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Diamantopoulos PT, Anastasopoulou A, Dimopoulou M, Samarkos M, Gogas H. Challenges in the treatment of melanoma with BRAF and MEK inhibitors in patients with sickle cell disease: case report and review of the literature. Ther Adv Hematol 2023; 14:20406207231155991. [PMID: 36936358 PMCID: PMC10021083 DOI: 10.1177/20406207231155991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/23/2023] [Indexed: 03/17/2023] Open
Abstract
Patients with sickle cell disease (SCD) suffer from complications due to anemia, inflammation, and vaso-occlusion. Factors that trigger sickling and/or inflammation may initiate such complications, while treatment with hydroxyurea (HU) reduces their emergence and prolongs survival. On the contrary, inhibition of the BRAF-MEK-ERK pathway with BRAF and MEK inhibitors (BRAF/MEKi) has revolutionized treatment of melanoma but their use has been correlated with inflammatory adverse events. Thus, treatment of patients with SCD with BRAF/MEKi may be quite challenging and pyrexia in those patients should be managed as a medical emergency. In this article, intrigued by the case of a 36-year-old female patient with S/β-thal under HU who was treated with dabrafenib and trametinib for melanoma, we analyze the mechanisms underlying inflammation and vaso-occlusion in SCD, the mechanisms of pyrexia and inflammation induced by BRAF/MEKi, their potential interconnections, the shared role of the inflammasome in these two entities, and the protective effect of HU in SCD. Since SCD is the most common inheritable blood disorder, the administration of BRAF/MEKi for melanoma in patients with SCD may be a rather common challenge. Thus, proper treatment with HU may pave the way for an uneventful management of such patients.
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Affiliation(s)
- Panagiotis T Diamantopoulos
- First Department of Internal Medicine, Laikon
General Hospital, National and Kapodistrian University of Athens, 17 Agiou
Thoma street, Goudi, 11527, Athens, Greece
| | - Amalia Anastasopoulou
- First Department of Internal Medicine, Laikon
General Hospital, National and Kapodistrian University of Athens, Athens,
Greece
| | | | - Michalis Samarkos
- First Department of Internal Medicine, Laikon
General Hospital, National and Kapodistrian University of Athens, Athens,
Greece
| | - Helen Gogas
- First Department of Internal Medicine, Laikon
General Hospital, National and Kapodistrian University of Athens, Athens,
Greece
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Beck TC, Arhontoulis DC, Morningstar JE, Hyams N, Stoddard A, Springs K, Mukherjee R, Helke K, Guo L, Moore K, Gensemer C, Biggs R, Petrucci T, Kwon J, Stayer K, Koren N, Harvey A, Holman H, Dunne J, Fulmer D, Vohra A, Mai L, Dooley S, Weninger J, Vaena S, Romeo M, Muise-Helmericks RC, Mei Y, Norris RA. Cellular and Molecular Mechanisms of MEK1 Inhibitor-Induced Cardiotoxicity. JACC CardioOncol 2022; 4:535-548. [PMID: 36444237 PMCID: PMC9700254 DOI: 10.1016/j.jaccao.2022.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Trametinib is a MEK1 (mitogen-activated extracellular signal-related kinase kinase 1) inhibitor used in the treatment of BRAF (rapid accelerated fibrosarcoma B-type)-mutated metastatic melanoma. Roughly 11% of patients develop cardiomyopathy following long-term trametinib exposure. Although described clinically, the molecular landscape of trametinib cardiotoxicity has not been characterized. Objectives The aim of this study was to test the hypothesis that trametinib promotes widespread transcriptomic and cellular changes consistent with oxidative stress and impairs cardiac function. Methods Mice were treated with trametinib (1 mg/kg/d). Echocardiography was performed pre- and post-treatment. Gross, histopathologic, and biochemical assessments were performed to probe for molecular and cellular changes. Human cardiac organoids were used as an in vitro measurement of cardiotoxicity and recovery. Results Long-term administration of trametinib was associated with significant reductions in survival and left ventricular ejection fraction. Histologic analyses of the heart revealed myocardial vacuolization and calcification in 28% of animals. Bulk RNA sequencing identified 435 differentially expressed genes and 116 differential signaling pathways following trametinib treatment. Upstream gene analysis predicted interleukin-6 as a regulator of 17 relevant differentially expressed genes, suggestive of PI3K/AKT and JAK/STAT activation, which was subsequently validated. Trametinib hearts displayed elevated markers of oxidative stress, myofibrillar degeneration, an 11-fold down-regulation of the apelin receptor, and connexin-43 mislocalization. To confirm the direct cardiotoxic effects of trametinib, human cardiac organoids were treated for 6 days, followed by a 6-day media-only recovery. Trametinib-treated organoids exhibited reductions in diameter and contractility, followed by partial recovery with removal of treatment. Conclusions These data describe pathologic changes observed in trametinib cardiotoxicity, supporting the exploration of drug holidays and alternative pharmacologic strategies for disease prevention.
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Affiliation(s)
- Tyler C. Beck
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Drug Discovery and Biomedical Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dimitrios C. Arhontoulis
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Jordan E. Morningstar
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nathaniel Hyams
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Andrew Stoddard
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kendra Springs
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rupak Mukherjee
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kris Helke
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Comparative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lilong Guo
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey Moore
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cortney Gensemer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rachel Biggs
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Taylor Petrucci
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennie Kwon
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristina Stayer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Natalie Koren
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew Harvey
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Heather Holman
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jaclyn Dunne
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Diana Fulmer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ayesha Vohra
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Le Mai
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah Dooley
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julianna Weninger
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Silvia Vaena
- Department of Biochemistry and Molecular Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Martin Romeo
- Department of Biochemistry and Molecular Biology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Robin C. Muise-Helmericks
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ying Mei
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Russell A. Norris
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Schaefer H, Rübben A, Esser A, Araujo A, Persa OD, Leijs M. A distinct four-value blood signature of pyrexia under combination therapy of malignant melanoma with dabrafenib and trametinib evidenced by an algorithm-defined pyrexia score. PLoS One 2022; 17:e0273478. [PMID: 36006943 PMCID: PMC9409555 DOI: 10.1371/journal.pone.0273478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
Pyrexia is a frequent adverse event of BRAF/MEK-inhibitor combination therapy in patients with metastasized malignant melanoma (MM). The study’s objective was to identify laboratory changes which might correlate with the appearance of pyrexia. Initially, data of 38 MM patients treated with dabrafenib plus trametinib, of which 14 patients developed pyrexia, were analysed retrospectively. Graphical visualization of time series of laboratory values suggested that a rise in C-reactive-protein, in parallel with a fall of leukocytes and thrombocytes, were indicative of pyrexia. Additionally, statistical analysis showed a significant correlation between lactate dehydrogenase (LDH) and pyrexia. An algorithm based on these observations was designed using a deductive and heuristic approach in order to calculate a pyrexia score (PS) for each laboratory assessment in treated patients. A second independent data set of 28 MM patients, 8 with pyrexia, was used for the validation of the algorithm. PS based on the four parameters CRP, LDH, leukocyte and thrombocyte numbers, were statistically significantly higher in pyrexia patients, differentiated between groups (F = 20.8; p = <0.0001) and showed a significant predictive value for the diagnosis of pyrexia (F = 6.24; p = 0.013). We provide first evidence that pyrexia in patients treated with BRAF/MEK-blockade can be identified by an algorithm that calculates a score.
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Affiliation(s)
- Hannah Schaefer
- Department of Dermatology, RWTH Aachen University Hospital, Aachen, Germany
| | - Albert Rübben
- Department of Dermatology, RWTH Aachen University Hospital, Aachen, Germany
- Department of Dermatology, St. Nikolaus Hospital, Eupen, Belgium
- Center for Integrated Oncology, CIO ABCD, Aachen, Bonn, Cologne, Düsseldorf, Germany
- * E-mail:
| | - André Esser
- Department of Occupational, Social and Environmental Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Arturo Araujo
- Department of Media, Culture and Language, University of Roehampton, London, United Kingdom
| | - Oana-Diana Persa
- Center for Integrated Oncology, CIO ABCD, Aachen, Bonn, Cologne, Düsseldorf, Germany
- Department of Dermatology and Venereology, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marike Leijs
- Department of Dermatology, RWTH Aachen University Hospital, Aachen, Germany
- Department of Dermatology, St. Nikolaus Hospital, Eupen, Belgium
- Center for Integrated Oncology, CIO ABCD, Aachen, Bonn, Cologne, Düsseldorf, Germany
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