1
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Abdulrahman FG, Abulkhair HS, Zidan RA, Alwakeel AI, Al-Karmalawy AA, Husseiny EM. Novel benzochromenes: design, synthesis, cytotoxicity, molecular docking and mechanistic investigations. Future Med Chem 2024; 16:105-123. [PMID: 38226455 DOI: 10.4155/fmc-2023-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024] Open
Abstract
Aim: A novel series of fused benzochromenes with expected cytotoxicity and HIF-1α inhibition was identified. Materials & methods: A bioisosterism-aided approach was applied to design new benzochromenes and assess their cytotoxicity against three cancer cell lines. The probable mechanistic effect and the in silico docking and pharmacokinetic profiles of the most effective derivatives were evaluated. Results: Compounds 3, 4, 5, 8 and 11 showed potent antiproliferative activity and excellent selectivity. Compound 8 showed significant HIF-1α inhibition with an IC50 value of 3.372 μM. It also enhanced apoptosis and arrested the HepG2 cell cycle at both the G0/G1 and S stages. Conclusion: Compound 8 was identified as a new potential anticancer candidate.
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Affiliation(s)
- Fatma G Abdulrahman
- Pharmaceutical Organic Chemistry Department, Al-Azhar University, Nasr City, 11754, Cairo, Egypt
| | - Hamada S Abulkhair
- Pharmaceutical Organic Chemistry Department, Al-Azhar University, Nasr City, 11884, Cairo, Egypt
- Pharmaceutical Chemistry Department, Horus University-Egypt, International Coastal Road, New Damietta, 34518, Egypt
| | - Riham A Zidan
- Department of Biochemistry, Al-Azhar University, Cairo, Egypt
| | - Asmaa I Alwakeel
- Department of Pharmacology & Toxicology, Al Azhar University, Cairo, Egypt
| | - Ahmed A Al-Karmalawy
- Pharmaceutical Chemistry Department, Horus University-Egypt, International Coastal Road, New Damietta, 34518, Egypt
- Pharmaceutical Chemistry Department, Ahram Canadian University, Giza, 12566, Egypt
| | - Ebtehal M Husseiny
- Pharmaceutical Organic Chemistry Department, Al-Azhar University, Nasr City, 11754, Cairo, Egypt
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2
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Othman EM, Fayed EA, Husseiny EM, Abulkhair HS. The effect of novel synthetic semicarbazone- and thiosemicarbazone-linked 1,2,3-triazoles on the apoptotic markers, VEGFR-2, and cell cycle of myeloid leukemia. Bioorg Chem 2022; 127:105968. [PMID: 35728289 DOI: 10.1016/j.bioorg.2022.105968] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/02/2022]
Abstract
Vascular Endothelial Growth Factor II (VEGFR-2) has been proved as a rational target in cancer therapy. Although currently prescribed VEGFR-2 inhibitors are showing potent antitumor activity, they are often causing serious unwanted effects, restricting their extensive use as chemotherapeutics. Herein, after analyzing the structures of the effective VEGFR-2 inhibitor molecules, we report the synthesis of a new set of semicarbazone- and thiosemicarbazone-linked 1,2,3-triazoles with expected potency of inhibiting the VEGFR-2 signaling. The design of new compounds considered maintaining the essential pharmacophoric features of sorafenib for effective binding with the receptor target. All compounds have been evaluated for their growth inhibition effect against a panel of sixty cancer cells at the National Cancer Institute. Leukemia cancer cells, especially HL-60 and SR, were shown to be the most sensitive to the cytotoxic effect of new compounds. Thiosemicarbazones 21, 26, and 30 exhibited the best activity against almost all tested cancer cells. Therefore, a set of subsequent in vitro biological evaluations has been performed to understand the mechanistic effect of these compounds further. They inhibited the VEGFR-2 with IC50 values of 0.128, 0.413, and 0.067 µM respectively compared with 0.048 µM of Sorafenib. The probable mechanistic effect of 30 has been further evaluated on a number of apoptotic and antiapoptotic markers including BAX, BCL2, caspase-3, and caspase-9. Results revealed the potential of the thiosemicarbazone-linked triazole 30 to induce both the early and the late apoptosis, elevate BAX/BCL2 ratio, induce caspase-3 & caspase-9, and arrest the HL-60 cell cycle at the G2/M and G0-G1 phases. Molecular docking of new semicarbazones and thiosemicarbazones into the proposed biological target receptor has also been performed. Results of docking studies proved the potential of new semicarbazone- and thiosemicarbazone-linked 1,2,3-triazoles to effectively bind with crucial residues of the VEGFR-2 binding pocket.
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Affiliation(s)
- Esraa M Othman
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University, Nasr City 11754, Cairo, Egypt
| | - Eman A Fayed
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University, Nasr City 11754, Cairo, Egypt
| | - Ebtehal M Husseiny
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy (Girls), Al-Azhar University, Nasr City 11754, Cairo, Egypt
| | - Hamada S Abulkhair
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Al-Azhar University, Nasr City 11884, Cairo, Egypt; Pharmaceutical Chemistry Department, Faculty of Pharmacy, Horus University-Egypt, International Coastal Road, New Damietta 34518, Egypt.
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3
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Song X, Liu X, Yu W, Jin Y. Amide-Assisted Rearrangement of Hydroxyarylformimidoyl Chloride to Diarylurea. Molecules 2021; 26:6437. [PMID: 34770846 PMCID: PMC8587945 DOI: 10.3390/molecules26216437] [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: 09/27/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
A novel amide-assisted rearrangement reaction of hydroxybenzimidoyl chloride has been established for the efficient synthesis of 1,3-diphenylurea derivatives. A variety of electronically and sterically different 1,3-diphenylurea derivatives can be obtained in good to excellent yields, and a proposed reaction mechanism is also presented.
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Affiliation(s)
- Xizhong Song
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan Provincial Center for Research & Development of Natural Products, School of Chemical Science and Technology, Yunnan University, Kunming 650091, China; (X.S.); (X.L.)
- Jianxi Nafutang Pharmaceutical Co., Ltd., Zhangshu 331200, China
| | - Xiaoyu Liu
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan Provincial Center for Research & Development of Natural Products, School of Chemical Science and Technology, Yunnan University, Kunming 650091, China; (X.S.); (X.L.)
| | - Wei Yu
- 920th Hospital of Joint Logistics Support Force, PLA, Kunming 650118, China
| | - Yi Jin
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan Provincial Center for Research & Development of Natural Products, School of Chemical Science and Technology, Yunnan University, Kunming 650091, China; (X.S.); (X.L.)
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4
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Novatcheva ED, Anouty Y, Saunders I, Mangan JK, Goodman AM. FMS-Like Tyrosine Kinase 3 Inhibitors for the Treatment of Acute Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e161-e184. [PMID: 34649791 DOI: 10.1016/j.clml.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
Acute myeloid leukemia (AML) is the most common acute leukemia of adults, with a five-year survival that remains poor (approximately 25%). Knowledge and understanding of AML genomics have expanded tremendously over the past decade and are now included in AML prognostication and treatment decisions. FMS-like tyrosine kinase 3 (FLT3) is a Class III receptor tyrosine kinase (RTK) expressed primarily in the cell membranes of early hematopoietic progenitor cells, found in 28% of all patients with AML. FLT3 is the second most frequent mutation in adult AML following Nuclear-cytoplasmic shuttling phosphoprotein (NPM1), which is found in 50% of cases.1 FLT3 inhibitors are promising new molecular therapeutics increasingly becoming standard of care for both newly diagnosed and relapsed/refractory FLT3 positive AML. This review will focus on the clinical trials/evidence, similarities, differences, clinical toxicities, and drug interactions relevant to treating clinicians as pertains to 5 FLT3-inhibitors: midostaurin, sorafenib, gilteritinib, crenolanib, and quizartinib.
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Affiliation(s)
| | - Yasmine Anouty
- Department of Pharmacy, University of California San Diego Health, La Jolla, CA
| | - Ila Saunders
- Department of Pharmacy, University of California San Diego Health, La Jolla, CA; UC San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, CA
| | - James K Mangan
- Department of Medicine, Division of Blood and Marrow Transplantation, University of California San Diego, La Jolla, CA
| | - Aaron M Goodman
- Department of Medicine, Division of Blood and Marrow Transplantation, University of California San Diego, La Jolla, CA.
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5
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Eguchi M, Minami Y, Kuzume A, Chi S. Mechanisms Underlying Resistance to FLT3 Inhibitors in Acute Myeloid Leukemia. Biomedicines 2020; 8:biomedicines8080245. [PMID: 32722298 PMCID: PMC7459983 DOI: 10.3390/biomedicines8080245] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 01/03/2023] Open
Abstract
FLT3-ITD and FLT3-TKD mutations were observed in approximately 20 and 10% of acute myeloid leukemia (AML) cases, respectively. FLT3 inhibitors such as midostaurin, gilteritinib and quizartinib show excellent response rates in patients with FLT3-mutated AML, but its duration of response may not be sufficient yet. The majority of cases gain secondary resistance either by on-target and off-target abnormalities. On-target mutations (i.e., FLT3-TKD) such as D835Y keep the TK domain in its active form, abrogating pharmacodynamics of type II FLT3 inhibitors (e.g., midostaurin and quizartinib). Second generation type I inhibitors such as gilteritinib are consistently active against FLT3-TKD as well as FLT3-ITD. However, a “gatekeeper” mutation F691L shows universal resistance to all currently available FLT3 inhibitors. Off-target abnormalities are consisted with a variety of somatic mutations such as NRAS, AXL and PIM1 that bypass or reinforce FLT3 signaling. Off-target mutations can occur just in the primary FLT3-mutated clone or be gained by the evolution of other clones. A small number of cases show primary resistance by an FL-dependent, FGF2-dependent, and stromal CYP3A4-mediated manner. To overcome these mechanisms, the development of novel agents such as covalently-coupling FLT3 inhibitor FF-10101 and the investigation of combination therapy with different class agents are now ongoing. Along with novel agents, gene sequencing may improve clinical approaches by detecting additional targetable mutations and determining individual patterns of clonal evolution.
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Affiliation(s)
- Motoki Eguchi
- Department of Hematology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan; (M.E.); (A.K.); (S.C.)
| | - Yosuke Minami
- Department of Hematology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan; (M.E.); (A.K.); (S.C.)
- Correspondence: ; Tel.: +81-4-7133-1111; Fax: +81-7133-6502
| | - Ayumi Kuzume
- Department of Hematology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan; (M.E.); (A.K.); (S.C.)
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa 296-8602, Japan
| | - SungGi Chi
- Department of Hematology, National Cancer Center Hospital East, Kashiwa 277-8577, Japan; (M.E.); (A.K.); (S.C.)
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6
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Abstract
The urea functionality is inherent to numerous bioactive compounds, including a variety of clinically approved therapies. Urea containing compounds are increasingly used in medicinal chemistry and drug design in order to establish key drug-target interactions and fine-tune crucial drug-like properties. In this perspective, we highlight physicochemical and conformational properties of urea derivatives. We provide outlines of traditional reagents and chemical procedures for the preparation of ureas. Also, we discuss newly developed methodologies mainly aimed at overcoming safety issues associated with traditional synthesis. Finally, we provide a broad overview of urea-based medicinally relevant compounds, ranging from approved drugs to recent medicinal chemistry developments.
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Affiliation(s)
- Arun K Ghosh
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, Indiana 47907, United States
| | - Margherita Brindisi
- Department of Chemistry and Department of Medicinal Chemistry, Purdue University, West Lafayette, Indiana 47907, United States.,Department of Excellence of Pharmacy, University of Naples Federico II, 80131 Naples, Italy
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7
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Bazarbachi AH, Al Hamed R, Malard F, Mohty M, Bazarbachi A. Allogeneic transplant for FLT3- ITD mutated AML: a focus on FLT3 inhibitors before, during, and after transplant. Ther Adv Hematol 2019; 10:2040620719882666. [PMID: 31700594 PMCID: PMC6826920 DOI: 10.1177/2040620719882666] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/25/2019] [Indexed: 01/17/2023] Open
Abstract
FMS-like tyrosine kinase 3 (FLT3) mutations are one of the most frequently encountered genetic alterations in acute myeloid leukemia (AML), and are generally associated with unfavorable outcomes. Several tools are currently available to provide an accurate prognosis for patients with these mutations, including FLT3 mutation type (internal tandem duplication versus tyrosine kinase domain), mutation allelic ratio (high versus low), and concurrent nucleophosmin-1 (NPM1) mutation, to help decide on optimal treatment. Recent advances in targeted therapies have paved the way for modern treatment strategies, such as the development of FLT3 kinase inhibitors. These novel drugs can be incorporated into any treatment component, including induction and consolidation, the relapse/refractory setting, bridging for transplant, salvage post-transplant, and as prophylactic long-term post-transplant maintenance. Many challenges remain though, such as their intolerability with high-dose chemotherapy in frail patients; whether their optimal use involves watchful waiting for molecular or hematologic relapse compared with prophylactic use as maintenance; and the exact role and indication for allogeneic stem cell transplantation, which arguably remains the only curative option for these high-risk patients.
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Affiliation(s)
- Abdul Hamid Bazarbachi
- Department of Haematology, Saint Antoine Hospital, Paris, France, INSERM UMR 938, Paris, France
- Sorbonne University, Paris, Île-de-France, France
| | - Rama Al Hamed
- Department of Haematology, Saint Antoine Hospital, Paris, France, INSERM UMR 938, Paris, France
- Sorbonne University, Paris, Île-de-France, France
| | - Florent Malard
- Department of Haematology, Saint Antoine Hospital, Paris, France, INSERM UMR 938, Paris, France
- Sorbonne University, Paris, Île-de-France, France
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France, INSERM UMR 938, Paris, France
- Sorbonne University, Paris, Île-de-France, France
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 113-6044, Beirut, Lebanon
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8
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Lange A, Jaskula E, Lange J, Dworacki G, Nowak D, Simiczyjew A, Mordak-Domagala M, Sedzimirska M. The sorafenib anti-relapse effect after alloHSCT is associated with heightened alloreactivity and accumulation of CD8+PD-1+ (CD279+) lymphocytes in marrow. PLoS One 2018; 13:e0190525. [PMID: 29304116 PMCID: PMC5755786 DOI: 10.1371/journal.pone.0190525] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/15/2017] [Indexed: 12/21/2022] Open
Abstract
We studied three FLT3 ITD acute myeloid leukemia (AML) patients who relapsed after allogeneic haematopoietic stem cell transplantation (alloHSCT) and received multikinase inhibitor (MKI) sorafenib as part of salvage therapy. MKI was given to block the effect of FLT3 ITD mutation which powers proliferation of blast cells. However, the known facts that sorafenib is more effective in patents post alloHSCT suggested that this MKI can augment the immune system surveillance on leukaemia. In the present study, we investigated in depth the effect of sorafenib on the alloreactivity seen post-transplant including that on leukaemia. The patients (i) responded to the treatment with cessation of blasts which lasted 1, 17 and 42+ months, (ii) developed skin lesions with CD3+ cell invasion of the epidermis, (iii) had marrow infiltrated with CD8+ lymphocytes which co-expressed PD-1 (programmed cell death protein 1 receptor, CD279) in higher proportions than those in the blood (163±32 x103 cells/μl vs 38±8 x103 cells/μl, p<0.001). The Lymphoprep fraction of marrow cells investigated for the expression of genes involved in lymphocyte activation showed in the patients with long lasting complete remission (CR) a similar pattern characterized by (i) a low expression of nitric oxide synthase 2 (NOS2) and colony stimulating factor 2 (CSF2) as well as that of angiopoietin-like 4 (ANGPTL4) (supporting the immune response and anti-angiogenic) genes, and (ii) higher expression of fibroblast growth factor 1 (FGF1) and collagen type IV alpha 3 chain (COL4A3) as well as toll like receptor 9 (TLR9) and interleukin-12 (IL-12) (pro-inflammatory expression profile) genes as compared with the normal individual. The positive effect in one patient hardly justified the presence of unwanted effects (progressive chronic graft-versus-host disease (cGvHD) and avascular necrosis of the femur), which were in contrast negligible in the other patient. The anti-leukemic and unwanted effects of sorafenib do not rely on each other.
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Affiliation(s)
- Andrzej Lange
- L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
- * E-mail:
| | - Emilia Jaskula
- L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | - Janusz Lange
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | - Grzegorz Dworacki
- Department of Immunology, Poznan University of Medical Sciences, Poznan, Poland
| | - Dorota Nowak
- Department of Cell Pathology, Faculty of Biotechnology, University of Wroclaw, Wroclaw, Poland
| | - Aleksandra Simiczyjew
- Department of Cell Pathology, Faculty of Biotechnology, University of Wroclaw, Wroclaw, Poland
| | - Monika Mordak-Domagala
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
| | - Mariola Sedzimirska
- Lower Silesian Center for Cellular Transplantation with National Bone Marrow Donor Registry, Wroclaw, Poland
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9
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Haghi A, Mohammadi S, Heshmati M, Ghavamzadeh A, Nikbakht M. Anti-Vascular Endothelial Growth Factor Effects of Sorafenib and Arsenic Trioxide in Acute Myeloid Leukemia Cell Lines. Asian Pac J Cancer Prev 2017; 18:1655-1661. [PMID: 28670885 PMCID: PMC6373800 DOI: 10.22034/apjcp.2017.18.6.1655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Acute myeloid leukemia (AML), is a clonal disorder caused by acquired somatic mutations and chromosomal
rearrangements. According to some evidence, progression of hematolymphoid malignancies depends on the induction
of new blood vessel formation under the influence of acute leukemia. Various factors are produced by cancer cells
under hypoxic conditions to increase vascular formation. Among these, vascular endothelial growth factor (VEGF)
plays a crucial role. Cytotoxicity and anticancer effects of arsenic trioxide (ATO) have been reported in many cancers.
Sorafenib, known as an angiogenic inhibitor, decreases leukemic cell survival. The aim of this study was to indicate
combination effects of ATO and sorafenib in two AML cell lines, KG-1 and U937. Effective doses was determined by
MTT assay for both single and combination treatments. Percentages of apoptotic cells were evaluated by Annexin V
FITC staining and mRNA levels of VEGF isoforms and receptor expression were investigated by Real-Time PCR. Our
data show that sorafenib (5μM and 7μM in KG-1 and U937 cell lines respectively), ATO (1.618μM and 1μM in KG-1
and U937 cell lines respectively), and also their combination significantly increased the percentage of apoptotic cells.
In addition the mRNA level of VEGF isoforms was downregulated in the U937 cell line while upregulated in KG-1
cells. Taken together, our results suggest that the VEGF autocrine loop may have an influence on AML development
and progression and could be consider as a therapeutic target. The combination of sorafenib as a VEGF inhibitor with
ATO synergistically inhibits cell proliferation and promotes apoptosis.
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Affiliation(s)
- Atousa Haghi
- Department of Molecular and Cellular Science, Faculty of Advanced Science and Technology, Islamic Azad University, Tehran-Iran.,Young Researchers and Elite Club, Pharmaceutical Science Branch, Islamic Azad University, Tehran-Iran.
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10
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Edginton AN, Zimmerman EI, Vasilyeva A, Baker SD, Panetta JC. Sorafenib metabolism, transport, and enterohepatic recycling: physiologically based modeling and simulation in mice. Cancer Chemother Pharmacol 2016; 77:1039-52. [PMID: 27053087 DOI: 10.1007/s00280-016-3018-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/23/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE This study used uncertainty and sensitivity analysis to evaluate a physiologically based pharmacokinetic (PBPK) model of the complex mechanisms of sorafenib and its two main metabolites, sorafenib glucuronide and sorafenib N-oxide in mice. METHODS A PBPK model for sorafenib and its two main metabolites was developed to explain disposition in mice. It included relevant influx (Oatp) and efflux (Abcc2 and Abcc3) transporters, hepatic metabolic enzymes (CYP3A4 and UGT1A9), and intestinal β-glucuronidase. Parameterization of drug-specific processes was based on in vitro, ex vivo, and in silico data along with plasma and liver pharmacokinetic data from single and multiple transporter knockout mice. RESULTS Uncertainty analysis demonstrated that the model structure and parameter values could explain the observed variability in the pharmacokinetic data. Global sensitivity analysis demonstrated the global effects of metabolizing enzymes on sorafenib and metabolite disposition and the local effects of transporters on their respective substrate exposures. In addition, through hypothesis testing, the model supported that the influx transporter Oatp is a weak substrate for sorafenib and a strong substrate for sorafenib glucuronide and that the efflux transporter Abcc2 is not the only transporter affected in the Abcc2 knockout mouse. CONCLUSIONS Translation of the mouse model to humans for the purpose of explaining exceptionally high human pharmacokinetic variability and its relationship with exposure-dependent dose-limiting toxicities will require delineation of the importance of these processes on disposition.
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Affiliation(s)
| | - Eric I Zimmerman
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Aksana Vasilyeva
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Sharyn D Baker
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pharmaceutics, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - John C Panetta
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
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11
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Erbas O, Pala HG, Pala EE, Artunc Ulkumen B, Akman L, Akman T, Oltulu F, Aktug H, Yavasoglu A. Therapeutic effect of sunitinib on diabetes mellitus related ovarian injury: an experimental rat model study. Gynecol Endocrinol 2015; 31:388-91. [PMID: 25703256 DOI: 10.3109/09513590.2015.1005593] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of our study is to investigate the effect of sunitinib on diabetes mellitus related-ovarian injury and fibrosis in rat models. An experimental diabetes mellitus model was created in 16 rats, and eight rats with normal blood glucose levels were included in control group (Group-1). The diabetic rats were divided into two groups:diabetic control group (water given) - Group-2 and sunitinib treatment group - Group-3. After four weeks, bilateral oophorectomy was performed and ovaries were examined histologically. The groups were compared by Student's t-test, analysis of variance (ANOVA) and Mann-Whitney's U-test. There was a significant increase in no-medication (water given) diabetic rat's ovary (Group-2) in terms of follicular degeneration, stromal degeneration, stromal fibrosis and NF-kappaB immune-expression compared with control group normal rats' ovary (Group-1) (p < 0.0001). Stromal degeneration (p = 0.04), stromal fibrosis (p = 0.01), follicular degeneration (p = 0.02), NF-kappaB immune-expression (p = 0.001) significantly decreased in sunitinib-treated diabetic rat's ovary (Group-3) when compared with no-medication (water given) diabetic rat's ovary (Group-2) (p < 0.05). When we used sunitinib in the treatment of diabetic rats, ovarian injury, fibrosis and NF-kappaB immunoexpression decreased significantly. The effects of sunitinib in rat models give hope to the improved treatment of premature ovarian failure due to diabetes mellitus in humans.
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Affiliation(s)
- Oytun Erbas
- Physiology Department, Istanbul Bilim University School of Medicine , Istanbul , Turkey
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12
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Fouladi F, Jehn LB, Metzelder SK, Hub F, Henkenius K, Burchert A, Brendel C, Stiewe T, Neubauer A. Sorafenib induces paradoxical phosphorylation of the extracellular signal-regulated kinase pathway in acute myeloid leukemia cells lacking FLT3-ITD mutation. Leuk Lymphoma 2015; 56:2690-8. [PMID: 25665465 PMCID: PMC4732463 DOI: 10.3109/10428194.2014.1003055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Gain-of-function mutations in the RAS and FLT3 genes are frequently found in cells of acute myeloid leukemia (AML), leading to constitutive activation of signaling pathways that regulate fundamental cellular processes, and are therefore attractive targets for AML therapy. The multi-targeted kinase inhibitor sorafenib is efficacious in AML with FLT3-internal tandem duplication (ITD), but resistance to therapy is an important clinical problem. It is unclear whether AML lacking FLT3-ITD responds to sorafenib. Using AML cell lines, we have shown that a low concentration of sorafenib induces opposing effects depending on the oncogenic background. In FLT3-ITD positive cells sorafenib blocks Erk activity and cell proliferation, and triggers apoptosis. However, in cells lacking FLT3-ITD, sorafenib paradoxically activates Erk2, and stimulates cellular proliferation and metabolic activity. Thus, depending on the genetic context, sorafenib is a beneficial inhibitor or paradoxical activator of mitogenic signaling pathways in AML. These results harbor important consequences in planning clinical trials in AML.
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Affiliation(s)
- Fariba Fouladi
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
| | - Lutz B Jehn
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
| | - Stephan K Metzelder
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
| | - Florian Hub
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
| | - Katharina Henkenius
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
| | - Andreas Burchert
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
| | - Cornelia Brendel
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
| | - Thorsten Stiewe
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
| | - Andreas Neubauer
- a Klinik für Innere Medizin und Hämatologie, Onkologie, Immunologie, Philipps Universität Marburg und Universitätsklinikum Gießen und Marburg , Marburg , Germany
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Pala HG, Erbas O, Pala EE, Artunc Ulkumen B, Akman L, Akman T, Oltulu F, Yavasoglu A. The effects of sunitinib on endometriosis. J OBSTET GYNAECOL 2014; 35:183-7. [DOI: 10.3109/01443615.2014.941345] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Copper-free azide–alkyne cycloaddition of targeting peptides to porous silicon nanoparticles for intracellular drug uptake. Biomaterials 2014; 35:1257-66. [DOI: 10.1016/j.biomaterials.2013.10.065] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/22/2013] [Indexed: 01/07/2023]
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Fontanelli G, Rocco M, Caracciolo F, Benedetti E, Buda G, Orciuolo E, Carulli G, Galimberti S, Azzarà A, Petrini M. Sorafenib as monotherapy or in association with cytarabine and clofarabine for the treatment of relapsed/refractory FLT3 ITD-positive advanced acute myeloid leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:e13-7. [PMID: 24144836 DOI: 10.1016/j.clml.2013.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Giulia Fontanelli
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Melania Rocco
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Caracciolo
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Edoardo Benedetti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Buda
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Orciuolo
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Carulli
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Galimberti
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Azzarà
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Petrini
- U.O. Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Kathawala RJ, Wang YJ, Ashby CR, Chen ZS. Recent advances regarding the role of ABC subfamily C member 10 (ABCC10) in the efflux of antitumor drugs. CHINESE JOURNAL OF CANCER 2013; 33:223-30. [PMID: 24103790 PMCID: PMC4026542 DOI: 10.5732/cjc.013.10122] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABCC10, also known as multidrug-resistant protein 7 (MRP7), is the tenth member of the C subfamily of the ATP-binding cassette (ABC) superfamily. ABCC10 mediates multidrug resistance (MDR) in cancer cells by preventing the intracellular accumulation of certain antitumor drugs. The ABCC10 transporter is a 171-kDa protein that is localized on the basolateral cell membrane. ABCC10 is a broad-specificity transporter of xenobiotics, including antitumor drugs, such as taxanes, epothilone B, vinca alkaloids, and cytarabine, as well as modulators of the estrogen pathway, such as tamoxifen. In recent years, ABCC10 inhibitors, including cepharanthine, lapatinib, erlotinib, nilotinib, imatinib, sildenafil, and vardenafil, have been reported to overcome ABCC10-mediated MDR. This review discusses some recent and clinically relevant aspects of the ABCC10 drug efflux transporter from the perspective of current chemotherapy, particularly its inhibition by tyrosine kinase inhibitors and phosphodiesterase type 5 inhibitors.
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Affiliation(s)
- Rishil J Kathawala
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA.
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Navid F, Christensen R, Inaba H, Li L, Chen Z, Cai X, Regel J, Baker SD. Alternative formulations of sorafenib for use in children. Pediatr Blood Cancer 2013; 60:1642-6. [PMID: 23788485 PMCID: PMC3800690 DOI: 10.1002/pbc.24619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/13/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sorafenib is an oral multikinase inhibitor with antiangiogenic and antitumor activity. In most cases, the commercially available 200 mg tablet is not suitable for administration to children. We studied the chemical and physical stability of extemporaneously prepared formulations and evaluated the pharmacokinetic profile of cut tablets and smaller-dosage capsules of sorafenib in children. PROCEDURE Commercially available 200 mg tablets of sorafenib tosylate were used to prepare liquid suspensions of sorafenib in oil and Ora-Plus(®):Ora-Sweet(®) solution, and to prepare 5, 10, 20, 50, and 100 mg capsules. Plasma concentrations of sorafenib were measured in patients receiving capsules and cut tablets, using a validated HPLC-based method with tandem mass spectrometric detection. RESULTS At room temperature and under refrigeration, sorafenib concentrations in Ora Plus(®):Ora Sweet(®) were highly variable (means ranging from 75% to 131% of the intended concentration of 50 mg/ml). In oil suspension, sorafenib concentrations were inconsistent during compounding. In contrast, all smaller-dosage capsules, except the 5 mg capsule, were within 91-99% of the intended content and were stable at room temperature for at least 8 months. Sorafenib pharmacokinetic parameters in patients receiving capsules or cut tablets were consistent with those reported previously in adults and children receiving intact tablets. CONCLUSIONS Sorafenib is not stable in an oral suspension prepared from commercially available tablets, but compounded capsules in smaller-dosage forms that can be sprinkled on food or cut tablets are alternatives for administration to children who need smaller doses based on body surface area or cannot swallow tablets.
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Affiliation(s)
- Fariba Navid
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
| | - Robbin Christensen
- Department of Pharmaceutical Services, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA,Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
| | - Lie Li
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Zhaoyuan Chen
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Xiangjun Cai
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | | | - Sharyn D. Baker
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
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Abstract
INTRODUCTION Tyrosine kinases (TKs) are intimately involved in multiple signal transduction pathways regulating survival, activation, proliferation and differentiation of lymphoid cells. Deregulation or overexpression of specific oncogenic TKs is implicated in maintaining the malignant phenotype in B-lineage lymphoid malignancies. Several novel targeted TK inhibitors (TKIs) have recently emerged as active in the treatment of relapsed or refractory B-cell lymphomas that inhibit critical signaling pathways, promote apoptotic mechanisms or modulate the tumor microenvironment. AREAS COVERED In this review, the authors summarize the clinical outcomes of newer TKIs in various B-cell lymphomas from published and ongoing clinical studies and abstracts from major cancer and hematology conferences. EXPERT OPINION Multiple clinical trials have demonstrated that robust antitumor activity can be obtained with TKIs directed toward specific oncogenic TKs that are genetically deregulated in various subtypes of B-cell lymphomas. Clinical success of targeting TKIs is dependent upon on identifying reliable molecular and clinical markers associated with select cohorts of patients. Further understanding of the signaling pathways should stimulate the identification of novel molecular targets and expand the development of new therapeutic options and individualized therapies.
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Affiliation(s)
- Osmond J D'Cruz
- Children's Hospital Los Angeles, Children's Center for Cancer and Blood Diseases, Los Angeles, CA 90027, USA
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Serve H, Krug U, Wagner R, Sauerland MC, Heinecke A, Brunnberg U, Schaich M, Ottmann O, Duyster J, Wandt H, Fischer T, Giagounidis A, Neubauer A, Reichle A, Aulitzky W, Noppeney R, Blau I, Kunzmann V, Stuhlmann R, Krämer A, Kreuzer KA, Brandts C, Steffen B, Thiede C, Müller-Tidow C, Ehninger G, Berdel WE. Sorafenib in Combination With Intensive Chemotherapy in Elderly Patients With Acute Myeloid Leukemia: Results From a Randomized, Placebo-Controlled Trial. J Clin Oncol 2013; 31:3110-8. [DOI: 10.1200/jco.2012.46.4990] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose The prognosis of elderly patients with acute myeloid leukemia (AML) is still dismal even with intensive chemotherapy. In this trial, we compared the antileukemic activity of standard induction and consolidation therapy with or without the addition of the kinase inhibitor sorafenib in elderly patients with AML. Patients and Methods All patients received standard cytarabine and daunorubicin induction (7+3 regimen) and up to two cycles of intermediate-dose cytarabine consolidation. Two hundred one patients were equally randomly assigned to receive either sorafenib or placebo between the chemotherapy cycles and subsequently for up to 1 year after the beginning of therapy. The primary objective was to test for an improvement in event-free survival (EFS). Overall survival (OS), complete remission (CR) rate, tolerability, and several predefined subgroup analyses were among the secondary objectives. Results Age, sex, CR and early death (ED) probability, and prognostic factors were balanced between both study arms. Treatment in the sorafenib arm did not result in significant improvement in EFS or OS. This was also true for subgroup analyses, including the subgroup positive for FLT3 internal tandem duplications. Results of induction therapy were worse in the sorafenib arm, with higher treatment-related mortality and lower CR rates. More adverse effects occurred during induction therapy in the sorafenib arm, and patients in this arm received less consolidation chemotherapy as a result of higher induction toxicity. Conclusion In conclusion, combination of standard induction and consolidation therapy with sorafenib in the schedule investigated in our trial is not beneficial for elderly patients with AML.
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Affiliation(s)
- Hubert Serve
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Utz Krug
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Ruth Wagner
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - M. Cristina Sauerland
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Achim Heinecke
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Uta Brunnberg
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Markus Schaich
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Oliver Ottmann
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Justus Duyster
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Hannes Wandt
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Thomas Fischer
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Aristoteles Giagounidis
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Andreas Neubauer
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Albrecht Reichle
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Walter Aulitzky
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Richard Noppeney
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Igor Blau
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Volker Kunzmann
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Reingard Stuhlmann
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Alwin Krämer
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Karl-Anton Kreuzer
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Christian Brandts
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Björn Steffen
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Christian Thiede
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Carsten Müller-Tidow
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Gerhard Ehninger
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
| | - Wolfgang E. Berdel
- Hubert Serve, Uta Brunnberg, Oliver Ottmann, Christian Brandts, Björn Steffen, Goethe-University, Frankfurt; Utz Krug, Ruth Wagner, Carsten Müller-Tidow, and Wolfgang E. Berdel, University Hospital; Ruth Wagner, M. Cristina Sauerland, Achim Heinecke, University of Muenster, Muenster; Markus Schaich, Christian Thiede, and Gerhard Ehninger, University Hospital, Dresden; Justus Duyster, Technische Universität München, München; Hannes Wandt, Klinikum Nürnberg, Nürnberg; Thomas Fischer, University Hospital,
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Watt TC, Cooper T. Sorafenib as treatment for relapsed or refractory pediatric acute myelogenous leukemia. Pediatr Blood Cancer 2012; 59:756-7. [PMID: 22052552 DOI: 10.1002/pbc.23394] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/21/2011] [Indexed: 11/09/2022]
Abstract
The prognosis for children with acute myelogenous leukemia (AML) has improved with overall survival rates of up to 65% [Pui et al. J Clin Oncol 2011; 29: 551-565]. However, the cure rate for AML lags behind that of acute lymphoblastic leukemia. Advances in AML leukemogenesis are leading to refined risk stratification. FMS like tyrosine kinase 3 (FLT3) mutations are independently associated with a poor prognosis. Newer kinase inhibitors, including sorafenib, have shown promise in adult studies. We report three pediatric patients with relapsed AML who achieved a sustained remission with sorafenib. Further trials are necessary to understand the role of sorafenib in pediatric AML.
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Affiliation(s)
- Tanya C Watt
- Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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22
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Zimmerman EI, Roberts JL, Li L, Finkelstein D, Gibson A, Chaudhry AS, Schuetz EG, Rubnitz JE, Inaba H, Baker SD. Ontogeny and sorafenib metabolism. Clin Cancer Res 2012; 18:5788-95. [PMID: 22927483 DOI: 10.1158/1078-0432.ccr-12-1967] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the role of ontogeny in sorafenib metabolism to the equipotent active metabolite sorafenib N-oxide. EXPERIMENTAL DESIGN Steady-state pharmacokinetic studies of sorafenib and metabolites were conducted in 30 children and young adults (17 males; median age, 9.5 years) receiving sorafenib 150 mg/m(2) or 200 mg/m(2) twice daily. Sorafenib metabolism was evaluated in vitro at 10 μmol/L using a panel of purified human cytochrome P450 (CYP) enzymes. Sorafenib metabolism and CYP3A4 expression was evaluated in 52 human liver samples from donors of ≤20 years old. The drug-drug interaction potential between sorafenib and azole antifungal agents was evaluated in vitro and in vivo. RESULTS No age-related differences in sorafenib apparent oral clearance were observed. Mean sorafenib N-oxide metabolite ratio was 0.27 ± 0.14. In children of ≤10 years of age, boys had approximately 2-fold higher N-oxide ratios than girls (0.40 ± 0.15 vs. 0.22 ± 0.12, P = 0.026). Of the CYPs evaluated, sorafenib was exclusively metabolized to sorafenib N-oxide by CYP3A4. A trend for increased N-oxide formation in boys was observed in liver samples, which correlated with CYP3A4 mRNA expression. Posaconazole and voriconazole potently inhibited sorafenib N-oxide formation in vitro, and reduced sorafenib N-oxide formation in 3 children given sorafenib concurrent with azoles. CONCLUSION We have identified several factors affecting interpatient variability in sorafenib metabolism to the active N-oxide metabolite including age, sex, and concurrent treatment with azole antifungals. This knowledge may provide important considerations for the clinical use of sorafenib in children and possibly other kinase inhibitors undergoing CYP3A4-mediated metabolism.
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Affiliation(s)
- Eric I Zimmerman
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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23
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Zhang H, Zhang FM, Yan SJ. Preparation, in vitro release, and pharmacokinetics in rabbits of lyophilized injection of sorafenib solid lipid nanoparticles. Int J Nanomedicine 2012; 7:2901-10. [PMID: 22787390 PMCID: PMC3391003 DOI: 10.2147/ijn.s32415] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Sorafenib solid lipid nanoparticles (S-SLN) were prepared by emulsion evaporation–solidification at low temperature. Morphology was examined by transmission electron microscope. Particle size and zeta potential were determined by laser granularity equipment. Encapsulation efficiency (EE) was detected by Sephadex gel chromatography and high-performance liquid chromatography (HPLC). The in vitro release profile of S-SLN was studied with dialysis technology. The lyophilized injection of S-SLN was prepared by freeze drying and analyzed by differential scanning calorimetry. The plasma concentration of sorafenib in blood was determined by HPLC. The solid lipid nanoparticles assumed a spherical shape with an even distribution of diameter and particle size 108.23 ± 7.01 nm (n = 3). The polydispersity index, zeta potential, and EE were determined to be 0.25 ± 0.02, −16.37 ± 0.65 mV, and 93.49% ± 1.87%, respectively (n = 3). The in vitro release accorded with the Weibull distribution model. An equal volume of 15% (w/v) mannitol performed better as the protective agent for a lyophilized injection of S-SLN with a new material phase formation. The pharmacokinetic processes of sorafenib solution and lyophilized injection of S-SLN in vivo were in accordance with the two-compartment and one-compartment models, respectively. S-SLN nanoparticles are thus considered a promising drug-delivery system.
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Affiliation(s)
- Hong Zhang
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.
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24
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Al-Kali A, Cortes J, Faderl S, Jones D, Abril C, Pierce S, Brandt M, Kantarjian H, Ravandi F. Patterns of molecular response to and relapse after combination of sorafenib, idarubicin, and cytarabine in patients with FLT3 mutant acute myeloid leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:361-6. [PMID: 21816375 DOI: 10.1016/j.clml.2011.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/03/2011] [Accepted: 01/20/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND FMS-like tyrosine kinase 3 (FLT3) is a class III receptor tyrosine kinase involved in hematopoietic progenitor cell development. Mutations of FLT3 have been reported in about a third of patients with acute myeloid leukemia (AML), and inhibitors of FLT3 are of clinical interest. Sorafenib is an orally active multikinase inhibitor with potent activity against FLT3 and the Raf/ERK/MEK kinase pathway. METHODS We studied the patterns of molecular response and relapse in 18 patients with mutated FLT3 treated with the combination of sorafenib, idarubicin, and cytarabine. RESULTS The median follow-up was 9 months. Sixteen patients achieved complete remission (CR), and the other 2 patients achieved CR but lacked platelet recovery for an overall response rate of 100%. Ten patients had their FLT3-mutated clone eradicated, with 6 patients who showed some residual FLT3-mutated cells, and 2 patients who showed persistent FLT3-mutated cells. The elimination of FLT3-mutated population at the time of morphologic CR, however, was not predictive of relapse. After a median follow-up of 9 months (range, 1-16 months), 10 (55%) patients had relapsed, with a median CR duration of 8.8 months (range, 1-9.5 months). By DNA sequencing, there was no evidence of an acquired FLT3 point mutation at the time of relapse in 7 patients tested, which suggested the presence of other mechanisms of sorafenib resistance. CONCLUSION Sorafenib, combined with chemotherapy, is effective in attaining CR, but relapses still occur.
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Affiliation(s)
- Aref Al-Kali
- Department of Leukemia, The University of Texas--M D Anderson Cancer Center, Houston, TX 77030, USA
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25
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Röllig C, Brandts C, Shaid S, Hentrich M, Krämer A, Junghanß C, Schleyer E, Müller-Tidow C, Berdel WE, Ritter B, Pflüger KH, Kramer M, Haibach M, Ehninger G, Serve H, Krause SW. Survey and analysis of the efficacy and prescription pattern of sorafenib in patients with acute myeloid leukemia. Leuk Lymphoma 2011; 53:1062-7. [PMID: 22054287 DOI: 10.3109/10428194.2011.637210] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sorafenib is a multi-kinase inhibitor with activity against several intracellular kinases which may play a role in the pathogenesis of acute myeloid leukemia (AML). In vitro data and results from early clinical trials suggest that sorafenib might be an effective drug for the treatment of AML. However, clinical data are still sparse, and there are only a few reported cases of monotherapy. The aim of the present research was to collect clinical data on efficacy and safety in a systematic way by conducting a survey on clinical experience with sorafenib. Thirty institutions were asked to document all patients treated with sorafenib diagnosed with AML. Of all 29 evaluable patients, six (21%) responded to sorafenib containing treatment by achieving a complete remission (CR, n = 2) or complete remission with incomplete platelet recovery (CRi, n = 4). In 23 patients receiving sorafenib as monotherapy, the CRi rate amounted to 13% and no CRs were documented. Of the 18 FLT-ITD positive patients with sorafenib monotherapy, two patients achieved a CRi (11%). In five FLT3-ITD negative cases, one CRi was documented (20%). Our results suggest the potential ability of the drug to induce remissions in refractory or relapsed AML even when given as monotherapy.
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Affiliation(s)
- Christoph Röllig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Dresden, Germany.
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26
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Abstract
Somatic, gain-of-function mutations in ras genes were the first specific genetic alterations identified in human cancer about 3 decades ago. Studies during the last quarter century have characterized the Ras proteins as essential components of signaling networks controlling cellular proliferation, differentiation, or survival. The oncogenic mutations of the H-ras, N-ras, or K-ras genes frequently found in human tumors are known to throw off balance the normal outcome of those signaling pathways, thus leading to tumor development. Oncogenic mutations in a number of other upstream or downstream components of Ras signaling pathways (including membrane RTKs or cytosolic kinases) have been detected more recently in association with a variety of cancers. Interestingly, the oncogenic Ras mutations and the mutations in other components of Ras/MAPK signaling pathways appear to be mutually exclusive events in most tumors, indicating that deregulation of Ras-dependent signaling is the essential requirement for tumorigenesis. In contrast to sporadic tumors, separate studies have identified germline mutations in Ras and various other components of Ras signaling pathways that occur in specific association with a number of different familial, developmental syndromes frequently sharing common phenotypic cardiofaciocutaneous features. Finally, even without being a causative force, defective Ras signaling has been cited as a contributing factor to many other human illnesses, including diabetes and immunological and inflammatory disorders. We aim this review at summarizing and updating current knowledge on the contribution of Ras mutations and altered Ras signaling to development of various tumoral and nontumoral pathologies.
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Davies RJ, Pierce AC, Forster C, Grey R, Xu J, Arnost M, Choquette D, Galullo V, Tian SK, Henkel G, Chen G, Heidary DK, Ma J, Stuver-Moody C, Namchuk M. Design, Synthesis, and Evaluation of a Novel Dual Fms-Like Tyrosine Kinase 3/Stem Cell Factor Receptor (FLT3/c-KIT) Inhibitor for the Treatment of Acute Myelogenous Leukemia. J Med Chem 2011; 54:7184-92. [DOI: 10.1021/jm200712h] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Robert J. Davies
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Albert C. Pierce
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Cornelia Forster
- Novartis IBMR, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - Ron Grey
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Jinwang Xu
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Michael Arnost
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Deborah Choquette
- Amgen, 1 Kendall Square, Cambridge, Massachusetts 02139, United States
| | - Vincent Galullo
- Astra Zeneca R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Shi-Kai Tian
- University of Science & Technology of China, Hefei, Anhui 230026, China
| | - Greg Henkel
- Arisan Therapeutics, 21512 Canaria, Mission Viejo, California 92692, United States
| | - Guanjing Chen
- Novartis IBMR, 250 Massachusetts Avenue, Cambridge, Massachusetts 02139, United States
| | - David K. Heidary
- University of Kentucky, Lexington, Kentucky 40506, United States
| | - Joanne Ma
- Merck West Point, 770 Sumneytown Pike, West Point, Pennsylvania 19486, United States
| | - Cameron Stuver-Moody
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
| | - Mark Namchuk
- Vertex Pharmaceuticals Inc., 130 Waverly Street, Cambridge, Massachusetts 02139, United States
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Sharma M, Ravandi F, Bayraktar UD, Chiattone A, Bashir Q, Giralt S, Chen J, Qazilbash M, Kebriaei P, Konopleva M, Andreeff M, Cortes J, McCue D, Kantarjian H, Champlin RE, de Lima M. Treatment of FLT3-ITD-positive acute myeloid leukemia relapsing after allogeneic stem cell transplantation with sorafenib. Biol Blood Marrow Transplant 2011; 17:1874-7. [PMID: 21767516 DOI: 10.1016/j.bbmt.2011.07.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 07/10/2011] [Indexed: 10/17/2022]
Abstract
Patients with acute myeloid leukemia (AML) and internal tandem duplication of FMS-like tyrosine kinase receptor-3 gene (FLT3-ITD) mutation have poor prognoses and are often treated with allogeneic hematopoietic stem cell transplantation (HSCT). Sorafenib, an inhibitor of multiple kinases including FLT3, has shown promising activity in FLT3-ITD-positive AML. We treated 16 patients with FLT3-ITD-positive AML who relapsed after HSCT with sorafenib alone (n = 8) or in combination with cytotoxic chemotherapy (n = 8). The number of circulating blasts decreased in 80% of cases, but none of the patients achieved complete remission (CR); 3 achieved partial remission. Two patients were bridged to a second transplantation but both relapsed within 3 months of the transplantation. Median overall survival (OS) was 83 days, with none surviving more than a year. Sorafenib is not effective in the treatment of FLT3-ITD-positive AML relapsing after HSCT. Preventive strategies after HSCT may be more suitable for these high-risk patients.
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Affiliation(s)
- Manish Sharma
- Department of Stem Cell Transplantation, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA
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29
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Inaba H, Rubnitz JE, Coustan-Smith E, Li L, Furmanski BD, Mascara GP, Heym KM, Christensen R, Onciu M, Shurtleff SA, Pounds SB, Pui CH, Ribeiro RC, Campana D, Baker SD. Phase I pharmacokinetic and pharmacodynamic study of the multikinase inhibitor sorafenib in combination with clofarabine and cytarabine in pediatric relapsed/refractory leukemia. J Clin Oncol 2011; 29:3293-300. [PMID: 21768474 DOI: 10.1200/jco.2011.34.7427] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To assess the toxicity, pharmacokinetics, and pharmacodynamics of multikinase inhibitor sorafenib in combination with clofarabine and cytarabine in children with relapsed/refractory leukemia. PATIENTS AND METHODS Twelve patients with acute leukemia (11 with acute myeloid leukemia [AML]) received sorafenib on days 1 to 7 and then concurrently with cytarabine (1 g/m(2)) and clofarabine (stratum one: 40 mg/m(2), n = 10; stratum two [recent transplantation or fungal infection]: 20 mg/m(2), n = 2) on days 8 to 12. Sorafenib was continued until day 28 if tolerated. Two sorafenib dose levels (200 mg/m(2) and 150 mg/m(2) twice daily) were planned. Sorafenib pharmacokinetic and pharmacodynamic studies were performed on days 7 and 8. RESULTS At sorafenib 200 mg/m(2), two of four patients in stratum one and one of two patients in stratum two had grade 3 hand-foot skin reaction and/or rash as dose-limiting toxicities (DLTs). No DLTs were observed in six patients in stratum one at sorafenib 150 mg/m(2). Sorafenib inhibited the phosphorylation of AKT, S6 ribosomal protein, and 4E-BP1 in leukemia cells. The rate of sorafenib conversion to its metabolite sorafenib N-oxide was high (mean, 33%; range, 17% to 69%). In vitro, the N-oxide potently inhibited FLT3-internal tandem duplication (ITD; binding constant, 70 nmol/L) and the viability of five AML cell lines. On day 8, sorafenib decreased blast percentages in 10 of 12 patients (median, 66%; range, 9% to 95%). After combination chemotherapy, six patients (three FLT3-ITD and three FLT3 wild-type AML) achieved complete remission, two (both FLT3-ITD AML) had complete remission with incomplete blood count recovery, and one (FLT3 wild-type AML) had partial remission. CONCLUSION Sorafenib in combination with clofarabine and cytarabine is tolerable and shows activity in relapsed/refractory pediatric AML.
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Affiliation(s)
- Hiroto Inaba
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
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30
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Hu S, Niu H, Inaba H, Orwick S, Rose C, Panetta JC, Yang S, Pounds S, Fan Y, Calabrese C, Rehg JE, Campana D, Rubnitz JE, Baker SD. Activity of the multikinase inhibitor sorafenib in combination with cytarabine in acute myeloid leukemia. J Natl Cancer Inst 2011; 103:893-905. [PMID: 21487100 PMCID: PMC3110171 DOI: 10.1093/jnci/djr107] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 02/14/2011] [Accepted: 02/25/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a genetically heterogeneous cancer that frequently exhibits aberrant kinase signaling. We investigated a treatment strategy combining sorafenib, a multikinase inhibitor with limited single-agent activity in AML, and cytarabine, a key component of AML chemotherapy. METHODS Using 10 human AML cell lines, we determined the effects of sorafenib (10 μM) on antileukemic activity by measuring cell viability, proliferation, ERK1/2 signaling, and apoptosis. We also investigated the effects of sorafenib treatment on the accumulation of cytarabine and phosphorylated metabolites in vitro. A human equivalent dose of sorafenib in nontumor-bearing NOD-SCID-IL2Rγ(null) mice was determined by pharmacokinetic studies using high performance liquid chromatography with tandem mass spectrometric detection, and steady-state concentrations were estimated by the fit of a one-compartment pharmacokinetic model to concentration-time data. The antitumor activity of sorafenib alone (60 mg/kg) twice daily, cytarabine alone (6.25 mg/kg administered intraperitoneally), or sorafenib once or twice daily plus cytarabine was evaluated in NOD-SCID-IL2Rγ(null) mice bearing AML xenografts. RESULTS Sorafenib at 10 μM inhibited cell viability, proliferation and ERK1/2 signaling, and induced apoptosis in all cell lines studied. Sorafenib also increased the cellular accumulation of cytarabine and metabolites resulting in additive to synergistic antileukemic activity. A dose of 60 mg/kg in mice produced a human equivalent sorafenib steady-state plasma exposure of 10 μM. The more dose-intensive twice-daily sorafenib plus cytarabine (n = 15) statistically significantly prolonged median survival in an AML xenograft model compared with sorafenib once daily plus cytarabine (n = 12), cytarabine alone (n = 26), or controls (n = 27) (sorafenib twice daily plus cytarabine, median survival = 46 days; sorafenib once daily plus cytarabine, median survival = 40 days; cytarabine alone, median survival = 36 days; control, median survival = 19 days; P < .001 for combination twice daily vs all other treatments listed). CONCLUSIONS Sorafenib in combination with cytarabine resulted in strong anti-AML activity in vitro and in vivo. These results warrant clinical evaluation of sorafenib with cytarabine-based regimens in molecularly heterogeneous AML.
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MESH Headings
- ATP-Binding Cassette Transporters/metabolism
- Animals
- Antimetabolites, Antineoplastic/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/pharmacokinetics
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Apoptosis/drug effects
- Benzenesulfonates/administration & dosage
- Benzenesulfonates/pharmacokinetics
- Benzenesulfonates/pharmacology
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Chromatography, High Pressure Liquid
- Confounding Factors, Epidemiologic
- Cytarabine/administration & dosage
- Cytarabine/pharmacology
- Disease Models, Animal
- Drug Administration Schedule
- Gene Expression Regulation, Neoplastic
- Humans
- Interleukin Receptor Common gamma Subunit/deficiency
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/metabolism
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Mitogen-Activated Protein Kinase 1/antagonists & inhibitors
- Mitogen-Activated Protein Kinase 1/metabolism
- Mitogen-Activated Protein Kinase 3/antagonists & inhibitors
- Mitogen-Activated Protein Kinase 3/metabolism
- Multidrug Resistance-Associated Proteins/metabolism
- Niacinamide/analogs & derivatives
- Phenylurea Compounds
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/pharmacokinetics
- Protein Kinase Inhibitors/pharmacology
- Pyridines/administration & dosage
- Pyridines/pharmacokinetics
- Pyridines/pharmacology
- Signal Transduction/drug effects
- Sorafenib
- Tandem Mass Spectrometry
- Time Factors
- Transplantation, Heterologous
- Treatment Outcome
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Affiliation(s)
- Shuiying Hu
- Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN 38105-3678, USA
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Wei G, Wang M, Hyslop T, Wang Z, Carr BI. Vitamin K enhancement of sorafenib-mediated HCC cell growth inhibition in vitro and in vivo. Int J Cancer 2011; 127:2949-58. [PMID: 21351273 DOI: 10.1002/ijc.25498] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The multikinase inhibitor sorafenib is the first oral agent to show activity against human hepatocellular carcinoma (HCC). Apoptosis has been shown to be induced in HCC by several agents, including sorafenib as well as by the naturally occurring K vitamins (VKs). As few nontoxic agents have activity against HCC growth, we evaluated the activity of sorafenib and VKs, both independently and together on the growth of HCC cells in vitro and in vivo. We found that when VK was combined with sorafenib, the concentration of sorafenib required for growth inhibition was substantially reduced. Conversely, VK enhanced sorafenib effects in several HCC cell lines on growth inhibition. Growth could be inhibited at doses of VK plus sorafenib that were ineffective with either agent alone, using vitamins K1, K2 and K5. Combination of VK1 plus sorafenib induced apoptosis on FACS, TUNEL staining and caspase activation. Phospho-extracellular signal-regulated kinase (ERK) levels were decreased as was myeloid cell leukemia sequence 1 (Mcl-1), an ERK target. Sorafenib alone inhibited growth of transplantable HCC in vivo. At subeffective sorafenib doses in vivo, addition of VK1 caused major tumor regression, with decreased phospho-ERK and Mcl-1 staining. Thus, combination of VK1 plus sorafenib strongly induced growth inhibition and apoptosis in rodent and human HCC and inhibited the RAF/mitogen-activated protein kinase kinase/ERK pathway. VK1 alone activated PKA, a mediator of inhibitory Raf phosphorylation. Thus, each agent can antagonize Raf: sorafenib as a direct inhibitor and VK1 through inhibitory Raf phosphorylation. As both agents are available for human use, the combination has potential for improving sorafenib effects in HCC.
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Affiliation(s)
- Gang Wei
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Prescott H, Kantarjian H, Cortes J, Ravandi F. Emerging FMS-like tyrosine kinase 3 inhibitors for the treatment of acute myelogenous leukemia. Expert Opin Emerg Drugs 2011; 16:407-23. [PMID: 21417961 DOI: 10.1517/14728214.2011.568938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The FMS-like tyrosine kinase 3 (FLT3) is highly expressed in acute leukemias. Mutations involving FLT3 are among the most common molecular abnormalities in acute myelogenous leukemia (AML). Available evidence suggests that these molecular lesions confer a shorter disease-free survival and overall survival in patients with intermediate-risk cytogenetics. Therefore, substantial interest in FLT3 as a therapeutic target has led to the development of several promising inhibitors that target this tyrosine kinase. AREAS COVERED This review covers the molecular pathways associated with FLT3 activation in patients with AML, the biological rationale for inhibiting FLT3 and recent clinical progress with FLT3 inhibitors for the treatment of AML. Six FLT3 inhibitors undergoing clinical evaluation are discussed. A review of selected published manuscripts on the subject of FLT3 inhibition in AML and a search of the English language manuscripts in PubMed using the index words FLT3 and AML were conducted and articles of interest selected. EXPERT OPINION Mutated forms of FLT3, specifically FLT3-internal tandem duplication, have a significant impact on the prognosis of AML patients, particularly those with a normal karyotype. Inhibiting FLT3 may lead to clinical benefit for patients with AML. Newly developed FLT3 inhibitors have shown encouraging activity as monotherapy and in combination with other therapeutic agents.
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Affiliation(s)
- Hillary Prescott
- The University of Texas, M.D. Anderson Cancer Center, Department of Leukemia, Houston, USA
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33
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Li L, Zhao M, Navid F, Pratz K, Smith BD, Rudek MA, Baker SD. Quantitation of sorafenib and its active metabolite sorafenib N-oxide in human plasma by liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:3033-8. [PMID: 20870468 PMCID: PMC2956857 DOI: 10.1016/j.jchromb.2010.08.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/24/2010] [Accepted: 08/30/2010] [Indexed: 01/07/2023]
Abstract
A simple and rapid method with high performance liquid chromatography/tandem mass spectrometry is described for the quantitation of the kinase inhibitor sorafenib and its active metabolite sorafenib N-oxide in human plasma. A protein precipitation extraction procedure was applied to 50 μL of plasma. Chromatographic separation of the two analytes, and the internal standard [(2)H(3)(13)C]-sorafenib, was achieved on a C(18) analytical column and isocratic flow at 0.3 mL/min for 4 min. Mean within-run and between-run precision for all analytes were <6.9% and accuracy was <5.3%. Calibration curves were linear over the concentration range of 50-10,000 ng/mL for sorafenib and 10-2500 ng/mL for sorafenib N-oxide. This method allows a specific, sensitive, and reliable determination of the kinase inhibitor sorafenib and its active metabolite sorafenib N-oxide in human plasma in a single analytical run.
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Affiliation(s)
- Lie Li
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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34
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Lal D, Park JA, Demock K, Marinaro J, Perez AM, Lin MH, Tian L, Mashtare TJ, Murphy M, Prey J, Wetzler M, Fetterly GJ, Wang ES. Aflibercept Exerts Antivascular Effects and Enhances Levels of Anthracycline Chemotherapy In vivo in Human Acute Myeloid Leukemia Models. Mol Cancer Ther 2010; 9:2737-51. [DOI: 10.1158/1535-7163.mct-10-0334] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Secondary resistance to sorafenib in two patients with acute myeloid leukemia (AML) harboring FLT3-ITD mutations. Ann Hematol 2010; 90:473-5. [PMID: 20652568 DOI: 10.1007/s00277-010-1027-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 06/30/2010] [Indexed: 01/27/2023]
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Ahmad R, Liu S, Weisberg E, Nelson E, Galinsky I, Meyer C, Kufe D, Kharbanda S, Stone R. Combining the FLT3 inhibitor PKC412 and the triterpenoid CDDO-Me synergistically induces apoptosis in acute myeloid leukemia with the internal tandem duplication mutation. Mol Cancer Res 2010; 8:986-93. [PMID: 20571062 DOI: 10.1158/1541-7786.mcr-10-0154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Mutations of the FLT3 receptor tyrosine kinase consisting of internal tandem duplications (ITD) have been detected in blasts from 20% to 30% of patients with acute myeloid leukemia (AML) and are associated with a poor prognosis. FLT3/ITD results in constitutive autophosphorylation of the receptor and factor-independent survival in leukemia cell lines. The C-28 methyl ester of the oleane triterpenoid (CDDO-Me) is a multifunctional molecule that induces apoptosis of human myeloid leukemia cells. Here, we report that CDDO-Me blocks targeting of NFkappaB to the nucleus by inhibiting IkappaB kinase beta-mediated phosphorylation of IkappaBalpha. Moreover, CDDO-Me blocked constitutive activation of the signal transducer and activator of transcription 3. We report the potent and selective antiproliferative effects of CDDO-Me on FLT3/ITD-positive myeloid leukemia cell lines and primary AML cells. The present studies show that CDDO-Me treatment results in caspase-3-mediated induction of apoptosis of FLT3/ITD-expressing cells and its antiproliferative effects are synergistic with PKC412, a FLT3-tyrosine kinase inhibitor currently in clinical trials. Taken together, our studies indicate that CDDO-Me greatly enhanced the efficacy of the FLT3 inhibitor PKC412, suggesting that combining two separate pathway inhibitors might be a viable therapeutic strategy for AML associated with a FLT3/ITD mutation.
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Affiliation(s)
- Rehan Ahmad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA
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Ravandi F, Cortes JE, Jones D, Faderl S, Garcia-Manero G, Konopleva MY, O'Brien S, Estrov Z, Borthakur G, Thomas D, Pierce SR, Brandt M, Byrd A, Bekele BN, Pratz K, Luthra R, Levis M, Andreeff M, Kantarjian HM. Phase I/II study of combination therapy with sorafenib, idarubicin, and cytarabine in younger patients with acute myeloid leukemia. J Clin Oncol 2010; 28:1856-62. [PMID: 20212254 PMCID: PMC2930809 DOI: 10.1200/jco.2009.25.4888] [Citation(s) in RCA: 293] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine the efficacy and toxicity of the combination of sorafenib, cytarabine, and idarubicin in patients with acute myeloid leukemia (AML) younger than age 65 years. PATIENTS AND METHODS In the phase I part of the study, 10 patients with relapsed AML were treated with escalating doses of sorafenib with chemotherapy to establish the feasibility of the combination. We then treated 51 patients (median age, 53 years; range, 18 to 65 years) who had previously untreated AML with cytarabine at 1.5 g/m(2) by continuous intravenous (IV) infusion daily for 4 days (3 days if > 60 years of age), idarubicin at 12 mg/m(2) IV daily for 3 days, and sorafenib at 400 mg orally twice daily for 7 days. RESULTS Overall, 38 (75%) patients have achieved a complete remission (CR), including 14 (93%) of 15 patients with mutated FMS-like tyrosine kinase-3 (FLT3; the 15th patient had complete remission with incomplete platelet recovery [CRp]) and 24 (66%) of 36 patients with FLT3 wild-type (WT) disease (three additional FLT3-WT patients had CRp). FLT3-mutated patients were more likely to achieve a CR than FLT3-WT patients (P = .033). With a median follow-up of 54 weeks (range, 8 to 87 weeks), the probability of survival at 1 year is 74%. Among the FLT3-mutated patients, 10 have relapsed and five remain in CR with a median follow-up of 62 weeks (range, 10 to 76 weeks). Plasma inhibitory assay demonstrated an on-target effect on FLT3 kinase activity. CONCLUSION Sorafenib can be safely combined with chemotherapy, produces a high CR rate in FLT3-mutated patients, and inhibits FLT3 signaling.
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Affiliation(s)
- Farhad Ravandi
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD.,Corresponding author: Farhad Ravandi, MD, Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 428, Houston, TX 77030; e-mail:
| | - Jorge E. Cortes
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Daniel Jones
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Stefan Faderl
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Guillermo Garcia-Manero
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Marina Y. Konopleva
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Susan O'Brien
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Zeev Estrov
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Gautam Borthakur
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Deborah Thomas
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Sherry R. Pierce
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Mark Brandt
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Anna Byrd
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - B. Nebiyou Bekele
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Keith Pratz
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Rajyalakshmi Luthra
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Mark Levis
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Michael Andreeff
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Hagop M. Kantarjian
- From the Departments of Leukemia, Hematopathology, Stem Cell Transplantation and Cellular Therapy, and Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX; and Division of Hematological Malignancies, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
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Schiller GJ, O'Brien SM, Pigneux A, DeAngelo DJ, Vey N, Kell J, Solomon S, Stuart RK, Karsten V, Cahill AL, Albitar MX, Giles FJ. Single-Agent Laromustine, A Novel Alkylating Agent, Has Significant Activity in Older Patients With Previously Untreated Poor-Risk Acute Myeloid Leukemia. J Clin Oncol 2010; 28:815-21. [DOI: 10.1200/jco.2009.24.2008] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose An international phase II study of laromustine (VNP40101M), a sulfonylhydrazine alkylating agent, was conducted in patients age 60 years or older with previously untreated poor-risk acute myeloid leukemia (AML). Patients and Methods Laromustine 600 mg/m2 was administered as a single 60-minute intravenous infusion. Patients were age 70 years or older or 60 years or older with at least one additional risk factor—unfavorable AML karyotype, Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2, and/or cardiac, pulmonary, or hepatic comorbidities. Results Eighty-five patients (median age, 72 years; range, 60 to 87 years) were treated. Poor-risk features included age 70 years or older, 78%; adverse karyotype, 47%; PS of 2, 41%; pulmonary disease, 77%; cardiac disease, 73%; and hepatic disease, 3%. Ninety-six percent of patients had at least two risk factors, and 39% had at least four risk factors. The overall response rate (ORR) was 32%, with 20 patients (23%) achieving complete response (CR) and seven (8%) achieving CR with incomplete platelet recovery (CRp). ORR was 20% in patients with adverse cytogenetics; 32% in those age 70 years or older; 32% in those with PS of 2; 32% in patients with baseline pulmonary dysfunction; 34% in patients with baseline cardiac dysfunction; and 27% in 33 patients with at least four risk factors. Twelve (14%) patients died within 30 days of receiving laromustine therapy. Median overall survival was 3.2 months, with a 1-year survival of 21%; the median duration of survival for those who achieved CR/CRp was 12.4 months, with a 1-year survival of 52%. Conclusion Laromustine has significant single-agent activity in elderly patients with poor-risk AML. Adverse events are predominantly myelosuppressive or respiratory. Response rates are consistent across a spectrum of poor-risk features.
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Affiliation(s)
- Gary J. Schiller
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Susan M. O'Brien
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Arnaud Pigneux
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Daniel J. DeAngelo
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Norbert Vey
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Jonathan Kell
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Scott Solomon
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Robert K. Stuart
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Verena Karsten
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Ann L. Cahill
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Maher X. Albitar
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
| | - Francis J. Giles
- From the David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles; Quest Diagnostics Nichols Institute, San Juan Capistrano, CA; The University of Texas M. D. Anderson Cancer Center, Houston; Cancer Therapy and Research Center at The University of Texas Health Science Center, San Antonio, TX; Hopital Haut Leveque, Bordeaux; Institut Paoli-Calmettes, Marseille, France; Dana-Farber Cancer Institute, Boston, MA; University Hospital of Wales, Cardiff, UK; Northside Hospital
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Miller SC, Huang R, Sakamuru S, Shukla SJ, Attene-Ramos MS, Shinn P, Van Leer D, Leister W, Austin CP, Xia M. Identification of known drugs that act as inhibitors of NF-kappaB signaling and their mechanism of action. Biochem Pharmacol 2010; 79:1272-80. [PMID: 20067776 DOI: 10.1016/j.bcp.2009.12.021] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 12/09/2009] [Accepted: 12/18/2009] [Indexed: 11/24/2022]
Abstract
Nuclear factor-kappa B (NF-kappaB) is a transcription factor that plays a critical role across many cellular processes including embryonic and neuronal development, cell proliferation, apoptosis, and immune responses to infection and inflammation. Dysregulation of NF-kappaB signaling is associated with inflammatory diseases and certain cancers. Constitutive activation of NF-kappaB signaling has been found in some types of tumors including breast, colon, prostate, skin and lymphoid, hence therapeutic blockade of NF-kappaB signaling in cancer cells provides an attractive strategy for the development of anticancer drugs. To identify small molecule inhibitors of NF-kappaB signaling, we screened approximately 2800 clinically approved drugs and bioactive compounds from the NIH Chemical Genomics Center Pharmaceutical Collection (NPC) in a NF-kappaB mediated beta-lactamase reporter gene assay. Each compound was tested at fifteen different concentrations in a quantitative high throughput screening format. We identified nineteen drugs that inhibited NF-kappaB signaling, with potencies as low as 20 nM. Many of these drugs, including emetine, fluorosalan, sunitinib malate, bithionol, narasin, tribromsalan, and lestaurtinib, inhibited NF-kappaB signaling via inhibition of IkappaBalpha phosphorylation. Others, such as ectinascidin 743, chromomycin A3 and bortezomib utilized other mechanisms. Furthermore, many of these drugs induced caspase 3/7 activity and had an inhibitory effect on cervical cancer cell growth. Our results indicate that many currently approved pharmaceuticals have previously unappreciated effects on NF-kappaB signaling, which may contribute to anticancer therapeutic effects. Comprehensive profiling of approved drugs provides insight into their molecular mechanisms, thus providing a basis for drug repurposing.
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Affiliation(s)
- Susanne C Miller
- NIH Chemical Genomics Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Ravandi F, Kantarjian H, Faderl S, Garcia-Manero G, O'Brien S, Koller C, Pierce S, Brandt M, Kennedy D, Cortes J, Beran M. Outcome of patients with FLT3-mutated acute myeloid leukemia in first relapse. Leuk Res 2009; 34:752-6. [PMID: 19878996 DOI: 10.1016/j.leukres.2009.10.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/01/2009] [Accepted: 10/01/2009] [Indexed: 11/19/2022]
Abstract
Mutations of Fms-like tyrosine kinase-3 (FLT3) have been described in about 30% of patients with acute myeloid leukemia (AML) and are associated with a shorter disease-free and overall survival after initial therapy. We sought to examine whether the presence of these mutations in relapsed disease was also associated with a poor response to salvage chemotherapy by comparing the outcome of 34 patients with diploid cytogenetics and mutated FLT3 (internal tandem duplication mutation, ITD) to 69 patients with normal karyotype and wild-type FLT3 (FLT3-WT) in first relapse. On univariate analysis, patients with mutated FLT3 were less likely to achieve a CR to first salvage compared to FLT3-WT patients (24% vs. 41%; P=0.09). Furthermore, survival was longer for the FLT3-WT patients achieving a second CR after salvage compared to FLT3-mutated patients (P=0.017). Overall, patients with mutated FLT3 had a shorter survival from the time of relapse compared to those with FLT3-WT (P<0.001). The adverse prognostic impact of FLT3 mutations appears to persist beyond the initial treatment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cohort Studies
- Follow-Up Studies
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/mortality
- Middle Aged
- Mutation/physiology
- Prognosis
- Recurrence
- Salvage Therapy
- Survival Analysis
- Treatment Outcome
- Young Adult
- fms-Like Tyrosine Kinase 3/genetics
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Affiliation(s)
- Farhad Ravandi
- Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Hu S, Chen Z, Franke R, Orwick S, Zhao M, Rudek MA, Sparreboom A, Baker SD. Interaction of the multikinase inhibitors sorafenib and sunitinib with solute carriers and ATP-binding cassette transporters. Clin Cancer Res 2009; 15:6062-9. [PMID: 19773380 DOI: 10.1158/1078-0432.ccr-09-0048] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare side-by-side the uptake of sorafenib and sunitinib in vitro by human uptake solute carriers of the SLC22A and SLCO families, the transport by and inhibition of efflux ATP-binding cassette (ABC) transporters, and the role of ABCB1 in the plasma pharmacokinetics and brain penetration of these agents. EXPERIMENTAL DESIGN Uptake of [(3)H]sorafenib or [(3)H]sunitinib was assessed in Xenopus laevis oocytes or mammalian cells transfected with cDNAs coding for human OATP1A2, OATP1B1, OATP1B3, OCT1, OAT2, OAT3, OCTN1, or OCTN2. Efflux and inhibition experiments were conducted in cells transfected with human ABCB1, ABCG2, ABCC2, or ABCC4. In vivo pharmacokinetic studies were done in knockout mice lacking Abcb1-type transporters. RESULTS Intracellular uptake was not appreciably affected by any of the studied solute carriers and was minute relative to the respective prototypical substrates. Sorafenib and sunitinib showed concentration-dependent (1 and 10 micromol/L), low to moderate affinity for ABCB1 but were not affected by the other ABC transporters. Both agents inhibited all tested ABC transporters. The absence of Abcb1 had no affect on plasma pharmacokinetics, but brain penetration was moderately increased by 1.9- and 2.9-fold for sorafenib and sunitinib, respectively, in knockout animals versus controls. CONCLUSIONS Unlike other tyrosine kinase inhibitors, sorafenib and sunitinib do not appear to rely on active transport to enter the cell nor are they high-affinity substrates for ABC efflux transporters. Based on these characteristics, these two drugs may be less susceptible to transporter-mediated alterations in systemic exposure and transporter-related resistance mechanisms.
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Affiliation(s)
- Shuiying Hu
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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Compassionate use of sorafenib in FLT3-ITD-positive acute myeloid leukemia: sustained regression before and after allogeneic stem cell transplantation. Blood 2009; 113:6567-71. [PMID: 19389879 DOI: 10.1182/blood-2009-03-208298] [Citation(s) in RCA: 211] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Acute myeloid leukemia (AML) patients with internal tandem duplication (ITD) mutations in the Fms-like tyrosine-3 (FLT3) gene have a dismal prognosis. Here we report compassionate-use results with the multikinase and FLT3-ITD inhibitor sorafenib for the treatment of relapsed or refractory FLT3-ITD-positive AML. Sorafenib induced clinically meaningful and very rapid responses in all 6 patients treated either before (n = 2), after (n = 3), or both before and after (n = 1) allogeneic stem cell transplantation (allo-SCT). Sorafenib-induced remissions facilitated allo-SCT in 2 of the 3 refractory patients. Two of the 4 patients who were treated after allo-SCT survived 216 and 221 days, respectively, whereas the other 2 remain in ongoing complete molecular remission. Sorafenib response was associated with an inhibition of the antiapoptotic FLT3-ITD target Stat-5 in vivo. Together, sorafenib monotherapy before or after allo-SCT has remarkable clinical activity in poor risk FLT3-ITD-positive AML and deserves further evaluation in prospective clinical trials.
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