1
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Liu HN, Zhu Y, Chi Y, Sun FF, Shan LS, Wang YT, Dai B. Synthetic approaches and application of representative clinically approved fluorine-enriched anti-cancer medications. Eur J Med Chem 2024; 276:116722. [PMID: 39079309 DOI: 10.1016/j.ejmech.2024.116722] [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: 05/13/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/11/2024]
Abstract
Fluorine possesses distinctive chemical characteristics, such as its strong electron-withdrawing ability and small atomic size, which render it an invaluable asset in the design and optimization of pharmaceuticals. The utilization of fluorine-enriched medications for combating cancer has emerged as a prominent approach in medicinal chemistry and drug discovery, offering improved clinical outcomes and enhanced pharmacological properties. This comprehensive review explores the synthetic approaches and clinical applications of approved 22 representative fluorinated anti-cancer drugs from 2019 to present, shedding light on their historical development, brand names, drug target activity, mechanism of action, preclinical pharmacodynamics, clinical efficacy, and toxicity. Additionally, the review provides an extensive analysis of the representative synthetic techniques employed. Overall, this review emphasizes the significance of incorporating fluorine chemistry into anti-cancer drug research while highlighting promising future prospects for exploring compounds enriched with fluorine in the battle against cancer.
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Affiliation(s)
- He-Nan Liu
- Department of Ophthalmology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Zhu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Yuan Chi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fei-Fei Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li-Shen Shan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Ya-Tao Wang
- Rega Institute for Medical Research, Medicinal Chemistry, KU Leuven, Herestraat 49-Box 1041, 3000, Leuven, Belgium.
| | - Bing Dai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
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2
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McCarthy WJ, Thomas SE, Olaleye T, Boland JA, Floto RA, Williams G, Blundell TL, Coyne AG, Abell C. A Fragment-Based Competitive 19F LB-NMR Platform For Hotspot-Directed Ligand Profiling. Angew Chem Int Ed Engl 2024; 63:e202406846. [PMID: 38896426 DOI: 10.1002/anie.202406846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/21/2024]
Abstract
Ligand binding hotspots are regions of protein surfaces that form particularly favourable interactions with small molecule pharmacophores. Targeting interactions with these hotspots maximises the efficiency of ligand binding. Existing methods are capable of identifying hotspots but often lack assays to quantify ligand binding and direct elaboration at these sites. Herein, we describe a fragment-based competitive 19F Ligand Based NMR (LB-NMR) screening platform that enables routine, quantitative ligand profiling focused at ligand-binding hotspots. As a proof of concept, the method was applied to 4'-phosphopantetheine adenylyltransferase (PPAT) from Mycobacterium abscessus (Mabs). X-ray crystallographic characterisation of the hits from a 960-member fragment screen identified three ligand-binding hotspots across the PPAT active site. From the fragment hits a collection of 19F reporter candidates were designed and synthesised. By rigorous prioritisation and use of optimisation workflows, a single 19F reporter molecule was generated for each hotspot. Profiling the binding of a set of structurally characterised ligands by competitive 19F LB-NMR with this suite of 19F reporters recapitulated the binding affinity and site ID assignments made by ITC and X-ray crystallography. This quantitative mapping of ligand binding events at hotspot level resolution establishes the utility of the fragment-based competitive 19F LB-NMR screening platform for hotspot-directed ligand profiling.
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Affiliation(s)
- William J McCarthy
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK, CB2 1EW
- Present Address: Molecular Structure of Cell Signalling Laboratory, The Francis Crick Institute, 1 Midland Road, London, UK, NW1 1AT
| | - Sherine E Thomas
- Department of Biochemistry, University of Cambridge, Tennis Court Road, Cambridge, UK, CB2 1GA
- Present Address: Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, UK, CB2 1PD
| | - Tayo Olaleye
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK, CB2 1EW
| | - Jennifer A Boland
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK, CB2 1EW
| | - R Andres Floto
- University of Cambridge Molecular Immunity Unit, MRC Laboratory of Molecular Biology, Cambridge, UK, CB2 0QH
- VPD Heart Lung Research Institute, Department of Medicine, University of Cambridge, Cambridge, UK, CB2 0BB
| | - Glyn Williams
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK, CB2 1EW
| | - Tom L Blundell
- Department of Biochemistry, University of Cambridge, Tennis Court Road, Cambridge, UK, CB2 1GA
- VPD Heart Lung Research Institute, Department of Medicine, University of Cambridge, Cambridge, UK, CB2 0BB
| | - Anthony G Coyne
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK, CB2 1EW
| | - Chris Abell
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge, UK, CB2 1EW
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3
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Combes FP, Sy SKB, Li YF, Lorenzo S, Dasgupta K, Kapoor S, Hoch M, Ho YY. Dose Justification for Asciminib in Patients with Philadelphia Chromosome-Positive Chronic Myeloid Leukemia with and Without the T315I Mutation. Clin Pharmacokinet 2024:10.1007/s40262-024-01411-1. [PMID: 39243304 DOI: 10.1007/s40262-024-01411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Asciminib is approved in patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase (Ph+ CML-CP) treated with ≥ 2 prior tyrosine kinase inhibitors. Here, we aimed to demonstrate similarity in efficacy/safety of asciminib 80 mg once daily (q.d.) versus 40 mg twice daily (b.i.d.) in patients with CML-CP without T315I mutation and support the use of the 200-mg b.i.d. dosage in patients harboring T315I, using model-informed drug development. METHODS Data were collected from 199 patients in the phase I (NCT02081378; 10-200 mg b.i.d. or 10-400 mg q.d.) and 154 patients in the phase III (NCT03106779; 40 mg b.i.d.) studies. Evaluations were based on population pharmacokinetics (PopPK) and exposure-response (efficacy/safety) analyses. RESULTS PopPK showed comparable exposure (area under the curve, AUC0-24h) for 40 mg b.i.d. and 80 mg q.d. (12,638 vs 12,646 ng*h/mL); average maximum and minimum plasma concentrations for 80 mg q.d. were 1.61- and 0.72-fold those of 40 mg b.i.d., respectively. Exposure-response analyses predicted similar major molecular response rates for 40 mg b.i.d. and 80 mg q.d. (Week 24: 27.6% vs 24.8%; Week 48: 32.3% vs 30.6%). Results also established adequacy of 200 mg b.i.d. in patients with T315I mutation (Week 24: 20.7%; Week 48: 23.7%), along with a similar safety profile for all dose regimens. CONCLUSIONS Similarity between 40 mg b.i.d. and 80 mg q.d. regimens was investigated, demonstrating similar and substantial efficacy with well-tolerated safety in patients without T315I mutation. The 200-mg b.i.d. dose was deemed safe and effective for patients with T315I mutation.
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Affiliation(s)
- Francois Pierre Combes
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA.
| | - Sherwin K B Sy
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA
| | - Ying Fei Li
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA
| | | | | | - Shruti Kapoor
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA
| | - Matthias Hoch
- Novartis Institute of Biomedical Research, Basel, Switzerland
| | - Yu-Yun Ho
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA
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4
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Stempel JM, Shallis RM, Wong R, Podoltsev NA. Challenges in management of older patients with chronic myeloid leukemia. Leuk Lymphoma 2024; 65:1219-1232. [PMID: 38652861 DOI: 10.1080/10428194.2024.2342559] [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: 02/01/2024] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have significantly improved the survival of patients with chronic myeloid leukemia (CML), however, older patients are often underrepresented in pivotal trials. Approximately 20% of older adults never start treatment and face significant barriers to accomplish favorable outcomes. The treatment goal is to improve survival, prevent progression, and preserve quality of life. This is achieved through optimizing TKI doses and employing discontinuation strategies to attain treatment-free remission (TFR), a goal increasingly pursued by older patients. Imatinib may be favored as the front-line option for older individuals due to its side effect profile and cost. Bosutinib's favorable cardiovascular tolerability makes it a suitable second-line agent, but lower-dose dasatinib may likewise be an attractive option. The prevalence of comorbidities can preclude the use of second generation TKIs in some older patients. Optimal care for older patients with CML centers on personalized treatment, close monitoring, and proactive support.
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Affiliation(s)
- Jessica M Stempel
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rong Wong
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
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5
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Cruz-Rodriguez N, Tang H, Bateman B, Tang W, Deininger M. BCR::ABL1 Proteolysis-targeting chimeras (PROTACs): The new frontier in the treatment of Ph + leukemias? Leukemia 2024; 38:1885-1893. [PMID: 39098922 DOI: 10.1038/s41375-024-02365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/19/2024] [Accepted: 07/24/2024] [Indexed: 08/06/2024]
Abstract
BCR::ABL1 tyrosine kinase inhibitors (TKIs) have turned chronic myeloid leukemia (CML) from a lethal condition into a chronic ailment. With optimal management, the survival of CML patients diagnosed in the chronic phase is approaching that of age-matched controls. However, only one-third of patients can discontinue TKIs and enter a state of functional cure termed treatment-free remission (TFR), while the remainder require life-long TKI therapy to avoid the recurrence of active leukemia. Approximately 10% of patients exhibit primary or acquired TKI resistance and eventually progress to the blast phase. It is thought that recurrence after attempted TFR originates from CML stem cells (LSCs) surviving despite continued suppression of BCR::ABL1 kinase. Although kinase activity is indispensable for induction of overt CML, kinase-independent scaffold functions of BCR::ABL1 are known to contribute to leukemogenesis, raising the intriguing but as yet hypothetical possibility, that degradation of BCR::ABL1 protein may accomplish what TKIs fail to achieve - eliminate residual LSCs to turn functional into real cures. The advent of BCR::ABL1 proteolysis targeting chimeras (PROTACs), heterobifunctional molecules linking a TKI-based warhead to an E3 ligase recruiter, has moved clinical protein degradation into the realm of the possible. Here we examine the molecular rationale as well as pros and cons of degrading BCR::ABL1 protein. We review reported BCR::ABL1 PROTACs, point out limitations of available data and compounds and suggest directions for future research. Ultimately, clinical testing of a potent and specific BCR::ABL1 degrader will be required to determine the efficacy and tolerability of this approach.
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MESH Headings
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/metabolism
- Proteolysis
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/pharmacology
- Drug Resistance, Neoplasm
- Proto-Oncogene Proteins c-abl/metabolism
- Animals
- Proteolysis Targeting Chimera
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Affiliation(s)
| | - Hua Tang
- Lachman Institute of Pharmaceutical Development, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Weiping Tang
- Lachman Institute of Pharmaceutical Development, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
- Department of Chemistry, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael Deininger
- Versiti Blood Research Institute, Milwaukee, WI, USA.
- Medical College of Wisconsin, Milwaukee, WI, USA.
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6
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Eadie LN, Lagonik E, Page EC, Schutz CE, Heatley SL, McClure BJ, Forgione MO, Yeung DT, Hughes TP, White DL. Asciminib is a novel inhibitor of ABL1 and ABL2 gene fusions in ALL but requires the ABL SH3 domain for efficacy. Blood 2024; 144:1022-1026. [PMID: 38848536 DOI: 10.1182/blood.2024024776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Laura N Eadie
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Elias Lagonik
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Sciences, Engineering and Technology, The University of Adelaide, Adelaide, Australia
| | - Elyse C Page
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Caitlin E Schutz
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Susan L Heatley
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Barbara J McClure
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Michelle O Forgione
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - David T Yeung
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Australasian Leukaemia and Lymphoma Group, Melbourne, Australia
- Haematology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Timothy P Hughes
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Australasian Leukaemia and Lymphoma Group, Melbourne, Australia
- Haematology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Deborah L White
- Blood Cancer Program, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Australasian Leukaemia and Lymphoma Group, Melbourne, Australia
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7
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Burda P, Hlavackova A, Polivkova V, Curik N, Laznicka A, Krizkova J, Suttnar J, Klener P, Polakova KM. Imatinib therapy of chronic myeloid leukemia significantly reduces carnitine cell intake, resulting in adverse events. Mol Metab 2024; 88:102016. [PMID: 39182842 DOI: 10.1016/j.molmet.2024.102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE A prominent, safe and efficient therapy for patients with chronic myeloid leukemia (CML) is inhibiting oncogenic protein BCR::ABL1 in a targeted manner with imatinib, a tyrosine kinase inhibitor. A substantial part of patients treated with imatinib report skeletomuscular adverse events affecting their quality of life. OCTN2 membrane transporter is involved in imatinib transportation into the cells. At the same time, the crucial physiological role of OCTN2 is cellular uptake of carnitine which is an essential co-factor for the mitochondrial β-oxidation pathway. This work investigates the impact of imatinib treatment on carnitine intake and energy metabolism of muscle cells. METHODS HTB-153 (human rhabdomyosarcoma) cell line and KCL-22 (CML cell line) were used to study the impact of imatinib treatment on intracellular levels of carnitine and vice versa. The energy metabolism changes in cells treated by imatinib were quantified and compared to changes in cells exposed to highly specific OCTN2 inhibitor vinorelbine. Mouse models were used to test whether in vitro observations are also achieved in vivo in thigh muscle tissue. The analytes of interest were quantified using a Prominence HPLC system coupled with a tandem mass spectrometer. RESULTS This work showed that through the carnitine-specific transporter OCTN2, imatinib and carnitine intake competed unequally and intracellular carnitine concentrations were significantly reduced. In contrast, carnitine preincubation did not influence imatinib cell intake or interfere with leukemia cell targeting. Blocking the intracellular supply of carnitine with imatinib significantly reduced the production of most Krebs cycle metabolites and ATP. However, subsequent carnitine supplementation rescued mitochondrial energy production. Due to specific inhibition of OCTN2 activity, the influx of carnitine was blocked and mitochondrial energy metabolism was impaired in muscle cells in vitro and in thigh muscle tissue in a mouse model. CONCLUSIONS This preclinical experimental study revealed detrimental effect of imatinib on carnitine-mediated energy metabolism of muscle cells providing a possible molecular background of the frequently occurred side effects during imatinib therapy such as fatigue, muscle pain and cramps.
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Affiliation(s)
- Pavel Burda
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Vendula Polivkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Nikola Curik
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Laznicka
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jitka Krizkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jiri Suttnar
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Pavel Klener
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic; First Medical Department- Dept. of Hematology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Katerina Machova Polakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic; Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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8
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Wang J, Ma W, Huang J, Qiu G, Zhang T, Wei Q, He C, Zhou D, Zhao M, Chen C, Xu X. HIF-2α inhibition disrupts leukemia stem cell metabolism and impairs vascular microenvironment to enhance chronic myeloid leukemia treatment. Cancer Lett 2024; 597:217060. [PMID: 38880225 DOI: 10.1016/j.canlet.2024.217060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
Leukemic stem cells (LSCs) in chronic myeloid leukemia (CML) contribute to treatment resistance and disease recurrence. Metabolism regulates LSCs, but the mechanisms remain elusive. Here, we show that hypoxia-inducible factor 2α (HIF-2α) is highly expressed in LSCs in mouse and human CML and increases after tyrosine kinase inhibitor (TKI) treatment. Deletion of HIF-2α suppresses disease progression, reduces LSC numbers, and enhances the efficacy of TKI treatment in BCL-ABL-induced CML mice. Mechanistically, HIF-2α deletion reshapes the metabolic profile of LSCs, leading to increased production of reactive oxygen species (ROS) and apoptosis in CML. Moreover, HIF-2α deletion decreases vascular endothelial growth factor (VEGF) expression, thereby suppressing neovascularization in the bone marrow of CML mice. Furthermore, pharmaceutical inhibition of HIF-2α by PT2399 attenuates disease progression and improves the efficacy of TKI treatment in both mouse and human CML. Overall, our findings highlight the role of HIF-2α in controlling the metabolic state and vascular niche remodeling in CML, suggesting it is a potential therapeutic target to enhance TKI therapy.
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MESH Headings
- Animals
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Basic Helix-Loop-Helix Transcription Factors/metabolism
- Basic Helix-Loop-Helix Transcription Factors/genetics
- Basic Helix-Loop-Helix Transcription Factors/antagonists & inhibitors
- Mice
- Humans
- Neoplastic Stem Cells/drug effects
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Tumor Microenvironment/drug effects
- Protein Kinase Inhibitors/pharmacology
- Apoptosis/drug effects
- Neovascularization, Pathologic/drug therapy
- Vascular Endothelial Growth Factor A/metabolism
- Vascular Endothelial Growth Factor A/genetics
- Reactive Oxygen Species/metabolism
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Affiliation(s)
- Jian Wang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weiwei Ma
- Key Laboratory of Stem Cells and Tissue Engineering (Ministry of Education), Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Junbin Huang
- State Key Laboratory of Oncology in South China, Department of Pediatrics, The Seventh Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Shenzhen, China
| | - Guo Qiu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tian Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qinghua Wei
- Key Laboratory of Stem Cells and Tissue Engineering (Ministry of Education), Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chong He
- Key Laboratory of Stem Cells and Tissue Engineering (Ministry of Education), Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dunhua Zhou
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Meng Zhao
- State Key Laboratory of Oncology in South China, Department of Pediatrics, The Seventh Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Shenzhen, China; Key Laboratory of Stem Cells and Tissue Engineering (Ministry of Education), Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Chun Chen
- State Key Laboratory of Oncology in South China, Department of Pediatrics, The Seventh Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Shenzhen, China.
| | - Xi Xu
- State Key Laboratory of Oncology in South China, Department of Pediatrics, The Seventh Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Shenzhen, China; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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9
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Yoshida C, Takaku T. Asciminib: the next-generation bullet for first-line treatment of chronic myeloid leukemia. MED 2024; 5:856-858. [PMID: 39127034 DOI: 10.1016/j.medj.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/01/2024] [Accepted: 07/01/2024] [Indexed: 08/12/2024]
Abstract
The standard of care for chronic myeloid leukemia (CML) involves tyrosine kinase inhibitors (TKIs), which suppress tyrosine kinase activity of BCR::ABL1. Hochhaus et al. reported that asciminib, a BCR::ABL1 inhibitor specifically targeting the ABL myristoyl pocket, showed superior efficacy and favorable safety compared with TKIs in the phase 3 ASC4FIRST trial in patients with newly diagnosed chronic-phase CML.1.
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Affiliation(s)
- Chikashi Yoshida
- Department of Hematology, NHO Mito Medical Center, Ibaraki, Japan.
| | - Tomoiku Takaku
- Department of Hematology, Saitama Medical University, Saitama, Japan
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10
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Leyte-Vidal A, Garrido Ruiz D, DeFilippis R, Leske IB, Rea D, Phan S, Miller KB, Hu F, Mase A, Shan Y, Hantschel O, Jacobson MP, Shah NP. BCR::ABL1 kinase N-lobe mutants confer moderate to high degrees of resistance to asciminib. Blood 2024; 144:639-645. [PMID: 38643492 DOI: 10.1182/blood.2023022538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/23/2024] Open
Abstract
ABSTRACT Secondary kinase domain mutations in BCR::ABL1 represent the most common cause of resistance to tyrosine kinase inhibitor (TKI) therapy in patients with chronic myeloid leukemia. The first 5 approved BCR::ABL1 TKIs target the adenosine triphosphate (ATP)-binding pocket. Mutations confer resistance to these ATP-competitive TKIs and those approved for other malignancies by decreasing TKI affinity and/or increasing ATP affinity. Asciminib, the first highly active allosteric TKI approved for any malignancy, targets an allosteric regulatory pocket in the BCR::ABL1 kinase C-lobe. As a non-ATP-competitive inhibitor, the activity of asciminib is predicted to be impervious to increases in ATP affinity. Here, we report several known mutations that confer resistance to ATP-competitive TKIs in the BCR::ABL1 kinase N-lobe that are distant from the asciminib binding pocket yet unexpectedly confer in vitro resistance to asciminib. Among these is BCR::ABL1 M244V, which confers clinical resistance even to escalated asciminib doses. We demonstrate that BCR::ABL1 M244V does not impair asciminib binding, thereby invoking a novel mechanism of resistance. Molecular dynamic simulations of the M244V substitution implicate stabilization of an active kinase conformation through impact on the α-C helix as a mechanism of resistance. These N-lobe mutations may compromise the clinical activity of ongoing combination studies of asciminib with ATP-competitive TKIs.
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Affiliation(s)
- Ariel Leyte-Vidal
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL
| | - Diego Garrido Ruiz
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA
| | - RosaAnna DeFilippis
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Inga B Leske
- Institute for Physiological Chemistry, Philipps University of Marburg, Marburg, Germany
| | - Delphine Rea
- Adult Hematology Department, Hôpital Saint-Louis, Paris, France
| | - Stacey Phan
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Kaeli B Miller
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Feifei Hu
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Anjeli Mase
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA
| | - Yibing Shan
- Antidote Health Foundation for Cure of Cancer, Cambridge, MA
| | - Oliver Hantschel
- Institute for Physiological Chemistry, Philipps University of Marburg, Marburg, Germany
| | - Matthew P Jacobson
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA
| | - Neil P Shah
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA
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11
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Liu Z, Wu D, Ke C, Nian Q, Chen Y, Huang Y, Chen M. Real-World Disproportionality Analysis of the Food and Drug Administration Adverse Event Reporting System Database for Asciminib. Oncology 2024:1-13. [PMID: 39102794 DOI: 10.1159/000540542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/19/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Asciminib is primarily utilized for treating Philadelphia chromosome-positive chronic myeloid leukemia in its chronic phase among patients harboring the T315I mutation or those who have been previously treated with at least two tyrosine kinase inhibitors. The safety profile of asciminib across a broad patient population over an extended timeframe remains unverified. This study uses a real-world pharmacovigilance database to evaluate the adverse events (AEs) linked with asciminib, providing valuable insights for clinical drug safety. METHODS Data from the FDA Adverse Event Reporting System (FAERS) database, spanning from October 2021 to December 2023, served as the basis for this analysis. The extent of disproportional events was assessed using sophisticated metrics such as the reporting odds ratio, proportional reporting ratio, information component, and empirical Bayesian geometric mean. RESULTS Within the specified period, the FAERS database documented 3,913,574 AE reports, with asciminib being associated with 966 incidents. Reactions to asciminib spanned 27 system organ categories. Utilizing four distinct analytical algorithms, 663 significant preferred terms exhibiting disproportional frequencies were identified. Notably, this investigation uncovered 26 significant AEs linked to off-label asciminib use, encompassing conditions such as gynecomastia, nephrotic syndrome, orchitis, pyelonephritis, hepatotoxicity, and pancreatitis. The median onset time for asciminib-related AEs was 52.5 days, ranging from 17 to 122.75 days. CONCLUSION The study sheds light on additional potential AEs associated with asciminib use, warranting further research to confirm these findings.
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Affiliation(s)
- Zhijing Liu
- Department of Pharmacy, Affiliated Hospital of Putian University, Pu Tian, China
| | - Dongzhi Wu
- Department of Orthopedics Institute, Fuzhou Second General Hospital, Fuzhou, China
| | - Chengjie Ke
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qichun Nian
- Department of Pharmacy, Pingtan Comprehensive Experimental Area Hospital, Pingtan Comprehensive Experimental Area, Fuzhou, China
| | - Yan Chen
- Department of Pharmacy, Pingtan Comprehensive Experimental Area Hospital, Pingtan Comprehensive Experimental Area, Fuzhou, China
| | - Yaping Huang
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
| | - Maohua Chen
- Department of Pharmacy, Pingtan Comprehensive Experimental Area Hospital, Pingtan Comprehensive Experimental Area, Fuzhou, China
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12
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Jabbour E, Kantarjian H. Chronic myeloid leukemia: 2025 update on diagnosis, therapy, and monitoring. Am J Hematol 2024. [PMID: 39093014 DOI: 10.1002/ajh.27443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
DISEASE OVERVIEW Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm with an annual incidence of two cases/100 000. It accounts for approximately 15% of newly diagnosed cases of leukemia in adults. DIAGNOSIS CML is characterized by a balanced genetic translocation, t(9;22) (q34;q11.2), involving a fusion of the Abelson murine leukemia (ABL1) gene from chromosome 9q34 with the breakpoint cluster region (BCR) gene on chromosome 22q11.2. This rearrangement is known as the Philadelphia chromosome. The molecular consequence of this translocation is the generation of a BCR::ABL1 fusion oncogene, which in turn translates into a BCR::ABL1 oncoprotein. FRONTLINE THERAPY Four tyrosine kinase inhibitors (TKIs), imatinib, dasatinib, bosutinib, and nilotinib, are approved by the United States Food and Drug Administration (FDA) for first-line treatment of newly diagnosed CML in the chronic phase (CML-CP). Clinical trials with second and third-generation TKIs in frontline CML-CP therapy reported significantly deeper and faster responses but had no impact on survival prolongation, likely because of their potent efficacy and the availability of effective TKIs salvage therapies for patients who have a cytogenetic relapse with frontline TKI therapy. All four TKIs are equivalent if the aim of therapy is to improve survival. In younger patients with high-risk disease and in whom the aim of therapy is to induce a treatment-free remission status, second-generation TKIs may be favored. SALVAGE THERAPY For CML post-failure on frontline therapy, second-line options include second and third-generation TKIs. Although potent and selective, these TKIs exhibit unique pharmacological profiles and response patterns relative to different patient and disease characteristics, such as patients' comorbidities and financial status, disease stage, and BCR::ABL1 mutational status. Patients who develop the T315I "gatekeeper" mutation display resistance to all currently available TKIs except ponatinib, asciminib, and olverembatinib. Allogeneic stem cell transplantation remains an important therapeutic option for patients with CML-CP and failure (due to resistance) of at least two TKIs and for all patients in advanced-phase disease. Older patients who have a cytogenetic relapse post-failure on all TKIs can maintain long-term survival if they continue a daily most effective/least toxic TKI, with or without the addition of non-TKI anti-CML agents (hydroxyurea, omacetaxine, azacitidine, decitabine, cytarabine, and others).
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Affiliation(s)
- Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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13
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Eshaq AM, Flanagan TW, Hassan SY, Al Asheikh SA, Al-Amoudi WA, Santourlidis S, Hassan SL, Alamodi MO, Bendhack ML, Alamodi MO, Haikel Y, Megahed M, Hassan M. Non-Receptor Tyrosine Kinases: Their Structure and Mechanistic Role in Tumor Progression and Resistance. Cancers (Basel) 2024; 16:2754. [PMID: 39123481 PMCID: PMC11311543 DOI: 10.3390/cancers16152754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/30/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Protein tyrosine kinases (PTKs) function as key molecules in the signaling pathways in addition to their impact as a therapeutic target for the treatment of many human diseases, including cancer. PTKs are characterized by their ability to phosphorylate serine, threonine, or tyrosine residues and can thereby rapidly and reversibly alter the function of their protein substrates in the form of significant changes in protein confirmation and affinity for their interaction with protein partners to drive cellular functions under normal and pathological conditions. PTKs are classified into two groups: one of which represents tyrosine kinases, while the other one includes the members of the serine/threonine kinases. The group of tyrosine kinases is subdivided into subgroups: one of them includes the member of receptor tyrosine kinases (RTKs), while the other subgroup includes the member of non-receptor tyrosine kinases (NRTKs). Both these kinase groups function as an "on" or "off" switch in many cellular functions. NRTKs are enzymes which are overexpressed and activated in many cancer types and regulate variable cellular functions in response to extracellular signaling-dependent mechanisms. NRTK-mediated different cellular functions are regulated by kinase-dependent and kinase-independent mechanisms either in the cytoplasm or in the nucleus. Thus, targeting NRTKs is of great interest to improve the treatment strategy of different tumor types. This review deals with the structure and mechanistic role of NRTKs in tumor progression and resistance and their importance as therapeutic targets in tumor therapy.
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Affiliation(s)
- Abdulaziz M. Eshaq
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA;
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (S.A.A.A.); (W.A.A.-A.); (M.O.A.); (M.O.A.)
| | - Thomas W. Flanagan
- Department of Pharmacology and Experimental Therapeutics, LSU Health Sciences Center, New Orleans, LA 70112, USA;
| | - Sofie-Yasmin Hassan
- Department of Pharmacy, Faculty of Science, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Sara A. Al Asheikh
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (S.A.A.A.); (W.A.A.-A.); (M.O.A.); (M.O.A.)
| | - Waleed A. Al-Amoudi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (S.A.A.A.); (W.A.A.-A.); (M.O.A.); (M.O.A.)
| | - Simeon Santourlidis
- Institute of Cell Therapeutics and Diagnostics, University Medical Center of Duesseldorf, 40225 Duesseldorf, Germany;
| | - Sarah-Lilly Hassan
- Department of Chemistry, Faculty of Science, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Maryam O. Alamodi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (S.A.A.A.); (W.A.A.-A.); (M.O.A.); (M.O.A.)
| | - Marcelo L. Bendhack
- Department of Urology, Red Cross University Hospital, Positivo University, Rua Mauá 1111, Curitiba 80030-200, Brazil;
| | - Mohammed O. Alamodi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia; (S.A.A.A.); (W.A.A.-A.); (M.O.A.); (M.O.A.)
| | - Youssef Haikel
- Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, 67000 Strasbourg, France;
- Department of Operative Dentistry and Endodontics, Dental Faculty, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Mossad Megahed
- Clinic of Dermatology, University Hospital of Aachen, 52074 Aachen, Germany;
| | - Mohamed Hassan
- Institut National de la Santé et de la Recherche Médicale, University of Strasbourg, 67000 Strasbourg, France;
- Department of Operative Dentistry and Endodontics, Dental Faculty, 67000 Strasbourg, France
- Research Laboratory of Surgery-Oncology, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA
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14
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Okamoto N, Yagi K, Imawaka S, Takaoka M, Aizawa F, Niimura T, Goda M, Miyata K, Kawada K, Izawa‐Ishizawa Y, Sakaguchi S, Ishizawa K. Asciminib, a novel allosteric inhibitor of BCR-ABL1, shows synergistic effects when used in combination with imatinib with or without drug resistance. Pharmacol Res Perspect 2024; 12:e1214. [PMID: 39031848 PMCID: PMC11191601 DOI: 10.1002/prp2.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 07/22/2024] Open
Abstract
In the treatment of chronic myeloid leukemia (CML), resistance to BCR-ABL inhibitors makes it difficult to continue treatment and is directly related to life expectancy. Therefore, asciminib was introduced to the market as a useful drug for overcoming drug resistance. While combining molecular targeted drugs is useful to avoid drug resistance, the new BCR-ABL inhibitor asciminib and conventional BCR-ABL inhibitors should be used as monotherapy in principle. Therefore, we investigated the synergistic effect and mechanism of the combination of asciminib and imatinib. We generated imatinib-resistant cells using the human CML cell line K562, examined the effects of imatinib and asciminib exposure on cell survival using the WST-8 assay, and comprehensively analyzed genetic variation related to drug resistance using RNA-seq and real-time PCR. A synergistic effect was observed when imatinib and asciminib were combined with or without imatinib resistance. Three genes, GRRP1, ESPN, and NOXA1, were extracted as the sites of action of asciminib. Asciminib in combination with BCR-ABL inhibitors may improve the therapeutic efficacy of conventional BCR-ABL inhibitors and prevent the development of resistance. Its dosage may be effective even at minimal doses that do not cause side effects. Further verification of this mechanism of action is needed. Additionally, cross-resistance between BCR-ABL inhibitors and asciminib may occur, which needs to be clarified through further validation as soon as possible.
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MESH Headings
- Imatinib Mesylate/pharmacology
- Humans
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Drug Synergism
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- K562 Cells
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Protein Kinase Inhibitors/pharmacology
- Cell Survival/drug effects
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Agents/pharmacology
- Niacinamide/analogs & derivatives
- Pyrazoles
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Affiliation(s)
- Naoki Okamoto
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Department of PharmacyTokushima University HospitalTokushimaJapan
| | - Kenta Yagi
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Clinical Research Center for Developmental TherapeuticsTokushima University HospitalTokushimaJapan
| | - Sayaka Imawaka
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
| | - Mayu Takaoka
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
| | - Fuka Aizawa
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Department of PharmacyTokushima University HospitalTokushimaJapan
| | - Takahiro Niimura
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Clinical Research Center for Developmental TherapeuticsTokushima University HospitalTokushimaJapan
| | - Mitsuhiro Goda
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Department of PharmacyTokushima University HospitalTokushimaJapan
| | - Koji Miyata
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
| | - Kei Kawada
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Department of Clinical Pharmacy Practice PedagogyTokushima University Graduate School of Biomedical SciencesTokushimaJapan
| | - Yuki Izawa‐Ishizawa
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Department of General MedicineTaoka HospitalTokushimaJapan
| | - Satoshi Sakaguchi
- Clinical Research Center for Developmental TherapeuticsTokushima University HospitalTokushimaJapan
- Department of Respiratory Medicine and RheumatologyTokushima University Graduate School of Biomedical SciencesTokushimaJapan
| | - Keisuke Ishizawa
- Department of Clinical Pharmacology and TherapeuticsTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Department of PharmacyTokushima University HospitalTokushimaJapan
- Clinical Research Center for Developmental TherapeuticsTokushima University HospitalTokushimaJapan
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15
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George B, Chan KH, Rios A. Therapeutic options for chronic myeloid leukemia following the failure of second-generation tyrosine kinase inhibitor therapy. Front Oncol 2024; 14:1446517. [PMID: 39139284 PMCID: PMC11320603 DOI: 10.3389/fonc.2024.1446517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
The management of chronic myeloid leukemia in the chronic phase (CML-CP) has witnessed significant advancements since the identification of a common chromosomal translocation anomaly involving chromosomes 9 and 22, which results in the formation of the Philadelphia chromosome driven by the BCR-ABL1 fusion protein. This discovery paved the way for the development of tyrosine kinase inhibitors (TKIs) that target the adenosine triphosphate (ATP) binding site of ABL1 through the BCR-ABL-1 fusion protein. Following the approval of Imatinib by the Food and Drug Administration (FDA) as the first TKI for CML treatment in 2001, the median overall survival (OS) for chronic phase CML (CML-CP) has significantly improved, approaching that of the general population. However, achieving this milestone crucially depends on reaching certain treatment response milestones. Since the introduction of imatinib, five additional TKIs have been approved for CML-CP treatment. Despite the availability of these treatments, many patients may experience treatment failure and require multiple lines of therapy due to factors such as the emergence of resistance, such as mutations in the ATP binding site of ABL, or intolerance to therapy. This review will primarily focus on exploring treatment options for patients who fail second-generation TKI therapy due to true resistance.
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Affiliation(s)
- Binsah George
- Division of Hematology/Oncology, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
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16
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Kettani ME, Shah K, Farooq H, Li K, Badar T. Chronic myeloid leukemia with involvement of membranous labyrinth. Leuk Res Rep 2024; 22:100471. [PMID: 39188694 PMCID: PMC11346178 DOI: 10.1016/j.lrr.2024.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/23/2024] [Indexed: 08/28/2024] Open
Abstract
This case report explains an extraordinary presentation of chronic myeloid leukemia (CML) in a 39-year-old male with a T315I mutation, presenting with acute bilateral hearing loss and imbalance secondary to myeloid blast crisis. Neurological involvement was confirmed through MRI brain and cerebrospinal fluid analysis. Initial treatment with ponatinib and FLAG (fludarabine, cytarabine, G-CSF) regimen showed promise, but complications necessitated discontinuation. The patient's complex clinical trajectory, marked by complications and intolerance to tyrosine kinase inhibitors, highlights the intricate nature of CML blast crisis with T315I mutation management. Recognizing atypical presentations and early mutation analysis are pivotal for tailored treatment strategies.
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Affiliation(s)
- Mobachir El Kettani
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Kashish Shah
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Hareem Farooq
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - Ke Li
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Florida, USA
| | - Talha Badar
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
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17
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Kaehler M, von Bubnoff N, Cascorbi I, Gorantla SP. Molecular biomarkers of leukemia: convergence-based drug resistance mechanisms in chronic myeloid leukemia and myeloproliferative neoplasms. Front Pharmacol 2024; 15:1422565. [PMID: 39104388 PMCID: PMC11298451 DOI: 10.3389/fphar.2024.1422565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024] Open
Abstract
Leukemia represents a diverse group of hematopoietic neoplasms that can be classified into different subtypes based on the molecular aberration in the affected cell population. Identification of these molecular classification is required to identify specific targeted therapeutic approaches for each leukemic subtype. In general, targeted therapy approaches achieve good responses in some leukemia subgroups, however, resistance against these targeted therapies is common. In this review, we summarize molecular drug resistance biomarkers in targeted therapies in BCR::ABL1-driven chronic myeloid leukemia (CML) and JAK2-driven myeloproliferative neoplasms (MPNs). While acquisition of secondary mutations in the BCR::ABL1 kinase domain is the a common mechanism associated with TKI resistance in CML, in JAK2-driven MPNs secondary mutations in JAK2 are rare. Due to high prevalence and lack of specific therapy approaches in MPNs compared to CML, identification of crucial pathways leading to inhibitor persistence in MPN model is utterly important. In this review, we focus on different alternative signaling pathways activated in both, BCR::ABL1-mediated CML and JAK2-mediated MPNs, by combining data from in vitro and in vivo-studies that could be used as potential biomarkers of drug resistance. In a nutshell, some common similarities, especially activation of PDGFR, Ras, PI3K/Akt signaling pathways, have been demonstrated in both leukemias. In addition, induction of the nucleoprotein YBX1 was shown to be involved in TKI-resistant JAK2-mediated MPN, as well as TKI-resistant CML highlighting deubiquitinating enzymes as potential biomarkers of TKI resistance. Taken together, whole exome sequencing of cell-based or patients-derived samples are highly beneficial to define specific resistance markers. Additionally, this might be helpful for the development of novel diagnostic tools, e.g., liquid biopsy, and novel therapeutic agents, which could be used to overcome TKI resistance in molecularly distinct leukemia subtypes.
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Affiliation(s)
- Meike Kaehler
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nikolas von Bubnoff
- Department of Hematology and Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sivahari Prasad Gorantla
- Department of Hematology and Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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18
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Liu B, Zhou H, Tan L, Siu KTH, Guan XY. Exploring treatment options in cancer: Tumor treatment strategies. Signal Transduct Target Ther 2024; 9:175. [PMID: 39013849 PMCID: PMC11252281 DOI: 10.1038/s41392-024-01856-7] [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: 01/23/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 07/18/2024] Open
Abstract
Traditional therapeutic approaches such as chemotherapy and radiation therapy have burdened cancer patients with onerous physical and psychological challenges. Encouragingly, the landscape of tumor treatment has undergone a comprehensive and remarkable transformation. Emerging as fervently pursued modalities are small molecule targeted agents, antibody-drug conjugates (ADCs), cell-based therapies, and gene therapy. These cutting-edge treatment modalities not only afford personalized and precise tumor targeting, but also provide patients with enhanced therapeutic comfort and the potential to impede disease progression. Nonetheless, it is acknowledged that these therapeutic strategies still harbour untapped potential for further advancement. Gaining a comprehensive understanding of the merits and limitations of these treatment modalities holds the promise of offering novel perspectives for clinical practice and foundational research endeavours. In this review, we discussed the different treatment modalities, including small molecule targeted drugs, peptide drugs, antibody drugs, cell therapy, and gene therapy. It will provide a detailed explanation of each method, addressing their status of development, clinical challenges, and potential solutions. The aim is to assist clinicians and researchers in gaining a deeper understanding of these diverse treatment options, enabling them to carry out effective treatment and advance their research more efficiently.
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Affiliation(s)
- Beilei Liu
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
| | - Hongyu Zhou
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Licheng Tan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Kin To Hugo Siu
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Xin-Yuan Guan
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China.
- State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
- Advanced Energy Science and Technology Guangdong Laboratory, Huizhou, China.
- MOE Key Laboratory of Tumor Molecular Biology, Jinan University, Guangzhou, China.
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19
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Combarel D, Dousset L, Bouchet S, Ferrer F, Tetu P, Lebbe C, Ciccolini J, Meyer N, Paci A. Tyrosine kinase inhibitors in cancers: Treatment optimization - Part I. Crit Rev Oncol Hematol 2024; 199:104384. [PMID: 38762217 DOI: 10.1016/j.critrevonc.2024.104384] [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: 01/24/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024] Open
Abstract
A multitude of TKI has been developed and approved targeting various oncogenetic alterations. While these have provided improvements in efficacy compared with conventional chemotherapies, resistance to targeted therapies occurs. Mutations in the kinase domain result in the inability of TKI to inactivate the protein kinase. Also, gene amplification, increased protein expression and downstream activation or bypassing of signalling pathways are commonly reported mechanisms of resistance. Improved understanding of mechanisms involved in TKI resistance has resulted in the development of new generations of targeted agents. In a race against time, the search for new, more potent and efficient drugs, and/or combinations of drugs, remains necessary as new resistance mechanisms to the latest generation of TKI emerge. This review examines the various generations of TKI approved to date and their common mechanisms of resistance, focusing on TKI targeting BCR-ABL, epidermal growth factor receptor, anaplastic lymphoma kinase and BRAF/MEK tyrosine kinases.
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Affiliation(s)
- David Combarel
- Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France; Service de Pharmacocinétique, Faculté de Pharmacie, Université Paris Saclay, Châtenay-Malabry 92 296, France
| | - Léa Dousset
- Dermatology Department, Bordeaux University Hospital, Bordeaux, France
| | - Stéphane Bouchet
- Département de Pharmacologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Florent Ferrer
- Department of Pharmacology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France; SMARTc Unit, CRCM Inserm U1068, Aix Marseille Univ and APHM, Marseille, France
| | - Pauline Tetu
- Department of Dermatology, APHP Dermatology, Paris 7 Diderot University, INSERM U976, Hôpital Saint-Louis, Paris, France
| | - Céleste Lebbe
- Department of Dermatology, APHP Dermatology, Paris 7 Diderot University, INSERM U976, Hôpital Saint-Louis, Paris, France
| | - Joseph Ciccolini
- SMARTc Unit, CRCM Inserm U1068, Aix Marseille Univ and APHM, Marseille, France
| | - Nicolas Meyer
- Université Paul Sabatier-Toulouse III, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1037-CRCT, Toulouse, France
| | - Angelo Paci
- Service de Pharmacologie, Département de Biologie et Pathologie médicales, Gustave Roussy, Villejuif 94805, France; Service de Pharmacocinétique, Faculté de Pharmacie, Université Paris Saclay, Châtenay-Malabry 92 296, France.
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20
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Cortes JE, Sasaki K, Kim DW, Hughes TP, Etienne G, Mauro MJ, Hochhaus A, Lang F, Heinrich MC, Breccia M, Deininger M, Goh YT, Janssen JJWM, Talpaz M, de Soria VGG, le Coutre P, DeAngelo DJ, Damon A, Cacciatore S, Polydoros F, Agrawal N, Rea D. Asciminib monotherapy in patients with chronic-phase chronic myeloid leukemia with the T315I mutation after ≥1 prior tyrosine kinase inhibitor: 2-year follow-up results. Leukemia 2024; 38:1522-1533. [PMID: 38755421 PMCID: PMC11217003 DOI: 10.1038/s41375-024-02278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
Asciminib targets the BCR::ABL1 myristoyl pocket, maintaining activity against BCR::ABL1T315I, which is resistant to most approved adenosine triphosphate-competitive tyrosine kinase inhibitors. We report updated phase I results (NCT02081378) assessing safety/tolerability and antileukemic activity of asciminib monotherapy 200 mg twice daily in 48 heavily pretreated patients with T315I-mutated chronic-phase chronic myeloid leukemia (CML-CP; data cutoff: January 6, 2021). With 2 years' median exposure, 56.3% of patients continued receiving asciminib. Overall, 62.2% of evaluable patients achieved BCR::ABL1 ≤1% on the International Scale (IS); 47.6% and 81.3% of ponatinib-pretreated and -naive patients, respectively, achieved BCR::ABL1IS ≤1%. Of 45 evaluable patients, 48.9% achieved a major molecular response (MMR, BCR::ABL1IS ≤0.1%), including 34.6% and 68.4% of ponatinib-pretreated and -naive patients, respectively. MMR was maintained until data cutoff in 19 of 22 patients who achieved it. The most common grade ≥3 adverse events (AEs) included increased lipase level (18.8%) and thrombocytopenia (14.6%). Five (10.4%) patients experienced AEs leading to discontinuation, including 2 who discontinued asciminib and died due to COVID-19; these were the only deaths reported. These results show asciminib's effectiveness, including in almost 50% of ponatinib pretreated patients, and confirm its risk-benefit profile, supporting its use as a treatment option for T315I-mutated CML-CP.
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Affiliation(s)
- Jorge E Cortes
- Georgia Cancer Center at Augusta University, Augusta, GA, USA.
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dong-Wook Kim
- Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si, South Korea
| | - Timothy P Hughes
- South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia
| | - Gabriel Etienne
- Department of Hematology, Institut Bergonié, Bordeaux, France
| | - Michael J Mauro
- Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Fabian Lang
- Department of Medicine, Hematology and Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Michael C Heinrich
- Portland VA Health Care System and OHSU Department of Medicine, Division of Hematology and Oncology, Knight Cancer Institute, Portland, OR, USA
| | - Massimo Breccia
- Department of Translational and Precision Medicine-Az., Policlinico Umberto I-Sapienza University, Rome, Italy
| | | | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Bukit Merah, Singapore
| | | | - Moshe Talpaz
- Division of Hematology-Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | | | - Philipp le Coutre
- Department of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Andrea Damon
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Delphine Rea
- Department of Hématologie, Hôpital Saint-Louis, Paris, France
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21
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Tamatam R, Mohammed A. Small molecule anticancer drugs approved during 2021-2022: Synthesis and clinical applications. Eur J Med Chem 2024; 272:116441. [PMID: 38759455 DOI: 10.1016/j.ejmech.2024.116441] [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: 02/29/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/19/2024]
Abstract
Drugs have structural homology across similar biological targets. Small molecule drugs have the efficacy to target specific molecular targets within the cancer cells with enhanced cell membrane permeability, oral administration, selectivity, and specific affinity. The objective of this review is to highlight the clinical importance and synthetic routes of new small molecule oncology drugs approved by the FDA during the period 2021-2022. These marketed drugs are listed based on the month and year of approval in chronological order. We believed that an in-depth insight into the synthetic approaches for the construction of these chemical entities would enhance the ability to develop new drugs more efficiently.
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Affiliation(s)
- Rekha Tamatam
- Department of Agriculture Science, Faculty of Agro Based Industry, Universiti Malaysia Kelantan, 17600, Jeli, Kelantan, Malaysia
| | - Arifullah Mohammed
- Department of Agriculture Science, Faculty of Agro Based Industry, Universiti Malaysia Kelantan, 17600, Jeli, Kelantan, Malaysia.
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22
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Tang K, Lipton JH. Stem cell allografting for chronic Myeloid leukemia in the tyrosine kinase era - forgotten but not gone. Leuk Lymphoma 2024; 65:705-714. [PMID: 38335007 DOI: 10.1080/10428194.2024.2313626] [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: 11/02/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
Due to the remarkable success of tyrosine kinase inhibitors (TKI) in chronic myeloid leukemia (CML), allogeneic stem cell transplantation (alloSCT) is not first-line treatment for delivering durable, long-term survival. Consequently, alloSCT is reserved for patients with TKI-resistant or TKI-intolerant chronic phase CML (CP-CML) and advanced phase CML (AP-CML). Advances in transplant technology, such as high-resolution HLA typing, introduction of reduced intensity conditioning and increased alternative donor availability, coupled with improved supportive care, have significantly reduced transplant-related mortality and expanded the pool of transplant-eligible patients. Refinement of conditioning regimens, innovative use of post-transplant cellular and pharmacological therapies, and judicious post-transplant monitoring are important strategies for reducing risk of relapse. Given its potential to cure, alloSCT will invariably remain a key part of the treatment algorithm. This article reviews the data underpinning the role and outcomes of alloSCT and provides an update on current recommendations.
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Affiliation(s)
- Kenny Tang
- Division of Medical Oncology and Hematology, University Health Network - Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Haematology, Blacktown Hospital, New South Wales, Australia
| | - Jeffrey H Lipton
- Division of Medical Oncology and Hematology, University Health Network - Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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23
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Curik N, Laznicka A, Polivkova V, Krizkova J, Pokorna E, Semerak P, Suchankova P, Burda P, Hochhaus A, Machova Polakova K. Combination therapies with ponatinib and asciminib in a preclinical model of chronic myeloid leukemia blast crisis with compound mutations. Leukemia 2024; 38:1415-1418. [PMID: 38615117 PMCID: PMC11147753 DOI: 10.1038/s41375-024-02248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024]
MESH Headings
- Pyridazines/therapeutic use
- Pyridazines/administration & dosage
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Imidazoles/therapeutic use
- Imidazoles/administration & dosage
- Mutation
- Humans
- Blast Crisis/genetics
- Blast Crisis/drug therapy
- Blast Crisis/pathology
- Animals
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Mice
- Fusion Proteins, bcr-abl/genetics
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/pharmacology
- Niacinamide/analogs & derivatives
- Pyrazoles
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Affiliation(s)
- Nikola Curik
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adam Laznicka
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vaclava Polivkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Jitka Krizkova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Eva Pokorna
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Semerak
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Pavla Suchankova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Pavel Burda
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andreas Hochhaus
- Abteilung Hämatologie/Onkologie, Klinik für Innere Medizin II, University of Jena, Jena, Germany
| | - Katerina Machova Polakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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24
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Savani S, Pawa A, Salim N, Savani T, Master S. Asciminib Use Highlighting Underlying Moyamoya Disease: A Case Report. Cureus 2024; 16:e63364. [PMID: 39077244 PMCID: PMC11283928 DOI: 10.7759/cureus.63364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
We highlight here a case of Moyamoya disease (MMD) developed after treatment for chronic myeloid leukemia (CML). Moyamoya, a term meaning "a hazy puff of smoke" in Japanese, denotes a chronic occlusive cerebrovascular condition involving bilateral stenosis or closure of the terminal part of the internal carotid arteries (ICAs) and the proximal sections of the anterior cerebral arteries (ACAs) and middle cerebral arteries (MCAs) resulting in the development of abnormal vascular collaterals. A 40-year-old African-American female with a past medical history of CML presented to the oncology clinic with expressive aphasia. Of note, she was diagnosed with CML eight years ago and was previously treated with dasatinib and nilotinib with only partial remission. She tested positive for the T315I mutation and was initiated on asciminib therapy about a month before her symptoms surfaced. Asciminib, an allosteric inhibitor targeting breakpoint cluster region-abelson murine leukemia 1 (BCR-ABL1) kinase activity, has gained approval for treating patients diagnosed with chronic-phase CML who have not responded to two prior lines of therapy or for those carrying the T315I mutation. During admission, the patient underwent brain magnetic resonance imaging (MRI) and a computed tomography (CT) angiogram of the head showed moderate to severe narrowing at the origins of the bilateral MCA and ACA, concerning Moyamoya syndrome. Although not classically associated with asciminib therapy, we report here a patient with CML who developed expressive aphasia one month after starting the medication. Due to the high index of suspicion, asciminib was discontinued, and the patient was referred for bone marrow transplant evaluation and concurrently started on cytarabine + peginterferon. The patient had improvement in her symptoms of aphasia after the drug was discontinued and returned to her baseline functional status. No cardiovascular side effects associated with the use of asciminib are currently reported in the literature. However, we have described a case of such an occurrence. Therefore, extra caution should be taken in prescribing asciminib in patients with risk factors or a prior history of stroke.
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Affiliation(s)
- Saloni Savani
- Internal Medicine, Willis-Knighton Health System, Shreveport, USA
| | - Arpita Pawa
- Internal Medicine, Willis-Knighton Health System, Shreveport, USA
| | - Naved Salim
- College of Medicine, Edward Via College of Osteopathic Medicine, Shreveport, USA
| | - Tithi Savani
- Internal Medicine, Gujarat Medical Education and Research Society, Ahmedabad, IND
| | - Samip Master
- Hematology and Oncology, Willis-Knighton Health System, Shreveport, USA
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25
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Hermosilla-Trespaderne M, Hu-Yang MX, Dannoura A, Frey AM, George AL, Trost M, Marín-Rubio JL. Proteomic Analysis Reveals Trilaciclib-Induced Senescence. Mol Cell Proteomics 2024; 23:100778. [PMID: 38679389 PMCID: PMC11141265 DOI: 10.1016/j.mcpro.2024.100778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/13/2024] [Accepted: 04/24/2024] [Indexed: 05/01/2024] Open
Abstract
Trilaciclib, a cyclin-dependent kinase 4/6 inhibitor, was approved as a myeloprotective agent for protecting bone marrow from chemotherapy-induced damage in extensive-stage small cell lung cancer. This is achieved through the induction of a temporary halt in the cell cycle of bone marrow cells. While it has been studied in various cancer types, its potential in hematological cancers remains unexplored. This research aimed to investigate the efficacy of trilaciclib in hematological cancers. Utilizing mass spectrometry-based proteomics, we examined the alterations induced by trilaciclib in the chronic myeloid leukemia cell line, K562. Interestingly, trilaciclib promoted senescence in these cells rather than cell death, as observed in acute myeloid leukemia, acute lymphoblastic leukemia, and myeloma cells. In K562 cells, trilaciclib hindered cell cycle progression and proliferation by stabilizing cyclin-dependent kinase 4/6 and downregulating cell cycle-related proteins, along with the concomitant activation of autophagy pathways. Additionally, trilaciclib-induced senescence was also observed in the nonsmall cell lung carcinoma cell line, A549. These findings highlight trilaciclib's potential as a therapeutic option for hematological cancers and underscore the need to carefully balance senescence induction and autophagy modulation in chronic myeloid leukemia treatment, as well as in nonsmall cell lung carcinoma cell line.
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Affiliation(s)
- Marina Hermosilla-Trespaderne
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK; Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Mark Xinchen Hu-Yang
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK; Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Abeer Dannoura
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Andrew M Frey
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Amy L George
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Matthias Trost
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK.
| | - José Luis Marín-Rubio
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
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26
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Hochhaus A, Wang J, Kim DW, Kim DDH, Mayer J, Goh YT, le Coutre P, Takahashi N, Kim I, Etienne G, Andorsky D, Issa GC, Larson RA, Bombaci F, Kapoor S, McCulloch T, Malek K, Yau L, Ifrah S, Hoch M, Cortes JE, Hughes TP. Asciminib in Newly Diagnosed Chronic Myeloid Leukemia. N Engl J Med 2024. [PMID: 38820078 DOI: 10.1056/nejmoa2400858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Patients with newly diagnosed chronic myeloid leukemia (CML) need long-term therapy with high efficacy and safety. Asciminib, a BCR::ABL1 inhibitor specifically targeting the ABL myristoyl pocket, may offer better efficacy and safety and fewer side effects than currently available frontline ATP-competitive tyrosine kinase inhibitors (TKIs). METHODS In a phase 3 trial, patients with newly diagnosed CML were randomly assigned in a 1:1 ratio to receive either asciminib (80 mg once daily) or an investigator-selected TKI, with randomization stratified by European Treatment and Outcome Study long-term survival score category (low, intermediate, or high risk) and by TKI selected by investigators before randomization (including imatinib and second-generation TKIs). The primary end points were major molecular response (defined as BCR::ABL1 transcript levels ≤0.1% on the International Scale [IS]) at week 48, for comparisons between asciminib and investigator-selected TKIs and between asciminib and investigator-selected TKIs in the prerandomization-selected imatinib stratum. RESULTS A total of 201 patients were assigned to receive asciminib and 204 to receive investigator-selected TKIs. The median follow-up was 16.3 months in the asciminib group and 15.7 months in the investigator-selected TKI group. A major molecular response at week 48 occurred in 67.7% of patients in the asciminib group, as compared with 49.0% in the investigator-selected TKI group (difference, 18.9 percentage points; 95% confidence interval [CI], 9.6 to 28.2; adjusted two-sided P<0.001]), and in 69.3% of patients in the asciminib group as compared with 40.2% in the imatinib group within the imatinib stratum (difference, 29.6 percentage points; 95% CI, 16.9 to 42.2; adjusted two-sided P<0.001). The percentage of patients with a major molecular response at week 48 was 66.0% with asciminib and 57.8% with TKIs in the second-generation TKI stratum (difference, 8.2 percentage points; 95% CI, -5.1 to 21.5). Adverse events of grade 3 or higher and events leading to discontinuation of the trial regimen were less frequent with asciminib (38.0% and 4.5%, respectively) than with imatinib (44.4% and 11.1%) and second-generation TKIs (54.9% and 9.8%). CONCLUSIONS In this trial comparing asciminib with investigator-selected TKIs and imatinib, asciminib showed superior efficacy and a favorable safety profile in patients with newly diagnosed chronic-phase CML. Direct comparison between asciminib and second-generation TKIs was not a primary objective. (Funded by Novartis; ASC4FIRST ClinicalTrials.gov number, NCT04971226).
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Affiliation(s)
- Andreas Hochhaus
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Jianxiang Wang
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Dong-Wook Kim
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Dennis Dong Hwan Kim
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Jiri Mayer
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Yeow-Tee Goh
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Philipp le Coutre
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Naoto Takahashi
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Inho Kim
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Gabriel Etienne
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - David Andorsky
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Ghayas C Issa
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Richard A Larson
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Felice Bombaci
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Shruti Kapoor
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Tracey McCulloch
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Kamel Malek
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Lillian Yau
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Sophie Ifrah
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Matthias Hoch
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Jorge E Cortes
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
| | - Timothy P Hughes
- From Klinik für Innere Medizin II, Hematology/Oncology, Universitätsklinikum Jena and Comprehensive Cancer Center Central Germany, Campus Jena, Jena (A.H.), and the Department of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin (P.C.) - both in Germany; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (J.W.); Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si (D.-W.K.), and the Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul (I.K.) - both in South Korea; Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto (D.D.H.K.); the Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, and Masaryk University - both in Brno, Czech Republic (J.M.); the Department of Hematology, Singapore General Hospital, Singapore (Y.-T.G.); the Department of Hematology, Akita University, Akita City, Japan (N.T.); the Hematology Department, Institut Bergonié, Bordeaux (G.E.), and Novartis Pharma, Paris (S.I.) - both in France; Rocky Mountain Cancer Centers, Boulder, CO (D.A.); the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (G.C.I.); the University of Chicago, Chicago (R.A.L.); CML Patients Group, CML Advocates Network, Turin, Italy (F.B.); Novartis Pharmaceuticals, East Hanover, NJ (S.K.); Novartis Pharma, Basel, Switzerland (T.M., K.M., L.Y., M.H.); Georgia Cancer Center at Augusta University, Augusta (J.E.C.); and the South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia (T.P.H.)
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Hussain S, Mursal M, Verma G, Hasan SM, Khan MF. Targeting oncogenic kinases: Insights on FDA approved tyrosine kinase inhibitors. Eur J Pharmacol 2024; 970:176484. [PMID: 38467235 DOI: 10.1016/j.ejphar.2024.176484] [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: 09/24/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
Protein kinases play pivotal roles in various biological functions, influencing cell differentiation, promoting survival, and regulating the cell cycle. The disruption of protein kinase activity is intricately linked to pathways in tumor development. This manuscript explores the transformative impact of protein kinase inhibitors on cancer therapy, particularly their efficacy in cases driven by targeted mutations. Focusing on key tyrosine kinase inhibitors (TKIs) like Bcr-Abl, Epidermal Growth Factor Receptor (EGFR), and Vascular Endothelial Growth Factor Receptor (VEGFR), it targets critical kinase families in cancer progression. Clinical trial details of these TKIs offer insights into their therapeutic potentials. Learning from FDA-approved kinase inhibitors, the review dissects trends in kinase drug development since imatinib's paradigm-shifting approval in 2001. TKIs have evolved into pivotal drugs, extending beyond oncology. Ongoing clinical trials explore novel kinase targets, revealing the vast potential within the human kinome. The manuscript provides a detailed analysis of advancements until 2022, discussing the roles of specific oncogenic protein kinases in cancer development and carcinogenesis. Our exploration on PubMed for relevant and significant TKIs undergoing pre-FDA approval phase III clinical trials enriches the discussion with valuable findings. While kinase inhibitors exhibit lower toxicity than traditional chemotherapy in cancer treatment, challenges like resistance and side effects emphasize the necessity of understanding resistance mechanisms, prompting the development of novel inhibitors like osimertinib targeting specific mutant proteins. The review advocates thorough research on effective combination therapies, highlighting the future development of more selective RTKIs to optimize patient-specific cancer treatment and reduce adverse events.
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Affiliation(s)
- Sahil Hussain
- Faculty of Pharmacy, Integral University, Kursi Road, Lucknow, 226026, India
| | - Mohd Mursal
- Faculty of Pharmacy, Integral University, Kursi Road, Lucknow, 226026, India
| | - Garima Verma
- RWE Specialist, HealthPlix Technologies, Bengaluru, Karnataka 560103, India
| | - Syed Misbahul Hasan
- Faculty of Pharmacy, Integral University, Kursi Road, Lucknow, 226026, India
| | - Mohemmed Faraz Khan
- Faculty of Pharmacy, Integral University, Kursi Road, Lucknow, 226026, India.
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Kantarjian H, Branford S, Breccia M, Cortes J, Haddad FG, Hochhaus A, Hughes T, Issa GC, Jabbour E, Nicolini FE, Sasaki K, Xavier-Mahon F. Are there new relevant therapeutic endpoints in the modern era of the BCR::ABL1 tyrosine kinase inhibitors in chronic myeloid leukemia? Leukemia 2024; 38:947-950. [PMID: 38531949 DOI: 10.1038/s41375-024-02229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Affiliation(s)
| | - Susan Branford
- SA Pathology, Centre For Cancer Biology Australia, Adelaide, SA, Australia
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University-Rome, Rome, Italy
| | | | - Fadi G Haddad
- Leukemia Department, MD Anderson Cancer Center, Madrid, Spain
| | | | - Timothy Hughes
- South Australian Health & Medical Institute, SAHMRI, Adelaide, SA, Australia
| | - Ghayas C Issa
- Leukemia Department, MD Anderson Cancer Center, Madrid, Spain
| | - Elias Jabbour
- Leukemia Department, MD Anderson Cancer Center, Madrid, Spain
| | - Franck E Nicolini
- Hematology Department and CRCL INSERM U 1052, Centre Léon Berard, Lyon, France
| | - Koji Sasaki
- Leukemia Department, MD Anderson Cancer Center, Madrid, Spain
| | - Francois Xavier-Mahon
- Institut Bergonié or Bergonié Institute 229 cours de l'Argonne, 33076, Bordeaux, France
- INSERM U1312 Bordeaux University, Bordeaux, France
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29
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Wang Y, Liang ZJ, Gale RP, Liao HZ, Ma J, Gong TJ, Shao YQ, Liang Y. Chronic myeloid leukaemia: Biology and therapy. Blood Rev 2024; 65:101196. [PMID: 38604819 DOI: 10.1016/j.blre.2024.101196] [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: 11/30/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Chronic myeloid leukaemia (CML) is caused by BCR::ABL1. Tyrosine kinase-inhibitors (TKIs) are the initial therapy. Several organizations have reported milestones to evaluate response to initial TKI-therapy and suggest when a change of TKI should be considered. Achieving treatment-free remission (TFR) is increasingly recognized as the optimal therapy goal. Which TKI is the best initial therapy for which persons and what depth and duration of molecular remission is needed to achieve TFR are controversial. In this review we discuss these issues and suggest future research directions.
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MESH Headings
- Humans
- Protein Kinase Inhibitors/therapeutic use
- Fusion Proteins, bcr-abl/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Remission Induction
- Biology
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Affiliation(s)
- Yun Wang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zhi-Jian Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Robert Peter Gale
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Hua-Ze Liao
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jun Ma
- Harbin Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, China
| | - Tie-Jun Gong
- Harbin Institute of Hematology and Oncology, Harbin First Hospital, Harbin 150010, China.
| | - Ying-Qi Shao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
| | - Yang Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Centre for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
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30
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Özmen D, Alpaydın DD, Saldoğan MA, Eşkazan AE. A safety review of tyrosine kinase inhibitors for chronic myeloid leukemia. Expert Opin Drug Saf 2024; 23:411-423. [PMID: 38484148 DOI: 10.1080/14740338.2024.2331190] [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: 10/17/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Since the introduction of first tyrosine kinase inhibitor (TKI) imatinib, the treatment of chronic myeloid leukemia (CML) has reached excellent survival expectancies. Long survival rates bring about issues regarding TKI safety. AREAS COVERED The aim of this review is to compare the side effects of current TKIs both in the first and later lines and outline a safety andprofile of CML treatment. Seminal studies on TKIs and other newer drugs and extended follow-up of these studies; real-life data of each drug were usedduring the course of this. PubMed was used as a search database and onlyarticles in English were included. EXPERT OPINION With longer follow-up CML patients, resistant slowgrade adverse events seem to be the major obstacle in the way of treatmentefficacy. If efficacy is the priority, vigorous treatment of side effect and administration of full dose TKI are reasonable. But when treatment goals are reached, dose modifications or alternative treatment regimens may be acceptedpossible. More studies are needed on dose modification protocols and potential benefits and safety of treatment-free remission.
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Affiliation(s)
- Deniz Özmen
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Duygu Demet Alpaydın
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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31
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Holzmayer SJ, Kauer J, Mauermann J, Roider T, Märklin M. Asciminib Maintains Antibody-Dependent Cellular Cytotoxicity against Leukemic Blasts. Cancers (Basel) 2024; 16:1288. [PMID: 38610966 PMCID: PMC11010908 DOI: 10.3390/cancers16071288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
B cell acute lymphoblastic leukemia (B-ALL) is characterized by an accumulation of malignant precursor cells. Treatment consists of multiagent chemotherapy followed by allogeneic stem cell transplantation in high-risk patients. In addition, patients bearing the BCR-ABL1 fusion gene receive concomitant tyrosine kinase inhibitor (TKI) therapy. On the other hand, monoclonal antibody therapy is increasingly used in both clinical trials and real-world settings. The introduction of rituximab has improved the outcomes in CD20 positive cases. Other monoclonal antibodies, such as tafasitamab (anti-CD19), obinutuzumab (anti-CD20) and epratuzumab (anti-CD22) have been tested in trials (NCT05366218, NCT04920968, NCT00098839). The efficacy of monoclonal antibodies is based, at least in part, on their ability to induce antibody-dependent cellular cytotoxicity (ADCC). Combination treatments, e.g., chemotherapy and TKI, should therefore be screened for potential interference with ADCC. Here, we report on in vitro data using BCR-ABL1 positive and negative B-ALL cell lines treated with rituximab and TKI. NK cell activation, proliferation, degranulation, cytokine release and tumor cell lysis were analyzed. In contrast to ATP site inhibitors such as dasatinib and ponatinib, the novel first-in-class selective allosteric ABL myristoyl pocket (STAMP) inhibitor asciminib did not significantly impact ADCC in our settings. Our results suggest that asciminib should be considered in clinical trials.
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Affiliation(s)
- Samuel J. Holzmayer
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany; (S.J.H.)
- Cluster of Excellence iFIT (EXC 2180), Image-Guided and Functionally Instructed Tumor Therapies, Eberhard Karls University, 72076 Tübingen, Germany
| | - Joseph Kauer
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany; (S.J.H.)
- Interfaculty Institute for Cell Biology, Department of Immunology, University of Tübingen, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tübingen, 72076 Tübingen, Germany
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69117 Heidelberg, Germany;
- European Molecular Biology Laboratory (EMBL), 69116 Heidelberg, Germany
| | - Jonas Mauermann
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany; (S.J.H.)
- Cluster of Excellence iFIT (EXC 2180), Image-Guided and Functionally Instructed Tumor Therapies, Eberhard Karls University, 72076 Tübingen, Germany
| | - Tobias Roider
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69117 Heidelberg, Germany;
- European Molecular Biology Laboratory (EMBL), 69116 Heidelberg, Germany
| | - Melanie Märklin
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany; (S.J.H.)
- Cluster of Excellence iFIT (EXC 2180), Image-Guided and Functionally Instructed Tumor Therapies, Eberhard Karls University, 72076 Tübingen, Germany
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32
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Yuan Y, Li P, Li J, Zhao Q, Chang Y, He X. Protein lipidation in health and disease: molecular basis, physiological function and pathological implication. Signal Transduct Target Ther 2024; 9:60. [PMID: 38485938 PMCID: PMC10940682 DOI: 10.1038/s41392-024-01759-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/31/2023] [Accepted: 01/24/2024] [Indexed: 03/18/2024] Open
Abstract
Posttranslational modifications increase the complexity and functional diversity of proteins in response to complex external stimuli and internal changes. Among these, protein lipidations which refer to lipid attachment to proteins are prominent, which primarily encompassing five types including S-palmitoylation, N-myristoylation, S-prenylation, glycosylphosphatidylinositol (GPI) anchor and cholesterylation. Lipid attachment to proteins plays an essential role in the regulation of protein trafficking, localisation, stability, conformation, interactions and signal transduction by enhancing hydrophobicity. Accumulating evidence from genetic, structural, and biomedical studies has consistently shown that protein lipidation is pivotal in the regulation of broad physiological functions and is inextricably linked to a variety of diseases. Decades of dedicated research have driven the development of a wide range of drugs targeting protein lipidation, and several agents have been developed and tested in preclinical and clinical studies, some of which, such as asciminib and lonafarnib are FDA-approved for therapeutic use, indicating that targeting protein lipidations represents a promising therapeutic strategy. Here, we comprehensively review the known regulatory enzymes and catalytic mechanisms of various protein lipidation types, outline the impact of protein lipidations on physiology and disease, and highlight potential therapeutic targets and clinical research progress, aiming to provide a comprehensive reference for future protein lipidation research.
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Affiliation(s)
- Yuan Yuan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peiyuan Li
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianghui Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China.
| | - Ying Chang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China.
| | - Xingxing He
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Hubei Clinical Center and Key Laboratory of Intestinal and Colorectal Diseases, Wuhan, China.
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33
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Wu A, Liu X, Fruhstorfer C, Jiang X. Clinical Insights into Structure, Regulation, and Targeting of ABL Kinases in Human Leukemia. Int J Mol Sci 2024; 25:3307. [PMID: 38542279 PMCID: PMC10970269 DOI: 10.3390/ijms25063307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024] Open
Abstract
Chronic myeloid leukemia is a multistep, multi-lineage myeloproliferative disease that originates from a translocation event between chromosome 9 and chromosome 22 within the hematopoietic stem cell compartment. The resultant fusion protein BCR::ABL1 is a constitutively active tyrosine kinase that can phosphorylate multiple downstream signaling molecules to promote cellular survival and inhibit apoptosis. Currently, tyrosine kinase inhibitors (TKIs), which impair ABL1 kinase activity by preventing ATP entry, are widely used as a successful therapeutic in CML treatment. However, disease relapses and the emergence of resistant clones have become a critical issue for CML therapeutics. Two main reasons behind the persisting obstacles to treatment are the acquired mutations in the ABL1 kinase domain and the presence of quiescent CML leukemia stem cells (LSCs) in the bone marrow, both of which can confer resistance to TKI therapy. In this article, we systemically review the structural and molecular properties of the critical domains of BCR::ABL1 and how understanding the essential role of BCR::ABL1 kinase activity has provided a solid foundation for the successful development of molecularly targeted therapy in CML. Comparison of responses and resistance to multiple BCR::ABL1 TKIs in clinical studies and current combination treatment strategies are also extensively discussed in this article.
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MESH Headings
- Humans
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Signal Transduction
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Affiliation(s)
- Andrew Wu
- Collings Stevens Chronic Leukemia Research Laboratory, Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada; (A.W.); (X.L.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Xiaohu Liu
- Collings Stevens Chronic Leukemia Research Laboratory, Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada; (A.W.); (X.L.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Clark Fruhstorfer
- Collings Stevens Chronic Leukemia Research Laboratory, Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada; (A.W.); (X.L.)
| | - Xiaoyan Jiang
- Collings Stevens Chronic Leukemia Research Laboratory, Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada; (A.W.); (X.L.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Veltmaat L, Cortes J. Arterio-occlusive events among patients with chronic myeloid leukemia on tyrosine kinase inhibitors. Blood 2024; 143:858-865. [PMID: 38194683 DOI: 10.1182/blood.2023022403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024] Open
Abstract
ABSTRACT Tyrosine kinase inhibitors (TKIs) are standard therapy for patients with chronic myeloid leukemia. Each of these drugs has a specific profile of tyrosine kinases that they inhibit and, although all are clinically effective, they each have unique toxicity profiles. With the introduction of ponatinib, arterio-occlusive events were first noted and later found to occur with all TKIs to various extents. The recognition of this "class effect" was delayed considering ponatinib was introduced 10 years after the introduction of imatinib. The reasons for the delay in identification of this class effect are likely multifaceted. Importantly, there is an inconsistency in adverse event reporting criteria among the major clinical trials of the various TKIs, likely resulting in mixed reporting of arterio-occlusive events. Reporting events based on a frequency threshold, lack of sufficient follow-up, attempts at causality attribution, and the primary focus on molecular response may all have played an additional role. Considering the increasing rate of arterio-occlusive events over time, the termination of many trials after only 5 years prevents full assessment of the impact of these events. A comprehensive evaluation of TKI adverse effects using uniform Medical Dictionary for Regulatory Activities terms and comprehensive adjudication of these events may be helpful in better assessing the real risk for patients with each TKI. Future clinical trials should use a uniform and comprehensive approach to reporting adverse events without attempting to assign causality to the study drug.
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Affiliation(s)
| | - Jorge Cortes
- Georgia Cancer Center at Augusta University, Augusta, GA
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35
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Uchida Y, Koyama D, Manabe K, Suzuki K, Asano N, Endo M, Fukatsu M, Sano T, Hayashi K, Takano M, Takahashi H, Kimura S, Ikezoe T. High Efficacy and Safety of Asciminib in a Chronic Myeloid Leukemia Patient with Chronic Kidney Disease Following Renal Transplantation. Intern Med 2024; 63:717-720. [PMID: 37407456 PMCID: PMC10982009 DOI: 10.2169/internalmedicine.2179-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm driven by the BCR::ABL1 tyrosine kinase. Tyrosine kinase inhibitors (TKIs) have been established as standard therapies for CML. However, some CML patients experience TKI intolerance. Asciminib was approved for CML patients either intolerant or refractory to TKI therapy. We herein report a 63-year-old CML patient who underwent renal transplantation and exhibited TKI intolerance. He was switched to asciminib, which achieved a deep molecular response without exacerbation of the renal function. Our experience revealed that asciminib is effective and safe for CML patients complicated with chronic kidney disease.
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Affiliation(s)
- Yasuhiro Uchida
- Department of Hematology, Fukushima Medical University, Japan
| | - Daisuke Koyama
- Department of Hematology, Fukushima Medical University, Japan
| | - Kazuya Manabe
- Department of Hematology, Fukushima Medical University, Japan
| | - Kengo Suzuki
- Department of Hematology, Fukushima Medical University, Japan
| | - Naomi Asano
- Department of Hematology, Fukushima Medical University, Japan
| | - Mamiko Endo
- Department of Hematology, Fukushima Medical University, Japan
| | | | - Takahiro Sano
- Department of Hematology, Fukushima Medical University, Japan
| | | | - Motoki Takano
- Department of Hematology, Fukushima Medical University, Japan
| | | | - Satoshi Kimura
- Department of Hematology, Fukushima Medical University, Japan
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University, Japan
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Cheng F, Wang H, Li W, Zhang Y. Clinical pharmacokinetics and drug-drug interactions of tyrosine-kinase inhibitors in chronic myeloid leukemia: A clinical perspective. Crit Rev Oncol Hematol 2024; 195:104258. [PMID: 38307392 DOI: 10.1016/j.critrevonc.2024.104258] [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: 09/27/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024] Open
Abstract
In the past decade, numerous tyrosine kinase inhibitors (TKIs) have been introduced in the treatment of chronic myeloid leukemia. Given the significant interpatient variability in TKIs pharmacokinetics, potential drug-drug interactions (DDIs) can greatly impact patient therapy. This review aims to discuss the pharmacokinetic characteristics of TKIs, specifically focusing on their absorption, distribution, metabolism, and excretion profiles. Additionally, it provides a comprehensive overview of the utilization of TKIs in special populations such as the elderly, children, and patients with liver or kidney dysfunction. We also highlight known or suspected DDIs between TKIs and other drugs, highlighting various clinically relevant interactions. Moreover, specific recommendations are provided to guide haemato-oncologists, oncologists, and clinical pharmacists in managing DDIs during TKI treatment in daily clinical practice.
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Affiliation(s)
- Fang Cheng
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Hongxiang Wang
- Department of Hematology, the Central Hospital of Wuhan, 430014, China
| | - Weiming Li
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China.
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Brown DG. A Drug Discovery Perspective on FDA Expedited Development and Incentive Programs. J Med Chem 2024; 67:1690-1700. [PMID: 38233132 DOI: 10.1021/acs.jmedchem.3c02165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Expedited development and approval pathways at the Food and Drug Administration (FDA) such as Priority review, Fast Track Designation, Breakthrough Designation, and Accelerated Approval are programs available to drug sponsors that aim to incentivize and expedite the delivery of drugs to patients in need. In addition, other incentive programs such as Orphan Drug Designation (ODD), Qualified Infectious Disease Product Designation (QIDP), and Rare Pediatric Disease Designation (RPDD) are available to drug sponsors to help motivate development of drugs that may have lower economic incentive for commercialization. These programs have been largely effective, and many new innovative drugs since 2010 have accessed these programs. This Perspective highlights how these programs have been used in recent FDA drug approvals and discusses future ways sponsors and regulatory agencies may further enable development of these innovative drugs in the most expeditious fashion.
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Affiliation(s)
- Dean G Brown
- Jnana Therapeutics, One Design Center Pl, Suite 19-400, Boston, Massachusetts 02210, United States
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Costa A, Breccia M. How to improve treatment-free remission eligibility in chronic myeloid leukaemia? Br J Haematol 2024; 204:434-448. [PMID: 38148564 DOI: 10.1111/bjh.19269] [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: 09/26/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
The achievement of treatment-free remission (TFR) has become a significant clinical end-point in the management of patients with chronic myeloid leukaemia (CML), providing an opportunity to discontinue therapy with tyrosine kinase inhibitors (TKIs) while maintaining deep molecular response (DMR). Early studies, such as the French STIM trial, have demonstrated that a portion of patients can maintain DMR after treatment cessation, with rates ranging from 40% to 50%, and most relapses occurring within the first 6 months. Key prognostic factors for successful TFR, including treatment duration, duration of DMR, risk scores, and transcript type, have been identified. Optimal patient selection for TFR remains a challenge, but recent research provides insights into potential strategies to increase TFR eligibility. Evidence suggests that early intervention switching to achieve optimal response, treatment combinations, proactive switch in the case of absence of DMR, dose-optimization and induction-maintenance approach can improve molecular responses and, consequently, enhance TFR eligibility. In this review, we report and discuss all the potential therapeutic strategies that may enhance eligibility for a first attempt at TFR, with a particular emphasis on potential future approaches.
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Affiliation(s)
- Alessandro Costa
- Hematology Unit, Department of Medical Sciences and Public Health, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
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Han HJ, Kim JJ, Pyne D, Travas A, Ambalavanan A, Kimura S, Deininger MW, Kim JW, Kim DDH. In vitro evidence of synergistic efficacy with asciminib combined with reduced dose of ATP-binding pocket tyrosine kinase inhibitors according to the ABL1 kinase domain mutation profile. Leukemia 2024; 38:412-415. [PMID: 38155246 DOI: 10.1038/s41375-023-02122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Ho-Jae Han
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jaeyoon John Kim
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Danielle Pyne
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anthea Travas
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Amirthagowri Ambalavanan
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | | | - Jong-Won Kim
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea.
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dennis Dong Hwan Kim
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
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Zhang YJ, Liang JX, Xu YS, Liu YX, Cui Y, Qiao ZY, Wang H. Covalent drugs based on small molecules and peptides for disease theranostics. Biomater Sci 2024; 12:564-580. [PMID: 37975197 DOI: 10.1039/d3bm01138k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Biomacromolecules, such as proteins, nucleic acids and polysaccharides, are widely distributed in the human body, and some of them have been recognized as the targets of drugs for disease theranostics. Drugs typically act on targets in two ways: non-covalent bond and covalent bond. Non-covalent bond-based drugs have some disadvantages, such as structural instability and environmental sensitivity. Covalent interactions between drugs and targets have a longer action time, higher affinity and controllability than non-covalent interactions of conventional drugs. With the development of artificial intelligence, covalent drugs have received more attention and have been developed rapidly in pharmaceutical research in recent years. From the perspective of covalent drugs, this review summarizes the design methods and the effects of covalent drugs. Finally, we discuss the application of covalent peptide drugs and expect to provide a new reference for cancer treatment.
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Affiliation(s)
- Ying-Jin Zhang
- Henan Institute of Advanced Technology, Zhengzhou University, Zhengzhou, 450052, P.R. China
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), No. 11 Beiyitiao, Zhongguancun, Beijing 100190, P.R. China.
| | - Jian-Xiao Liang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), No. 11 Beiyitiao, Zhongguancun, Beijing 100190, P.R. China.
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, No. 19(A) Yuquan Road, Shijingshan District, Beijing 100049, P.R. China
| | - Yin-Sheng Xu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), No. 11 Beiyitiao, Zhongguancun, Beijing 100190, P.R. China.
| | - Yi-Xuan Liu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), No. 11 Beiyitiao, Zhongguancun, Beijing 100190, P.R. China.
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, No. 19(A) Yuquan Road, Shijingshan District, Beijing 100049, P.R. China
| | - Yingying Cui
- Department of Food and Drug, Laiwu Vocational and Technical, College, Jinan, China
| | - Zeng-Ying Qiao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), No. 11 Beiyitiao, Zhongguancun, Beijing 100190, P.R. China.
| | - Hao Wang
- Henan Institute of Advanced Technology, Zhengzhou University, Zhengzhou, 450052, P.R. China
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology (NCNST), No. 11 Beiyitiao, Zhongguancun, Beijing 100190, P.R. China.
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, No. 19(A) Yuquan Road, Shijingshan District, Beijing 100049, P.R. China
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Sun J, Hu R, Han M, Tan Y, Xie M, Gao S, Hu JF. Mechanisms underlying therapeutic resistance of tyrosine kinase inhibitors in chronic myeloid leukemia. Int J Biol Sci 2024; 20:175-181. [PMID: 38164178 PMCID: PMC10750272 DOI: 10.7150/ijbs.86305] [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: 05/18/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
Chronic myeloid leukemia (CML) is a malignant clonal disease involving hematopoietic stem cells that is characterized by myeloid cell proliferation in bone marrow and peripheral blood, and the presence of the Philadelphia (Ph) chromosome with BCR-ABL fusion gene. Treatment of CML has dramatically improved since the advent of tyrosine kinase inhibitors (TKI). However, there are a small subset of CML patients who develop resistance to TKI. Mutations in the ABL kinase domain (KD) are currently recognized as the leading cause of TKI resistance in CML. In this review, we discuss the concept of resistance and summarize recent advances exploring the mechanisms underlying CML resistance. Overcoming TKI resistance appears to be the most successful approach to reduce the burden of leukemia and enhance cures for CML. Advances in new strategies to combat drug resistance may rapidly change the management of TKI-resistant CML and expand the prospects for available therapies.
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MESH Headings
- Humans
- Tyrosine Kinase Inhibitors
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/therapeutic use
- Protein Kinase Inhibitors/therapeutic use
- Protein Kinase Inhibitors/pharmacology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
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Affiliation(s)
- Jingnan Sun
- Hematology Department, First hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Ruiping Hu
- Hematology Department, First hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Mengyuan Han
- Hematology Department, First hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Yehui Tan
- Hematology Department, First hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Mengqing Xie
- Hematology Department, First hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
- Oncology Department, Cancer hospital Chinese Academy of Medical Sciences, Langfang District, 065001, P.R. China
| | - Sujun Gao
- Hematology Department, First hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
| | - Ji-Fan Hu
- Hematology Department, First hospital of Jilin University, Changchun, Jilin, 130021, P.R. China
- Stanford University Medical School, Palo Alto Veterans Institute for Research, Palo Alto, CA94304, USA
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Alshurafa A, Afshan Adil, Yassin MA. Safety and Efficacy of Asciminib in Chronic Myeloid Leukemia Patient with Chronic Kidney Diseases: A Case Report. Case Rep Oncol 2024; 17:96-100. [PMID: 38229976 PMCID: PMC10791132 DOI: 10.1159/000535958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction Chronic myeloid leukemia (CML) is characterized by the presence of the BCR::ABL1 fusion gene, and the advent of tyrosine kinase inhibitors (TKIs) has revolutionized its therapeutic landscape. Asciminib, a STAMP inhibitor, emerges as a promising option for patients unresponsive or intolerant to multiple conventional TKIs. However, the safety and efficacy of asciminib in individuals with chronic kidney disease remain understudied. Case Presentation In this report, we detail the case of a 62-year-old patient with CML and stage 3 chronic kidney disease, who faced intolerance to traditional TKIs primarily due to fluid retention. The transition to asciminib therapy resulted in a profound molecular response and did not exacerbate renal function, effectively addressing the fluid retention issue. Conclusion This case highlights the potential of asciminib as a viable therapeutic alternative for CML patients with chronic kidney disease, particularly those intolerant to standard TKIs. Further research is warranted to establish the broader safety and efficacy profile of asciminib in this patient population.
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Affiliation(s)
- Awni Alshurafa
- Hematology Department, Hamad Medical Corporation, Doha, Qatar
| | - Afshan Adil
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
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Zhang Y, Wu X, Sun X, Yang J, Liu C, Tang G, Lei X, Huang H, Peng J. The Progress of Small Molecule Targeting BCR-ABL in the Treatment of Chronic Myeloid Leukemia. Mini Rev Med Chem 2024; 24:642-663. [PMID: 37855278 DOI: 10.2174/0113895575218335230926070130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/14/2023] [Accepted: 07/14/2023] [Indexed: 10/20/2023]
Abstract
Chronic myelogenous leukemia (CML) is a malignant myeloproliferative disease. According to the American Cancer Society's 2021 cancer data report, new cases of CML account for about 15% of all leukemias. CML is generally divided into three stages: chronic phase, accelerated phase, and blast phase. Nearly 90% of patients are diagnosed as a chronic phase. Allogeneic stem cell transplantation and chemotherapeutic drugs, such as interferon IFN-α were used as the earliest treatments for CML. However, they could generate obvious side effects, and scientists had to seek new treatments for CML. A new era of targeted therapy for CML began with the introduction of imatinib, the first-generation BCR-ABL kinase inhibitor. However, the ensuing drug resistance and mutant strains led by T315I limited the further use of imatinib. With the continuous advancement of research, tyrosine kinase inhibitors (TKI) and BCR-ABL protein degraders with novel structures and therapeutic mechanisms have been discovered. From biological macromolecules to classical target protein inhibitors, a growing number of compounds are being developed to treat chronic myelogenous leukemia. In this review, we focus on summarizing the current situation of a series of candidate small-molecule drugs in CML therapy, including TKIs and BCR-ABL protein degrader. The examples provided herein describe the pharmacology activity of small-molecule drugs. These drugs will provide new enlightenment for future treatment directions.
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Affiliation(s)
- Yuan Zhang
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Xin Wu
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Xueyan Sun
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Jun Yang
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Chang Liu
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Guotao Tang
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Xiaoyong Lei
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Honglin Huang
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
| | - Junmei Peng
- Department of Pharmacy, School of Pharmacy, Hengyang Medical School, Institute of Pharmacy and Pharmacology, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, Hunan, 421001, China
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Harada H, Moriya K, Kobuchi H, Ishihara N, Utsumi T. Protein N-myristoylation plays a critical role in the mitochondrial localization of human mitochondrial complex I accessory subunit NDUFB7. Sci Rep 2023; 13:22991. [PMID: 38151566 PMCID: PMC10752898 DOI: 10.1038/s41598-023-50390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023] Open
Abstract
The present study examined human N-myristoylated proteins that specifically localize to mitochondria among the 1,705 human genes listed in MitoProteome, a mitochondrial protein database. We herein employed a strategy utilizing cellular metabolic labeling with a bioorthogonal myristic acid analog in transfected COS-1 cells established in our previous studies. Four proteins, DMAC1, HCCS, NDUFB7, and PLGRKT, were identified as N-myristoylated proteins that specifically localize to mitochondria. Among these proteins, DMAC1 and NDUFB7 play critical roles in the assembly of complex I of the mitochondrial respiratory chain. DMAC1 functions as an assembly factor, and NDUFB7 is an accessory subunit of complex I. An analysis of the intracellular localization of non-myristoylatable G2A mutants revealed that protein N-myristoylation occurring on NDUFB7 was important for the mitochondrial localization of this protein. Furthermore, an analysis of the role of the CHCH domain in NDUFB7 using Cys to Ser mutants revealed that it was essential for the mitochondrial localization of NDUFB7. Therefore, the present results showed that NDUFB7, a vital component of human mitochondrial complex I, was N-myristoylated, and protein N-myrisotylation and the CHCH domain were both indispensable for the specific targeting and localization of NDUFB7 to mitochondria.
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Affiliation(s)
- Haruna Harada
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Japan
| | - Koko Moriya
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Japan
| | - Hirotsugu Kobuchi
- Department of Cell Chemistry, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Naotada Ishihara
- Department of Biological Sciences, Graduate School of Science, Osaka University, Osaka, Japan
| | - Toshihiko Utsumi
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Yamaguchi, Japan.
- Department of Biological Chemistry, Faculty of Agriculture, Yamaguchi University, Yamaguchi, Japan.
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Atallah E, Saini L, Maegawa R, Rajput T, Corbin R, Viana R. Therapy for patients with chronic phase-chronic myeloid leukemia previously treated with ⩾2 tyrosine kinase inhibitors: a systematic literature review. Ther Adv Hematol 2023; 14:20406207221150305. [PMID: 38105770 PMCID: PMC10725100 DOI: 10.1177/20406207221150305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/22/2022] [Indexed: 12/19/2023] Open
Abstract
Background ATP-competitive tyrosine kinase inhibitors (TKIs) are the current standard of care for patients with chronic phase-chronic myeloid leukemia (CP-CML) in the first-line and second-line (2 L) setting. Treatment after 2 L is not clearly established. Objective The objective of this study was to summarize the available evidence to compare the efficacy and safety of interventions in the treatment of CP-CML patients who had received ⩾2 prior TKIs. Design A systematic literature review was performed. Data source and methods A systematic literature review (SLR) of studies published until May 2021, reporting clinical outcomes in adult patients with CP-CML who had received ⩾ 2 prior TKIs was performed. Studies were identified through the database searches via Ovid platform (Embase, MEDLINE Epub Ahead of Print, In-Process and Other Non-Indexed Citations, and Cochrane Central Register of Controlled Trials), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), bibliographic search of relevant reviews, and proceedings from the previous 3 years of the key conferences in the field of oncology. Results Our search identified 38 relevant studies. Among the identified studies of the current third-line treatments, the major molecular response (MMR) rate for ponatinib was 19.0-66.7%, 23.3-25.5% for asciminib, 19.2% for omacetaxine, and 13.2% for bosutinib at 6 months. The complete cytogenetic response (CCyR) rate was 21.4-64.8% for ponatinib, 38.7-40.8% for asciminib, 18-24.2% for bosutinib, and 16.1% for omacetaxine at 6 months. Conclusion The findings from current SLR demonstrated the lack of data for patients with CML treated with ⩾2 TKIs. TKIs such as asciminib, ponatinib, and bosutinib are valid options for those patients. Further research is needed to identify the best treatment option for patients with CML receiving later lines of therapy.
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Affiliation(s)
- Ehab Atallah
- Cancer Center – Froedtert Hospital, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Regina Corbin
- Novartis Services Inc, One Health Plaza, East Hanover, NJ 07936-1080, USA
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Soverini S. Resistance mutations in CML and how we approach them. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:469-475. [PMID: 38066920 PMCID: PMC10727040 DOI: 10.1182/hematology.2023000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Among the variety of resistance mechanisms that may underlie a non-optimal response to tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia patients, secondary point mutations in the BCR::ABL1 kinase domain (KD) represent the only actionable one. Each of the 5 ATP-competitive inhibitors (imatinib, dasatinib, nilotinib, bosutinib, ponatinib) has a well-defined spectrum of resistance mutations. Growing clinical experience will soon allow to also elucidate the full spectrum of mutations conferring resistance to asciminib (that appear not to be confined to the myristate binding pocket). Regular molecular response (MR) monitoring is fundamental for evaluating treatment efficacy, catching early signs of relapse, and intervening promptly in case of confirmed failure. Whenever MR is not deemed satisfactory according to the European LeukemiaNet or the National Comprehensive Cancer Network definitions, BCR::ABL1 KD mutations testing should be performed. When needed, prompt and informed TKI switch can improve response and outcome and prevent the accumulation of mutations, including highly challenging compound mutations. Novel technologies like next-generation sequencing and digital polymerase chain reaction have recently been explored for BCR::ABL1 KD mutation testing; they have both advantages and disadvantages that are discussed in this article. This review also provides suggestions for interpretation and clinical translation of mutation testing results, which may not always be straightforward, particularly in cases of low-level or unknown mutations.
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Affiliation(s)
- Simona Soverini
- Department of Medical and Surgical Sciences (DIMEC), Institute of Hematology “Lorenzo e Ariosto Seràgnoli,” University of Bologna, Bologna, Italy
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47
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Iurlo A, Cattaneo D, Bucelli C, Spallarossa P, Passamonti F. Cardiovascular Adverse Events of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: Clinical Relevance, Impact on Outcome, Preventive Measures and Treatment Strategies. Curr Treat Options Oncol 2023; 24:1720-1738. [PMID: 38047977 DOI: 10.1007/s11864-023-01149-1] [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] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
OPINION STATEMENT The introduction of TKIs into the therapeutic armamentarium of CML has changed the disease paradigm, increasing long-term survival from 20% to over 80%, with a life expectancy now approaching that of the general population. Although highly effective, TKIs also have a toxicity profile that is often mild to moderate, but sometimes severe, with multiple kinases involved in the development of adverse events (AEs). Among others, cardiovascular AEs observed in TKI-treated CML patients may represent a significant cause of morbidity and mortality, and their pathogenesis is still only partially understood. In view of the recent introduction into daily clinical practice of new TKIs, namely the STAMP inhibitor asciminib, with a distinct safety profile, hematologists now more than ever have the opportunity to select the most suitable TKI for each patient, an aspect that will be fundamental in terms of personalized preventive and therapeutic strategies. Furthermore, physicians should be aware of the feasibility of TKI dose modifications at all stages of the patients' treatment journey, both at diagnosis for frail or elderly subjects or with multiple comorbidities, and during follow-up for those patients who experience toxicity, as well as to prevent it, with the main objective of reducing side effects while maintaining the response. Consequently, preserving the cardiovascular health of CML patients will likely be a more urgent topic in the near future, with specific measures aimed at controlling cardiovascular risk factors through a multidisciplinary approach involving a panel of healthcare professionals together with the hematologist.
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Affiliation(s)
- Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy.
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino - Italian IRCCS Cardiology Network, Genova, Italy
| | - Francesco Passamonti
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Lima K, Carvalho MFL, Pereira-Martins DA, Nogueira FL, de Miranda LBL, do Nascimento MC, Cavaglieri RDC, Schuringa JJ, Machado-Neto JA, Rego EM. Pharmacological Inhibition of PIP4K2 Potentiates Venetoclax-Induced Apoptosis in Acute Myeloid Leukemia. Int J Mol Sci 2023; 24:16899. [PMID: 38069220 PMCID: PMC10706459 DOI: 10.3390/ijms242316899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Phosphatidylinositol-5-phosphate 4-kinase type 2 (PIP4K2) protein family members (PIP4K2A, PIP4K2B, and PIP4K2C) participate in the generation of PIP4,5P2, which acts as a secondary messenger in signal transduction, a substrate for metabolic processes, and has structural functions. In patients with acute myeloid leukemia (AML), high PIP4K2A and PIP4K2C levels are independent markers of a worse prognosis. Recently, our research group reported that THZ-P1-2 (PIP4K2 pan-inhibitor) exhibits anti-leukemic activity by disrupting mitochondrial homeostasis and autophagy in AML models. In the present study, we characterized the expression of PIP4K2 in the myeloid compartment of hematopoietic cells, as well as in AML cell lines and clinical samples with different genetic abnormalities. In ex vivo assays, PIP4K2 expression levels were related to sensitivity and resistance to several antileukemia drugs and highlighted the association between high PIP4K2A levels and resistance to venetoclax. The combination of THZ-P1-2 and venetoclax showed potentiating effects in reducing viability and inducing apoptosis in AML cells. A combined treatment differentially modulated multiple genes, including TAp73, BCL2, MCL1, and BCL2A1. In summary, our study identified the correlation between the expression of PIP4K2 and the response to antineoplastic agents in ex vivo assays in AML and exposed vulnerabilities that may be exploited in combined therapies, which could result in better therapeutic responses.
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Affiliation(s)
- Keli Lima
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Internal Medicine, Hematology Division, Faculdade de Medicina, University of São Paulo, São Paulo CEP 13566-590, Brazil; (K.L.); (D.A.P.-M.); (F.L.N.); (M.C.d.N.)
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo CEP 13566-590, Brazil; (M.F.L.C.); (L.B.L.d.M.); (R.d.C.C.); (J.A.M.-N.)
| | - Maria Fernanda Lopes Carvalho
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo CEP 13566-590, Brazil; (M.F.L.C.); (L.B.L.d.M.); (R.d.C.C.); (J.A.M.-N.)
| | - Diego Antonio Pereira-Martins
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Internal Medicine, Hematology Division, Faculdade de Medicina, University of São Paulo, São Paulo CEP 13566-590, Brazil; (K.L.); (D.A.P.-M.); (F.L.N.); (M.C.d.N.)
- Department of Experimental Hematology, University of Groningen, 9718 BG Groningen, The Netherlands;
| | - Frederico Lisboa Nogueira
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Internal Medicine, Hematology Division, Faculdade de Medicina, University of São Paulo, São Paulo CEP 13566-590, Brazil; (K.L.); (D.A.P.-M.); (F.L.N.); (M.C.d.N.)
| | - Lívia Bassani Lins de Miranda
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo CEP 13566-590, Brazil; (M.F.L.C.); (L.B.L.d.M.); (R.d.C.C.); (J.A.M.-N.)
| | - Mariane Cristina do Nascimento
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Internal Medicine, Hematology Division, Faculdade de Medicina, University of São Paulo, São Paulo CEP 13566-590, Brazil; (K.L.); (D.A.P.-M.); (F.L.N.); (M.C.d.N.)
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo CEP 13566-590, Brazil; (M.F.L.C.); (L.B.L.d.M.); (R.d.C.C.); (J.A.M.-N.)
| | - Rita de Cássia Cavaglieri
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo CEP 13566-590, Brazil; (M.F.L.C.); (L.B.L.d.M.); (R.d.C.C.); (J.A.M.-N.)
| | - Jan Jacob Schuringa
- Department of Experimental Hematology, University of Groningen, 9718 BG Groningen, The Netherlands;
| | - João Agostinho Machado-Neto
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo CEP 13566-590, Brazil; (M.F.L.C.); (L.B.L.d.M.); (R.d.C.C.); (J.A.M.-N.)
| | - Eduardo Magalhães Rego
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Internal Medicine, Hematology Division, Faculdade de Medicina, University of São Paulo, São Paulo CEP 13566-590, Brazil; (K.L.); (D.A.P.-M.); (F.L.N.); (M.C.d.N.)
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Wang Y, Travers RJ, Farrell A, Lu Q, Bays JL, Stepanian A, Chen C, Jaffe IZ. Differential vascular endothelial cell toxicity of established and novel BCR-ABL tyrosine kinase inhibitors. PLoS One 2023; 18:e0294438. [PMID: 37983208 PMCID: PMC10659179 DOI: 10.1371/journal.pone.0294438] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023] Open
Abstract
BCR-ABL tyrosine kinase inhibitors (TKIs) have dramatically improved survival in Philadelphia chromosome-positive leukemias. Newer BCR-ABL TKIs provide superior cancer outcomes but with increased risk of acute arterial thrombosis, which further increases in patients with cardiovascular comorbidities and mitigates survival benefits compared to imatinib. Recent studies implicate endothelial cell (EC) damage in this toxicity by unknown mechanisms with few side-by-side comparisons of multiple TKIs and with no available data on endothelial impact of recently approved TKIs or novels TKIs being tested in clinical trials. To characterize BCR-ABL TKI induced EC dysfunction we exposed primary human umbilical vein ECs in 2D and 3D culture to clinically relevant concentrations of seven BCR-ABL TKIs and quantified their impact on EC scratch-wound healing, viability, inflammation, and permeability mechanisms. Dasatinib, ponatinib, and nilotinib, the TKIs associated with thrombosis in patients, all significantly impaired EC wound healing, survival, and proliferation compared to imatinib, but only dasatinib and ponatinib impaired cell migration and only nilotinib enhanced EC necrosis. Dasatinib and ponatinib increased leukocyte adhesion to ECs with upregulation of adhesion molecule expression in ECs (ICAM1, VCAM1, and P-selectin) and leukocytes (PSGL1). Dasatinib increased permeability and impaired cell junctional integrity in human engineered microvessels, consistent with its unique association with pleural effusions. Of the new agents, bafetinib decreased EC viability and increased microvessel permeability while asciminib and radotinib did not impact any EC function tested. In summary, the vasculotoxic TKIs (dasatinib, ponatinib, nilotinib) cause EC toxicity but with mechanistic differences, supporting the potential need for drug-specific vasculoprotective strategies. Asciminib and radotinib do not induce EC toxicity at clinically relevant concentrations suggesting a better safety profile.
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Affiliation(s)
- Yihua Wang
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States of America
- Tufts University, Medford, MA, United States of America
| | - Richard J. Travers
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States of America
- The Biological Design Center and Department of Biomedical Engineering, Boston University, Boston, MA, United States of America
| | - Alanna Farrell
- The Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States of America
| | - Qing Lu
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States of America
| | - Jennifer L. Bays
- The Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States of America
| | - Alec Stepanian
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States of America
| | - Christopher Chen
- The Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, United States of America
| | - Iris Z. Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States of America
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50
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Nian L, Xiaohua L, Rongcheng L, Song-Bai L. Types of DNA damage and research progress. NUCLEOSIDES, NUCLEOTIDES & NUCLEIC ACIDS 2023:1-21. [PMID: 37948546 DOI: 10.1080/15257770.2023.2277194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
DNA damage is a modification in the structure of DNA under the influence of endogenous or exogenous factors. DNA damage can cause different types of diseases and is closely related to genetic mutations, cancer, and aging. The cause of the corresponding reaction process is essential for the study of related cancers and other genetically related diseases. Therefore, it is essential to gain a deeper understanding of the various types of DNA damage. This paper provides a comprehensive review of recent advances in the types of DNA damage and associated reaction processes, including damage to DNA bases, nucleotides, and strands, as well as the biological implications of the damage.
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Affiliation(s)
- Liu Nian
- School of Chemistry and Life Sciences, Suzhou University of Science and Technology, Suzhou, China
- Suzhou Key Laboratory of Medical Biotechnology, Suzhou Vocational Health College, Suzhou, China
| | - Li Xiaohua
- Thyroid and breast surgery, Wuzhong People's Hospital of Suzhou City, Suzhou, China
| | - Li Rongcheng
- School of Chemistry and Life Sciences, Suzhou University of Science and Technology, Suzhou, China
- Suzhou Key Laboratory of Medical Biotechnology, Suzhou Vocational Health College, Suzhou, China
| | - Liu Song-Bai
- School of Chemistry and Life Sciences, Suzhou University of Science and Technology, Suzhou, China
- Suzhou Key Laboratory of Medical Biotechnology, Suzhou Vocational Health College, Suzhou, China
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