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Yang Y, Li Y, Li R, Wang Z. Research progress on arsenic, arsenic-containing medicinal materials, and arsenic-containing preparations: clinical application, pharmacological effects, and toxicity. Front Pharmacol 2024; 15:1338725. [PMID: 38495096 PMCID: PMC10943982 DOI: 10.3389/fphar.2024.1338725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction: The toxicity of arsenic is widely recognized globally, mainly harming human health by polluting water, soil, and food. However, its formulations can also be used for the clinical treatment of diseases such as leukemia and tumors. Arsenic has been used as a drug in China for over 2,400 years, with examples such as the arsenic-containing drug realgar mentioned in Shennong's Herbal Classic. We have reviewed references on arsenic over the past thirty years and found that research has mainly focused on clinical, pharmacological, and toxicological aspects. Results and Discussion: The finding showed that in clinical practice, arsenic trioxide is mainly used in combination with all-trans retinoic acid (ATRA) at a dose of 10 mg/d for the treatment of acute promyelocytic leukemia (APL); realgar can be used to treat acute promyelocytic leukemia, myelodysplastic syndrome, and lymphoma. In terms of pharmacology, arsenic mainly exerts anti-tumor effects. The dosage range of the action is 0.01-80 μmol/L, and the concentration of arsenic in most studies does not exceed 20 μmol/L. The pharmacological effects of realgar include antiviral activity, inhibition of overactivated lactate dehydrogenase, and resistance to malaria parasites. In terms of toxicity, arsenic is toxic to multiple systems in a dose-dependent manner. For example, 5 μmol/L sodium arsenite can induce liver oxidative damage and promote the expression of pro-inflammatory factors, and 15 μmol/L sodium arsenite induces myocardial injury; when the concentration is higher, it is more likely to cause toxic damage.
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Affiliation(s)
- Yichu Yang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yiye Li
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ran Li
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- College of Ethnomedicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhang Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- College of Ethnomedicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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2
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Yan M, Wang H, Wei R, Li W. Arsenic trioxide: applications, mechanisms of action, toxicity and rescue strategies to date. Arch Pharm Res 2024; 47:249-271. [PMID: 38147202 DOI: 10.1007/s12272-023-01481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
Arsenical medicine has obtained its status in traditional Chinese medicine for more than 2,000 years. In the 1970s, arsenic trioxide was identified to have high efficacy and potency for the treatment of acute promyelocytic leukemia, which promoted many studies on the therapeutic effects of arsenic trioxide. Currently, arsenic trioxide is widely used to treat acute promyelocytic leukemia and various solid tumors through various mechanisms of action in clinical practice; however, it is accompanied by a series of adverse reactions, especially cardiac toxicity. This review presents a comprehensive overview of arsenic trioxide from preclinical and clinical efficacy, potential mechanisms of action, toxicities, and rescue strategies for toxicities to provide guidance or assistance for the clinical application of arsenic trioxide.
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Affiliation(s)
- Meng Yan
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China.
| | - Hao Wang
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
| | - Rui Wei
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
- Pharmacy Department, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenwen Li
- Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China
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3
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Ryu S, Ye X, Olson JJ, Mikkelsen T, Bangiyev L, Lesser GJ, Batchelor T, Nabors B, Desideri S, Walbert T, Grossman SA. Phase I and pharmacodynamic study of arsenic trioxide plus radiotherapy in patients with newly diagnosed glioblastoma. Neurooncol Adv 2024; 6:vdae089. [PMID: 38978961 PMCID: PMC11229030 DOI: 10.1093/noajnl/vdae089] [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] [Indexed: 07/10/2024] Open
Abstract
Background When arsenic trioxide (ATO) was combined with radiation for treatment of transplanted murine gliomas in the brain, tumor response improved with disrupted tumor blood flow and survival was significantly prolonged. Methods Total of 31 patients with newly diagnosed glioblastoma were accrued to a multi-institutional, NCI-funded, phase I study to determine the maximum tolerated dose (MTD) of ATO administered with radiation. Secondary objectives were survival and pharmacodynamic changes in perfusion on magnetic resonance imaging (MRI). Patients (unknown MGMT and IDH status) received ATO either once or twice weekly during radiation without concurrent or adjuvant temozolomide. Results Median age: 54.9 years, male: 68%, KPS ≥ 90: 77%, debulking surgery: 77%. Treatments were well-tolerated: 81% of patients received all the planned ATO doses. Dose-limiting toxicities included elevated liver function tests, hypokalemia, and edema. The MTD on the weekly schedule was 0.4 mg/kg and on the biweekly was 0.3 mg/kg. The median survival (mOS) for all patients was 17.7 months. Survival on the biweekly schedule (22.8 months) was longer than on the weekly schedule (12.1 months) (P = .039) as was progression-free survival (P = .004). Similarly, cerebral blood flow was significantly reduced in patients treated on the biweekly schedule (P = .007). Conclusions ATO with standard radiation is well tolerated in patients with newly diagnosed glioblastoma. Even without temozolomide or adjuvant therapy, the overall survival of all patients (17.7 months) and especially patients who received biweekly ATO (22.8 months) is surprising and accompanied by pharmacodynamic changes on MRI. Further studies of this regimen are warranted.
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Affiliation(s)
- Samuel Ryu
- Department of Radiation Oncology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tom Mikkelsen
- Jeffries Center for Precision Medicine, Henry Ford Health, Detroit, Michigan, USA
| | - Lev Bangiyev
- Department of Radiology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Glenn J Lesser
- Department of Internal Medicine, Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Tracy Batchelor
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Burt Nabors
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Serena Desideri
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tobias Walbert
- Department of Neurology, Henry Ford Health, Wayne State School of Medicine, Detroit, Michigan, USA
- Department of Surgery, Michigan State University, Detroit, Michigan, USA
| | - Stuart A Grossman
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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4
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Klier K, Patel YJ, Schinköthe T, Harbeck N, Schmidt A. Corrected QT Interval (QTc) Diagnostic App for the Oncological Routine: Development Study. JMIR Cardio 2023; 7:e48096. [PMID: 37695655 PMCID: PMC10520775 DOI: 10.2196/48096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Numerous antineoplastic drugs such as chemotherapeutics have cardiotoxic side effects and can lead to long QT syndrome (LQTS). When diagnosed and treated in time, the potentially fatal outcomes of LQTS can be prevented. Therefore, regular electrocardiogram (ECG) assessments are critical to ensure patient safety. However, these assessments are associated with patient discomfort and require timely support of the attending oncologist by a cardiologist. OBJECTIVE This study aimed to examine whether this approach can be made more efficient and comfortable by a smartphone app (QTc Tracker), supporting single-lead ECG records on site and transferring to a tele-cardiologist for an immediate diagnosis. METHODS To evaluate the QTc Tracker, it was implemented in 54 cancer centers in Germany. In total, 266 corrected QT interval (QTc) diagnoses of 122 patients were recorded. Moreover, a questionnaire on routine ECG workflow, turnaround time, and satisfaction (1=best, 6=worst) was answered by the centers before and after the implementation of the QTc Tracker. RESULTS Compared to the routine ECG workflow, the QTc Tracker enabled a substantial turnaround time reduction of 98% (mean 2.67, 95% CI 1.72-2.67 h) and even further time efficiency in combination with a cardiologic on-call service (mean 12.10, 95% CI 5.67-18.67 min). Additionally, nurses and patients reported higher satisfaction when using the QTc Tracker. In particular, patients' satisfaction sharply improved from 2.59 (95% CI 2.41-2.88) for the routine ECG workflow to 1.25 (95% CI 0.99-1.51) for the QTc Tracker workflow. CONCLUSIONS These results reveal a significant improvement regarding reduced turnaround time and increased user satisfaction. Best patient care might be guaranteed as the exposure of patients with an uncontrolled risk of QTc prolongations can be avoided by using the fast and easy QTc Tracker. In particular, as regular side-effect monitoring, the QTc Tracker app promises more convenience for patients and their physicians. Finally, future studies are needed to empirically test the usability and validity of such mobile ECG assessment methods. TRIAL REGISTRATION ClinicalTrials.gov NCT04055493; https://classic.clinicaltrials.gov/ct2/show/NCT04055493.
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Affiliation(s)
- Kristina Klier
- Institute of Sport Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | | | - Timo Schinköthe
- CANKADO GmbH, Ottobrunn, Germany
- Research Center for Smart Digital Health, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany
| | - Annette Schmidt
- Institute of Sport Science, University of the Bundeswehr Munich, Neubiberg, Germany
- Research Center for Smart Digital Health, University of the Bundeswehr Munich, Neubiberg, Germany
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Cholujova D, Koklesova L, Lukacova Bujnakova Z, Dutkova E, Valuskova Z, Beblava P, Matisova A, Sedlak J, Jakubikova J. In vitro and ex vivo anti-myeloma effects of nanocomposite As 4S 4/ZnS/Fe 3O 4. Sci Rep 2022; 12:17961. [PMID: 36289430 PMCID: PMC9606304 DOI: 10.1038/s41598-022-22672-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/18/2022] [Indexed: 02/06/2023] Open
Abstract
Nanoparticles in medicine can integrate actively targeted imaging agents and drug delivery vehicles, and combining multiple types of therapeutics in a single particle has numerous advantages, especially in multiple myeloma. MM is an incurable hematological disorder characterized by clonal proliferation of plasma cells in the bone marrow. In this study, we evaluated the anti-myeloma activity of 3 nanocomposites (3NPs): As4S4/ZnS/Fe3O4 (1:4:1), As4S4/ZnS/Fe3O4 with folic acid (FA), and As4S4/ZnS/Fe3O4 with FA and albumin with reduced survival MM cell lines and primary MM samples by each of 3NP. Cytotoxic effects of 3NPs were associated with caspase- and mitochondria-dependent apoptosis induction and reduced c-Myc expression. Modulation of cell cycle regulators, such as p-ATM/ATM and p-ATR/ATR, and increases in p-Chk2, cyclin B1, and histones were accompanied by G2/M arrest triggered by 3NPs. In addition, 3NPs activated several myeloma-related signaling, including JNK1/2/3, ERK1/2 and mTOR. To overcome BM microenvironment-mediated drug resistance, nanocomposites retained its anti-MM activity in the presence of stroma. 3NPs significantly decreased the stem cell-like side population in MM cells, even in the context of stroma. We observed strong synergistic effects of 3NPs combined with lenalidomide, pomalidomide, or melphalan, suggesting the potential of these combinations for future clinical studies.
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Affiliation(s)
- Danka Cholujova
- grid.420087.90000 0001 2106 1943Department of Tumor Immunology, Biomedical Research Center, Cancer Research Institute, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84505 Slovakia ,grid.419303.c0000 0001 2180 9405Centre for Advanced Materials Application, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84511 Slovakia
| | - Lenka Koklesova
- grid.420087.90000 0001 2106 1943Department of Tumor Immunology, Biomedical Research Center, Cancer Research Institute, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84505 Slovakia ,grid.7634.60000000109409708Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, 03601 Slovakia
| | - Zdenka Lukacova Bujnakova
- grid.419303.c0000 0001 2180 9405Department of Mechanochemistry, Institute of Geotechnics, Slovak Academy of Sciences, Watsonova 45, Košice, 04001 Slovakia
| | - Erika Dutkova
- grid.419303.c0000 0001 2180 9405Department of Mechanochemistry, Institute of Geotechnics, Slovak Academy of Sciences, Watsonova 45, Košice, 04001 Slovakia
| | - Zuzana Valuskova
- grid.420087.90000 0001 2106 1943Department of Tumor Immunology, Biomedical Research Center, Cancer Research Institute, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84505 Slovakia
| | - Patricia Beblava
- grid.420087.90000 0001 2106 1943Department of Tumor Immunology, Biomedical Research Center, Cancer Research Institute, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84505 Slovakia
| | - Anna Matisova
- grid.420087.90000 0001 2106 1943Department of Tumor Immunology, Biomedical Research Center, Cancer Research Institute, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84505 Slovakia
| | - Jan Sedlak
- grid.420087.90000 0001 2106 1943Department of Tumor Immunology, Biomedical Research Center, Cancer Research Institute, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84505 Slovakia
| | - Jana Jakubikova
- grid.420087.90000 0001 2106 1943Department of Tumor Immunology, Biomedical Research Center, Cancer Research Institute, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84505 Slovakia ,grid.419303.c0000 0001 2180 9405Centre for Advanced Materials Application, Slovak Academy of Sciences, Dubravska Cesta 9, Bratislava, 84511 Slovakia
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6
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Giles BH, Mann KK. Arsenic as an immunotoxicant. Toxicol Appl Pharmacol 2022; 454:116248. [PMID: 36122737 DOI: 10.1016/j.taap.2022.116248] [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: 07/22/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 10/31/2022]
Abstract
Arsenic is world-wide contaminant to which millions of people are exposed. The health consequences of arsenic exposure are varied, including cancer, cardiometabolic disease, and respiratory disorders. Arsenic is also toxic to the immune system, which may link many of the pathologies associated with arsenic exposure. The immune system can be classified into two interconnected arms: the innate and the adaptive immune responses. Herein, we discuss the effects of arsenic on key cell types within each of these arms, highlighting both in vitro and in vivo responses. These cells include macrophages, neutrophils, dendritic cells, and both B and T lymphocytes. Furthermore, we will explore data from human populations where altered immune status is implicated in disease and identify several data gaps where research is needed to complete our understanding of the immunotoxic effects of arsenic.
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Affiliation(s)
- Braeden H Giles
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - Koren K Mann
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
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7
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Mehta K, Kaur B, Pandey KK, Kaler S, Dhar P. Curcumin supplementation shows modulatory influence on functional and morphological features of hippocampus in mice subjected to arsenic trioxide exposure. Anat Cell Biol 2020; 53:355-365. [PMID: 32929054 PMCID: PMC7527119 DOI: 10.5115/acb.18.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 06/13/2019] [Accepted: 09/16/2019] [Indexed: 12/20/2022] Open
Abstract
Since, oxidative stress has been suggested as one of the mechanisms underlying arsenic-induced toxicity, the present study focused on the role of antioxidant (curcumin) supplementation on behavioral, biochemical, and morphological alterations with context to mice hippocampus (CA1) following arsenic trioxide (As2O3) administration. Healthy male Swiss albino mice were divided into control and experimental groups. As2O3 (2 mg/kg bw) alone or along with curcumin (100 mg/kg bw) was administered to experimental groups by oral route for 45 days whereas the control groups received either no treatment or vehicle for curcumin. Animals were subjected to behavioral study towards the end of the experimental period (day 33-45). On day 46, the brain samples were obtained and subjected either to immersion fixation (for morphometric observations) or used afresh for biochemical test. Behavioral tests (open field, elevated plus maze, and Morris water maze) revealed enhanced anxiety levels and impairment of cognitive functions in As2O3 alone treated groups whereas a trend of recovery was evident in mice simultaneously treated with As2O3 and curcumin. Morphological observations showed noticeable reduction in stratum pyramidale thickness (CA1), along with decrease in density and size of pyramidal neurons in As2O3 alone exposed group as compared to As2O3+Cu co-treated group. Hippocampal glutathione levels were found to be downregulated in animals receiving As2O3 as against the levels of controls and curcumin supplemented animals, thereby, suggestive of beneficial role of curcumin on As2O3 induced adverse effects.
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Affiliation(s)
- Kamakshi Mehta
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Balpreet Kaur
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Kumar Pandey
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Saroj Kaler
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Pushpa Dhar
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
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Wang QQ, Jiang Y, Naranmandura H. Therapeutic strategy of arsenic trioxide in the fight against cancers and other diseases. Metallomics 2020; 12:326-336. [PMID: 32163072 DOI: 10.1039/c9mt00308h] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Arsenic trioxide (ATO) has been recognized as a drug for the treatment of various diseases in traditional medicine for more than two thousand years. Although ATO has recently shown excellent efficacy for the treatment of acute promyelocytic leukemia (APL), it could not provide satisfactory outcomes as a single-agent for the management of non-APL leukemia or different solid tumors. Nevertheless, combination treatment strategies, e.g., ATO with other agents, have shown promising results against different diseases. Here, we introduce in depth the latest evidence and detailed insights into ATO-mediated cures for APL by targeting PML/RARα chimeric protein, followed by the preclinical and clinical efficacy of ATO on various non-APL malignancies and solid tumors. Likewise, the antiviral activity of ATO against human immunodeficiency virus (HIV) and hepatitis C virus (HCV) was also discussed briefly. Our review would provide a clear prospect for the combination of ATO with other agents for treatment of numerous neoplastic diseases, and open a new era in the clinically applicable range of arsenicals.
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Affiliation(s)
- Qian Qian Wang
- Department of Hematology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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9
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Qian W, Wang L, Li P, Hu Y, Wang Q, Yi K, Wu M, Xu Y, Song J, Chen P, Zhang H, Ma J, Xie Y. Efficiency and Tolerability of Induction and Consolidation Therapy with Arsenic Trioxide/Bortezomib/Ascorbic Acid/Dexamethasone (ABCD) Regimen Compared to Bortezomib/Dexamethasone (BD) Regimen in Newly Diagnosed Myeloma Patients. Cancer Manag Res 2020; 12:431-441. [PMID: 32021455 PMCID: PMC6980852 DOI: 10.2147/cmar.s212455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/05/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was aimed at comparing the efficacy and tolerability of an arsenic trioxide/bortezomib/ascorbic acid/dexamethasone (ABCD) regimen with efficacy and tolerability of a bortezomib/dexamethasone (BD) regimen in patients with newly diagnosed myeloma. Patients and Methods Fifty-seven and sixty-four patients were treated with the ABCD and BD regimens, respectively. Eligible and agreeable patients received autologous hematopoietic stem cell transplantation followed by consolidation. Results The response rates (above VGPR) were 74.1% and 32.8% in the ABCD- and BD-treated groups, respectively (P = 0.000). Compared to BD regimen, ABCD regimen significantly improved PFS (P = 0.026) and OS (P = 0.000) in newly diagnosed patients. Patients with a high tumor burden, low or standard risk, and without auto-HSCT seemed to especially benefit compared to the same group with BD regimen. ABCD also showed better tolerability with lower bone marrow suppression (P = 0.026). Furthermore, complete response or near CR after induction therapy was a good prognostic factor for ABCD-associated OS and PFS. Conclusion ABCD is an effective and tolerable regimen compared with BD regimen in newly diagnosed myeloma patients. ABCD regimen could be an economical, effective, and tolerable choice in low- and standard-risk patients.
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Affiliation(s)
- Wensi Qian
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Li Wang
- Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Pei Li
- Department of Hematology, Huashan Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Yingwei Hu
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Qian Wang
- Department of Hematology, Huashan Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Ke Yi
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Min Wu
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Yu Xu
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Jin Song
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Pingping Chen
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Hongdi Zhang
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Jiexian Ma
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
| | - Yanhui Xie
- Department of Hematology, Huadong Hospital Affiliated with Fudan University, Shanghai, People's Republic of China
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10
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Zhu Y, Chen W, Guan W, Fang Y, Hao C. Study of As2O3 regulating proliferation and apoptosis of Tca8113 cells by inhibiting the expression of Id-1. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:1932-1937. [PMID: 31079498 DOI: 10.1080/21691401.2019.1613419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yanfeng Zhu
- Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Weihui Chen
- Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Weiqun Guan
- Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yihong Fang
- Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chunfeng Hao
- Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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11
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Cholujova D, Bujnakova Z, Dutkova E, Hideshima T, Groen RW, Mitsiades CS, Richardson PG, Dorfman DM, Balaz P, Anderson KC, Jakubikova J. Realgar nanoparticles versus ATO arsenic compounds induce in vitro and in vivo activity against multiple myeloma. Br J Haematol 2017; 179:756-771. [PMID: 29048129 DOI: 10.1111/bjh.14974] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
Multiple myeloma (MM), a B cell malignancy characterized by clonal proliferation of plasma cells in the bone marrow, remains incurable despite the use of novel and conventional therapies. In this study, we demonstrated MM cell cytotoxicity triggered by realgar (REA; As4 S4 ) nanoparticles (NREA) versus Arsenic trioxide (ATO) against MM cell lines and patient cells. Both NREA and ATO showed in vivo anti-MM activity, resulting in significantly decreased tumour burden. The anti-MM activity of NREA and ATO is associated with apoptosis, evidenced by DNA fragmentation, depletion of mitochondrial membrane potential, cleavage of caspases and anti-apoptotic proteins. NREA induced G2 /M cell cycle arrest and modulation of cyclin B1, p53 (TP53), p21 (CDKN1A), Puma (BBC3) and Wee-1 (WEE1). Moreover, NREA induced modulation of key regulatory molecules in MM pathogenesis including JNK activation, c-Myc (MYC), BRD4, and histones. Importantly, NREA, but not ATO, significantly depleted the proportion and clonogenicity of the MM stem-like side population, even in the context of the bone marrow stromal cells. Finally, our study showed that both NREA and ATO triggered synergistic anti-MM activity when combined with lenalidomide or melphalan. Taken together, the anti-MM activity of NREA was more potent compared to ATO, providing the preclinical framework for clinical trials to improve patient outcome in MM.
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Affiliation(s)
- Danka Cholujova
- Cancer Research Institute, Biomedical Research Center SAS, Bratislava, Slovakia
| | | | | | - Teru Hideshima
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Richard W Groen
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Constantine S Mitsiades
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Paul G Richardson
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - David M Dorfman
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Balaz
- Institute of Geotechnics SAS, Košice, Slovakia
| | - Kenneth C Anderson
- Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jana Jakubikova
- Cancer Research Institute, Biomedical Research Center SAS, Bratislava, Slovakia.,Department of Medical Oncology, Jerome Lipper Multiple Myeloma Center, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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12
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Abstract
Background. Multiple myeloma accounts for 10% of all haematologic malignancies worldwide. In Europe, over 10 000 new cases and nearly 8000 deaths were attributed to multiple myeloma in 2000. Unlike other malignancies, in which surgery and radiation are important treatment modalities, myeloma is exclusively treated with stem cell transplantation and drug therapy, requiring pharmacists to stay abreast of new developments. The melphalan-prednisolone and vincristine-doxorubicin-dexamethasone (VAD) regimens, which have been standard treatments for multiple myeloma over the past few decades, have yielded responses without real survival benefits. Transplantation utilizing high-dose chemotherapy has produced the only meaningful survival benefits for patients with multiple myeloma, but many patients are not candidates for this aggressive treatment option. More effective therapies for multiple myeloma are needed. Objective. To address the mechanisms of action, safety, and efficacy of novel approaches to the treatment of myeloma involving bortezomib, thalidomide and its analogues, lenalidomide and CC-4047 (ActimidTM), and arsenic trioxide as single agents or in combination regimens. Data sources. Published preclinical and primary clinical trial results, as well as scientific or clinical meeting abstracts. The author determined the relevance and subsequent inclusion of the data. Conclusions. Bortezomib is approved in the US and Europe as single-agent therapy for the treatment of relapsed or refractory multiple myeloma. Thalidomide, its analogues, and arsenic trioxide have demonstrated activity and are under investigation in this disease. Further clinical trials of the efficacy and toxicity of these novel agents are ongoing and will further define optimal combinations and sequencing with conventional therapies.
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Fan L, Goss PE, Strasser-Weippl K. Current Status and Future Projections of Breast Cancer in Asia. Breast Care (Basel) 2015; 10:372-8. [PMID: 26989355 PMCID: PMC4789872 DOI: 10.1159/000441818] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Asia is the world's largest continent comprising about 3/5 of the human population. Breast cancer is the most common type of cancer and the second leading cause of cancer-related deaths among women in Asia, accounting for 39% of all breast cancers diagnosed worldwide. The incidence of breast cancer in Asia varies widely across the continent and is still lower than in Western countries, but the proportional contribution of Asia to the global breast cancer rates is increasing rapidly in parallel to the socioeconomic development. However, the mortality-to-incidence ratios are much higher for Asia than for Western countries. Most Asian countries are low- and middle-income countries (LMICs) where breast cancer presents at a younger age and a later stage, and where patients are more likely to die from the disease than those in Western countries. Moreover, diagnostic workup, treatment and palliative services are inadequate in most Asian LMICs. In this review, we present an overview of the breast cancer risk factors and epidemiology, control measures, and cancer care among Asian countries.
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Affiliation(s)
- Lei Fan
- Breast Cancer Institute, Cancer Hospital, Department of Oncology, Shanghai Medical College, Institutes of Biomedical Science, Fudan University, Shanghai, China
| | - Paul E. Goss
- Global Cancer Institute, Boston, MA, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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14
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Wang X, Zhang M. Synergistic effects of valproic acid and arsenic trioxide on RPMI8226 cells in vitro and the possible underlying mechanisms. Mol Med Rep 2015; 12:1449-56. [PMID: 25815518 DOI: 10.3892/mmr.2015.3519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 02/27/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the synergistic effects of valproic acid (VPA) and arsenic trioxide (ATO) on the proliferation of RPMI8226 cells and the possible underlying mechanisms. Cell apoptosis was assessed by flow cytometry. The mRNA expression levels were analyzed by semi-quantitative polymerase chain reaction, and the protein expression levels were analyzed by western blotting. The histone acetylation and methylation states of the gene promoters were detected using a chromatin immunoprecipitation technique. The apoptotic rates of the RPMI8226 cells in the combined drug groups were significantly increased compared with those of the single drug groups (P<0.05). The mRNA and protein expression levels of Bcl-2 and the expression levels of HDAC1 mRNA and H3K9me2 protein decreased significantly in the combined groups compared with the single drug groups. The mRNA and protein expression levels of Bax, Caspase 8, Caspase 9 and LSD1, and the protein expression of acetylated H3 increased significantly in the combination groups compared with the single drug groups. Histone methylation and acetylation of the Bcl-2 and bax gene promoters were increased in the combination groups compared with the single drug groups. VPA and ATO had synergistic effects on the proliferation of RPMI8226 cells, which may have been associated with the decreased expression of Bcl-2 and the increased expression levels of Bcl-2-associated X protein, Caspase 8 and Caspase 9. Therefore, the expression levels of the Bcl-2 gene family may have been regulated by the levels of gene promoter methylation and acetylation.
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Affiliation(s)
- Xiaoning Wang
- Department of Hematology, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Mei Zhang
- Department of Hematology, The First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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15
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Wang X, Zhang M, Wang M, He P, Liu X, Chen L, Xi J, Wang M, Li J, Liu H, Zhang H. Arsenic Trioxide Combined with VCMP or VAD Chemotherapy in Patients with Refractory or Relapsed Multiple Myeloma in a Single Institution of China. Indian J Hematol Blood Transfus 2014; 30:259-64. [PMID: 25435724 DOI: 10.1007/s12288-013-0320-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 12/20/2013] [Indexed: 11/28/2022] Open
Abstract
Arsenic trioxide (ATO) combined with dexamethasone, melphalan or other cytostatic agents had been used to treat refractory or relapsed multiple myeloma (MM) patients. We assessed the safety and efficacy of ATO combined with vindesine/cyclophosphamide/melphalan/prednisone (VCMP) or vindesine/doxorubicin/dexamethsone (VAD) chemotherapy for MM patients who failed more than two different prior regimens. All patients received ATO (0.25 mg/kg day) for 10 days/cycle combined with VCMP or VAD in 30-day cycles. Vindesine (1.4 mg/m(2)) was given intravenously on day 1, cyclophosphamide (400 mg/m(2) day) was given intravenously on days 2, 4, 6, 8, 10, melphalan (6 mg/day) and prednisone (1 mg/kg day) were given orally day 1 to day 10 for VCMP regimen. VAD regimen consisted of vindesine 1 mg/day and doxorubicin 10 mg/day intravenously drip for 4 days with oral dexamethasone 40 mg/day for days 1-4, 9-12, 17-20. Patients who completed at least one cycle were evaluated for response to treatment. Objective responses occurred in 35 of 63 (56 %) patients, including seven complete, 14 partial and 14 minor responses. Median progression-free survival and overall survival were 6 and 23 months respectively. 12 patients had elevated serum creatinine levels (SCr) at baseline, and 9 of 12 (75 %) showed decreased SCr levels during treatment. Frequent Grade 3/4 non-hematological adverse events included arrhythmia, hypertension, fatigue and neuropathy. These results indicate that ATO combined with VCMP or VAD was effective and well tolerated as a new therapeutic option for patients with relapsed or refractory MM.
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Affiliation(s)
- Xiaoning Wang
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Mei Zhang
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Meihua Wang
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Pengcheng He
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Xin Liu
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Limei Chen
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Jieying Xi
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Mengchang Wang
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Jin Li
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Huasheng Liu
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
| | - Haitao Zhang
- Department of Hematology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, 277 West of Yanta Road, Xi'an, Shaanxi, 710061 P.R. China
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16
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He X, Yang K, Chen P, Liu B, Zhang Y, Wang F, Guo Z, Liu X, Lou J, Chen H. Arsenic trioxide-based therapy in relapsed/refractory multiple myeloma patients: a meta-analysis and systematic review. Onco Targets Ther 2014; 7:1593-9. [PMID: 25246802 PMCID: PMC4166211 DOI: 10.2147/ott.s67165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple myeloma (MM) is a clonal malignancy characterized by the proliferation of malignant plasma cells in the bone marrow and the production of monoclonal immunoglobulin. Although some newly approved drugs (thalidomide, lenalidomide, and bortezomib) demonstrate significant benefit for MM patients with improved survival, all MM patients still relapse. Arsenic trioxide (ATO) is the most active single agent in acute promyelocytic leukemia, the antitumor activity of which is partly dependent on the production of reactive oxygen species. Due to its multifaceted effects observed on MM cell lines and primary myeloma cells, Phase I/II trials have been conducted in heavily pretreated patients with relapsed or refractory MM. Therapy regimens varied dramatically as to the dosage of ATO and monotherapy versus combination therapy with other agents available for the treatment of MM. Although ATO-based combination treatment was well tolerated by most patients, most trials found that ATO has limited effects on MM patients. However, since small numbers of patients were randomized to different treatment arms, trials have not been statistically powered to determine the differences in progression-free survival and overall survival among the experimental arms. Therefore, large Phase III studies of ATO-based randomized controlled trials will be needed to establish whether ATO has any potential beneficial effects in the clinical setting.
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Affiliation(s)
- Xuepeng He
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Kai Yang
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Peng Chen
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Bing Liu
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Yuan Zhang
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Fang Wang
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Zhi Guo
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Xiaodong Liu
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Jinxing Lou
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
| | - Huiren Chen
- Department of Hematology, General Hospital of Beijing Military Area of PLA, Beijing, People's Republic of China
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17
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Chim CS, Wong KY. Bortezomib/bendamustine/dexamethasone induced good PR in refractory relapse post auto-SCT with constitutive RAS activation due to V600E BRAF mutation. Bone Marrow Transplant 2014; 49:1545-7. [PMID: 25133896 DOI: 10.1038/bmt.2014.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- C S Chim
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - K Y Wong
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
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18
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Wu Y, Dai J, Zhang W, Yan R, Zhang Y, Ruan C, Dai K. Arsenic trioxide induces apoptosis in human platelets via C-Jun NH2-terminal kinase activation. PLoS One 2014; 9:e86445. [PMID: 24466103 PMCID: PMC3899281 DOI: 10.1371/journal.pone.0086445] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/10/2013] [Indexed: 01/18/2023] Open
Abstract
Arsenic trioxide (ATO), one of the oldest drugs in both Western and traditional Chinese medicine, has become an effective anticancer drug, especially in the treatment of acute promyelocytic leukemia (APL). However, thrombocytopenia occurred in most of ATO-treated patients with APL or other malignant diseases, and the pathogenesis remains unclear. Here we show that ATO dose-dependently induces depolarization of mitochondrial inner transmembrane potential (ΔΨm), up-regulation of Bax and down-regulation of Bcl-2 and Bcl-XL, caspase-3 activation, and phosphotidylserine (PS) exposure in platelets. ATO did not induce surface expression of P-selectin and PAC-1 binding, whereas, obviously reduced collagen, ADP, and thrombin induced platelet aggregation. ATO dose-dependently induced c-Jun NH2-terminal kinase (JNK) activation, and JNK specific inhibitor dicumarol obviously reduced ATO-induced ΔΨm depolarization in platelets. Clinical therapeutic dosage of ATO was intraperitoneally injected into C57 mice, and the numbers of circulating platelets were significantly reduced after five days of continuous injection. The data demonstrate that ATO induces caspase-dependent apoptosis via JNK activation in platelets. ATO does not incur platelet activation, whereas, it not only impairs platelet function but also reduces circulating platelets in vivo, suggesting the possible pathogenesis of thrombocytopenia in patients treated with ATO.
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Affiliation(s)
- Yicun Wu
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou, China
| | - Jin Dai
- School of Life Sciences, Peking University, Beijing, China
| | - Weilin Zhang
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou, China
| | - Rong Yan
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou, China
| | - Yiwen Zhang
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou, China
| | - Changgeng Ruan
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou, China
| | - Kesheng Dai
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou, China
- * E-mail:
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19
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Abstract
Multiple myeloma continues to be an incurable illness. Improvement in our understanding of the disease is leading to new therapeutic modalities and the definition of new targeted therapy. Several pathways have been identified as areas for targeted therapy, and this review will discuss key molecules in some detail. New agents and molecules with biologic modulator activity appear to be changing the natural history of the disease. Agents such as thalidomide or its analogs, arsenic trioxide or bortezomib, hold great promise; however, much is yet to be learned on how to integrate these agents into disease management.
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Affiliation(s)
- Mohamed A Hussein
- Cleveland Clinic, Multidisciplinary Multiple Myeloma Research Program, Cleveland, OH 44195, USA.
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20
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Regulatory Effects of Arsenic on Cellular Signaling Pathways: Biological Effects and Therapeutic Implications. NUCLEAR SIGNALING PATHWAYS AND TARGETING TRANSCRIPTION IN CANCER 2014. [DOI: 10.1007/978-1-4614-8039-6_5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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21
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Activity of 129 single-agent drugs in 228 phase I and II clinical trials in multiple myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:284-290.e5. [PMID: 24565465 DOI: 10.1016/j.clml.2013.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND More than 400 preclinical studies report ≥ 1 compound as cytotoxic to multiple myeloma (MM) cells; however, few of these agents became relevant in the clinic. Thus, the utility of such assays in predicting future clinical value is debatable. PATIENTS AND METHODS We examined the application of early-phase trial experiences to predict future clinical adoption. We identified 129 drugs explored as single agents in 228 trials involving 7421 patients between 1961 and 2013. RESULTS All drugs in common use in MM (melphalan, dexamethasone, prednisone, cyclophosphamide, bendamustine, thalidomide, lenalidomide, pomalidomide, bortezomib, carfilzomib, and doxorubicin) demonstrated a best reported response rate of ≥ 22%. Older agents, including teniposide, fotemustine, paclitaxel, and interferon, also appear active by this criterion; however, if mean response rates from all reported trials for an agent are considered, then only drugs with a mean response rate of 15% partial response are in clinical use. CONCLUSION Our analysis suggests that thresholds of 20% for best or 15% for mean response are highly predictive of future clinical success. Below these thresholds, no drug has yet reached regulatory approval or widespread use in the clinic. Thus, this benchmark provides 1 element of the framework for guiding choice of drugs for late-stage clinical testing.
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Swindell EP, Hankins PL, Chen H, Miodragović ÐU, O'Halloran TV. Anticancer activity of small-molecule and nanoparticulate arsenic(III) complexes. Inorg Chem 2013; 52:12292-304. [PMID: 24147771 PMCID: PMC3893798 DOI: 10.1021/ic401211u] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Starting in ancient China and Greece, arsenic-containing compounds have been used in the treatment of disease for over 3000 years. They were used for a variety of diseases in the 20th century, including parasitic and sexually transmitted illnesses. A resurgence of interest in the therapeutic application of arsenicals has been driven by the discovery that low doses of a 1% aqueous solution of arsenic trioxide (i.e., arsenous acid) lead to complete remission of certain types of leukemia. Since Food and Drug Administration (FDA) approval of arsenic trioxide (As2O3) for treatment of acute promyelocytic leukemia in 2000, it has become a front-line therapy in this indication. There are currently over 100 active clinical trials involving inorganic arsenic or organoarsenic compounds registered with the FDA for the treatment of cancers. New generations of inorganic and organometallic arsenic compounds with enhanced activity or targeted cytotoxicity are being developed to overcome some of the shortcomings of arsenic therapeutics, namely, short plasma half-lives and a narrow therapeutic window.
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Affiliation(s)
- Elden P. Swindell
- Department of Chemical and Biological Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113
- Chemistry of Life Processes Institute, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113
| | - Patrick L. Hankins
- Department of Chemistry, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113
- Chemistry of Life Processes Institute, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113
| | - Haimei Chen
- Chemistry of Life Processes Institute, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113
| | - Ðenana U. Miodragović
- Chemistry of Life Processes Institute, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113
| | - Thomas V. O'Halloran
- Department of Chemistry, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113
- Chemistry of Life Processes Institute, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113
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23
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Kritharis A, Bradley TP, Budman DR. The evolving use of arsenic in pharmacotherapy of malignant disease. Ann Hematol 2013; 92:719-30. [DOI: 10.1007/s00277-013-1707-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/11/2013] [Indexed: 12/01/2022]
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Held LA, Rizzieri D, Long GD, Gockerman JP, Diehl LF, de Castro CM, Moore JO, Horwitz ME, Chao NJ, Gasparetto C. A Phase I study of arsenic trioxide (Trisenox), ascorbic acid, and bortezomib (Velcade) combination therapy in patients with relapsed/refractory multiple myeloma. Cancer Invest 2013; 31:172-6. [PMID: 23406188 DOI: 10.3109/07357907.2012.756109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This Phase I study assessed the feasibility of concomitant arsenic trioxide (ATO), ascorbic acid (AA), and bortezomib (Velcade™) (AAV) for patients with relapsed/refractory multiple myeloma. EXPERIMENTAL DESIGN ATO (0.25 mg/kg) and AA (1 g) were given with an escalating dose of bortezomib (1 mg/m(2) or 1.3 mg/m(2) IV bolus on days 1 and 8 of a 21-day cycle). RESULTS Ten patients (median age 62 years), with a median of 3 prior regimens, were enrolled. Four (40%) patients achieved clinical benefit, with one patient achieving a durable partial response. No formal DLTs were encountered. CONCLUSION AAV combination was feasible and demonstrated some benefits in this heavily pretreated population.
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Affiliation(s)
- Lauren A Held
- Division of Cellular Therapy, Duke University Medical Center, Durham, North Carolina 27710, USA
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25
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Jung HJ, Chen Z, McCarty N. Synergistic anticancer effects of arsenic trioxide with bortezomib in mantle cell lymphoma. Am J Hematol 2012; 87:1057-64. [PMID: 22965904 DOI: 10.1002/ajh.23317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 06/28/2012] [Accepted: 07/18/2012] [Indexed: 12/12/2022]
Abstract
Mantle cell lymphoma (MCL) is a subtype of B-cell Non-Hodgkin's Lymphoma (NHL) and accounts for ~6% of all lymphomas. MCL is highly refractory to most chemotherapy including newer antibody-based therapeutic approaches, and high-grade MCL has one of the worst survival rates among NHLs. Therefore, the development of new therapeutic strategies to overcome drug resistance of MCL is important. In this article, we tested the effects of arsenic trioxide (As(2) O(3) , ATO) in bortezomib-resistant MCL. ATO is reported to induce complete remission in the patients with relapsed or refractory acute promyelocytic leukemia. Their effects in MCL, however, have not been explored. In this report, we show that ATO effectively inhibited the growth of MCL cells in vitro. ATO treatment also reduced cyclin D1 expression which is a genetic hallmark of MCL and NF-kB expression which was reported to have a prosurvival role in some MCL cells. The induction of apoptosis in MCL was partially due to reduced levels of cyclin D1 and increased levels of apoptosis-related molecules. The antiproliferative effects of bortezomib on MCL greatly increased when the cells were also treated with ATO, indicating ATO can sensitize MCL to bortezomib. Similar results were noted in bortezomib-resistant cell lines. In conclusion, ATO may be an alternative drug for use in combined adjuvant therapies for MCL, and further clinical testing should be performed.
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Affiliation(s)
- Hyun Joo Jung
- Center for Stem Cell and Regenerative Medicine, Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM) University of Texas-Health Science Center at Houston, Houston, TX 77030, USA
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Kotowski U, Heiduschka G, Brunner M, Erovic BM, Martinek H, Thurnher D. Arsenic trioxide enhances the cytotoxic effect of cisplatin in head and neck squamous cell carcinoma cell lines. Oncol Lett 2012; 3:1326-1330. [PMID: 22783443 DOI: 10.3892/ol.2012.643] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/01/2012] [Indexed: 12/31/2022] Open
Abstract
Arsenic trioxide (ATO) has been approved for the treatment of relapsed acute promyelocytic leukaemia. The aim of this study was to determine whether ATO would lead to cell death in head and neck squamous cell carcinoma (HNSCC) cell lines and whether it was able to enhance the cytotoxicity of cisplatin, a standard chemotherapeutic agent. The four HNSCC cell lines SCC9, SCC25, CAL27 and FADU were treated with ATO or cisplatin alone or with ATO and cisplatin in combination. Cytotoxicity assays, immunohistochemistry, western blot analysis and flow cytometry were carried out. Possible interactions between the two drugs were calculated using the Chou-Talalay equation. Ther results demonstrated a synergistic cytotoxic effect of the combination of ATO and cisplatin at high doses. The two agents induced apoptosis in all four HNSCC cell lines. In conclusion, this study showed that ATO is a promising therapeutic drug with cytotoxic effects in HNSCC. We demonstrated a synergistic effect in the combined treatment with cisplatin at high doses.
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Affiliation(s)
- Ulana Kotowski
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, A-1090 Vienna, Austria
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27
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Kumazaki M, Ando H, Sasaki A, Koshimizu TA, Ushijima K, Hosohata K, Oshima Y, Fujimura A. Protective Effect of α-Lipoic Acid Against Arsenic Trioxide–Induced Acute Cardiac Toxicity in Rats. J Pharmacol Sci 2011; 115:244-248. [DOI: 10.1254/jphs.10280sc] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022] Open
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Abeltino M, Bonomini S, Bolzoni M, Storti P, Colla S, Todoerti K, Agnelli L, Neri A, Rizzoli V, Giuliani N. The proapoptotic effect of zoledronic acid is independent of either the bone microenvironment or the intrinsic resistance to bortezomib of myeloma cells and is enhanced by the combination with arsenic trioxide. Exp Hematol 2011; 39:55-65. [DOI: 10.1016/j.exphem.2010.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 09/16/2010] [Accepted: 10/18/2010] [Indexed: 11/25/2022]
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Wen J, Feng Y, Bjorklund CC, Wang M, Orlowski RZ, Shi ZZ, Liao B, O'Hare J, Zu Y, Schally AV, Chang CC. Luteinizing Hormone-Releasing Hormone (LHRH)-I antagonist cetrorelix inhibits myeloma cell growth in vitro and in vivo. Mol Cancer Ther 2010; 10:148-58. [PMID: 21062912 DOI: 10.1158/1535-7163.mct-10-0829] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to determine the effects of an luteinizing hormone-releasing hormone (LHRH)-I antagonist, Cetrorelix, on human multiple myeloma (MM) cells and to elucidate the mechanisms of action. We showed that LHRH-I and LHRHR-I genes were expressed in MM cell lines and primary MM cells. Treatment with Cetrorelix inhibited growth and colony-forming ability of myeloma cells, including cell lines resistant to arsenic trioxide, bortezomib, or lenalidomide. Cetrorelix induced apoptosis in myeloma cells including primary myeloma cells. In addition, Cetrorelix inhibited the growth of human myeloma cells xenografted into mice without any apparent side effects. Cetrorelix downregulated the nuclear factor-kappa B (NF-κB) pathway activity and the expression of cytokines, including interleukin 6, insulin-like growth factor 1, VEGF-A, and stromal-derived factor 1, important for myeloma cell growth and survival in myeloma cells and/or marrow stromal cells from myeloma patients. Cetrorelix decreased the phosphorylation of extracellular signal regulated kinase 1/2 and STAT3 in myeloma cells, two crucial pathways for myeloma cells growth and survival. Moreover, the expression of p21 and p53 was increased, whereas that of antiapoptotic proteins Bcl-2 and Bcl-x(L) was reduced by Cetrorelix. Our findings indicate that Cetrorelix induces cytotoxicity in myeloma cells through various mechanisms and provide a rationale for investigating Cetrorelix for the treatment of MM.
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Affiliation(s)
- Jianguo Wen
- Department of Pathology, The Methodist Hospital and The Methodist Hospital Research Institute, 6565 Fannin MS205, Houston, TX 77030, USA
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Abstract
Over the last 17 years, clinical trials conducted worldwide have demonstrated the efficacy of arsenic trioxide (As(2)O(3)) in the treatment of relapsed acute promyelocytic leukemia (APL). Currently, the role of As(2)O(3) in front-line therapy is under investigation. Recent trials in the US have demonstrated that the addition of As(2)O(3) to standard treatment regimens improves survival outcomes in patients with APL and may allow a reduction in cytotoxic chemotherapy exposure. As(2)O(3) has also shown efficacy in other malignancies, particularly multiple myeloma and myelodysplastic syndromes. Therapeutic doses of As(2)O(3) are well tolerated, with no evidence of long-term toxicity. Adverse events include APL differentiation syndrome, electrocardiographic abnormalities, and mild elevations in liver enzymes. This review highlights trials investigating the role of As(2)O(3) in induction and consolidation for newly diagnosed APL, as well as its role in other hematologic malignancies. The chemistry, mechanisms of action, and clinical side effects of As(2)O(3) are also discussed.
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Affiliation(s)
- Ashkan Emadi
- Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21231-1000, United States.
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Ge F, Lu XP, Zeng HL, He QY, Xiong S, Jin L, He QY. Proteomic and functional analyses reveal a dual molecular mechanism underlying arsenic-induced apoptosis in human multiple myeloma cells. J Proteome Res 2009; 8:3006-19. [PMID: 19364129 DOI: 10.1021/pr9001004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Multiple myeloma (MM) is an incurable plasma cell malignancy with a terminal phase marked by increased proliferation and resistance to therapy. Arsenic trioxide (ATO), an antitumor agent with a multifaceted mechanism of action, displayed clinical activity in patients with late-stage multiple myeloma. However, the precise mechanism(s) of action of ATO has not been completely elucidated. In the present study, we used proteomics to analyze the ATO-induced protein alterations in MM cell line U266 and then investigated the molecular pathways responsible for the anticancer actions of ATO. Several clusters of proteins altered in expression in U266 cells upon ATO treatment were identified, including down-regulated signal transduction proteins and ubiquitin/proteasome members, and up-regulated immunity and defense proteins. Significantly regulated 14-3-3zeta and heat shock proteins (HSPs) were selected for further functional studies. Overexpression of 14-3-3zeta in MM cells attenuated ATO-induced cell death, whereas RNAi-based 14-3-3zeta knock-down or the inhibition of HSP90 enhanced tumor cell sensitivity to the ATO induction. These observations implicate 14-3-3zeta and HSP90 as potential molecular targets for drug intervention of multiple myeloma and thus improve our understanding on the mechanisms of antitumor activity of ATO.
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Affiliation(s)
- Feng Ge
- Institute of Life and Health Engineering, Jinan University, Guangzhou 510632, China
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32
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The efficacy of arsenic trioxide for the treatment of relapsed and refractory multiple myeloma: A systematic review. Cancer Treat Rev 2009; 35:425-30. [DOI: 10.1016/j.ctrv.2009.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 04/13/2009] [Accepted: 04/15/2009] [Indexed: 11/19/2022]
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33
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Potential pharmacological control of the NF-κB pathway. Trends Pharmacol Sci 2009; 30:313-21. [PMID: 19446347 DOI: 10.1016/j.tips.2009.03.004] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/20/2009] [Accepted: 03/23/2009] [Indexed: 12/31/2022]
Abstract
Nuclear factor (NF)-kappaB governs the expression of numerous genes that are important for various cellular responses. Its activation is induced by a wide variety of stimuli including stress, cigarette smoke, viral and bacterial products, cytokines, free radicals, carcinogens and tumor promoters to name a few. Deregulation of the NF-kappaB pathway has been observed in and attributed to the development of a variety of human ailments including cancers, autoimmune disorders, pulmonary, cardiovascular, neurodegenerative and skin diseases. Efforts to develop modulators of NF-kappaB have yielded several candidates, some of which are currently in Phase I/II of clinical trials. In addition, it is now becoming apparent that several of the approved drugs being currently used also work, in part, owing to their ability to influence the NF-kappaB pathway. In this article, we focus on the druggable components of the NF-kappaB signaling system and on the recent development of novel therapeutics that target NF-kappaB in various diseases.
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Matulis SM, Morales AA, Yehiayan L, Croutch C, Gutman D, Cai Y, Lee KP, Boise LH. Darinaparsin induces a unique cellular response and is active in an arsenic trioxide-resistant myeloma cell line. Mol Cancer Ther 2009; 8:1197-206. [PMID: 19417148 DOI: 10.1158/1535-7163.mct-08-1072] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Here, we report on the organic arsenical darinaparsin (ZIO-101, S-dimethylarsino-glutathione) and its anti-myeloma activity compared with inorganic arsenic trioxide. Darinaparsin induced apoptosis in multiple myeloma cell lines in a dose-dependent manner, and the addition of N-acetylcysteine, which increases intracellular glutathione (GSH), blocked cytotoxicity of both darinaparsin and arsenic trioxide. In contrast to arsenic trioxide, intracellular GSH does not appear to be important for darinaparsin metabolism, as an inhibitor of GSH synthesis, buthionine sulfoximine, had little effect on drug activity. This discrepancy was resolved when we determined the effects of thiols on drug uptake. The addition of exogenous GSH, L-cysteine, or D-cysteine prevented darinaparsin cellular uptake and cell death but had no effect on the uptake or activity of arsenic trioxide, suggesting a difference in the transport mechanism of these two drugs. In addition, gene expression profiling revealed differences in the signaling of protective responses between darinaparsin and arsenic trioxide. Although both arsenicals induced a transient heat shock response, only arsenic trioxide treatment induced transcription of metal response genes and anti-oxidant genes related to the Nrf2-Keap1 pathway. In contrast to the protective responses, both arsenicals induced up-regulation of BH3-only proteins. Moreover, silencing of BH3-only proteins Noxa, Bim, and Bmf protected myeloma cells from darinaparsin-induced cell death. Finally, treatment of an arsenic trioxide-resistant myeloma cell line with darinaparsin resulted in dose-dependent apoptosis, indicating that cross-resistance does not necessarily develop between these two forms of arsenic in multiple myeloma cell lines. These results suggest darinaparsin may be useful as an alternative treatment in arsenic trioxide-resistant hematologic cancers.
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Affiliation(s)
- Shannon M Matulis
- Microbiology and Immunology and The Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, Florida, USA
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35
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Chang JE, Voorhees PM, Kolesar JM, Ahuja HG, Sanchez FA, Rodriguez GA, Kim K, Werndli J, Bailey HH, Kahl BS. Phase II study of arsenic trioxide and ascorbic acid for relapsed or refractory lymphoid malignancies: a Wisconsin Oncology Network study. Hematol Oncol 2009; 27:11-6. [PMID: 18668698 DOI: 10.1002/hon.870] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Arsenic trioxide (As(2)O(3)) has established clinical activity in acute promyelocytic leukaemia and has pre-clinical data suggesting activity in lymphoid malignancies. Cell death from As(2)O(3) may be the result of oxidative stress. Agents which deplete intracellular glutathione, such as ascorbic acid (AA), may potentiate arsenic-mediated apoptosis. This multi-institution phase II study investigated a novel dosing schedule of As(2)O(3) and AA in patients with relapsed or refractory lymphoid malignancies. Patients received As(2)O(3) 0.25 mg/kg iv and AA 1000 mg iv for five consecutive days during the first week of each cycle followed by twice weekly infusions during weeks 2-6. Cycles were repeated every 8 weeks. The primary end point was objective response. In a subset of patients, sequential levels of intracellular glutathione and measures of Bcl-2 and Bax gene expression were evaluated in peripheral blood mononuclear cells during treatment. Seventeen patients were enrolled between March 2002 and February 2004. The median age was 71, and the majority of enrolled patients had non-Hodgkin's lymphoma (12/17). Sixteen patients were evaluable, and one patient with mantle cell lymphoma achieved an unconfirmed complete response after five cycles of therapy for an overall response rate of 6%. The trial, which had been designed as a two-stage study, was closed after the first stage analysis due to lack of activity. Haematologic toxicities were the most commonly reported events in this heavily pre-treated population, and comprised the majority of grade 3 and 4 toxicities. Intracellular depletion of glutathione was not consistently observed during treatment. As(2)O(3) and AA in this novel dosing strategy was generally well tolerated but had limited activity in patients with relapsed and refractory lymphoid malignancies.
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Affiliation(s)
- J E Chang
- Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI, USA
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36
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Qazilbash MH, Saliba RM, Nieto Y, Parikh G, Pelosini M, Khan FB, Jones RB, Hosing C, Mendoza F, Weber DM, Wang M, Popat U, Alousi A, Anderlini P, Champlin RE, Giralt S. Arsenic trioxide with ascorbic acid and high-dose melphalan: results of a phase II randomized trial. Biol Blood Marrow Transplant 2009; 14:1401-7. [PMID: 19041063 DOI: 10.1016/j.bbmt.2008.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Accepted: 09/23/2008] [Indexed: 12/22/2022]
Abstract
Arsenic trioxide (ATO) is synergistic with ascorbic acid (AA) and melphalan against myeloma both in vitro and in vivo. The aim of this randomized phase II trial was to determine the safety and efficacy of a combination of ATO, melphalan, and AA as preparative regimen in 48 patients undergoing autologous hematopoietic stem cell transplantation (ASCT) for multiple myeloma (MM). Forty-eight patients received melphalan 200 mg/m2 i.v. over 2 days and AA 1000 mg i.v. over 7 days in 3 treatment arms: no ATO (arm 1), ATO 0.15 mg/kg i.v. x 7 days (arm 2), and ATO 0.25 mg/kg i.v. x 7 days (arm 3). No dose-limiting toxicity, engraftment failure, or nonrelapse mortality (NRM) was seen in the first 100 days post-ASCT. Complete responses (CR) were seen in 12 of 48 patients (25%), with an overall response rate (ORR = CR + PR) of 85%. Median progression-free survival (PFS) was 25 months; median overall survival (OS) has not yet been reached. There was no significant difference in CR, PFS, or OS among the 3 treatment arms, and no adverse effect of ATO on melphalan pharmacokinetics. Addition of ATO + AA to high-dose melphalan is safe and well tolerated as a preparative regimen for MM.
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Affiliation(s)
- Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, UT M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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37
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Incidence and prophylaxis of venous thromboembolic events in multiple myeloma patients receiving immunomodulatory therapy. Thromb Res 2009; 123:679-86. [PMID: 18992924 DOI: 10.1016/j.thromres.2008.09.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 09/21/2008] [Accepted: 09/28/2008] [Indexed: 12/21/2022]
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38
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Abstract
Nuclear factor kappaB (NF-kappaB) transcription factors have a key role in many physiological processes such as innate and adaptive immune responses, cell proliferation, cell death, and inflammation. It has become clear that aberrant regulation of NF-kappaB and the signalling pathways that control its activity are involved in cancer development and progression, as well as in resistance to chemotherapy and radiotherapy. This article discusses recent evidence from cancer genetics and cancer genome studies that support the involvement of NF-kappaB in human cancer, particularly in multiple myeloma. The therapeutic potential and benefit of targeting NF-kappaB in cancer, and the possible complications and pitfalls of such an approach, are explored.
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39
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Abruzzese E, Iuliano F, Trawinska MM, Di Maio M. 153Sm: its use in multiple myeloma and report of a clinical experience. Expert Opin Investig Drugs 2008; 17:1379-87. [PMID: 18694370 DOI: 10.1517/13543784.17.9.1379] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the past years the bone seeking radiopharmaceutical samarium lexidronam ((153)Sm-EDTMP) has been increasingly used alone or in conjunction with chemotherapy and/or bisphosphonates for the treatment of painful bone metastasis. OBJECTIVE Its use has been explored in different solid tumours. In this report we explore its interesting characteristics and describe our experience in multiple myeloma (MM). METHODS (153)Sm-EDTMP has an affinity for bone and concentrates in areas of bone turnover. It decays as a therapeutic beta-emission and at the same time as gamma-photon that can be used for tracking its concentration with bone scan imaging. Ten patients with symptomatic MM were treated to achieve pain control. RESULTS Encouraging results were obtained in MM patients. The use of this radioisotope could be largely improved.
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Affiliation(s)
- Elisabetta Abruzzese
- Tor Vergata University, S. Eugenio Hospital, Hematology, P.le dell'Umanesimo 10, 00144 Rome, Italy.
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40
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Abstract
PURPOSE OF REVIEW Advances in the understanding of multiple myeloma pathogenesis have led to the development of innovative targeted therapies and improved management of this aggressive hematological neoplasia. This review will focus on the clinical trials that have reinforced the use of these new agents. Also, we will briefly take a look at the newer drugs making their way out of the laboratory and into early phase studies. RECENT FINDINGS During the past decade new multiple myeloma therapies featuring bortezomib and lenalidomide have come to light, whereas known agents such as thalidomide and arsenic trioxide have been reintroduced as key factors in multiple myeloma management. These new agents and their combinations have shown increased response rates and have added more options for patients with multiple myeloma whose disease has become resistant to conventional therapy. With these drug therapies has come a more targeted approach to treatment enabling not only improved antimyeloma efficacy but also the use of decreased dosing enhancing the safety and tolerability of these regimens. Newer agents including the histone deacetylase, hsp90, mammalian target of rapamycin and Akt inhibitors are showing promise preclinically and are now being assessed in phase I/II trials. SUMMARY This new antimultiple myeloma arsenal has shown its worth in both the relapsed/refractory and frontline setting and provides valuable options for patients with this debilitating disease.
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41
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Targeting MEK/MAPK signal transduction module potentiates ATO-induced apoptosis in multiple myeloma cells through multiple signaling pathways. Blood 2008; 112:2450-62. [DOI: 10.1182/blood-2007-10-114348] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Abstract
We demonstrate that blockade of the MEK/ERK signaling module, using the small-molecule inhibitors PD184352 or PD325901 (PD), strikingly enhances arsenic trioxide (ATO)–induced cytotoxicity in human myeloma cell lines (HMCLs) and in tumor cells from patients with multiple myeloma (MM) through a caspase-dependent mechanism. In HMCLs retaining a functional p53, PD treatment greatly enhances the ATO-induced p53 accumulation and p73, a p53 paralog, cooperates with p53 in caspase activation and apoptosis induction. In HMCLs carrying a nonfunctional p53, cotreatment with PD strikingly elevates the (DR4 + DR5)/(DcR1 + DcR2) tumor necrosis factor (TNF)–related apoptosis-inducing ligand (TRAIL) receptors ratio and caspase-8 activation of ATO-treated cells. In MM cells, irrespective of p53 status, the combined PD/ATO treatment increases the level of the proapoptotic protein Bim (PD-mediated) and decreases antiapoptotic protein Mcl-1 (ATO-mediated). Moreover, Bim physically interacts with both DR4 and DR5 TRAIL receptors in PD/ATO-treated cells, and loss of Bim interferes with the activation of both extrinsic and intrinsic apoptotic pathways in response to PD/ATO. Finally, PD/ATO treatment induces tumor regression, prolongs survival, and is well tolerated in vivo in a human plasmacytoma xenograft model. These preclinical studies provide the framework for testing PD325901 and ATO combination therapy in clinical trials aimed to improve patient outcome in MM.
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42
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Abstract
BACKGROUND The ancient drug, arsenic, has remarkable efficacy in the treatment of relapsed acute promyelocytic leukemia (APL) and this success has led to exploration of its use in other malignancies. OBJECTIVE To provide an overview of the mechanism of action of arsenic and summarize its development in the treatment of APL and other malignant disorders. METHODS A 20-year search of MEDLINE, EMBASE and Web of Science was conducted. RESULTS/CONCLUSIONS A series of clinical trials with arsenic trioxide has confirmed its benefit in the therapy of APL. Its role in the treatment of other malignancies remains to be determined. Careful attention to the clinical management of patients on arsenic trioxide therapy can significantly lessen the risk of major side effects.
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Affiliation(s)
- Mark R Litzow
- Mayo Clinic, Division of Hematology, 200 First Street SW, Rochester, MN 55905, USA.
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43
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Redzepovic J, Weinmann G, Ott I, Gust R. Current Trends in Multiple Myeloma Management. J Int Med Res 2008; 36:371-86. [DOI: 10.1177/147323000803600301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Treatment of multiple myeloma, a B-cell cancer, is usually palliative, however, as a result of intensive clinical research there are numerous new treatment options available today. The present review summarizes non-transplant treatment options for multiple myeloma on the basis of available publications. Treatment with new substances, such as immunomodulatory agents, farnesyl transferase inhibitors and apoptosis stimulators, and their mechanisms of action are discussed. In addition to this systematic review of the available evidence on multiple myeloma therapy we have also summarized current recommendations from national and international organizations on aspects of the treatment of multiple myeloma. This should enable readers to see different points of view at a glance and, hopefully, will provide a basis for translation of the available evidence into the best possible therapy.
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Affiliation(s)
- J Redzepovic
- Institute of Pharmacy, Free University of Berlin, Berlin, Germany
| | | | - I Ott
- Institute of Pharmacy, Free University of Berlin, Berlin, Germany
| | - R Gust
- Institute of Pharmacy, Free University of Berlin, Berlin, Germany
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44
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BH3-only proteins Noxa, Bmf, and Bim are necessary for arsenic trioxide-induced cell death in myeloma. Blood 2008; 111:5152-62. [PMID: 18354037 DOI: 10.1182/blood-2007-10-116889] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The use of arsenic trioxide (ATO) to treat multiple myeloma (MM) is supported by preclinical studies as well as several phase 2 studies, but the precise mechanism(s) of action of ATO has not been completely elucidated. We used gene expression profiling to determine the regulation of apoptosis-related genes by ATO in 4 MM cell lines and then focused on Bcl-2 family genes. ATO induced up-regulation of 3 proapoptotic BH3-only proteins (Noxa, Bmf, and Puma) and down-regulation of 2 antiapoptotic proteins Mcl-1 and Bcl-X(L). Coimmunoprecipitation demonstrated that Noxa and Puma bind Mcl-1 to release Bak and Bim within 6 hours of ATO addition. Bak and Bim are also released from Bcl-X(L). Silencing of Bmf, Noxa, and Bim significantly protected cells from ATO-induced apoptosis, while Puma silencing had no effect. Consistent with a role for Noxa inhibition of Mcl-1, the Bad-mimetic ABT-737 synergized with ATO in the killing of 2 MM lines. Finally, Noxa expression was enhanced by GSH depletion and inhibited by increasing GSH levels in the cells. Understanding the pattern of BH3-only protein response should aid in the rational design of arsenic-containing regimens.
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45
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Binet F, Chiasson S, Girard D. Arsenic trioxide induces de novo protein synthesis of annexin-1 in neutrophils: association with a heat shock-like response and not apoptosis. Br J Haematol 2008; 140:454-63. [DOI: 10.1111/j.1365-2141.2007.06941.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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46
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Hayden PJ, Mitsiades CS, Anderson KC, Richardson PG. From the bench to the bedside: emerging new treatments in multiple myeloma. Target Oncol 2007. [DOI: 10.1007/s11523-007-0072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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Mitsiades CS, Hayden PJ, Anderson KC, Richardson PG. From the bench to the bedside: emerging new treatments in multiple myeloma. Best Pract Res Clin Haematol 2007; 20:797-816. [PMID: 18070720 PMCID: PMC3445017 DOI: 10.1016/j.beha.2007.09.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Within the last decade, several novel classes of anti-myeloma therapeutics have become available. The clinical successes achieved by thalidomide, lenalidomide, and the proteasome inhibitor bortezomib, and in particular the ability of these agents to lead to major clinical responses in patients resistant to conventional or high-dose chemotherapy, have highlighted the importance of expanding further the spectrum of classes of agents utilized for the treatment of myeloma. Herein, we review the current status for the development of novel anti-myeloma agents, with emphasis on classes of therapeutics which have already translated into clinical trials or those in advanced stages of preclinical development. These include second-generation proteasome inhibitors (NPI-0052 and PR-171), heat shock protein 90 (hsp90) inhibitors, 2-methoxyestradiol, histone deacetylase (HDAC) inhibitors (e.g. SAHA and LBH589), fibroblast growth factor receptor 3 (FGF-R3) inhibitors, insulin-like growth factor 1 receptor (IGF-1R) inhibitors, mTOR inhibitors, monoclonal antibodies, and agents specifically targeting the tumor microenvironment, such as defibrotide.
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Affiliation(s)
| | - Patrick J. Hayden
- Dana Farber Cancer Institute, 44 Binney St, Dana 1B02, Boston, MA 02115, USA
| | - Kenneth C. Anderson
- Dana Farber Cancer Institute, 44 Binney St, Dana 1B02, Boston, MA 02115, USA
| | - Paul G. Richardson
- Dana Farber Cancer Institute, 44 Binney St, Dana 1B02, Boston, MA 02115, USA
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48
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Abstract
The advent of new therapies for multiple myeloma brings new hope for patients but also new side effects. Emerging information about the risks of supportive care therapies, including long-term, high-intensity bisphosphonate use and erythropoiesis-stimulating agents, is examined. As the number of drugs in the myeloma armamentarium grows, so does the list of possible side effects and interactions. With current progress, not only are there more complications to consider but patients are also living longer and the risk for delayed complications is becoming more relevant. The author provides perspective about the risks for the most active and commonly used single-agent and combination myeloma therapies.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
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49
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Abstract
Although multiple myeloma remains incurable with conventional treatments, management of the disease has recently been transformed with the introduction of three novel agents, bortezomib, thalidomide, and lenalidomide. The proteasome inhibitor bortezomib is approved for the treatment of patients who have received one prior therapy; there is a growing body of clinical evidence showing its effectiveness alone and in combination in the frontline setting, with high response rates and consistently high rates of complete response. Thalidomide plus dexamethasone is approved as frontline treatment of multiple myeloma. Other combination regimens including thalidomide have demonstrated substantial activity in both relapsed and frontline settings. Recently, the thalidomide analogue lenalidomide has been approved, in combination with dexamethasone, for the treatment of patients who have received one prior therapy; this regimen has shown promising results in the frontline setting. These agents represent a new generation of treatments for multiple myeloma that affect both specific intracellular signaling pathways and the tumor microenvironment. Other novel, targeted therapies are also being evaluated in preclinical and clinical studies. Regimens incorporating bortezomib, thalidomide, lenalidomide, and other novel agents, together with commonly used conventional drugs, represent a promising future direction in myeloma treatment. At present, further investigation is required to assess the safety and activity of combinations integrating these other novel agents. However, bortezomib, thalidomide, and lenalidomide are now in widespread clinical use. This review therefore focuses on the extensive clinical data available from studies of these drugs in the treatment of newly diagnosed and advanced multiple myeloma.
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Affiliation(s)
- Paul G Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, 44 Binney Street, Dana 1B02, Boston, Massachusetts 02115, USA.
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50
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Campbell RA, Sanchez E, Steinberg JA, Baritaki S, Gordon M, Wang C, Shalitin D, Chen H, Pang S, Bonavida B, Said J, Berenson JR. Antimyeloma effects of arsenic trioxide are enhanced by melphalan, bortezomib and ascorbic acid. Br J Haematol 2007; 138:467-78. [PMID: 17587338 DOI: 10.1111/j.1365-2141.2007.06675.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arsenic trioxide (ATO) induces apoptosis of malignant plasma cells through multiple mechanisms, including inhibition of DNA binding by nuclear factor kappa-B, a key player in the development of chemoresistance in multiple myeloma (MM). This activity suggests that ATO may be synergistic when combined with other active antimyeloma drugs. To evaluate this, we examined the antimyeloma effects of ATO alone and in combination with bortezomib, melphalan and ascorbic acid (AA) both in vitro and in vivo using a severe combined immunodeficient (SCID)-hu murine myeloma model. Marked synergistic antimyeloma effects were demonstrated when human MM Los Angeles xenograft IgG lambda light chain (LAGlambda-1) cells were treated in vitro with ATO and any one of these agents. SCID mice bearing human MM LAGlambda-1 tumours were treated with single-agent ATO, bortezomib, melphalan, or AA, or combinations of ATO with either bortezomib or melphalan and AA. Animals treated with any of these drugs alone showed tumour growth and increases in paraprotein levels similar to control mice, whereas animals treated with ATO-containing combinations showed markedly suppressed tumour growth and significantly reduced serum paraprotein levels. These in vitro and in vivo results suggest that addition of ATO to other antimyeloma agents may result in improved outcomes for patients with relapsed or refractory MM.
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Affiliation(s)
- Richard A Campbell
- Institute for Myeloma & Bone Cancer Research, West Hollywood, CA 90069, USA
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