that persistence of chronic myeloid leukemia stem cells or acquisition of stem cell-like characteristics prevents complete elimination of chronic myeloid leukemia by tyrosine kinase inhibition alone. This review focuses on several recently emerging concepts regarding the existence and characteristics of chronic myeloid leukemia stem cells. Definitions based on human primary cells and animal model studies are highlighted as are the potential signaling pathways associated with disease repopulating cells. Finally, several recently defined therapeutic targets and active compounds that have emerged from stem cell studies are described. Our goal is to provide an unbiased report on the current state of discovery within the chronic myeloid leukemia stem cell field and to orient the reader to emerging therapeutic targets and strategies that may lead to elimination of this leukemia.
Collapse
Affiliation(s)
- Nicholas J Donato
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109, USA.
| | | |
Collapse
|