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Mujahid K, Rana I, Suliman IH, Li Z, Wu J, He H, Nam J. Biomaterial-Based Sustained-Release Drug Formulations for Localized Cancer Immunotherapy. ACS APPLIED BIO MATERIALS 2023. [PMID: 38050811 DOI: 10.1021/acsabm.3c00808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Cancer immunotherapy has revolutionized clinical cancer treatments by taking advantage of the immune system to selectively and effectively target and kill cancer cells. However, clinical cancer immunotherapy treatments often have limited efficacy and/or present severe adverse effects associated primarily with their systemic administration. Localized immunotherapy has emerged to overcome these limitations by directly targeting accessible tumors via local administration, reducing potential systemic drug distribution that hampers drug efficacy and safety. Sustained-release formulations can prolong drug activity at target sites, which maximizes the benefits of localized immunotherapy to increase the therapeutic window using smaller dosages than those used for systemic injection, avoiding complications of frequent dosing. The performance of sustained-release formulations for localized cancer immunotherapy has been validated preclinically using various implantable and injectable scaffold platforms. This review introduces the sustained-release formulations developed for localized cancer immunotherapy and highlights their biomaterial-based platforms for representative classes, including inorganic scaffolds, natural hydrogels, synthetic hydrogels, and microneedle patches. The design rationale and other considerations are summarized for further development of biomaterials for the construction of optimal sustained-release formulations.
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Affiliation(s)
- Khizra Mujahid
- College of Pharmacy, Chonnam National University, Gwangju 61186, South Korea
| | - Isra Rana
- College of Pharmacy, Chonnam National University, Gwangju 61186, South Korea
| | | | - Zhen Li
- College of Pharmacy, Chonnam National University, Gwangju 61186, South Korea
| | - Jiang Wu
- School of Pharmaceutical Sciences, Key Laboratory of Biotechnology and Pharmaceutical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China
| | - Huacheng He
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, Zhejiang 325000, P. R. China
| | - Jutaek Nam
- College of Pharmacy, Chonnam National University, Gwangju 61186, South Korea
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Atta H, Alzahaby N, Hamdy NM, Emam SH, Sonousi A, Ziko L. New trends in synthetic drugs and natural products targeting 20S proteasomes in cancers. Bioorg Chem 2023; 133:106427. [PMID: 36841046 DOI: 10.1016/j.bioorg.2023.106427] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/15/2023] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Abstract
Cancer is a global health challenge that remains to be a field of extensive research aiming to find new anticancer therapeutics. The 20S proteasome complex is one of the targets of anticancerdrugs, as it is correlated with several cancer types. Herein, we aim to discuss the 20S proteasome subunits and investigatethe currently studied proteasome inhibitors targeting the catalytically active proteasome subunits. In this review, we summarize the proteindegradation mechanism of the 20S proteasome complex and compareit with the 26S proteasome complex. Afterwards, the localization of the 20S proteasome is summarized as well as its use as a diagnosticandprognostic marker. The FDA-approved proteasome inhibitors (PIs) under clinical trials are summarized and their current limited use in solid tumors is also reviewed in addition to the expression of theβ5 subunit in differentcell lines. The review discusses in-silico analysis of the active subunit of the 20S proteasome complex. For development of new proteasome inhibitor drugs, the natural products inhibiting the 20S proteasome are summarized, as well as novel methodologies and challenges for the natural product discovery and current information about the biosynthetic gene clusters encoding them. We herein briefly summarize some resistancemechanismsto the proteasomeinhibitors. Additionally, we focus on the three main classes of proteasome inhibitors: 1] boronic acid, 2] beta-lactone and 3] epoxide inhibitor classes, as well as other PI classes, and their IC50 values and their structure-activity relationship (SAR). Lastly,we summarize several future prospects of developing new proteasome inhibitors towards the treatment of tumors, especially solid tumors.
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Affiliation(s)
- Hind Atta
- School of Life and Medical Sciences, University of Hertfordshire Hosted By Global Academic Foundation, Egypt
| | - Nouran Alzahaby
- Biochemistry Department, Faculty of Pharmacy, Ain Shams University, Abassia 11566, Cairo, Egypt
| | - Nadia M Hamdy
- Biochemistry Department, Faculty of Pharmacy, Ain Shams University, Abassia 11566, Cairo, Egypt
| | - Soha H Emam
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Amr Sonousi
- School of Life and Medical Sciences, University of Hertfordshire Hosted By Global Academic Foundation, Egypt; Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Laila Ziko
- School of Life and Medical Sciences, University of Hertfordshire Hosted By Global Academic Foundation, Egypt; Biology Department, School of Sciences and Engineering, American University in Cairo, Egypt.
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Hu B, Zhou Q, Hu Y, Zhuang L, Yi L, Cao J, Li T, Wang J. Efficacy and Safety of Once‐Weekly versus Twice‐Weekly Bortezomib in Patients with Hematologic Malignancies: A Meta‐analysis with Trial Sequential Analysis. Pharmacotherapy 2019; 39:697-708. [PMID: 30985015 DOI: 10.1002/phar.2267] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Bin Hu
- Department of Hematology First People's Hospital of Changde City Changde Hunan China
| | - Quan Zhou
- Department of Science and Education First People's Hospital of Changde City Changde Hunan China
| | - Yang‐yang Hu
- Department of Rheumatology and Immunology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China
| | - Lan Zhuang
- Department of Hematology First People's Hospital of Changde City Changde Hunan China
| | - Li‐ping Yi
- Department of Hematology First People's Hospital of Changde City Changde Hunan China
| | - Jin‐xia Cao
- Department of Hematology First People's Hospital of Changde City Changde Hunan China
| | - Tian‐qi Li
- Department of Hematology First People's Hospital of Changde City Changde Hunan China
| | - Jun Wang
- Department of Hematology First People's Hospital of Changde City Changde Hunan China
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Romaguera JE, Wang M, Feng L, Fayad LE, Hagemeister F, McLaughlin P, Rodriguez MA, Fanale M, Orlowski R, Kwak LW, Neelapu S, Oki Y, Pro B, Younes A, Samaniego F, Fowler N, Hartig K, Valentinetti M, Smith J, Ford P, Naig A, Medeiros LJ, Kantarjian HM, Goy A. Phase 2 trial of bortezomib in combination with rituximab plus hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with bortezomib, rituximab, methotrexate, and cytarabine for untreated mantle cell lymphoma. Cancer 2018; 124:2561-2569. [DOI: 10.1002/cncr.31361] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Jorge E. Romaguera
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michael Wang
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Lei Feng
- Department of Biostatistics; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Luis E. Fayad
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Frederick Hagemeister
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Peter McLaughlin
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - M. Alma Rodriguez
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Michelle Fanale
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Robert Orlowski
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | | | - Sattva Neelapu
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Yasuhiro Oki
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Barbara Pro
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Anas Younes
- Lymphoma Service, Memorial Sloan Kettering Cancer Center; New York New York
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Nathan Fowler
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Kimberly Hartig
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Marisa Valentinetti
- Lymphoma Division; John Theurer Cancer Hackensack University Medical Center; Hackensack New Jersey
| | - Judy Smith
- Lymphoma Division; John Theurer Cancer Hackensack University Medical Center; Hackensack New Jersey
| | - Peggy Ford
- Lymphoma Division; John Theurer Cancer Hackensack University Medical Center; Hackensack New Jersey
| | - Adam Naig
- Department of Lymphoma and Myeloma; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - L. Jeffrey Medeiros
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Hagop M. Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Andre Goy
- Lymphoma Division; John Theurer Cancer Hackensack University Medical Center; Hackensack New Jersey
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Dreyling M, Aurer I, Cortelazzo S, Hermine O, Hess G, Jerkeman M, Le Gouill S, Ribrag V, Trněný M, Visco C, Walewski J, Zaja F, Zinzani PL. Treatment for patients with relapsed/refractory mantle cell lymphoma: European-based recommendations. Leuk Lymphoma 2017; 59:1814-1828. [DOI: 10.1080/10428194.2017.1403602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Martin Dreyling
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, LMU München, Germany
| | - Igor Aurer
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Olivier Hermine
- Department of Adult Haematology, Paris Descartes University, Paris, France
| | - Georg Hess
- University Medical School of the Johannes Gutenberg-University, Mainz, Germany
| | - Mats Jerkeman
- Department of Oncology, Lund University, Lund, Sweden
| | | | | | - Marek Trněný
- General Hospital, Charles University, Praha, Czech Republic
| | | | - Jan Walewski
- Maria Sklodowska-Curie Institute Oncology Centre, Warszawa, Poland
| | - Francesco Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari “Carlo Melzi,” University of Udine, Udine, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology “Seràgnoli,” University of Bologna, Bologna, Italy
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Yuan T, Zhang F, Yao QM, Liu YX, Zhu XJ, Wang X. Weekly versus biweekly bortezomib given in patients with indolent non-Hodgkin lymphoma: A meta-analysis. PLoS One 2017; 12:e0177950. [PMID: 28531181 PMCID: PMC5439710 DOI: 10.1371/journal.pone.0177950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/05/2017] [Indexed: 01/11/2023] Open
Abstract
Background Bortezomib is recently studied as a novel agent in indolent lymphoma. The optimal schedule of bortezomib used in indolent lymphoma is still uncertain. Methods We did a systematic review and meta-analysis of the clinical trials comparing the efficacy and toxicity of the weekly and biweekly schedules of bortezomib in patients with indolent lymphoma. We searched Pubmed, Cochrane Library and Emabase from inception to July 29, 2016. The primary outcome was the overall response rate including the complete response rate and the partial response rate. The secondary outcomes were the proportions of patients in each group experiencing the adverse events including the neutropathy, fatigue, diarrhea, nausea and neutropenia. Findings After final screening, six trials were considered eligible for analysis. The results showed that the overall response rate of biweekly schedule was higher than that of weekly schedule in indolent lymphoma (OR 1.691;95%CI 1.02–2.80). Furthermore, there were no significant differences between the two schedules of bortezomib for the main adverse events. Interpretation The biweekly schedule of bortezomib was more effective than the weekly schedule in indolent lymphoma, with similar proportion of toxicities.
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Affiliation(s)
- Ting Yuan
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Feng Zhang
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Qing-min Yao
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Yan-xia Liu
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Xiao-juan Zhu
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, P.R. China
- * E-mail:
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Cencini E, Guerrini S, Mazzei MA, Chiappella A, Fabbri A. Impressive and durable response in a case of multiple relapsed mantle cell lymphoma treated with bortezomib and rituximab. J Chemother 2016; 28:435-40. [DOI: 10.1080/1120009x.2016.1181293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
| | - Susanna Guerrini
- Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Annalisa Chiappella
- Department of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
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Dreyling M, Ferrero S. The role of targeted treatment in mantle cell lymphoma: is transplant dead or alive? Haematologica 2016; 101:104-14. [PMID: 26830211 PMCID: PMC4938333 DOI: 10.3324/haematol.2014.119115] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/17/2015] [Indexed: 12/16/2022] Open
Abstract
Based on the profound biological insights of the last years into the molecular pathogenesis of mantle cell lymphoma and the clinical introduction of new targeted drugs, with high efficacy and a good safety profile, the therapeutic scenario for this tumor has been shown to be thoroughly favourable. No longer characterized by a uniformly dismal prognosis, mantle cell lymphoma has been revealed as a spectrum of different diseases, ranging from very indolent cases to highly aggressive and refractory ones. Thus, there is an urgent need to adapt therapy to accommodate the diverse presentations of the disease. High-dose chemotherapy, followed by autologous stem cell transplantation is the current standard of care for younger patients, generally providing high responses and long survival rates, but hampered by acute and long-term toxicity. In addition, some patients may be overtreated, while others could benefit from targeted approaches, based on the new, molecular-directed compounds. Such a personalized treatment based on the specific characteristics of individual patients may be guided by validated prognostic tools, such as the Mantle Cell Lymphoma International Prognostic Index and the Ki-67 Proliferative Index, as well as by early predictors of treatment response, like minimal residual disease analysis. Moreover, mutation screening of distinctive genomic alterations may provide new, predictive biomarkers, with an additional impact on clinical practice. Only after tailoring treatment according to the clinical and biological heterogeneity of the disease the role of transplantation and modern therapeutic options will be redefined in mantle cell lymphoma.
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Affiliation(s)
- Martin Dreyling
- Department of Medicine III, Hospital of the University LMU München, Germany
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Italy
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Abstract
INTRODUCTION Bortezomib , the first proteasome inhibitor (PI) to be evaluated in humans, is approved in the USA and Europe for the treatment of patients with multiple myeloma, and in the USA for patients with relapsed mantle cell lymphoma (MCL). AREAS COVERED This review examines the role of bortezomib in the therapy of non-Hodgkin's lymphoma (NHL). Bortezomib may be particularly effective against the NF-κB-dependent activated B-cell subtype of diffuse large B-cell lymphoma. The combination of bortezomib with rituximab and dexamethasone represents a standard approach for the treatment of Waldenström's macroglobulinemia, and that with bendamustine and rituximab has demonstrated excellent efficacy in follicular lymphoma. Combinations with other novel agents, such as inhibitors of cyclin-dependent kinases or histone deacetylases, also hold substantial promise in NHL. Unmet needs in NHL, competitor compounds, chemistry, pharmacokinetics, pharmacodynamics and safety and tolerability of bortezomib are also discussed. EXPERT OPINION The success of bortezomib in MCL has validated the proteasome as a therapeutic target in NHL. Rational combinations, for example, with Bruton's tyrosine kinase inhibitors or BH3-mimetics, may hold the key to optimizing the therapeutic potential of PIs in NHL. Future trials are likely to involve newer agents with improved pharmacodynamic (e.g., carfilzomib, marizomib) or pharmacokinetic (e.g., ixazomib, oprozomib) properties.
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Affiliation(s)
- Prithviraj Bose
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
- Virginia Commonwealth University, Department of Internal Medicine, Richmond, VA, USA
| | - Michael S. Batalo
- Virginia Commonwealth University, Department of Internal Medicine, Richmond, VA, USA
| | - Beata Holkova
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
- Virginia Commonwealth University, Department of Internal Medicine, Richmond, VA, USA
| | - Steven Grant
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
- Virginia Commonwealth University, Department of Internal Medicine, Richmond, VA, USA
- Virginia Commonwealth University, Department of Microbiology and Immunology, Richmond, VA, USA
- Virginia Commonwealth University, Department of Biochemistry and Molecular Biology, Richmond, VA, USA
- Virginia Commonwealth University, Department of Human and Molecular Genetics, Richmond, VA, USA
- Virginia Commonwealth University, Institute for Molecular Medicine, 401 College Street, P.O. Box 980035, Richmond, VA 23298, USA Tel: +1 804 828 5211
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Badawi HM, Förner W, Ali SA. A comparative study of the conformational equilibria, vibrational, (1)H and (13)C NMR spectra of isobutyranilide and its derivative the anticancer drug flutamide. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2014; 131:249-260. [PMID: 24835733 DOI: 10.1016/j.saa.2014.03.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 03/26/2014] [Accepted: 03/29/2014] [Indexed: 06/03/2023]
Abstract
The molecular structure of isobutyranilide and flutamide were investigated by DFT-B3LYP/6-311G(**) and MP2/6-311G(**) calculations. Isobutyranilide was predicted to exist predominantly in a planar cis conformation, while flutamide in non-planar structures with the CF3 and the NO2 groups adopting an out of the phenyl-plane configuration. The vibrational frequencies of the low energy structures of the two molecules were computed at the DFT-B3LYP level of theory. From the calculated Gibb's free energies, isobutyranilide is estimated to have an equilibrium mixture of 91% cis and 9% trans structures, while flutamide is calculated to have a mixture of 65% cis-cis and 28% trans-cis structures at 298.15K. The analysis of the observed vibrational spectra supports the presence of isobutyranilide in only one conformation at room temperature. From a 1:1 acetonitrile solvent experiment flutamide is determined to exist in more than one conformation at ambient temperature. Complete vibrational assignments of the normal modes of isobutyranilide and flutamide were provided on the basis of combined normal coordinate calculations and experimental Infrared and Raman spectra. The (1)H and (13)C NMR spectra of isobutyranilide were measured and their chemical shifts were compared to the corresponding ones of flutamide.
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Affiliation(s)
- Hassan M Badawi
- Department of Chemistry, King Fahd University of Petroleum & Minerals (KFUPM), Dhahran 31261, Saudi Arabia.
| | - Wolfgang Förner
- Department of Chemistry, King Fahd University of Petroleum & Minerals (KFUPM), Dhahran 31261, Saudi Arabia
| | - Shaikh A Ali
- Department of Chemistry, King Fahd University of Petroleum & Minerals (KFUPM), Dhahran 31261, Saudi Arabia
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Furtado M, Johnson R, Kruger A, Turner D, Rule S. Addition of bortezomib to standard dose chop chemotherapy improves response and survival in relapsed mantle cell lymphoma. Br J Haematol 2014; 168:55-62. [PMID: 25146720 DOI: 10.1111/bjh.13101] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/26/2014] [Indexed: 11/28/2022]
Abstract
The proteasome inhibitor, bortezomib, potentially increases cell sensitivity to chemotherapy. This study was performed to determine the overall response rate (ORR), overall survival (OS), progression-free survival (PFS) and toxicity of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) compared to CHOP + bortezomib chemotherapy in mantle cell lymphoma (MCL) patients at first relapse. Forty-six patients were randomly assigned to standard dose CHOP ± bortezomib 1·6 mg/m(2) given on a 21-d cycle for up to eight cycles of treatment. Median age was 71 years (CHOP arm) and 69 years (CHOP-bortezomib arm). Median Eastern Cooperative Oncology Group performance status was 1 (CHOP) and 0 (CHOP-bortezomib) with 65% and 52%, respectively, having a disease stage of IV. ORR was 47·8% (CHOP) and 82·6% (CHOP-bortezomib). Complete response rate was 21·7% (CHOP) vs. 34·8% (CHOP-bortezomib); partial response rate was 26·1% (CHOP) vs. 47·8% (CHOP-bortezomib). Median OS was 11·8 months (CHOP) and 35·6 months (CHOP-bortezomib) (P = 0·01, Hazard ratio [HR] 0·37 [95% confidence interval (CI) 0·16-0·83)] and there was a non-significant improvement in PFS: 8·1 months (CHOP) and 16·5 months (CHOP-bortezomib) [P = 0·12, HR 0·60 (95% CI 0·31-1·15)]. Severe (≥grade 3) sensory neuropathy was similar in both arms (4·3% CHOP vs. 6·5% CHOP-bortezomib). We conclude that the addition of bortezomib to CHOP chemotherapy for relapsed MCL significantly improves outcome with a manageable increase in toxicity.
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Craig M, Hanna WT, Cabanillas F, Chen CS, Esseltine DL, Neuwirth R, O'Connor OA. Phase II study of bortezomib in combination with rituximab, cyclophosphamide and prednisone with or without doxorubicin followed by rituximab maintenance in patients with relapsed or refractory follicular lymphoma. Br J Haematol 2014; 166:920-8. [DOI: 10.1111/bjh.12991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/17/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Craig
- Mary Babb Randolph Cancer Center; West Virginia University Robert C Byrd Health Science Center; Morgantown WV USA
| | - Wahid T. Hanna
- University of Tennessee Cancer Institute; Knoxville TN USA
| | | | - Chien-Shing Chen
- Division of Hematology/Oncology; Loma Linda University School of Medicine; Loma Linda CA USA
| | | | | | - Owen A. O'Connor
- Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
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13
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How to manage mantle cell lymphoma. Leukemia 2014; 28:2117-30. [DOI: 10.1038/leu.2014.171] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/28/2014] [Accepted: 05/19/2014] [Indexed: 12/30/2022]
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Podar K. Efficacy of Subcutaneous Bortezomib in the Management of Patients with Multiple Myeloma or Relapsed Mantle Cell Lymphoma. ACTA ACUST UNITED AC 2014. [DOI: 10.4137/cmt.s9308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The identification of the ubiquitin–proteasome system as a new therapeutic target has been one of the most recent successes in cancer treatment. The development and clinical approval of the first-in-class proteasome inhibitor, bortezomib has revolutionized the treatment of multiple myeloma (MM) and mantle cell lymphoma (MCL). In MM, bortezomib is now integrated in induction, conditioning, consolidation, maintenance, and salvage treatment protocols. Bortezomib-based regimens provide high remission rates and confer significant survival advantage compared to conventional chemotherapy in both the bone marrow transplant and non-transplant setting. In MCL, overall response rates in patients who have received at least one prior therapy range from 30 to 45%, even in chemotherapy resistant patients. Clinical trials to further improve the sequencing of bortezomib-containing combination therapies are ongoing. Until recently, intravenous injection was the standard route of bortezomib administration. However, severe adverse side effects, peripheral neuropathy in particular, were observed in up to 16% of MM patients and up to 54% of MCL patients treated with intravenous bortezomib, with grade 3 and 4 in 11 and 12% of patients, respectively. Moreover, complete remission rates, if at all, are low and duration of response is short both in MM and MCL. These limitations may be overcome by changing the method of bortezomib administration as well as by rationally combining bortezomib with other therapeutic agents. Indeed, recent data demonstrate that subcutaneous bortezomib administration is non-inferior to intravenous administration, with an improved systemic safety profile, good local tolerance, and a more convenient route of administration. Based on these data, subcutaneous bortezomib injection was approved as a supplemental new drug application for all approved indications in MM and MCL after at least one prior therapy. More than 30 clinical trials in MM and MCL are currently ongoing to evaluate the efficacy and safety profile of subcutaneous bortezomib also in induction, maintenance, and salvage therapy.
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Affiliation(s)
- Klaus Podar
- Medical Oncology, National Center for Tumor Diseases (NCT), University of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Goy A. Mantle cell lymphoma: continuously improving the odds! Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.854700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kadoch C, Li J, Wong VS, Chen L, Cha S, Munster P, Lowell CA, Shuman MA, Rubenstein JL. Complement activation and intraventricular rituximab distribution in recurrent central nervous system lymphoma. Clin Cancer Res 2013; 20:1029-41. [PMID: 24190981 DOI: 10.1158/1078-0432.ccr-13-0474] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To elucidate the mechanistic basis for efficacy of intrathecal rituximab. We evaluated complement activation as well as the pharmacokinetics of intraventricular rituximab in patients who participated in two phase 1 multicenter studies. EXPERIMENTAL DESIGN We evaluated complement activation as a candidate mediator of rituximab within the central nervous system (CNS). Complement C3 and C5b-9 were quantified by ELISA in serial cerebrospinal fluid (CSF) specimens after intraventricular rituximab administration. We determined rituximab concentration profiles in CSF and serum. A population three- compartment pharmacokinetic model was built to describe the disposition of rituximab following intraventricular administration. The model was derived from results of the first trial and validated with results of the second trial. RESULTS Complement C3 and C5b-9 were reproducibly activated in CSF after intraventricular rituximab. Ectopic expression of C3 mRNA and protein within CNS lymphoma lesions was localized to myeloid cells. Constitutive high C3 activation at baseline was associated with adverse prognosis. A pharmacokinetic model was built, which contains three distinct compartments, to describe the distribution of rituximab within the neuroaxis after intraventricular administration. CONCLUSIONS We provide the first evidence of C3 activation within the neuroaxis with intraventricular immunotherapy and suggest that complement may contribute to immunotherapeutic responses of rituximab in CNS lymphoma. Penetration of rituximab into neural tissue is supported by this pharmacokinetic model and may contribute to efficacy. These findings have general implications for intraventricular immunotherapy. Our data highlight potential innovations to improve efficacy of intraventricular immunotherapy both via modulation of the innate immune response as well as innovations in drug delivery.
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Affiliation(s)
- Cigall Kadoch
- Authors' Affiliations: Division of Hematology/Oncology, Genentech, South San Francisco; Helen Diller Comprehensive Cancer Center; and Department of Radiology, Laboratory Medicine, University of California, San Francisco, San Francisco, California
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Abstract
Indolent lymphoma comprises a unique and challenging subset of non-Hodgkin lymphoma (NHL). While definitions of indolence will vary, the most common indolent NHL subtypes include follicular lymphoma, marginal zone lymphoma, and small lymphocytic lymphoma. Patients with indolent NHL (iNHL) excluding those with rare localized presentations are often met with an incurable but highly treatable NHL. In the rituximab era, response rates are approaching 90% with rituximab plus chemotherapy and time to next treatment are beginning to be measured in years. As a result of a prolonged natural history, we are encountering a gridlock of novel regimens and agents that appropriately fill peer-reviewed journals. In this review, we tackle a spectrum of topics in the management of indolent lymphoma including the initial approach to the newly diagnosed patient, approaches to first cytotoxic chemotherapy, maintenance and consolidation techniques, as well as highlight promising treatments on the horizon in iNHL. Clinicians continue to face tough choices in the management of iNHL. Through well-thought out clinical trials and peer-reviewed vetting of data we will continue to determine how to best manage the clinical continuum that is iNHL.
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Affiliation(s)
- Matthew Lunning
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, Phone: 212-639-3127, Fax: 646-422-2164
| | - Julie M. Vose
- Internal Medicine, University of Nebraska Medical Center, 987680 NE Med Center, Omaha, NE, 68198 Phone: 402-559-3848, Fax: 402-559-6520
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Koprivnikar JL, Cheson BD. Bortezomib: a proteasome inhibitor with an evolving role in select subtypes of B-cell non-Hodgkin's lymphoma. Future Oncol 2012; 8:359-71. [PMID: 22515439 DOI: 10.2217/fon.12.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bortezomib is a novel proteasome inhibitor initially approved for use in multiple myeloma and currently under continued investigation as a treatment for numerous subtypes of non-Hodgkin's lymphoma. One postulated mechanism of action in non-Hodgkin's lymphoma is the ability of bortezomib to ameliorate molecular dysregulation in NF-κB activation and regain cell cycle control. Results of clinical trials have varied widely based on lymphoma subtype. While response to bortezomib has been dismal in chronic lymphocytic leukemia and small lymphocytic lymphoma, reasonable responses have been attained in mantle cell lymphoma leading to its US FDA approval as a second-line agent for the treatment of mantle cell lymphoma in 2006. Bortezomib in combination with R-CHOP has also been suggested to improve response in certain molecular subgroups of diffuse large B-cell lymphoma. The role of bortezomib in follicular and marginal zone lymphomas remains less clear.
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Peron M, Bonvini P, Rosolen A. Effect of inhibition of the ubiquitin-proteasome system and Hsp90 on growth and survival of rhabdomyosarcoma cells in vitro. BMC Cancer 2012; 12:233. [PMID: 22691173 PMCID: PMC3480867 DOI: 10.1186/1471-2407-12-233] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 05/21/2012] [Indexed: 01/04/2023] Open
Abstract
Background The ubiquitin-proteasome system (UPS) and the heat shock response (HSR) are two critical regulators of cell homeostasis, as their inhibition affects growth and survival of normal cells, as well as stress response and invasiveness of cancer cells. We evaluated the effects of the proteasome inhibitor Bortezomib and of 17-DMAG, a competitive inhibitor of Hsp90, in rhabdomyosarcoma (RMS) cells, and analyzed the efficacy of single-agent exposures with combination treatments. Methods To assess cytotoxicity induced by Bortezomib and 17-DMAG in RMS cells, viability was measured by MTT assay after 24, 48 and 72 hours. Western blotting and immunofluorescence analyses were carried out to elucidate the mechanisms of action. Apoptosis was measured by FACS with Annexin-V-FITC and Propidium Iodide. Results Bortezomib and 17-DMAG, when combined at single low-toxic concentrations, enhanced growth inhibition of RMS cells, with signs of autophagy that included intensive cytoplasmic vacuolization and conversion of cytosolic LC3-I protein to its autophagosome-associated form. Treatment with lysosomal inhibitor chloroquine facilitates apoptosis, whereas stimulation of autophagy by rapamycin prevents LC3-I conversion and cell death, suggesting that autophagy is a resistance mechanism in RMS cells exposed to proteotoxic drugs. However, combination treatment also causes caspase-dependent apoptosis, PARP cleavage and Annexin V staining, as simultaneous inhibition of both UPS and HSR systems limits cytoprotective autophagy, exacerbating stress resulting from accumulation of misfolded proteins. Conclusion The combination of proteasome inhibitor Bortezomib with Hsp90 inhibitor 17-DMAG, appears to have important therapeutic advantages in the treatment of RMS cells compared with single-agent exposure, because compensatory survival mechanisms that occur as side effects of treatment may be prevented.
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Affiliation(s)
- Marica Peron
- Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera-Università di Padova, Via Giustiniani 3, Padova 35128, Italy
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Bortezomib (Velcade), rituximab, cyclophosphamide, and dexamethasone combination regimen is active as front-line therapy of low-grade non-Hodgkin lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 12:26-31. [PMID: 21752745 DOI: 10.1016/j.clml.2011.05.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 05/10/2011] [Accepted: 05/13/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and toxicity of the combination of VRCD (velcade/rituximab/cyclophosphamide/dexamethasone) in chemotherapy-naïve low-grade non-Hodgkin lymphoma or patients with transplantation-ineligible mantle cells. METHODS The patients were treated with velcade, at 1.6 mg/m(2), on days 1, 8, 15, and 22 on every 35-day cycle. Rituximab was given at 375 mg/m(2) on the same days as velcade during cycle 1 and then only on day 1 in subsequent cycles. Dexamethasone was given orally at 40 mg on days 1, 2, 8, 9, 15, 16, 22, and 23. Cyclophosphamide was administered orally at 400 mg/m(2) on days 1-4. The patients had to meet criteria to initiate therapy and had to demonstrate adequate performance status and organ function. RESULTS Twelve patients were enrolled, after which the study was closed due to a lack of funding. The median age was 68 years (37-83 years), with 83% having stage III/IV disease. Five patients had marginal zone, 4 had follicular, 2 had small lymphocytic, and 1 had mantle cell histologies. The overall response rate was 90% (complete response, 54%). At a median follow-up of 22 months, 9 (75%) patients remain alive, and the median time to progression has not been reached. A third of the patients required dose reductions after a median of 6.5 cycles. No grade 3 or 4 peripheral neuropathy was witnessed. CONCLUSIONS Although the number of studied patients is small, VRCD appears safe and active as front-line therapy for low-grade non-Hodgkin lymphoma. Further studies are justified.
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