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Rathi S, Oh JH, Zhang W, Mladek AC, Garcia DA, Xue Z, Burgenske DM, Zhang W, Le J, Zhong W, Sarkaria JN, Elmquist WF. Preclinical Systemic Pharmacokinetics, Dose Proportionality, and Central Nervous System Distribution of the ATM Inhibitor WSD0628, a Novel Radiosensitizer for the Treatment of Brain Tumors. J Pharmacol Exp Ther 2024; 390:260-275. [PMID: 38858089 PMCID: PMC11264258 DOI: 10.1124/jpet.123.001971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
Radiation therapy, a standard treatment option for many cancer patients, induces DNA double-strand breaks (DSBs), leading to cell death. Ataxia telangiectasia mutated (ATM) kinase is a key regulator of DSB repair, and ATM inhibitors are being explored as radiosensitizers for various tumors, including primary and metastatic brain tumors. Efficacy of radiosensitizers for brain tumors may be influenced by a lack of effective drug delivery across the blood-brain barrier. The objective of this study was to evaluate the systemic pharmacokinetics and mechanisms that influence the central nervous system (CNS) distribution of WSD0628, a novel and potent ATM inhibitor, in the mouse. Further, we have used these observations to form the basis of predicting effective exposures for clinical application. We observed a greater than dose proportional increase in exposure, likely due to saturation of clearance processes. Our results show that WSD0628 is orally bioavailable and CNS penetrant, with unbound partitioning in CNS (i.e., unbound tissue partition coefficient) between 0.15 and 0.3. CNS distribution is not limited by the efflux transporters P-glycoprotein and breast cancer resistant protein. WSD0628 is distributed uniformly among different brain regions. Thus, WSD0628 has favorable pharmacokinetic properties and potential for further exploration to determine the pharmacodynamics-pharmacokinetics efficacy relationship in CNS tumors. This approach will provide critical insights for the clinical translation of WSD0628 for the treatment of primary and secondary brain tumors. SIGNIFICANCE STATEMENT: This study evaluates the preclinical systemic pharmacokinetics, dose proportionality, and mechanisms influencing CNS distribution of WSD0628, a novel ATM inhibitor for the treatment of brain tumors. Results indicate that WSD0628 is orally bioavailable and CNS penetrant without efflux transporter liability. We also observed a greater than dose proportional increase in exposure in both the plasma and brain. These favorable pharmacokinetic properties indicate WSD0628 has potential for further exploration for use as a radiosensitizer in the treatment of brain tumors.
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Affiliation(s)
- Sneha Rathi
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Ju-Hee Oh
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Wenjuan Zhang
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Ann C Mladek
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Darwin A Garcia
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Zhiyi Xue
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Danielle M Burgenske
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Wenqiu Zhang
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Jiayan Le
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Wei Zhong
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - Jann N Sarkaria
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
| | - William F Elmquist
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.R., J.-H.O., W.J.Z., W.Q.Z., J.L., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., D.A.G., Z.X., D.M.B., J.N.S.); and WayShine Biopharm, Shanghai, China (W.Z.)
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2
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Cheng F, Wang H, Li W, Zhang Y. Clinical pharmacokinetics and drug-drug interactions of tyrosine-kinase inhibitors in chronic myeloid leukemia: A clinical perspective. Crit Rev Oncol Hematol 2024; 195:104258. [PMID: 38307392 DOI: 10.1016/j.critrevonc.2024.104258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024] Open
Abstract
In the past decade, numerous tyrosine kinase inhibitors (TKIs) have been introduced in the treatment of chronic myeloid leukemia. Given the significant interpatient variability in TKIs pharmacokinetics, potential drug-drug interactions (DDIs) can greatly impact patient therapy. This review aims to discuss the pharmacokinetic characteristics of TKIs, specifically focusing on their absorption, distribution, metabolism, and excretion profiles. Additionally, it provides a comprehensive overview of the utilization of TKIs in special populations such as the elderly, children, and patients with liver or kidney dysfunction. We also highlight known or suspected DDIs between TKIs and other drugs, highlighting various clinically relevant interactions. Moreover, specific recommendations are provided to guide haemato-oncologists, oncologists, and clinical pharmacists in managing DDIs during TKI treatment in daily clinical practice.
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Affiliation(s)
- Fang Cheng
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China
| | - Hongxiang Wang
- Department of Hematology, the Central Hospital of Wuhan, 430014, China
| | - Weiming Li
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan 430022, China.
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3
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Zhang W, Oh JH, Zhang W, Rathi S, Le J, Talele S, Sarkaria JN, Elmquist WF. How Much is Enough? Impact of Efflux Transporters on Drug delivery Leading to Efficacy in the Treatment of Brain Tumors. Pharm Res 2023; 40:2731-2746. [PMID: 37589827 PMCID: PMC10841221 DOI: 10.1007/s11095-023-03574-1] [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: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
The lack of effective chemotherapeutic agents for the treatment of brain tumors is a serious unmet medical need. This can be attributed, in part, to inadequate delivery through the blood-brain barrier (BBB) and the tumor-cell barrier, both of which have active efflux transporters that can restrict the transport of many potentially effective agents for both primary and metastatic brain tumors. This review briefly summarizes the components and function of the normal BBB with respect to drug penetration into the brain and the alterations in the BBB due to brain tumor that could influence drug delivery. Depending on what is rate-limiting a compound's distribution, the limited permeability across the BBB and the subsequent delivery into the tumor cell can be greatly influenced by efflux transporters and these are discussed in some detail. Given these complexities, it is necessary to quantify the extent of brain distribution of the active (unbound) drug to compare across compounds and to inform potential for use against brain tumors. In this regard, the metric, Kp,uu, a brain-to-plasma unbound partition coefficient, is examined and its current use is discussed. However, the extent of active drug delivery is not the only determinant of effective therapy. In addition to Kp,uu, drug potency is an important parameter that should be considered alongside drug delivery in drug discovery and development processes. In other words, to answer the question - How much is enough? - one must consider how much can be delivered with how much needs to be delivered.
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Affiliation(s)
- Wenjuan Zhang
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Ju-Hee Oh
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Wenqiu Zhang
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Sneha Rathi
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Jiayan Le
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Surabhi Talele
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - William F Elmquist
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.
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Sánchez-Dengra B, Alfonso M, González-Álvarez I, Bermejo M, González-Álvarez M, Martínez-Máñez R. Intranasal administration of molecular-gated mesoporous nanoparticles to increase ponatinib delivery to the brain. Nanomedicine (Lond) 2023; 18:1799-1813. [PMID: 37990994 DOI: 10.2217/nnm-2023-0131] [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] [Indexed: 11/23/2023] Open
Abstract
Background: Glioblastoma is the most common and lethal brain cancer. New treatments are needed. However, the presence of the blood-brain barrier is limiting the development of new treatments directed toward the brain, as it restricts the access and distribution of drugs to the CNS. Materials & methods: In this work, two different nanoparticles (i.e., mesoporous silica nanoparticles and magnetic mesoporous silica nanoparticles) loaded with ponatinib were prepared. Results & conclusion: Both particles were characterized and tested in vitro and in vivo, proving that they are not toxic for blood-brain barrier cells and they increase the amount of drug reaching the brain when administered intranasally in comparison with the results obtained for the free drug.
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Affiliation(s)
- Bárbara Sánchez-Dengra
- Engineering: Pharmacokinetics & Pharmaceutical Technology Area, Miguel Hernandez University, San Juan Alicante, 03550, Spain
| | - María Alfonso
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico, Universitat Politècnica de València, Universitat de València, Camino de Vera s/n, Valencia, 46022, Spain
| | - Isabel González-Álvarez
- Engineering: Pharmacokinetics & Pharmaceutical Technology Area, Miguel Hernandez University, San Juan Alicante, 03550, Spain
| | - Marival Bermejo
- Engineering: Pharmacokinetics & Pharmaceutical Technology Area, Miguel Hernandez University, San Juan Alicante, 03550, Spain
| | - Marta González-Álvarez
- Engineering: Pharmacokinetics & Pharmaceutical Technology Area, Miguel Hernandez University, San Juan Alicante, 03550, Spain
| | - Ramón Martínez-Máñez
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico, Universitat Politècnica de València, Universitat de València, Camino de Vera s/n, Valencia, 46022, Spain
- Unidad Mixta UPV-CIPF de Investigación en Mecanismos de Enfermedades y Nanomedicina, València, Universitat Politècnica de València, Centro de Investigación Príncipe Felipe, València, 46012, Spain
- Unidad Mixta de Investigación en Nanomedicina y Sensores, Universitat Politècnica de València, Instituto de Investigación Sanitaria La Fe, València, 46026, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, 28029, Spain
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5
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Allegra S, Dondi E, Chiara F, De Francia S. Pharmacokinetics of Four Tyrosine Kinase Inhibitors in Adult and Paediatric Chronic Myeloid Leukaemia Patients. Biomedicines 2023; 11:2478. [PMID: 37760918 PMCID: PMC10525795 DOI: 10.3390/biomedicines11092478] [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: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Tyrosine kinase inhibitors work by blocking the tyrosine kinases responsible for the dysregulation of intracellular signalling pathways in tumour cells. This study looked at the impact of age and sex on the levels of imatinib, dasatinib, nilotinib, and ponatinib in plasma and cerebrospinal fluid samples of patients with chronic myeloid leukaemia. Imatinib and dasatinib were used to treat the majority of the enrolled patients, and most of them were paediatrics. A total of 82.4% of the patients were men; however, sex-related differences in the drugs' pharmacokinetics were not found. Age and imatinib plasma concentration were found to be inversely correlated. The dasatinib concentrations in plasma were found to be substantially lower than those found in cerebrospinal fluid, particularly in paediatrics. Analysing the obtained data, we can state that therapeutic drug monitoring is a useful method for adjusting a patient's treatment schedule that depends on drug concentrations in biological fluids. The use of therapeutic drug monitoring in conjunction with tyrosine kinase inhibitors for the treatment of chronic myeloid leukaemia is supported by a number of sources of evidence. As a result, as the research develops, the tyrosine kinase inhibitor therapeutic drug monitoring classification needs to be refined in terms of factors like sex and age.
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Vanbilloen WJF, Rechberger JS, Anderson JB, Nonnenbroich LF, Zhang L, Daniels DJ. Nanoparticle Strategies to Improve the Delivery of Anticancer Drugs across the Blood-Brain Barrier to Treat Brain Tumors. Pharmaceutics 2023; 15:1804. [PMID: 37513992 PMCID: PMC10383584 DOI: 10.3390/pharmaceutics15071804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Primary brain and central nervous system (CNS) tumors are a diverse group of neoplasms that occur within the brain and spinal cord. Although significant advances in our understanding of the intricate biological underpinnings of CNS neoplasm tumorigenesis and progression have been made, the translation of these discoveries into effective therapies has been stymied by the unique challenges presented by these tumors' exquisitely sensitive location and the body's own defense mechanisms (e.g., the brain-CSF barrier and blood-brain barrier), which normally protect the CNS from toxic insult. These barriers effectively prevent the delivery of therapeutics to the site of disease. To overcome these obstacles, new methods for therapeutic delivery are being developed, with one such approach being the utilization of nanoparticles. Here, we will cover the current state of the field with a particular focus on the challenges posed by the BBB, the different nanoparticle classes which are under development for targeted CNS tumor therapeutics delivery, and strategies which have been developed to bypass the BBB and enable effective therapeutics delivery to the site of disease.
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Affiliation(s)
- Wouter J. F. Vanbilloen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA (J.S.R.)
- Department of Neurology, Elisabeth-Tweesteden Hospital, 5022 GC Tilburg, The Netherlands
| | - Julian S. Rechberger
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA (J.S.R.)
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
| | - Jacob B. Anderson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA (J.S.R.)
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
- Medical Scientist Training Program, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Leo F. Nonnenbroich
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA (J.S.R.)
- Hopp Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), 69120 Heidelberg, Germany
| | - Liang Zhang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA (J.S.R.)
| | - David J. Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA (J.S.R.)
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
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Kaehler M, Cascorbi I. Molecular Mechanisms of Tyrosine Kinase Inhibitor Resistance in Chronic Myeloid Leukemia. Handb Exp Pharmacol 2023; 280:65-83. [PMID: 36882601 DOI: 10.1007/164_2023_639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The hematopoietic neoplasm chronic myeloid leukemia (CML) is a rare disease caused by chromosomal reciprocal translocation t(9;22)(q34:q11) with subsequent formation of the BCR-ABL1 fusion gene. This fusion gene encodes a constitutively active tyrosine kinase, which results in malignant transformation of the cells. Since 2001, CML can be effectively treated using tyrosine kinase inhibitors (TKIs) such as imatinib, which prevent phosphorylation of downstream targets by blockade of the BCR-ABL kinase. Due to its tremendous success, this treatment became the role model of targeted therapy in precision oncology. Here, we review the mechanisms of TKI resistance focusing on BCR-ABL1-dependent and -independent mechanisms. These include the genomics of the BCR-ABL1, TKI metabolism and transport and alternative signaling pathways.
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Affiliation(s)
- Meike Kaehler
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel, Germany.
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Fukushi Y, Akamine Y, Abumiya M, Tozawa N, Yamashita T, Nara M, Kameoka Y, Takahashi N, Miura M. Effects of ABCB1 polymorphisms on the transport of ponatinib into the cerebrospinal fluid in Japanese Philadelphia chromosome-positive acute lymphoblastic leukaemia patients. Br J Clin Pharmacol 2022; 89:1695-1700. [PMID: 36541130 DOI: 10.1111/bcp.15650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
The effects of polymorphisms of ABCB1 and ABCG2 on the dose-adjusted plasma trough concentrations and cerebrospinal fluid (CSF)-to-plasma ratios of ponatinib were evaluated. Blood (C4 ) and CSF (CSF4 ) concentrations at 4 h after administration were determined. The median (95% confidence interval) CSF4 -to-C4 ratio of ponatinib in subjects homozygous for ABCB1 variants 1236T/T, 2677T/T + T/A or 3435T/T were significantly higher than that in a group of subjects with other genotypes (P = .026, .012 and .015, respectively). The median (95% confidence interval) CSF4 -to-C4 ratio of ponatinib in 4 patients with the combination of ABCB1 variants 1236T/T-2677T/T + T/A-3435T/T was 2.62% (1.42-3.42%); this ratio was significantly higher than that in subjects with other genotypes (1.08% [0.89-1.47%]; P = .006). The brain distribution of ponatinib was affected by ABCB1 polymorphisms and therefore seems to be modulated by P-glycoprotein at the blood-brain and blood-CSF barriers.
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Affiliation(s)
- Yayoi Fukushi
- Department of Pharmacy, Akita University Hospital, 1-1-1 Hondo, Akita, Japan
| | - Yumiko Akamine
- Department of Pharmacy, Akita University Hospital, 1-1-1 Hondo, Akita, Japan
| | - Maiko Abumiya
- Department of Pharmacy, Akita University Hospital, 1-1-1 Hondo, Akita, Japan
| | - Nagi Tozawa
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takaya Yamashita
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Miho Nara
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Kameoka
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Masatomo Miura
- Department of Pharmacy, Akita University Hospital, 1-1-1 Hondo, Akita, Japan.,Department of Pharmacokinetics, Akita University Graduate School of Medicine, Akita, Japan
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9
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Grigoreva TA, Sagaidak AV, Novikova DS, Tribulovich VG. Implication of ABC transporters in non-proliferative diseases. Eur J Pharmacol 2022; 935:175327. [DOI: 10.1016/j.ejphar.2022.175327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
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10
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Ronaldson PT, Davis TP. Transport Mechanisms at the Blood-Brain Barrier and in Cellular Compartments of the Neurovascular Unit: Focus on CNS Delivery of Small Molecule Drugs. Pharmaceutics 2022; 14:1501. [PMID: 35890396 PMCID: PMC9324459 DOI: 10.3390/pharmaceutics14071501] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 02/06/2023] Open
Abstract
Ischemic stroke is a primary origin of morbidity and mortality in the United States and around the world. Indeed, several research projects have attempted to discover new drugs or repurpose existing therapeutics to advance stroke pharmacotherapy. Many of these preclinical stroke studies have reported positive results for neuroprotective agents; however, only one compound (3K3A-activated protein C (3K3A-APC)) has advanced to Phase III clinical trial evaluation. One reason for these many failures is the lack of consideration of transport mechanisms at the blood-brain barrier (BBB) and neurovascular unit (NVU). These endogenous transport processes function as a "gateway" that is a primary determinant of efficacious brain concentrations for centrally acting drugs. Despite the knowledge that some neuroprotective agents (i.e., statins and memantine) are substrates for these endogenous BBB transporters, preclinical stroke studies have largely ignored the role of transporters in CNS drug disposition. Here, we review the current knowledge on specific BBB transporters that either limit drug uptake into the brain (i.e., ATP-binding cassette (ABC) transporters) or can be targeted for optimized drug delivery (i.e., solute carrier (SLC) transporters). Additionally, we highlight the current knowledge on transporter expression in astrocytes, microglia, pericytes, and neurons with an emphasis on transport mechanisms in these cell types that can influence drug distribution within the brain.
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Affiliation(s)
- Patrick T. Ronaldson
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ 85724-5050, USA;
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11
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Talele S, Zhang W, Oh JH, Burgenske DM, Mladek AC, Dragojevic S, Sarkaria JN, Elmquist WF. Central Nervous System Delivery of the Catalytic Subunit of DNA-Dependent Protein Kinase Inhibitor Peposertib as Radiosensitizer for Brain Metastases. J Pharmacol Exp Ther 2022; 381:217-228. [PMID: 35370138 PMCID: PMC9190234 DOI: 10.1124/jpet.121.001069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/21/2022] [Indexed: 07/22/2023] Open
Abstract
Cytotoxic effects of chemotherapy and radiation therapy (RT) used for the treatment of brain metastases results from DNA damage within cancer cells. Cells rely on highly evolved DNA damage response (DDR) pathways to repair the damage caused by these treatments. Inhibiting these repair pathways can further sensitize cancer cells to chemotherapy and RT. The catalytic subunit of DNA-dependent protein kinase, in a complex with Ku80 and Ku70, is a pivotal regulator of the DDR, and peposertib is a potent inhibitor of this catalytic subunit. The characterization of central nervous system (CNS) distributional kinetics of peposertib is critical in establishing a therapeutic index in the setting of brain metastases. Our studies demonstrate that the delivery of peposertib is severely restricted into the CNS as opposed to peripheral organs, by active efflux at the blood-brain barrier (BBB). Peposertib has a low free fraction in the brain and spinal cord, further reducing the active concentration, and distributes to the same degree within different anatomic regions of the brain. However, peposertib is heterogeneously distributed within the metastatic tumor, where its concentration is highest within the tumor core (with disrupted BBB) and substantially lower within the invasive tumor rim (with a relatively intact BBB) and surrounding normal brain. These findings are critical in guiding the potential clinical deployment of peposertib as a radiosensitizing agent for the safe and effective treatment of brain metastases. SIGNIFICANCE STATEMENT: Effective radiosensitization of brain metastases while avoiding toxicity to the surrounding brain is critical in the development of novel radiosensitizers. The central nervous system distribution of peposertib, a potent catalytic subunit of DNA-dependent protein kinase inhibitor, is restricted by active efflux in the normal blood-brain barrier (BBB) but can reach significant concentrations in the tumor core. This finding suggests that peposertib may be an effective radiosensitizer for intracranial tumors with an open BBB, while limited distribution into normal brain will decrease the risk of enhanced radiation injury.
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Affiliation(s)
- Surabhi Talele
- Department of Pharmaceutics, Brain Barriers Research Center, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., J.-H.O., W.F.E.) and Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., A.C.M., S.D., J.N.S.)
| | - Wenjuan Zhang
- Department of Pharmaceutics, Brain Barriers Research Center, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., J.-H.O., W.F.E.) and Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., A.C.M., S.D., J.N.S.)
| | - Ju-Hee Oh
- Department of Pharmaceutics, Brain Barriers Research Center, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., J.-H.O., W.F.E.) and Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., A.C.M., S.D., J.N.S.)
| | - Danielle M Burgenske
- Department of Pharmaceutics, Brain Barriers Research Center, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., J.-H.O., W.F.E.) and Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., A.C.M., S.D., J.N.S.)
| | - Ann C Mladek
- Department of Pharmaceutics, Brain Barriers Research Center, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., J.-H.O., W.F.E.) and Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., A.C.M., S.D., J.N.S.)
| | - Sonja Dragojevic
- Department of Pharmaceutics, Brain Barriers Research Center, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., J.-H.O., W.F.E.) and Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., A.C.M., S.D., J.N.S.)
| | - Jann N Sarkaria
- Department of Pharmaceutics, Brain Barriers Research Center, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., J.-H.O., W.F.E.) and Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., A.C.M., S.D., J.N.S.)
| | - William F Elmquist
- Department of Pharmaceutics, Brain Barriers Research Center, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., J.-H.O., W.F.E.) and Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., A.C.M., S.D., J.N.S.)
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12
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Wang W, Sun Y, Liu X, Kumar SK, Jin F, Dai Y. Dual-Targeted Therapy Circumvents Non-Genetic Drug Resistance to Targeted Therapy. Front Oncol 2022; 12:859455. [PMID: 35574302 PMCID: PMC9093074 DOI: 10.3389/fonc.2022.859455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
The introduction of various targeted agents into the armamentarium of cancer treatment has revolutionized the standard care of patients with cancer. However, like conventional chemotherapy, drug resistance, either preexisting (primary or intrinsic resistance) or developed following treatment (secondary or acquired resistance), remains the Achilles heel of all targeted agents with no exception, via either genetic or non-genetic mechanisms. In the latter, emerging evidence supports the notion that intracellular signaling pathways for tumor cell survival act as a mutually interdependent network via extensive cross-talks and feedback loops. Thus, dysregulations of multiple signaling pathways usually join forces to drive oncogenesis, tumor progression, invasion, metastasis, and drug resistance, thereby providing a basis for so-called "bypass" mechanisms underlying non-genetic resistance in response to targeted agents. In this context, simultaneous interruption of two or more related targets or pathways (an approach called dual-targeted therapy, DTT), via either linear or parallel inhibition, is required to deal with such a form of drug resistance to targeted agents that specifically inhibit a single oncoprotein or oncogenic pathway. Together, while most types of tumor cells are often addicted to two or more targets or pathways or can switch their dependency between them, DTT targeting either intrinsically activated or drug-induced compensatory targets/pathways would efficiently overcome drug resistance caused by non-genetic events, with a great opportunity that those resistant cells might be particularly more vulnerable. In this review article, we discuss, with our experience, diverse mechanisms for non-genetic resistance to targeted agents and the rationales to circumvent them in the treatment of cancer, emphasizing hematologic malignancies.
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Affiliation(s)
- Wei Wang
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
| | - Yue Sun
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
| | - Xiaobo Liu
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
| | - Shaji K. Kumar
- Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Fengyan Jin
- Department of Hematology, The First Hospital of Jilin University, Changchun, China
| | - Yun Dai
- Laboratory of Cancer Precision Medicine, The First Hospital of Jilin University, Changchun, China
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13
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Chen X, Huang J, Xu N, Fan Z, Nie D, Huang F, Sun Q, Zhang X, Liang X, Shi P, Wang Z, Liu H, Xu J, Dai M, Yu G, Zhang Y, Sun J, Liu Q, Xuan L. A phase 2 study of sorafenib combined with conventional therapies in refractory central nervous system leukemia. Cancer 2022; 128:2138-2147. [PMID: 35315510 DOI: 10.1002/cncr.34182] [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: 11/10/2021] [Revised: 01/28/2022] [Accepted: 02/18/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with refractory central nervous system leukemia (CNSL) have a dismal prognosis and lack effective therapy. Case reports have shown that sorafenib is effective against brain metastases, including leukemia. METHODS To explore the efficacy of sorafenib combined with conventional therapies for refractory CNSL, a phase 2 study was conducted. The primary end point was the complete remission rate (CRR) within 8 weeks of treatment. Secondary end points included the overall response rate (ORR), event-free survival (EFS), overall survival (OS), and adverse events (AEs). RESULTS Twenty-six patients with refractory CNSL were enrolled; they included 17 with isolated CNSL, 7 with hematological relapse, and 2 with another extramedullary relapse. After 8 weeks of treatment, 21 patients achieved complete remission, 2 achieved partial remission, and 3 achieved no remission for a CRR of 80.8% (95% CI, 62.1%-91.5%) and an ORR of 88.5% (95% CI, 71.0%-96.0%). Twenty patients survived, and 6 died. The 2-year EFS and OS rates were 75.0% (95% CI, 54.5%-88.3%) and 76.9% (95% CI, 54.2%-90.4%), respectively. Six patients experienced grade 3 or 4 treatment-related AEs, including moderate chronic graft-vs-host disease (n = 3), grade 3 or 4 acute graft-vs-host disease (n = 2), and grade 3 skin rash (n = 1). No treatment-related deaths occurred during the therapy of refractory CNSL. CONCLUSIONS Sorafenib combined with conventional therapies is effective and safe for refractory CNSL. LAY SUMMARY Sorafenib combined with conventional therapies is effective and safe for refractory central nervous system leukemia.
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Affiliation(s)
- Xiaoxia Chen
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junwei Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Danian Nie
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qixin Sun
- Department of Geriatrics, Hematology and Oncology Ward, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xinyou Zhang
- Department of Hematology, Shenzhen People's Hospital, Shenzhen, China
| | - Xinquan Liang
- Department of Hematology, First People's Hospital of Chenzhou, Chenzhou, China
| | - Pengcheng Shi
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhixiang Wang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Dai
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guopan Yu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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14
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Kadoguchi M, Arakawa H, Honda R, Hotta K, Shirasaka Y, Deguchi Y, Tamai I. Characterization of Aripiprazole Uptake Transporter in the Blood-Brain Barrier Model hCMEC/D3 Cells by Targeted siRNA Screening. Pharm Res 2022; 39:1549-1559. [PMID: 35314999 DOI: 10.1007/s11095-022-03223-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/03/2022] [Indexed: 12/12/2022]
Abstract
AIM Identification of blood-brain barrier (BBB) uptake transporters is a major challenge in the research and development of central nervous system (CNS) drugs. However, conventional methods that consider known drug uptake characteristics have failed at identifying the responsible transporter molecule. The present study aimed at identifying aripiprazole uptake transporters in BBB model hCMEC/D3 cells using a knockdown screening study targeting various transporters, including uncharacterized ones. METHODS We evaluated the effect of 214 types of siRNA targeting transporters on the uptake of aripiprazole, an atypical antipsychotic drug, in hCMEC/D3 cells. Aripiprazole uptake was determined using Xenopus oocytes expressing the candidate genes extracted from the siRNA screening assay. RESULTS The estimated unbound brain to plasma concentration ratio (Kp,uu,brain) of aripiprazole was estimated as 0.67 in wild-type mice and 1.94 in abcb1a/1b/abcg2 knockout mice, suggesting the involvement of both uptake and efflux transporters in BBB permeation. According to siRNA knockdown screening studies, organic cation/carnitine transporter 2 (OCTN2) and long-chain fatty acid transporter 1 (FATP1) were identified as candidate genes. The uptake of aripiprazole by hCMEC/D3 cells was decreased by OCTN2 inhibitors, but not by FATP1 inhibitors. A partially increased uptake of aripiprazole was observed in OCTN2-expressing Xenopus oocytes. Finally, to evaluate transporter-mediated BBB permeation of drugs, the reported and estimated Kp,uu,brain values were summarized. CONCLUSIONS A knockdown screening study in combination with Kp,uu,brain values showed that aripiprazole was a potential substrate of OCTN2. The technique described in this study can be applied to identifying novel BBB transporters for CNS drugs.
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Affiliation(s)
- Moeno Kadoguchi
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Hiroshi Arakawa
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Ryokichi Honda
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Kazuki Hotta
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Yoshiyuki Shirasaka
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan
| | - Yoshiharu Deguchi
- Faculty of Pharma-Sciences, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Ikumi Tamai
- Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa, 920-1192, Japan.
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15
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Transport and metabolism of tyrosine kinase inhibitors associated with chronic myeloid leukemia therapy: a review. Mol Cell Biochem 2022; 477:1261-1279. [DOI: 10.1007/s11010-022-04376-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/27/2022] [Indexed: 12/14/2022]
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16
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Talele S, Zhang W, Burgenske DM, Kim M, Mohammad AS, Dragojevic S, Gupta SK, Bindra RS, Sarkaria JN, Elmquist WF. Brain Distribution of Berzosertib: An Ataxia Telangiectasia and Rad3-Related Protein Inhibitor for the Treatment of Glioblastoma. J Pharmacol Exp Ther 2021; 379:343-357. [PMID: 34556535 PMCID: PMC9351722 DOI: 10.1124/jpet.121.000845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022] Open
Abstract
The effective treatment of brain tumors is a considerable challenge in part because of the presence of the blood-brain barrier (BBB) that limits drug delivery. Glioblastoma multiforme (GBM) is an aggressive and infiltrative primary brain tumor with an extremely poor prognosis after standard-of-care therapy with surgery, radiotherapy (RT), and chemotherapy. DNA damage response (DDR) pathways play a critical role in DNA repair in cancer cells, and inhibition of these pathways can potentially augment RT and chemotherapy tumor cell toxicity. The ataxia telangiectasia and Rad3-related protein (ATR) kinase is a key regulator of the DDR network and is potently and selectively inhibited by the ATR inhibitor berzosertib. Although in vitro studies demonstrate a synergistic effect of berzosertib in combination with temozolomide, in vivo efficacy studies have yet to recapitulate this observation using intracranial tumor models. In the current study, we demonstrate that delivery of berzosertib to the brain is restricted by efflux at the BBB. Berzosertib has a high binding affinity to brain tissue compared with plasma, thereby leading to low free drug concentrations in the brain. Berzosertib distribution is heterogenous within the tumor, wherein concentrations are substantially lower in normal brain and invasive tumor rim (wherein the BBB is intact) when compared with those in the tumor core (wherein the BBB is leaky). These results demonstrate that high tissue binding and limited and heterogenous brain distribution of berzosertib may be important factors that influence the efficacy of berzosertib therapy in GBM. SIGNIFICANCE STATEMENT: This study examined the brain delivery and efficacy of berzosertib in patient-derived xenograft models of glioblastoma multiforme (GBM). Berzosertib is actively effluxed at the blood-brain barrier and is highly bound to brain tissue, leading to low free drug concentrations in the brain. Berzosertib is heterogeneously distributed into different regions of the brain and tumor and, in this study, was not efficacious in vivo when combined with temozolomide. These factors inform the future clinical utility of berzosertib for GBM.
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Affiliation(s)
- Surabhi Talele
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Wenjuan Zhang
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Danielle M Burgenske
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Minjee Kim
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Afroz S Mohammad
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Sonja Dragojevic
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Shiv K Gupta
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Ranjit S Bindra
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Jann N Sarkaria
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - William F Elmquist
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
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Aldaz P, Arozarena I. Tyrosine Kinase Inhibitors in Adult Glioblastoma: An (Un)Closed Chapter? Cancers (Basel) 2021; 13:5799. [PMID: 34830952 PMCID: PMC8616487 DOI: 10.3390/cancers13225799] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma (GBM) is the most common and lethal form of malignant brain tumor. GBM patients normally undergo surgery plus adjuvant radiotherapy followed by chemotherapy. Numerous studies into the molecular events driving GBM highlight the central role played by the Epidermal Growth Factor Receptor (EGFR), as well as the Platelet-derived Growth Factor Receptors PDGFRA and PDGFRB in tumor initiation and progression. Despite strong preclinical evidence for the therapeutic potential of tyrosine kinase inhibitors (TKIs) that target EGFR, PDGFRs, and other tyrosine kinases, clinical trials performed during the last 20 years have not led to the desired therapeutic breakthrough for GBM patients. While clinical trials are still ongoing, in the medical community there is the perception of TKIs as a lost opportunity in the fight against GBM. In this article, we review the scientific rationale for the use of TKIs targeting glioma drivers. We critically analyze the potential causes for the failure of TKIs in the treatment of GBM, and we propose alternative approaches to the clinical evaluation of TKIs in GBM patients.
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Affiliation(s)
- Paula Aldaz
- Cancer Signaling Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), 31008 Pamplona, Spain
- Health Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
| | - Imanol Arozarena
- Cancer Signaling Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), 31008 Pamplona, Spain
- Health Research Institute of Navarre (IdiSNA), 31008 Pamplona, Spain
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18
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Chowdhury EA, Noorani B, Alqahtani F, Bhalerao A, Raut S, Sivandzade F, Cucullo L. Understanding the brain uptake and permeability of small molecules through the BBB: A technical overview. J Cereb Blood Flow Metab 2021; 41:1797-1820. [PMID: 33444097 PMCID: PMC8327119 DOI: 10.1177/0271678x20985946] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The brain is the most important organ in our body requiring its unique microenvironment. By the virtue of its function, the blood-brain barrier poses a significant hurdle in drug delivery for the treatment of neurological diseases. There are also different theories regarding how molecules are typically effluxed from the brain. In this review, we comprehensively discuss how the different pharmacokinetic techniques used for measuring brain uptake/permeability of small molecules have evolved with time. We also discuss the advantages and disadvantages associated with these different techniques as well as the importance to utilize the right method to properly assess CNS exposure to drug molecules. Even though very strong advances have been made we still have a long way to go to ensure a reduction in failures in central nervous system drug development programs.
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Affiliation(s)
- Ekram Ahmed Chowdhury
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Behnam Noorani
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Aditya Bhalerao
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Snehal Raut
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Farzane Sivandzade
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Luca Cucullo
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, USA
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19
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Gong X, Li L, Wei H, Liu B, Zhou C, Zhang G, Liu K, Lin D, Gong B, Wei S, Li Y, Mi Y, Wang Y, Wang J. A Higher Dose of Dasatinib May Increase the Possibility of Crossing the Blood-Brain Barrier in the Treatment of Patients With Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia. Clin Ther 2021; 43:1265-1271.e1. [PMID: 34120773 DOI: 10.1016/j.clinthera.2021.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/09/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Dasatinib is a second-generation tyrosine kinase inhibitor with higher central nervous system (CNS) penetration compared with imatinib and nilotinib in in vitro studies. However, limited clinical data are available regarding the dosage and CNS penetration of dasatinib. The purpose of this study was to investigate the actual ability of dasatinib to cross the blood-brain barrier in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). METHODS Plasma and cerebrospinal fluid (CSF) samples collected from Ph+ ALL patients treated with dasatinib were analyzed by using an LC-MS/MS assay. FINDINGS Orally administered dasatinib 100 mg once daily was well absorbed by the patient but penetrated poorly into the CSF. The use of a higher drug dosage (140 mg/d) may increase systemic drug exposure and enhance the penetration of dasatinib into the CSF. IMPLICATIONS Based on this study, the use of a higher dosage of dasatinib (140 mg/d) is recommended in patients at high risk of CNS relapse or patients who need treatment for CNS leukemia. ClinicalTrials.gov identifier: NCT02523976.
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Affiliation(s)
- Xiaoyuan Gong
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Le Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Hui Wei
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Bingcheng Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Chunlin Zhou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Guangji Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Kaiqi Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Dong Lin
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Benfa Gong
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Shuning Wei
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yan Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yingchang Mi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Ying Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
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20
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Leotta S, Markovic U, Pirosa MC, Stella S, Tringali S, Martino M, Specchia G, Carluccio P, Risitano AM, Grimaldi F, Vigna E, Palmieri F, Palmieri R, Annunziata M, Pisapia G, Palazzo G, Milone GA, Pelle AC, Scalise L, Di Giorgio MA, Bulla A, Leotta V, Di Raimondo F, Milone G. The role of ponatinib in adult BCR-ABL1 positive acute lymphoblastic leukemia after allogeneic transplantation: a real-life retrospective multicenter study. Ann Hematol 2021; 100:1743-1753. [PMID: 33774681 DOI: 10.1007/s00277-021-04504-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
The experience of third-generation tyrosine kinase inhibitor ponatinib treatment in Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph'+ ALL) patients post-allogeneic transplantation is limited. We retrospectively collected data on 25 Ph'+ ALL patients who were started on ponatinib after allogeneic transplantation between July 2015 and July 2019 from nine transplantation centers in Italy. Ponatinib was given in prophylaxis in five (20%), as pre-emptive treatment in seven (28%), and as salvage therapy in thirteen (52%) patients. It was combined with donor leukocyte infusions in ten patients. Half of the patients (12/25) harbored T315I mutation of BCR/ABL1, while in the remaining mutational analysis was negative or not performed. Among the 20 patients who received ponatinib as pre-emptive/salvage treatment, complete molecular response was achieved in 15 (75%) patients. Estimated overall survival at 2-year post-initiation of treatment in the whole cohort was 65% (respectively 60%, 60%, and 78% for the prophylaxis, pre-emptive, and salvage therapy groups). In patients with T315I-positive mutational status, the estimated 2-year survival was 40%. Fourteen patients (56%) experienced toxicity, requiring temporary or definitive suspension of treatment. In conclusion, treatment of Ph'+ ALL patients with ponatinib after transplantation is effective, although the question of adequate drug dose and treatment duration remains unanswered.
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Affiliation(s)
- Salvatore Leotta
- Divisione di Ematologia con Trapianto di midollo osseo - Azienda ospedaliero, universitaria Policlinico Vittorio Emanuele, Catania, Italy.
| | - Uros Markovic
- Dipartimento di specialità medico-chirurgiche - sezione di Ematologia, Università di Catania, Catania, Italy
| | - Maria Cristina Pirosa
- Divisione di Ematologia con Trapianto di midollo osseo - Azienda ospedaliero, universitaria Policlinico Vittorio Emanuele, Catania, Italy
| | - Stefania Stella
- Centro di Oncoematologia sperimentale, Università di Catania, Catania, Italy
| | - Stefania Tringali
- UOS Trapianto di midollo, Azienda ospedaliera Villa Sofia-Cervello, Palermo, Italy
| | - Massimo Martino
- Centro unico regionale trapianto cellule staminali e terapie cellulari A. Neri, Ospedale Bianchi - Melacrinò - Morelli, Reggio Calabria, Italy
| | - Giorgina Specchia
- Ematologia con trapianto - Azienda ospedaliero, universitaria Policlinico, Bari, Italy
| | - Paola Carluccio
- Ematologia con trapianto - Azienda ospedaliero, universitaria Policlinico, Bari, Italy
| | - Antonio M Risitano
- UOC di Ematologia e Trapianti di midollo - Azienda ospedaliero, universitaria Federico II, Naples, Italy
| | - Francesco Grimaldi
- UOC di Ematologia e Trapianti di midollo - Azienda ospedaliero, universitaria Federico II, Naples, Italy
| | - Ernesto Vigna
- Divisione di Ematologia, Azienda ospedaliera di Cosenza, Cosenza, Italy
| | - Fausto Palmieri
- Divisione di Ematologia, Azienda ospedaliera San Giuseppe Moscati, Avellino, Italy
| | - Raffaele Palmieri
- Divisione di Ematologia, Azienda ospedaliera San Giuseppe Moscati, Avellino, Italy
| | - Mario Annunziata
- Divisione di Ematologia, Azienda ospedaliera Cardarelli, Naples, Italy
| | - Giovanni Pisapia
- Divisione di Ematologia, Ospedale San Giuseppe Moscati, Taranto, Italy
| | - Giulia Palazzo
- Divisione di Ematologia, Ospedale San Giuseppe Moscati, Taranto, Italy
| | - Giulio Antonio Milone
- Dipartimento di specialità medico-chirurgiche - sezione di Ematologia, Università di Catania, Catania, Italy
| | - Angelo Curto Pelle
- Dipartimento di specialità medico-chirurgiche - sezione di Ematologia, Università di Catania, Catania, Italy
| | - Luca Scalise
- Dipartimento di specialità medico-chirurgiche - sezione di Ematologia, Università di Catania, Catania, Italy
| | - Mary Ann Di Giorgio
- Dipartimento di specialità medico-chirurgiche - sezione di Ematologia, Università di Catania, Catania, Italy
| | - Anna Bulla
- Dipartimento di specialità medico-chirurgiche - sezione di Ematologia, Università di Catania, Catania, Italy
| | - Valerio Leotta
- Dipartimento di specialità medico-chirurgiche - sezione di Ematologia, Università di Catania, Catania, Italy
| | - Francesco Di Raimondo
- Divisione di Ematologia con Trapianto di midollo osseo - Azienda ospedaliero, universitaria Policlinico Vittorio Emanuele, Catania, Italy.,Dipartimento di specialità medico-chirurgiche - sezione di Ematologia, Università di Catania, Catania, Italy
| | - Giuseppe Milone
- Divisione di Ematologia con Trapianto di midollo osseo - Azienda ospedaliero, universitaria Policlinico Vittorio Emanuele, Catania, Italy
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Ravi K, Franson A, Homan MJ, Roberts H, Pai MP, Miklja Z, He M, Wen B, Benitez LL, Perissinotti AJ, Bixby DL, Koschmann C, Marini BL. Comparative pharmacokinetic analysis of the blood-brain barrier penetration of dasatinib and ponatinib in mice. Leuk Lymphoma 2021; 62:1990-1994. [PMID: 33682631 DOI: 10.1080/10428194.2021.1894647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Karthik Ravi
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrea Franson
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Morgan J Homan
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Holly Roberts
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Manjunath P Pai
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Miao He
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Bo Wen
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Lydia L Benitez
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Dale L Bixby
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Carl Koschmann
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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22
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Barbaro D, Lapi P, Viacava P, Torregrossa L. Low-intermediate dose of lenvatinib in anaplastic thyroid cancer is highly effective and safe. BMJ Case Rep 2020; 13:13/12/e236934. [PMID: 33370973 PMCID: PMC7757514 DOI: 10.1136/bcr-2020-236934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We report two cases of anaplastic thyroid cancer (ATC) which had a very good response to a treatment with lenvatinib at 14 mg. A 73-year-old man with ATC stage IVB was operated on, undergoing a near-total thyroidectomy, and the pathological remnant tissue showed a quick and partial response to treatment with the drug. The patient had a single metastasis in the brain after 9 months, but then died due to bronchopneumonia after undergoing a neurosurgical intervention for the complete removal of the lesion. A 74-year-old woman with ATC stage IV was operated on, undergoing a near-total thyroidectomy after a neoadjuvant treatment with the drug, that was continued after surgical treatment. She had a partial remission of the local disease and of distant metastasis, which lasted for 14 months. She then died 4 months later due to cancer progression. Lenvatinib at 14 mg appears to be effective, fast and well tolerated.
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Affiliation(s)
- Daniele Barbaro
- Department of Medicine, UO Endocrinology, USL North West Tuscany, General Hospital of Livorno, Livorno, Italy
| | - Paola Lapi
- Department of Surgery, UO Pathology, USL North West Tuscany Office in Livorno, Livorno, Toscana, Italy
| | - Paolo Viacava
- Department of Surgery, UO Pathology, USL North West Tuscany Office in Livorno, Livorno, Toscana, Italy
| | - Liborio Torregrossa
- Deparment of Surgery, UO Pathology, University of Pisa, Pisa, Toscana, Italy
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23
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Gainor JF, Gadgeel S, Ou SHI, Yeap B, Otterson GA, Shaw AT. A Phase II Study of the Multikinase Inhibitor Ponatinib in Patients With Advanced, RET-Rearranged NSCLC. JTO Clin Res Rep 2020; 1:100045. [PMID: 34589941 PMCID: PMC8474450 DOI: 10.1016/j.jtocrr.2020.100045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction RET rearrangements define a distinct molecular subset of NSCLC. The multikinase inhibitor ponatinib reveals potent activity in preclinical models of RET-rearranged NSCLC. Methods In this single-arm, multicenter, phase II trial, we evaluated the clinical activity of ponatinib in patients with advanced, previously treated, RET-rearranged NSCLC (NCT01813734). RET rearrangements were identified through fluorescence in situ hybridization or next-generation sequencing. Ponatinib was administered at a dose of 30 mg once daily. Patients without a documented objective response were eligible to dose-escalate ponatinib to 45 mg daily. The primary end point was objective response rate. Results Between August 2014 and December 2017, nine patients were enrolled. The median age was 58 years (range 49–73 y). Eight patients (89%) had a history of brain metastases. The median number of previous lines of therapy was three (range 1–5). Of the nine evaluated patients, five (55%) experienced tumor shrinkage from baseline, but no confirmed responses were observed (objective response rate 0%). The disease control rate was 55%. With a median follow-up of 9.33 months, the median progression-free survival and overall survival were 3.80 months (95% CI: 1.83–5.30) and 17.47 months (95% CI: 6.57–19.20), respectively. The most common treatment-related adverse events were rash (n = 5; 56%), constipation (n = 4; 44%), and diarrhea (n = 4; 44%). No treatment-related thromboembolic or cardiac events were observed. The study was stopped prematurely owing to slow accrual and lack of clinical activity. Conclusions Ponatinib has limited clinical activity in patients with RET-rearranged NSCLC. Continued development of more potent and selective RET inhibitors is needed.
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Affiliation(s)
- Justin F Gainor
- Department of Medicine, Center for Thoracic Cancers, Massachusetts General Hospital, Boston, Massachusetts
| | - Shirish Gadgeel
- Department of Medicine, Division of Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sai-Hong I Ou
- Division of Hematology and Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, California
| | - Beow Yeap
- Department of Medicine, Center for Thoracic Cancers, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory A Otterson
- Division of Medical Oncology, Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Alice T Shaw
- Department of Medicine, Center for Thoracic Cancers, Massachusetts General Hospital, Boston, Massachusetts
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24
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Jena L, McErlean E, McCarthy H. Delivery across the blood-brain barrier: nanomedicine for glioblastoma multiforme. Drug Deliv Transl Res 2020; 10:304-318. [PMID: 31728942 PMCID: PMC7066289 DOI: 10.1007/s13346-019-00679-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The malignant brain cancer, glioblastoma multiforme (GBM), is heterogeneous, infiltrative, and associated with chemo- and radioresistance. Despite pharmacological advances, prognosis is poor. Delivery into the brain is hampered by the blood-brain barrier (BBB), which limits the efficacy of both conventional and novel therapies at the target site. Current treatments for GBM remain palliative rather than curative; therefore, innovative delivery strategies are required and nanoparticles (NPs) are at the forefront of future solutions. Since the FDA approval of Doxil® (1995) and Abraxane (2005), the first generation of nanomedicines, development of nano-based therapies as anti-cancer treatments has escalated. A new generation of NPs has been investigated to efficiently deliver therapeutic agents to the brain, overcoming the restrictive properties of the BBB. This review discusses obstacles encountered with systemic administration along with integration of NPs incorporated with conventional and emerging treatments. Barriers to brain drug delivery, NP transport mechanisms across the BBB, effect of opsonisation on NPs administered systemically, and peptides as NP systems are addressed.
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Affiliation(s)
- Lynn Jena
- School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Emma McErlean
- School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Helen McCarthy
- School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
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25
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Williams EI, Betterton RD, Davis TP, Ronaldson PT. Transporter-Mediated Delivery of Small Molecule Drugs to the Brain: A Critical Mechanism That Can Advance Therapeutic Development for Ischemic Stroke. Pharmaceutics 2020; 12:pharmaceutics12020154. [PMID: 32075088 PMCID: PMC7076465 DOI: 10.3390/pharmaceutics12020154] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022] Open
Abstract
Ischemic stroke is the 5th leading cause of death in the United States. Despite significant improvements in reperfusion therapies, stroke patients still suffer from debilitating neurocognitive deficits. This indicates an essential need to develop novel stroke treatment paradigms. Endogenous uptake transporters expressed at the blood-brain barrier (BBB) provide an excellent opportunity to advance stroke therapy via optimization of small molecule neuroprotective drug delivery to the brain. Examples of such uptake transporters include organic anion transporting polypeptides (OATPs in humans; Oatps in rodents) and organic cation transporters (OCTs in humans; Octs in rodents). Of particular note, small molecule drugs that have neuroprotective properties are known substrates for these transporters and include 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (i.e., statins) for OATPs/Oatps and 1-amino-3,5-dimethyladamantane (i.e., memantine) for OCTs/Octs. Here, we review current knowledge on specific BBB transporters that can be targeted for improvement of ischemic stroke treatment and provide state-of-the-art perspectives on the rationale for considering BBB transport properties during discovery/development of stroke therapeutics.
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26
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He JB, Zhang X, Guo ZW, Liu MM, Xu N, Huang F, Fan ZP, Xuan L, Deng L, Lin SH, Xu J, Sun J, Liu QF. Ponatinib therapy in recurrent Philadelphia chromosome-positive central nervous system leukemia with T315I mutation after Allo-HSCT. Int J Cancer 2019; 147:1071-1077. [PMID: 31785158 DOI: 10.1002/ijc.32817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
Central nervous system leukemia (CNSL) relapse is relatively common among Philadelphia chromosome-positive (Ph+) leukemia patients who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT). The prognosis of patients is dismal for those with a BCR-ABL T315I mutation, which is resistant to TKIs including second-generation drugs. We assessed ponatinib for nine patients with recurrent Ph+ CNSL and a T315I mutation after allo-HSCT, including five patients with Ph+ acute lymphoblastic leukemia and four with chronic myelogenous leukemia. Five patients experienced isolated CNSL relapse, and four experienced CNSL with hematologic relapse. All patients received ponatinib combined with intrathecal chemotherapy, and four patients with hematologic relapse received systemic chemotherapy and/or donor lymphocyte infusion. All patients achieved a deep molecular response and central nervous system remission (CNSR) at a median time of 1.5 (range: 0.7-3) months after ponatinib treatment. Two patients experienced a second CNSL relapse due to ponatinib reduction, but they achieved CNSR again after an increase to the standard dosage. Six patients developed graft versus host disease. By April 1, 2019, eight patients were alive, and one died of pneumonia. The median time of survival after the first CNSL relapse posttransplantation was 18 (range: 11.2-48.5) months. Our data from a small number of samples suggests that ponatinib is effective for recurrent Ph+ CNSL patients with a BCR-ABL T315I mutation after allo-HSCT and warrants broader clinical evaluation.
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Affiliation(s)
- Jia-Bao He
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Zhang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zi-Wen Guo
- Department of Hematology, Zhongshan City People's Hospital, Zhongshan, China
| | - Miao-Miao Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Ping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lan Deng
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shu-Hua Lin
- Department of Hematology, Zhongshan City People's Hospital, Zhongshan, China
| | - Jun Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qi-Fa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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27
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Kim M, Laramy JK, Gampa G, Parrish KE, Brundage R, Sarkaria JN, Elmquist WF. Brain Distributional Kinetics of a Novel MDM2 Inhibitor SAR405838: Implications for Use in Brain Tumor Therapy. Drug Metab Dispos 2019; 47:1403-1414. [PMID: 31619389 DOI: 10.1124/dmd.119.088716] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/01/2019] [Indexed: 01/10/2023] Open
Abstract
Achieving an effective drug concentration in the brain is as important as targeting the right pathway when developing targeted agents for brain tumors. SAR405838 is a novel molecularly targeted agent that is in clinical trials for various solid tumors. Its application for tumors in the brain has not yet been examined, even though the target, the MDM2-p53 interaction, is attractive for tumors that could occur in the brain, including glioblastoma and brain metastases. In vitro and in vivo studies indicate that SAR405838 is a substrate of P-glycoprotein (P-gp). P-gp mediated active efflux at the blood-brain barrier plays a dominant role in limiting SAR405838 brain distribution. Even though the absence of P-gp significantly increases the drug exposure in the brain, the systemic exposure, including absorption and clearance processes, were unaffected by P-gp deletion. Model-based parameters of SAR405838 distribution across the blood-brain barrier indicate the CLout of the brain was approximately 40-fold greater than the CLin The free fraction of SAR405838 in plasma and brain were found to be low, and subsequent Kpuu values were less than unity, even in P-gp/Bcrp knockout mice. These results indicate additional efflux transporters other than P-gp and Bcrp may be limiting distribution of SAR405838 to the brain. Concomitant administration of elacridar significantly increased brain exposure, also without affecting the systemic exposure. This study characterized the brain distributional kinetics of SAR405838, a novel MDM2 inhibitor, to evaluate its potential in the treatment of primary and metastatic brain tumors. SIGNIFICANCE STATEMENT: This paper examined the brain distributional kinetics of a novel MDM2-p53 targeted agent, SAR405838, to see its possible application for brain tumors by using in vitro, in vivo, and in silico approaches. SAR405838 is found to be a substrate of P-glycoprotein (P-gp), which limits its distribution to the brain. Based on the findings in the paper, manipulation of the function of P-gp can significantly increase the brain exposure of SAR405838, which may give an insight on its potential benefit as a treatment for primary and metastatic brain cancer.
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Affiliation(s)
- Minjee Kim
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (M.K., J.K.L., G.G., K.E.P., W.F.E.); Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota (R.B.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Janice K Laramy
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (M.K., J.K.L., G.G., K.E.P., W.F.E.); Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota (R.B.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Gautham Gampa
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (M.K., J.K.L., G.G., K.E.P., W.F.E.); Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota (R.B.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Karen E Parrish
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (M.K., J.K.L., G.G., K.E.P., W.F.E.); Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota (R.B.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Richard Brundage
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (M.K., J.K.L., G.G., K.E.P., W.F.E.); Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota (R.B.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Jann N Sarkaria
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (M.K., J.K.L., G.G., K.E.P., W.F.E.); Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota (R.B.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - William F Elmquist
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (M.K., J.K.L., G.G., K.E.P., W.F.E.); Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota (R.B.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
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28
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陈 晨, 许 娜, 江 雪, 吴 婉, 周 璇, 刘 靓, 黄 继, 阴 常, 曹 睿, 廖 立, 徐 丹, 张 宇, 刘 启, 刘 晓. [Clinical characteristics of chronic myeloid leukemia with T315I mutation and the efficacy of ponatinib]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:364-368. [PMID: 31068313 PMCID: PMC6765683 DOI: 10.12122/j.issn.1673-4254.2019.03.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the clinical features of chronic myeloid leukemia (CML) with T315 I mutation (CML-T315I) and compare the effectiveness of different treatments. METHODS We retrospectively analyzed the clinical data and outcomes of 19 patients with CML-T315I receiving different treatments. The T315 I mutations in these patients were detected by examination of BCR-ABL kinase domain (KD) mutation by RTQ-PCR and Sanger sequencing. The relapse following the treatments, defined as hematological, cytogenetic and molecular biological recurrences, were analyzed in these patients. RESULTS Of the 19 patients with CML-T315I, 14 (73.7%) were in CML-CP stage at the initial diagnosis, and 13 (81.2%) were high-risk patients based on the Sokal scores. All the 19 patients were treated with TKI after the initial diagnosis, and during the treatment, 15 (78.9%) patients were found to have additional chromosomal aberrations, and 10 (52.6%) had multiple mutations; 13 (68.4%) of the patients experienced disease progression (accelerated phase/blast crisis) before the detection of T315I mutation, with a median time of 40 months (5-120 months) from the initial diagnosis to the mutation detection. After detection of the mutation, 12 patients were treated with ponatinib and 7 were managed with the conventional chemotherapy regimen, and their overall survival rates at 3 years were 83.3% and 14.2%, respectively (P < 0.001). CONCLUSIONS CML patients resistant to TKI are more likely to have T315I mutations, whose detection rate is significantly higher in the progressive phase than in the chronic phase. These patients often have additional chromosomal aberrations and multiple gene mutations with poor prognoses and a high recurrence rate even after hematopoietic stem cell transplantation. Long-term maintenance therapy with ponatinib may improve the prognosis and prolong the survival time of the patients.
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Affiliation(s)
- 晨 陈
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 娜 许
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 雪杰 江
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 婉儿 吴
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 璇 周
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 靓 刘
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 继贤 黄
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 常欣 阴
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 睿 曹
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 立斌 廖
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 丹 徐
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 宇明 张
- 广东医科大学附属医院血液科,广东 湛江 524000Department of Hematology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - 启发 刘
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 晓力 刘
- 南方医科大学南方医院血液科,广东 广州 510515Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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