1
|
Meraz-Munoz A, Mian H, Kirkwood D, Jeyakumar N, McCurdy A, Tangri N, Saskin R, Leung N, Wald R, Kitchlu A. Pomalidomide Use and Kidney Outcomes in Patients With Relapsed/Refractory Multiple Myeloma and Chronic Kidney Disease: A Real-World, Population-Based Cohort Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00265-9. [PMID: 39117532 DOI: 10.1016/j.clml.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Pomalidomide-based regimens are the cornerstone of treatment for relapsed/refractory MM (RRMM). Despite the high incidence of chronic kidney disease (CKD) in RRMM, individuals with advanced CKD have been excluded from phase II/III RCTs, creating a gap in our understanding of the effects of pomalidomide use in patients with RRMM complicated with advanced CKD. We undertook a cohort to study to understand the efficacy safety of pomalidomide-based regimens among patients with CKD using real-world data. METHODS Population-based, cohort study of patients ≥ 18 years with RRMM treated with pomalidomide in Ontario, Canada. Primary outcome was all-cause mortality. Secondary outcomes were time-to-major adverse kidney events (MAKE), time-to-next treatment, kidney response and safety. RESULTS Total 748 patients with RRMM utilizing pomalidomide were included; 440 had preserved kidney function, 210 had moderate CKD (eGFR 30-59 mL/min/1.73m2), and 98 had advanced CKD (eGFR < 30 mL/min/1.73m2). Mean age was 70.2 years, 43.3% were women. Patients with advanced CKD had a higher risk of all-cause mortality compared to the preserved kidney function group (aHR 1.37, 95% CI 1.06, 1.78). MAKE was higher in advanced CKD (aHR 1.70, 95% CI 1.03, 2.35). Kidney response was similar between moderate and severe CKD groups (aOR 1.04, 95%, CI 0.56-1.90). Safety outcomes were similar between groups. CONCLUSIONS Patients with advanced CKD and RRMM on pomalidomide-based regimens exhibited reduced survival and a higher risk for MAKE. However, the probability of experiencing some degree of kidney recovery is 50% in both moderate and severe CKD, with comparable safety outcomes.
Collapse
Affiliation(s)
- Alejandro Meraz-Munoz
- Department of Medicine, University of Manitoba, St. Boniface General Hospital, Winnipeg, MB, Canada.
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Navdeep Tangri
- Department of Medicine, University of Manitoba, Seven Oaks General Hospital, Winnipeg, Canada
| | | | - Nelson Leung
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Ron Wald
- Division of Nephrology, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, University of Toronto, University Health Network Toronto, ON, Canada
| |
Collapse
|
2
|
Huang YN, Greig NH, Huang PS, Chiang YH, Hoffer A, Yang CH, Tweedie D, Chen Y, Ou JC, Wang JY. Pomalidomide Improves Motor Behavioral Deficits and Protects Cerebral Cortex and Striatum Against Neurodegeneration Through a Reduction of Oxidative/Nitrosative Damages and Neuroinflammation After Traumatic Brain Injury. Cell Transplant 2024; 33:9636897241237049. [PMID: 38483119 PMCID: PMC10943757 DOI: 10.1177/09636897241237049] [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: 06/21/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 03/18/2024] Open
Abstract
Neuronal damage resulting from traumatic brain injury (TBI) causes disruption of neuronal projections and neurotransmission that contribute to behavioral deficits. Cellular generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) is an early event following TBI. ROS often damage DNA, lipids, proteins, and carbohydrates while RNS attack proteins. The products of lipid peroxidation 4-hydroxynonenal (4-HNE) and protein nitration 3-nitrotyrosine (3-NT) are often used as indicators of oxidative and nitrosative damages, respectively. Increasing evidence has shown that striatum is vulnerable to damage from TBI with a disturbed dopamine neurotransmission. TBI results in neurodegeneration, oxidative stress, neuroinflammation, neuronal apoptosis, and autophagy in the striatum and contribute to motor or behavioral deficits. Pomalidomide (Pom) is a Food and Drug Administration (FDA)-approved immunomodulatory drug clinically used in treating multiple myeloma. We previously showed that Pom reduces neuroinflammation and neuronal death induced by TBI in rat cerebral cortex. Here, we further compared the effects of Pom in cortex and striatum focusing on neurodegeneration, oxidative and nitrosative damages, as well as neuroinflammation following TBI. Sprague-Dawley rats subjected to a controlled cortical impact were used as the animal model of TBI. Systemic administration of Pom (0.5 mg/kg, intravenous [i.v.]) at 5 h post-injury alleviated motor behavioral deficits, contusion volume at 24 h after TBI. Pom alleviated TBI-induced neurodegeneration stained by Fluoro-Jade C in both cortex and striatum. Notably, Pom treatment reduces oxidative and nitrosative damages in cortex and striatum and is more efficacious in striatum (93% reduction in 4-HNE-positive and 84% reduction in 3-NT-positive neurons) than in cerebral cortex (42% reduction in 4-HNE-positive and 55% reduction in 3-NT-positive neurons). In addition, Pom attenuated microgliosis, astrogliosis, and elevations of proinflammatory cytokines in cortical and striatal tissue. We conclude that Pom may contribute to improved motor behavioral outcomes after TBI through targeting oxidative/nitrosative damages and neuroinflammation.
Collapse
Affiliation(s)
- Ya-Ni Huang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei
- Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan City
| | - Nigel H. Greig
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Pen-Sen Huang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei
- Neuroscience Research Center, Taipei Medical University, Taipei
| | - Alan Hoffer
- Department of Neurosurgery, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Chih-Hao Yang
- Department of Pharmacology, College of Medicine, Taipei Medical University, Taipei
| | - David Tweedie
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Ying Chen
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei
| | - Ju-Chi Ou
- Neuroscience Research Center, Taipei Medical University, Taipei
| | - Jia-Yi Wang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei
- Neuroscience Research Center, Taipei Medical University, Taipei
| |
Collapse
|
3
|
Mikulski D, Robak P, Mirocha G, Ryżewska W, Stańczak K, Okoński K, Kościelny K, Robak T. An elevated systemic inflammation index is related to an inferior response to pomalidomide and dexamethasone treatment in patients with relapsed and refractory multiple myeloma. Contemp Oncol (Pozn) 2023; 27:139-146. [PMID: 38239862 PMCID: PMC10793620 DOI: 10.5114/wo.2023.133506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/19/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction The systemic inflammation index (SII) might serve as an indicator of the equilibrium between the inflammatory and immune responses. The aim of the study was to determine the clinical value and prognostic significance of SII in the cohort of multiple myeloma (MM) patients treated with a regimen of pomalidomide and dexamethasone (Pd). Material and methods This retrospective, real-life study included patients who received a Pd regimen in our centre between November 2018 and July 2022. The systemic inflammation index was calculated from peripheral blood counts of platelets, neutrophils, and lymphocytes collected shortly before commencement of Pd treatment using the equation: SII = N × P/L, where N, P, and L are the respective counts per litre of peripheral blood for neutrophils, platelets, and lymphocytes. Results The study group consisted of 54 patients. Most patients received Pd as the third (38.9%) or fourth (37.0%) line of treatment. The median number of completed treatment cycles was 5 (IQR: 1-12). The median progression-free survival (PFS) was 6.8 months and overall survival (OS) 14.8 months. High SII (> 374) was an independent prognostic factor for PFS (HR = 3.0, 95% CI: 1.4-6.3, p < 0.01) and OS (HR = 2.2, 95% CI: 1.0-4.6, p = 0.04). In the low SII group, the respective median PFS and OS values were 9.6 and 21.7 months, compared to 2.6 (p = 0.018) and 5.5 months (p = 0.035) in the high SII group. Conclusions The systemic inflammation index has prognostic significance in MM patients treated with Pd. A high SII predicts a poorer outcome in pretreated MM patients undergoing Pd treatment evaluation. As such, it may well be a key factor for guiding subsequent treatment decisions.
Collapse
Affiliation(s)
- Damian Mikulski
- Department of Hematooncology, Copernicus Memorial Hospital, Comprehensive Cancer Centre and Traumatology, Łódź, Poland
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | - Paweł Robak
- Department of Hematooncology, Copernicus Memorial Hospital, Comprehensive Cancer Centre and Traumatology, Łódź, Poland
- Department of Hematology, Medical University of Łódź, Łódź, Poland
| | - Grzegorz Mirocha
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | | | - Kamila Stańczak
- Department of Hematology, Medical University of Łódź, Łódź, Poland
| | - Karol Okoński
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | - Kacper Kościelny
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | - Tadeusz Robak
- Department of Hematology, Medical University of Łódź, Łódź, Poland
- Department of General Hematology, Copernicus Memorial Hospital, Comprehensive Cancer Centre and Traumatology, Łódź, Poland
| |
Collapse
|
4
|
Wang X, Wang X, Zhao Y, Qi Z. LY103, a pomalidomide derivative, alleviates taxol resistance in NSCLC via energy metabolism crosstalk and tumor microenvironment intervention. Bioorg Chem 2023; 136:106558. [PMID: 37105001 DOI: 10.1016/j.bioorg.2023.106558] [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: 10/10/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
In this study, we identified HIF 1α as a potential target for reversing taxol resistance in lung cancer by combining bioinformatics analysis with pharmacological analysis. Furthermore, pomalidomide derivative LY103 was also be synthesized by introducing an isatin analogue into the amino terminal ofpomalidomide, and it has a broad antitumor spectrum and showed excellent activity against A549/Taxol cells (IC50 = 6.33 ± 0.51 μM). The results of molecular docking showed that not only LY103 was inclined to bind to HIF 1α stably, it could also form multiple hydrogen bonds with VAL376, ASP256, ILE454, and GLU455 of HIF 1α even was reduced to LY103-NH2 by nitroreductase, which was further stabilized the complex formed by them, thereby inhibiting the activity of HIF 1α. LY103 was able to significantly induce DNA damage and inhibit angiogenesis. Concurrently, LY103 activated the immune response, reduced the expression of cytokines TNF-α, IL-6, and IL-1β, thus might be inhibit the proliferation and metastasis of tumor cells. Pharmacological analysis proved that LY103 led to cell apoptosis through the mitochondrial pathway, and its combination with taxol significantly promoted this process. In general, the consumption of glutathione, the crosstalk of energy metabolism, and the improvement of the tumor microenvironment caused by LY103 eventually led to the decrease of ABCC1 protein expression and the drug resistance was reversed. The rational design of LY103 provided a basis for the application of nitro compounds in the treatment of hypoxic tumors and the reversal of taxol resistance.
Collapse
Affiliation(s)
- Xing Wang
- School of Chemistry and Chemical Engineering, Southeast University, Nanjing 211189, PR China
| | - Xiaohan Wang
- School of Chemistry and Chemical Engineering, Southeast University, Nanjing 211189, PR China
| | - Yongfei Zhao
- School of Chemistry and Chemical Engineering, Southeast University, Nanjing 211189, PR China
| | - Zhengjian Qi
- School of Chemistry and Chemical Engineering, Southeast University, Nanjing 211189, PR China.
| |
Collapse
|
5
|
[Expert consensus on the prevention and treatment of multiple myeloma related venous thromboembolism in China (2022)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:726-731. [PMID: 36709165 PMCID: PMC9613487 DOI: 10.3760/cma.j.issn.0253-2727.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 12/05/2022]
|
6
|
Afari J, Spektor TM, Turner C, Cohen A, Bessudo A, Jhangiani H, Gabrail N, Kubba S, Neidhart JD, Eshaghian S, Swift RA, Eades BM, Kim C, Kim S, Vescio R, Berenson JR. Efficacy and safety of replacing lenalidomide with pomalidomide for patients with multiple myeloma refractory to a lenalidomide-containing combination regimen. Exp Hematol 2022; 114:54-60. [DOI: 10.1016/j.exphem.2022.07.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/04/2022]
|
7
|
Fotiou D, Gavriatopoulou M, Terpos E, Dimopoulos MA. Pomalidomide- and dexamethasone-based regimens in the treatment of refractory/relapsed multiple myeloma. Ther Adv Hematol 2022; 13:20406207221090089. [PMID: 35585966 PMCID: PMC9109494 DOI: 10.1177/20406207221090089] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Pomalidomide is a potent immunomodulatory agent that is currently a standard of care backbone for the treatment of multiple myeloma (MM) patients in the relapsed/refractory setting after exposure to lenalidomide and a proteasome inhibitor. The present review addresses current knowledge regarding the clinical use of pomalidomide in relapsed myeloma patients. Pomalidomide has direct myeloma cell tumoricidal effects by activating proteasomal degradation of Ikaros and Aiolos transcription factors and also indirect effects by modulation of immune responses, interaction with bone marrow stromal cells, and inhibition of angiogenesis. It is approved by regulatory authorities as doublet combination with dexamethasone but four more triplets are also approved for this setting. Many ongoing trials are evaluating the pomalidomide-dexamethasone backbone with newer anti-myeloma class agents or in quadruplet combinations. Pomalidomide-dexamethasone is currently one of the powerful tools available for use in the relapsed/refractory MM setting. Insights into the synergistic immunomodulatory effects of pomalidomide and other anti-myeloma agents and the mechanisms that overcome clonal resistance will potentially allow targeted use of triplet combinations at each relapse.
Collapse
Affiliation(s)
- Despina Fotiou
- Department of Clinical Therapeutics, National
and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National
and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National
and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A. Dimopoulos
- Alexandra Hospital, Department of Clinical
Therapeutics, National and Kapodistrian University of Athens, Vas. Sofias 80
and Lourou 4, 11528, Athens, Greece
| |
Collapse
|
8
|
Mitsiades CS. Biological and Translational Considerations regarding the Recent Therapeutic Successes and Upcoming Challenges for Multiple Myeloma. Cold Spring Harb Perspect Med 2021; 11:a034900. [PMID: 32928892 PMCID: PMC8247558 DOI: 10.1101/cshperspect.a034900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Even though multiple myeloma (MM) is still considered incurable, the therapeutic management of this disease has undergone a major transformation over the last two decades, with several new classes of therapeutics and diverse options for their combined use in many different regimens that have contributed to major improvement in overall survival of patients. This review discusses key themes underlying the pharmacological and immune-based therapies that represent the cornerstones of this progress. A major part of the clinical progress achieved by these classes' therapeutics has depended on the targeting of molecular pathways with distinct or preferential roles for the biology of plasma cells-normal or malignant-and the ability of many of these agents to be incorporated into combination regimens that exhibit enhanced antimyeloma responses, without precipitating acceptable levels of toxicity. This review also discusses why these advances have not yet translated into curative outcomes and how these remaining barriers could be overcome.
Collapse
Affiliation(s)
- Constantine S Mitsiades
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
- Department of Medicine, Harvard Medical School, Broad Institute of MIT & Harvard, Boston, Massachusetts 02215, USA
| |
Collapse
|
9
|
HRI depletion cooperates with pharmacologic inducers to elevate fetal hemoglobin and reduce sickle cell formation. Blood Adv 2021; 4:4560-4572. [PMID: 32956454 DOI: 10.1182/bloodadvances.2020002475] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
Increasing fetal hemoglobin (HbF) provides clinical benefit in patients with sickle cell disease (SCD). We recently identified heme-regulated inhibitor (HRI, EIF2AK1), as a novel HbF regulator. Because HRI is an erythroid-specific protein kinase, it presents a potential target for pharmacologic intervention. We found that maximal HbF induction required >80% to 85% HRI depletion. Because it remains unclear whether this degree of HRI inhibition can be achieved pharmacologically, we explored whether HRI knockdown can be combined with pharmacologic HbF inducers to achieve greater HbF production and minimize potential adverse effects associated with treatments. Strongly cooperative HbF induction was observed when HRI depletion was combined with exposure to pomalidomide or the EHMT1/2 inhibitor UNC0638, but not to hydroxyurea. Mechanistically, reduction in the levels of the HbF repressor BCL11A reflected the cooperativity of HRI loss and pomalidomide treatment, whereas UNC0638 did not modulate BCL11A levels. In conjunction with HRI loss, pomalidomide maintained its HbF-inducing activity at 10-fold lower concentrations, in which condition there were minimal observed detrimental effects on erythroid cell maturation and viability, as well as fewer alterations in the erythroid transcriptome. When tested in cells from patients with SCD, combining HRI depletion with pomalidomide or UNC0638 achieved up to 50% to 60% HbF and 45% to 50% HbF, respectively, as measured by high-performance liquid chromatography, and markedly counteracted cell sickling. In summary, this study provides a foundation for the exploration of combining future small-molecule HRI inhibitors with additional pharmacologic HbF inducers to maximize HbF production and preserve erythroid cell functionality for the treatment of SCD and other hemoglobinopathies.
Collapse
|
10
|
Pomalidomide induced lupus type hypersensitivity reaction. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
van Nieuwenhuijzen N, Frunt R, May AM, Minnema MC. Therapeutic outcome of early-phase clinical trials in multiple myeloma: a meta-analysis. Blood Cancer J 2021; 11:44. [PMID: 33649328 PMCID: PMC7921415 DOI: 10.1038/s41408-021-00441-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 01/31/2023] Open
Abstract
Great progress in the treatment of patients with multiple myeloma (MM) has been made due to the development of novel drugs. Patients with relapsed/refractory MM (RRMM) can be enrolled in early-phase clinical trials, but their performance across the last decade is unknown. We conducted a meta-analysis on the overall response rate (ORR) and toxicity. PubMed, Embase, and Cochrane Library were systematically searched for phase I and phase II trials investigating an experimental compound as a single agent or in combination with dexamethasone, published from January 1, 2010 to July 1, 2020. Eighty-eight articles were included, describing 61 phase I trials involving 1835 patients and 37 phase II trials involving 2644 patients. There was a high degree of heterogeneity. Using a random-effects model, the 95% CIs of the estimated ORR were 8-17% for phase I trials and 18-28% for phase II trials. There were significant subgroup differences in ORR between the years of publication in phase I trials and between drug classes in both phase I and phase II trials. The ORR in early-phase clinical trials in RRMM is substantial, especially in phase II trials, but due to high heterogeneity a general assessment of clinical benefit before participation is difficult to offer to patients.
Collapse
Affiliation(s)
- Niels van Nieuwenhuijzen
- Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rowan Frunt
- Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| |
Collapse
|
12
|
Manasanch EE, Jain P, Chen W, Oriabure O, Badillo M, Feng L, Berkova Z, Orlowski RZ, Wang M. Phase I/II study of high dose pomalidomide with G-CSF support and dexamethasone in patients with relapsed/refractory multiple myeloma. Am J Hematol 2020; 95:E232-E235. [PMID: 32390148 DOI: 10.1002/ajh.25858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Elisabet E. Manasanch
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Preetesh Jain
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Wendy Chen
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Onyeka Oriabure
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Maria Badillo
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Lei Feng
- Department of Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Zuzana Berkova
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Robert Z. Orlowski
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
- Department of Experimental Therapeutics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Michael Wang
- Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
| |
Collapse
|
13
|
Ria R, Melaccio A, Racanelli V, Vacca A. Anti-VEGF Drugs in the Treatment of Multiple Myeloma Patients. J Clin Med 2020; 9:E1765. [PMID: 32517267 PMCID: PMC7355441 DOI: 10.3390/jcm9061765] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023] Open
Abstract
The interaction between the bone marrow microenvironment and plasma cells plays an essential role in multiple myeloma progression and drug resistance. The vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) pathway in vascular endothelial cells activates and promotes angiogenesis. Moreover, VEGF activates and promotes vasculogenesis and vasculogenic mimicry when it interacts with VEGF receptors expressed in precursor cells and inflammatory cells, respectively. In myeloma bone marrow, VEGF and VEGF receptor expression are upregulated and hyperactive in the stromal and tumor cells. It has been demonstrated that several antiangiogenic agents can effectively target VEGF-related pathways in the preclinical phase. However, they are not successful in treating multiple myeloma, probably due to the vicarious action of other cytokines and signaling pathways. Thus, the simultaneous blocking of multiple cytokine pathways, including the VEGF/VEGFR pathway, may represent a valid strategy to treat multiple myeloma. This review aims to summarize recent advances in understanding the role of the VEGF/VEGFR pathway in multiple myeloma, and mainly focuses on the transcription pathway and on strategies that target this pathway.
Collapse
Affiliation(s)
- Roberto Ria
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari “Aldo Moro” Medical School, 70124 Bari, Italy; (A.M.); (V.R.); (A.V.)
| | | | | | | |
Collapse
|
14
|
Immunomodulation with pomalidomide at early lymphocyte recovery after induction chemotherapy in newly diagnosed AML and high-risk MDS. Leukemia 2020; 34:1563-1576. [PMID: 31900407 DOI: 10.1038/s41375-019-0693-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/24/2019] [Accepted: 12/06/2019] [Indexed: 11/09/2022]
Abstract
An immunosuppressive microenvironment promoting leukemia cell immune escape plays an important role in the pathogenesis of AML. Through its interaction with cereblon, a substrate receptor for the E3 ubiquitin ligase complex, pomalidomide leads to selective ubiquitination of transcription factors Aiolos and Ikaros thereby promoting immune modulation. In this phase I trial, 51 newly diagnosed non-favorable risk AML and high-risk MDS patients were enrolled and treated with AcDVP16 (cytarabine 667 mg/m2/day IV continuous infusion days 1-3, daunorubicin 45 mg/m2 IV days 1-3, etoposide 400 mg/m2 IV days 8-10) induction therapy followed by dose- and duration-escalation pomalidomide beginning at early lymphocyte recovery. Forty-three patients (AML: n = 39, MDS: n = 4) received pomalidomide. The maximum tolerated dose of pomalidomide was 4 mg for 21 consecutive days. The overall complete remission (CR + CRi) rate, median overall survival, and disease-free survival were 75%, 27.1 and 20.6 months, respectively. Subset analyses revealed 86% CR/CRi rate in AML patients with unfavorable-risk karyotype treated with pomalidomide. Pomalidomide significantly decreased Aiolos expression in both CD4+ and CD8+ peripheral blood and bone marrow T cells, promoted T cell differentiation, proliferation, and heightened their cytokine production. Finally, pomalidomide induced distinct gene expression changes in immune function-related ontologies in CD4+ and CD8+ T cells.
Collapse
|
15
|
Eleutherakis-Papaiakovou E, Gavriatopoulou M, Ntanasis-Stathopoulos I, Kastritis E, Terpos E, Dimopoulos MA. Elotuzumab in combination with pomalidomide and dexamethasone for the treatment of multiple myeloma. Expert Rev Anticancer Ther 2019; 19:921-928. [DOI: 10.1080/14737140.2019.1685879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| |
Collapse
|
16
|
Oka S, Ono K, Nohgawa M. Successful treatment with pomalidomide and intrathecal injections for central nervous system plasmacytoma in a patient under haemodialysis. J Clin Pharm Ther 2019; 45:221-225. [PMID: 31602676 DOI: 10.1111/jcpt.13054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/13/2019] [Accepted: 08/23/2019] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES The involvement of the central nervous system (CNS) in multiple myeloma (MM) is uncommon and has an extremely poor prognosis, and optimal treatment strategies for the CNS MM patients have not yet been established. CASE SUMMARY A 71-year-old MM patient with severe renal impairment exhibited extramedullary relapse in the CNS and progression while being treated with lenalidomide and dexamethasone. However, she achieved very good partial remission after a treatment with pomalidomide, cyclophosphamide and dexamethasone (PCD) in combination with intrathecal chemotherapy. WHAT IS NEW AND CONCLUSION This is the first case report to describe MM with CNS involvement in a patient who had responded to PCD under haemodialysis. The combined intrathecal administration of cytotoxic agents and PCD may prolong survival and is tolerated well by patients with severe renal impairment.
Collapse
Affiliation(s)
- Satoko Oka
- Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Kazuo Ono
- Division of Pathology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Masaharu Nohgawa
- Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| |
Collapse
|
17
|
Jakubowiak AJ, Jasielec JK, Rosenbaum CA, Cole CE, Chari A, Mikhael J, Nam J, McIver A, Severson E, Stephens LA, Tinari K, Rosebeck S, Zimmerman TM, Hycner T, Turowski A, Karrison T, Zonder JA. Phase 1 study of selinexor plus carfilzomib and dexamethasone for the treatment of relapsed/refractory multiple myeloma. Br J Haematol 2019; 186:549-560. [PMID: 31124580 PMCID: PMC6772147 DOI: 10.1111/bjh.15969] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/22/2019] [Indexed: 02/06/2023]
Abstract
Selinexor, an oral Selective Inhibitor of Nuclear Export, targets Exportin 1 (XPO1, also termed CRM1). Non-clinical studies support combining selinexor with proteasome inhibitors (PIs) and corticosteroids to overcome resistance in relapsed/refractory multiple myeloma (RRMM). We conducted a phase I dose-escalation trial of twice-weekly selinexor in combination with carfilzomib and dexamethasone (SKd) to determine maximum tolerated dose in patients with RRMM (N = 21), with an expansion cohort to assess activity in carfilzomib-refractory disease and identify a recommended phase II dose (RP2D). During dose escalation, there was one dose-limiting toxicity (cardiac failure). The RP2D of twice-weekly SKd was selinexor 60 mg, carfilzomib 20/27 mg/m2 and dexamethasone 20 mg. The most common grade 3/4 treatment-emergent adverse events included thrombocytopenia (71%), anaemia (33%), lymphopenia (33%), neutropenia (33%) and infections (24%). Rates of ≥minimal response, ≥partial response and very good partial response were 71%, 48% and 14%, respectively; similar response outcomes were observed for dual-class refractory (PI and immunomodulatory drug)/quad-exposed (carfilzomib, bortezomib, lenalidomide and pomalidomide) patients (n = 17), and patients refractory to carfilzomib in last line of therapy (n = 13). Median progression-free survival was 3·7 months, and overall survival was 22·4 months in the overall population. SKd was tolerable and re-established disease control in RRMM patients, including carfilzomib-refractory patients. Registered at ClinicalTrials.gov (NCT02199665).
Collapse
Affiliation(s)
| | | | | | - Craig E. Cole
- Department of MedicineDivision of Hematology/OncologyUniversity of Michigan School of MedicineAnn ArborMIUSA
| | - Ajai Chari
- Tisch Cancer Institute/Multiple Myeloma ProgramMount Sinai School of MedicineNew YorkNYUSA
| | - Joseph Mikhael
- Mayo Clinic, Phoenix, AZ, and International Myeloma FoundationLos AngelesCAUSA
- Present address:
Translational Genomics Research InstituteCity of Hope Cancer CenterPhoenixAZUSA
| | - Jennifer Nam
- University of Chicago Medical CenterChicagoILUSA
| | | | | | | | | | | | | | - Tyler Hycner
- University of Chicago Medical CenterChicagoILUSA
| | | | | | - Jeffrey A. Zonder
- Barbara Ann Karmanos Cancer InstituteWayne State UniversityDetroitMIUSA
| |
Collapse
|
18
|
Lin HM, Davis KL, Kaye JA, Luptakova K, Nagar SP, Mohty M. Real-World Treatment Patterns, Outcomes, and Healthcare Resource Utilization in Relapsed or Refractory Multiple Myeloma: Evidence from a Medical Record Review in France. Adv Hematol 2019; 2019:4625787. [PMID: 30838045 PMCID: PMC6374830 DOI: 10.1155/2019/4625787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/16/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Limited data are available from real-world practices in Europe describing prevailing treatment patterns and outcomes in relapsed/refractory multiple myeloma (RRMM), particularly by cytogenetic risk. METHODS A retrospective medical record review was conducted in 200 RRMM patients in France. From first relapse, patients were assessed on second-/third-line treatments, progression-free survival (PFS), overall survival (OS), and healthcare utilization. RESULTS Fifty-five high risk and 113 standard risk patients were identified. Overall, 192 patients (96%) received second-line therapy after relapse. Lenalidomide-based regimens were most common (>50%) in second line. Hospitalization incidence in high risk patients was approximately twice that of standard risk patients. From Kaplan-Meier estimation, median (95% CI) second-line PFS was 21.4 (17.5, 25.0) months (by high versus standard risk: 10.6 [6.4, 17.0] versus 28.7 [22.1, 37.3] months). Among second-line recipients, 47.4% were deceased at data collection. Median second-line OS was 59.4 (38.8, NE) months (by high versus standard risk: 36.5 [17.4, 50.6] versus 73.6 [66.5, NE] months). CONCLUSIONS The prognostic importance of cytogenetic risk in RRMM was apparent, whereby high (versus standard) risk patients had decidedly shorter PFS and OS. Frequent hospitalizations indicated potentially high costs associated with RRMM, particularly for high risk patients. These findings may inform economic evaluations of RRMM therapies.
Collapse
Affiliation(s)
- Huamao Mark Lin
- Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA 02139, USA
| | - Keith L. Davis
- RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709, USA
| | - James A. Kaye
- RTI Health Solutions, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Katarina Luptakova
- Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA 02139, USA
| | - Saurabh P. Nagar
- RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709, USA
| | - Mohamad Mohty
- Department of Haematology, Hôpital Saint-Antoine, Sorbonne University, INSERM UMRs 938, EBMT Paris Study Office, CEREST-TC, Saint-Antoine Hospital, Paris, France
| |
Collapse
|
19
|
Fuchs O. Treatment of Lymphoid and Myeloid Malignancies by Immunomodulatory Drugs. Cardiovasc Hematol Disord Drug Targets 2019; 19:51-78. [PMID: 29788898 DOI: 10.2174/1871529x18666180522073855] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
Thalidomide and its derivatives (lenalidomide, pomalidomide, avadomide, iberdomide hydrochoride, CC-885 and CC-90009) form the family of immunomodulatory drugs (IMiDs). Lenalidomide (CC5013, Revlimid®) was approved by the US FDA and the EMA for the treatment of multiple myeloma (MM) patients, low or intermediate-1 risk transfusion-dependent myelodysplastic syndrome (MDS) with chromosome 5q deletion [del(5q)] and relapsed and/or refractory mantle cell lymphoma following bortezomib. Lenalidomide has also been studied in clinical trials and has shown promising activity in chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL). Lenalidomide has anti-inflammatory effects and inhibits angiogenesis. Pomalidomide (CC4047, Imnovid® [EU], Pomalyst® [USA]) was approved for advanced MM insensitive to bortezomib and lenalidomide. Other IMiDs are in phases 1 and 2 of clinical trials. Cereblon (CRBN) seems to have an important role in IMiDs action in both lymphoid and myeloid hematological malignancies. Cereblon acts as the substrate receptor of a cullin-4 really interesting new gene (RING) E3 ubiquitin ligase CRL4CRBN. This E3 ubiquitin ligase in the absence of lenalidomide ubiquitinates CRBN itself and the other components of CRL4CRBN complex. Presence of lenalidomide changes specificity of CRL4CRBN which ubiquitinates two transcription factors, IKZF1 (Ikaros) and IKZF3 (Aiolos), and casein kinase 1α (CK1α) and marks them for degradation in proteasomes. Both these transcription factors (IKZF1 and IKZF3) stimulate proliferation of MM cells and inhibit T cells. Low CRBN level was connected with insensitivity of MM cells to lenalidomide. Lenalidomide decreases expression of protein argonaute-2, which binds to cereblon. Argonaute-2 seems to be an important drug target against IMiDs resistance in MM cells. Lenalidomide decreases also basigin and monocarboxylate transporter 1 in MM cells. MM cells with low expression of Ikaros, Aiolos and basigin are more sensitive to lenalidomide treatment. The CK1α gene (CSNK1A1) is located on 5q32 in commonly deleted region (CDR) in del(5q) MDS. Inhibition of CK1α sensitizes del(5q) MDS cells to lenalidomide. CK1α mediates also survival of malignant plasma cells in MM. Though, inhibition of CK1α is a potential novel therapy not only in del(5q) MDS but also in MM. High level of full length CRBN mRNA in mononuclear cells of bone marrow and of peripheral blood seems to be necessary for successful therapy of del(5q) MDS with lenalidomide. While transfusion independence (TI) after lenalidomide treatment is more than 60% in MDS patients with del(5q), only 25% TI and substantially shorter duration of response with occurrence of neutropenia and thrombocytopenia were achieved in lower risk MDS patients with normal karyotype treated with lenalidomide. Shortage of the biomarkers for lenalidomide response in these MDS patients is the main problem up to now.
Collapse
Affiliation(s)
- Ota Fuchs
- Institute of Hematology and Blood Transfusion, U Nemocnice 1, 128 20 Prague 2, Czech Republic
| |
Collapse
|
20
|
Phase 1 study of pomalidomide and dexamethasone for relapsed/refractory primary CNS or vitreoretinal lymphoma. Blood 2018; 132:2240-2248. [PMID: 30262659 DOI: 10.1182/blood-2018-02-835496] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 09/19/2018] [Indexed: 12/22/2022] Open
Abstract
The combination of pomalidomide (POM) and dexamethasone (DEX) was evaluated for relapsed/refractory primary central nervous system lymphoma (PCNSL) and primary vitreoretinal lymphoma (PVRL) to determine the maximal tolerated dose (MTD) of POM as the primary objective, and overall response rate (ORR), progression-free survival (PFS), and safety profile as secondary objectives. A cohorts-of-3 study design was used with a dose-escalation schedule consisting of POM (3, 5, 7, or 10 mg) orally daily for 21 days every 28 days and DEX 40 mg orally every week. After 2 cycles, POM was continued alone until disease progression, intolerance, or subject withdrawal. Following MTD determination, the MTD cohort was expanded. Twenty-five of 29 patients with the median of 3 prior treatments were eligible for assessment as per international PCNSL collaborative group criteria. The MTD of POM was 5 mg daily for 21 days every 28 days. Whole-study ORR was 48% (12 of 25; 95% confidence interval [CI], 27.8%, 68.7%) with 6 complete response (CR), 2 complete response, unconfirmed (CRu), and 4 partial response (PR). MTD cohort ORR was 50% (8 of 16; 95% CI, 24.7%, 75.4%) with 5 CR, 1 CRu, and 2 PR. Median PFS was 5.3 months (whole study) and 9 months (for responders). One patient had pseudoprogression. Grade 3/4 hematologic toxicities included neutropenia (21%), anemia (8%), and thrombocytopenia (8%). Grade 3/4 nonhematologic toxicities included lung infection (12%), sepsis (4%), fatigue (8%), syncope (4%), dyspnea (4%), hypoxia (4%), respiratory failure (8%), and rash (4%). POM/DEX treatment is feasible with significant therapeutic activity against relapsed/refractory PCNSL and PVRL. This trial was registered at www.clinicaltrials.gov as #NCT01722305.
Collapse
|
21
|
Vo MC, Yang S, Jung SH, Chu TH, Lee HJ, Lakshmi TJ, Park HS, Kim HJ, Lee JJ. Synergistic Antimyeloma Activity of Dendritic Cells and Pomalidomide in a Murine Myeloma Model. Front Immunol 2018; 9:1798. [PMID: 30123221 PMCID: PMC6085413 DOI: 10.3389/fimmu.2018.01798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/20/2018] [Indexed: 01/14/2023] Open
Abstract
We have previously shown that immunization with tumor antigen-loaded dendritic cells (DCs) and the immunomodulating drug, lenalidomide, synergistically potentiates the enhancing antitumor immunity in a myeloma mouse model. In this study, we investigated the immunogenicity of DCs combined with pomalidomide and dexamethasone in a myeloma mouse model. MOPC-315 cells were injected subcutaneously to establish myeloma-bearing mice. Four test groups were used to mimic clinical protocol: (1) PBS control, (2) DCs, (3) pomalidomide + dexamethasone, and (4) DCs + pomalidomide + dexamethasone. The combination of DCs plus pomalidomide and dexamethasone displayed greater inhibition of tumor growth compared to the other groups. This effect was closely related with reduced numbers of immune suppressor cells including myeloid-derived suppressor cells, M2 macrophages, and regulatory T cells, with the induction of immune effector cells such as CD4+ and CD8+ T cells, memory T cells, natural killer (NK) cells, and M1 macrophages, and with the activation of T lymphocytes and NK cells in the spleen. Moreover, the level of the immunosuppressive factor vascular endothelial growth factor was significantly reduced in the tumor microenvironment. The collective findings in the murine myeloma model suggest that tumor antigen-loaded DCs combined with pomalidomide and dexamethasone synergistically enhance antitumor immunity by skewing the immune-suppressive status toward an immune-supportive status.
Collapse
Affiliation(s)
- Manh-Cuong Vo
- Research Center for Cancer Immunotherapy, Chonnam National University Hwasun Hospital, Hwasun, South Korea.,Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Seoyun Yang
- Research Center for Cancer Immunotherapy, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Sung-Hoon Jung
- Research Center for Cancer Immunotherapy, Chonnam National University Hwasun Hospital, Hwasun, South Korea.,Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Tan-Huy Chu
- Research Center for Cancer Immunotherapy, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Hyun-Ju Lee
- Vaxcell-Bio Therapeutics, Hwasun, South Korea
| | - Thangaraj Jaya Lakshmi
- Research Center for Cancer Immunotherapy, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Hye-Seong Park
- Research Center for Cancer Immunotherapy, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Je-Jung Lee
- Research Center for Cancer Immunotherapy, Chonnam National University Hwasun Hospital, Hwasun, South Korea.,Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, South Korea.,Vaxcell-Bio Therapeutics, Hwasun, South Korea
| |
Collapse
|
22
|
Reed-Guy L, Hoteit MA, Garfall AL. Acute Liver Failure Associated With Pomalidomide Therapy for Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e337-e338. [DOI: 10.1016/j.clml.2018.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/23/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022]
|
23
|
Bladé J, Rosiñol L, Cibeira MT, Fernández de Larrea C. Treatment of Relapsed Myeloma in a Patient With Renal Insufficiency. J Clin Oncol 2018; 36:2012-2016. [PMID: 29851545 DOI: 10.1200/jco.2017.77.6419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 45-year-old man was diagnosed in March 2010 with stage III immunoglobulin G kappa multiple myeloma (MM) after presenting with bone pain as a result of multiple lytic bone lesions and T12 vertebral collapse. Laboratory work-up showed a serum M protein of 72 g/L and a 24-hour kappa light-chain urine protein excretion of 730 mg, hemoglobin of 10.2 g/dL, serum albumin of 49 g/L, serum β2-microglobulin of 6.4 mg/L, serum creatinine level of 1.6 mg/dL with an estimated glomerular filtration rate (eGFR) of 47 mL/min/1.73 m2, and normal serum calcium and lactate dehydrogenase (LDH) levels. His bone marrow contained 58% plasma cells, which showed the 17p deletion abnormality (Fig 1). He was treated with vertebroplasty and alternating chemotherapy with carmustine, vincristine, cyclophosphamide, melphalan, and prednisone and vincristine, carmustine, doxorubicin and dexamethasone. Because of progressive disease, salvage therapy with bortezomib and dexamethasone was administered with no response. The patient was then switched to lenalidomide and dexamethasone, which yielded minimal response. He underwent autologous stem-cell transplantation (ASCT) with melphalan 200 mg/m2 as high-dose therapy in February 2011, which led to a partial response, but in December 2011, progressive disease was documented, and the patient was enrolled in a clinical trial of carfilzomib monotherapy, with stable disease for 33 cycles. In October 2014 serum M protein rose to 38.6 g/L, with 24-hour kappa light-chain urine protein excretion of 840 mg, serum creatinine of 2.1 mg/dL, and an eGFR of 41 mL/min/1.73 m2. He presented to discuss ongoing treatment options.
Collapse
Affiliation(s)
- Joan Bladé
- Joan Bladé, Laura Rosiñol, María Teresa Cibeira, and Carlos Fernández de Larrea, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Joan Bladé, Laura Rosiñol, María Teresa Cibeira, and Carlos Fernández de Larrea, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - María Teresa Cibeira
- Joan Bladé, Laura Rosiñol, María Teresa Cibeira, and Carlos Fernández de Larrea, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Joan Bladé, Laura Rosiñol, María Teresa Cibeira, and Carlos Fernández de Larrea, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| |
Collapse
|
24
|
Cetani G, Boccadoro M, Oliva S. A look at treatment strategies for relapsed multiple myeloma. Expert Rev Anticancer Ther 2018; 18:735-750. [PMID: 29768064 DOI: 10.1080/14737140.2018.1477594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Multiple myeloma treatment considerably improved during the past decade, thanks to novel effective drugs, a better understanding of myeloma biology and clonal heterogeneity, and an improved management of toxicities. The choice of regimen at relapse is usually based on prior response, toxicities, age and comorbidities of relapsed patients. Areas covered: A review was performed of the most recent and effective therapeutic strategies for the relapsed myeloma setting, by documenting the latest clinical evidence from phase II and III clinical trials. Of note, new drugs, such as carfilzomib, ixazomib, pomalidomide, daratumumab and elotuzumab, alone or in combinations in doublet or triplet regimens, have greatly increased the treatment armamentarium against myeloma. Expert commentary: Impressive results have been obtained with new drugs in relapsed patients. Besides number of prior therapies and previous response, other factors play a crucial role in the selection of therapy. Re-challenge with previous drugs can be adopted if previous responses lasted at least 6 months and therapy had induced low toxicity. Patients' risk status can further help to appropriately select therapy at relapse, and clinical trials will allow physicians to use newer targeted therapies and immune-therapies, thus delaying palliative approaches to later relapse stages.
Collapse
Affiliation(s)
- Giusy Cetani
- a Myeloma Unit, Division of Hematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Mario Boccadoro
- a Myeloma Unit, Division of Hematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Stefania Oliva
- a Myeloma Unit, Division of Hematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| |
Collapse
|
25
|
Lee DH, Fradley MG. Cardiovascular Complications of Multiple Myeloma Treatment: Evaluation, Management, and Prevention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:19. [DOI: 10.1007/s11936-018-0618-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
26
|
Krishnan A, Kapoor P, Palmer JM, Tsai NC, Kumar S, Lonial S, Htut M, Karanes C, Nathwani N, Rosenzweig M, Sahebi F, Somlo G, Duarte L, Sanchez JF, Auclair D, Forman SJ, Berdeja JG. Phase I/II trial of the oral regimen ixazomib, pomalidomide, and dexamethasone in relapsed/refractory multiple myeloma. Leukemia 2018; 32:1567-1574. [PMID: 32082000 PMCID: PMC6005710 DOI: 10.1038/s41375-018-0038-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/17/2017] [Accepted: 11/24/2017] [Indexed: 11/09/2022]
Abstract
In this phase I/II trial, a triplet regimen of ixazomib (Ixa: 3 or 4 mg), pomalidomide (Pom: 4 mg), and dexamethasone (Dex: 40 mg) was administered to 32 lenalidomide-refractory multiple myeloma (MM) patients; 31 were evaluable for response and toxicity. At dose level 1 (DL1, 3 mg Ixa), 1/3 patients experienced grade 3 fatigue, grade 3 lung infection, grade 4 neutropenia, and grade 4 thrombocytopenia; all were considered dose-limiting. Per 3 + 3 phase I design, an additional three patients were enrolled to DL1, with no further dose-limiting toxicity (DLT). At dose level 2 (DL2, 4 mg Ixa), 1/3 patients had dose-limiting febrile neutropenia, neutropenia, and thrombocytopenia (grade 4 each). DL2 was expanded to enroll three additional patients with no further DLT, establishing the recommended phase II dose (RP2D). In phase II, 19 additional patients were treated at RP2D. With a median follow-up of 11.9 months, 48% achieved ≥ partial response (PR), with 5 patients (20%) achieving very good partial response (VGPR) and 76% experiencing ≥ stable disease. The most common adverse events (≥grade 2) were anemia, neutropenia, thrombocytopenia, and infections. Peripheral neuropathy was infrequent. In summary, Ixa/Pom/Dex is a well-tolerated and effective oral combination therapy for patients with relapsed/refractory MM.
Collapse
Affiliation(s)
- Amrita Krishnan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA. .,Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA.
| | | | | | - Ni-Chun Tsai
- Department of Biostatistics, City of Hope, Duarte, CA, USA
| | - Shaji Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Sagar Lonial
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Myo Htut
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.,Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Chatchada Karanes
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.,Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Nitya Nathwani
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.,Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Michael Rosenzweig
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.,Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Firoozeh Sahebi
- Southern California Kaiser Permanente Bone Marrow Transplant Program, Los Angeles, CA, USA
| | - George Somlo
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.,Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | - Lupe Duarte
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA.,Department of Biostatistics, City of Hope, Duarte, CA, USA
| | - James F Sanchez
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.,Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA
| | | | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | | |
Collapse
|
27
|
Abstract
Pomalidomide (originally CC-4047 or 3-amino-thalidomide) is a derivative of thalidomide that is antiangiogenic and also acts as immunomodulatory. Pomalidomide, the recent immunomodulatory agent (IMiD), has shown substantial in vitro antiproliferative and proapoptotic effects. In vivo studies have suggested limited cross-resistance between lenalidomide and pomalidomide. Moreover, pomalidomide achieved very convincing responses in relapsed and refractory multiple myeloma (RRMM) patients, including those, who are refractory to both lenalidomide and bortezomib. Since pomalidomide plus low-dose dexamethasone has shown better responses, progression-free survival (PFS) and overall survival (OS) than high-dose dexamethasone or pomalidomide alone, subsequent trials have pursued or are still investigating pomalidomide triplet combinations, using cyclophosphamide or other novel agents, such as proteasome inhibitors (PI: bortezomib, carfilzomib) or antibodies, like elotuzumab or daratumumab. Pomalidomide has also been assessed in AL amyloidosis, MPNs (myelofibrosis [MF]), Waldenstrom's macroglobulinemia, solid tumors (sarcoma, lung cancer), or HIV, and-for AL amyloidosis and MF-has already been proven to be remarkably active. Due to its potency, pomalidomide was approved for RRMM by the US Food and Drug Administration (FDA) and by the European Medicines Agency (EMA) in 2013 and for drug combination with low-dose dexamethasone in 2015. In June 2017, the FDA further expanded approval for pomalidomide in combination with daratumumab and low-dose dexamethasone for patients with RRMM.
Collapse
|
28
|
Nakae Y, Hyuga M, Terada Y, Kishimoto W, Fukunaga A, Tabata S, Maesako Y, Komatsu K, Higuchi O, Nakane T, Arima N. Multiple Myeloma Presenting with Autoimmune Autonomic Ganglionopathy. Intern Med 2017; 56:3347-3351. [PMID: 29021436 PMCID: PMC5790725 DOI: 10.2169/internalmedicine.9096-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Autoimmune autonomic ganglionopathy is an autonomic disorder that occurs as a symptom of paraneoplastic neurological syndrome. To date, there have been no reports on multiple myeloma with autoimmune autonomic ganglionopathy. A 37-year-old Japanese woman suffered from orthostatic hypotension was diagnosed with multiple myeloma (IgG kappa type), and a serological examination revealed the presence of anti-ganglionic nicotinic acetylcholine receptor (anti-gAChR) antibodies. She was treated for multiple myeloma, as a result, the autonomic disturbance improved and her anti-gAChR antibody titer decreased to undetectable levels, despite the fact that she only achieved a partial remission of multiple myeloma. Treatment for multiple myeloma may improve autoimmune autonomic ganglionopathy.
Collapse
Affiliation(s)
- Yoshiki Nakae
- Department of Hematology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Mizuki Hyuga
- Department of Hematology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Yuta Terada
- Department of Neurology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Wataru Kishimoto
- Department of Hematology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Akiko Fukunaga
- Department of Hematology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Sumie Tabata
- Department of Hematology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Yoshitomo Maesako
- Department of Hematology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Kenichi Komatsu
- Department of Neurology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Osamu Higuchi
- Department of Clinical Research, National Hospital Organization Nagasaki Kawatana Medical Center, Japan
| | | | - Nobuyoshi Arima
- Department of Hematology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| |
Collapse
|
29
|
Cohen A, Spektor TM, Stampleman L, Bessudo A, Rosen PJ, Klein LM, Woliver T, Flam M, Eshaghian S, Nassir Y, Maluso T, Swift RA, Vescio R, Berenson JR. Safety and efficacy of pomalidomide, dexamethasone and pegylated liposomal doxorubicin for patients with relapsed or refractory multiple myeloma. Br J Haematol 2017; 180:60-70. [PMID: 29164606 DOI: 10.1111/bjh.14992] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/14/2017] [Indexed: 01/02/2023]
Affiliation(s)
| | | | | | - Alberto Bessudo
- California Cancer Associates for Research and Excellence; San Diego CA USA
| | | | | | | | | | | | | | - Tina Maluso
- James R. Berenson, MD, Inc; West Hollywood CA USA
| | | | | | - James R. Berenson
- Oncotherapeutics; West Hollywood CA USA
- James R. Berenson, MD, Inc; West Hollywood CA USA
- Institute for Myeloma and Bone Cancer Research; West Hollywood CA USA
| |
Collapse
|
30
|
Seki JT, Sakurai N, Lam W, Reece DE. Pomalidomide desensitization in a patient hypersensitive to immunomodulating agents. ACTA ACUST UNITED AC 2017; 24:e328-e332. [PMID: 28874903 DOI: 10.3747/co.24.3572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite progressive treatments with tandem stem-cell transplantation, patients with incurable myeloma eventually succumb to relapsed or refractory disease if left untreated. Promising agents such as proteasome inhibitors and immunomodulating imide drugs (imids), including the newer-generation agent pomalidomide, in combination with lower-dose dexamethasone, have been shown to be effective and to significantly improve and prolong survival in pretreated patients. Although the incidence of pomalidomide hypersensitivity reaction (hsr) in this class of drugs is not as well known, we have documented cutaneous toxicity (grade 3 by the Common Terminology Criteria for Adverse Events, version 4) in 2 separate cases (not yet published). Because the imids are chemically, structurally, and pharmacologically similar, it is not unreasonable to consider possible cross-reactivity in pomalidomide recipients who developed hsr when receiving previous lines of imids. As a patient's advocate, it is only prudent to provide a responsible, and yet practical, means to better address cross-sensitivity for patients. Intervention with the use of a rapid desensitization program (rdp) as a preventive measure should be introduced before initiating pomalidomide. Such a proactive measure for the patient's safety will ensure a smooth transition into pomalidomide treatment. A hsr can be either related or non-related to immunoglobulin E. As imids become an essential treatment backbone for myeloma and other plasma-cell diseases, an increasing number of patients could experience skin and other life-threatening toxicities, resulting in unnecessary discontinuation of these life-prolonging agents. An extemporaneously prepared pomalidomide suspension developed at our centre enables patients to undergo rdp safely. Patients enjoy a good quality of life and clinical response after the rdp procedure.
Collapse
Affiliation(s)
- J T Seki
- Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network.,Leslie Dan Faculty of Pharmacy, University of Toronto; and
| | - N Sakurai
- Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network
| | - W Lam
- Department of Pharmacy, Princess Margaret Cancer Centre, University Health Network
| | - D E Reece
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| |
Collapse
|
31
|
Affiliation(s)
- T Zander
- Department of Medical Oncology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - S Aebi
- Department of Medical Oncology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - T Pabst
- Department of Medical Oncology, University Hospital Berne, Berne, Switzerland
| | - C Renner
- Onkozentrum Hirslanden, Zurich, Switzerland
| | - C Driessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
32
|
Larocca A, Mina R, Gay F, Bringhen S, Boccadoro M. Emerging drugs and combinations to treat multiple myeloma. Oncotarget 2017; 8:60656-60672. [PMID: 28948001 PMCID: PMC5601169 DOI: 10.18632/oncotarget.19269] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/26/2017] [Indexed: 02/06/2023] Open
Abstract
In the past few years, multiple targeted therapies and immunotherapies including second generation immunomodulatory drugs (pomalidomide) and proteasome inhibitors (carfilzomib, ixazomib), monoclonal antibodies and checkpoint inhibitors were approved for the treatment of myeloma or entered advanced phases of clinical testing. These agents showed significant activity in advanced myeloma and increased the available treatment strategies. Pomalidomide is well-tolerated and effective in patients with relapsed/refractory multiple myeloma who have exhausted any possible treatment with lenalidomide and bortezomib. Carfilzomib, a second-generation proteasome inhibitor, is active as a single agent and in combination with other anti-myeloma agents. Ixazomib is the first oral proteasome inhibitor to be evaluated in myeloma and is associated with a good safety profile and anti-myeloma activity in relapsed/refractory patients, even in those refractory to bortezomib. Monoclonal antibodies and immune checkpoint inhibitors are likely to play a major role in the treatment of myeloma over the next decade. In phase 3 studies, triplet regimens based on these agents combined with a backbone therapy (including lenalidomide, pomalidomide or bortezomib) were more efficacious than doublet regimens in patients with relapsed/refractory multiple myeloma, with limited additional toxic effects. This paper aims to provide an overview of the recent use of these agents for the treatment of myeloma, in particular focusing on the role of multi-agent combinations.
Collapse
Affiliation(s)
- Alessandra Larocca
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Roberto Mina
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Sara Bringhen
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| |
Collapse
|
33
|
Lee HC, Mark TM, Shah JJ. Practical Approaches to the Management of Dual Refractory Multiple Myeloma. Curr Hematol Malig Rep 2017; 11:148-55. [PMID: 26898556 DOI: 10.1007/s11899-016-0312-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The outcome of myeloma patients' dual refractory to lenalidomide and bortezomib is generally poor and represents a significant clinical challenge with a clear need for new therapeutic approaches. This has prompted the development of next-generation proteasome inhibitors and immunodulatory drugs (IMiDs), as well as new classes of drugs with novel mechanisms of action. As a result, several of these agents have received regulatory approval that have shown promising activity in the dual refractory setting including the second-generation proteasome inhibitor carfilzomib and third-generation IMiD pomalidomide. Moreover, the regulatory approval of several first-in-class drugs for myeloma such as the histone deacetylase (HDAC) inhibitor panobinostat and the anti-CD38 monoclonal antibody daratumumab has further broadened the therapeutic landscape for these patients. Collectively, these advances have provided new treatment strategies in dual refractory myeloma as well as important insights for the development of future studies with rationally designed drug combinations to target this challenging patient population.
Collapse
Affiliation(s)
- Hans C Lee
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 429, Houston, TX, 77030, USA
| | - Tomer M Mark
- Multiple Myeloma Center, Weil Cornell Medical College, 428 E. 72nd street, Suite 300, New York, NY, 10021, USA
| | - Jatin J Shah
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 429, Houston, TX, 77030, USA.
| |
Collapse
|
34
|
Ríos-Tamayo R, Martín-García A, Alarcón-Payer C, Sánchez-Rodríguez D, de la Guardia AMDVD, García Collado CG, Jiménez Morales A, Jurado Chacón M, Cabeza Barrera J. Pomalidomide in the treatment of multiple myeloma: design, development and place in therapy. Drug Des Devel Ther 2017; 11:2399-2408. [PMID: 28860711 PMCID: PMC5574598 DOI: 10.2147/dddt.s115456] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Multiple myeloma is a very heterogeneous disease with variable survival. Despite recent progress and the widespread use of new agents, patients with relapsed and refractory disease have a poor outcome. Immunomodulatory drugs play a key role in both the front-line and the relapsed/refractory setting. The combination of pomalidomide (POM) and dexamethasone is safe and effective in relapsed and refractory patients, even in those with high-risk cytogenetic features. Furthermore, it can be used in most patients without the need to adjust according to the degree of renal failure. In order to further improve the results, POM-based triplet therapies are currently used. This article highlights the most relevant issues of POM and POM-based combinations in the relapsed/refractory multiple myeloma setting, from a pharmacological and clinical point of view.
Collapse
Affiliation(s)
- Rafael Ríos-Tamayo
- Monoclonal Gammopathies Unit
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Agustín Martín-García
- Department of Pharmacy
- Clinical Trials Unit, University Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | | | | | - Manuel Jurado Chacón
- Monoclonal Gammopathies Unit
- Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - José Cabeza Barrera
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Department of Pharmacy
| |
Collapse
|
35
|
Podar K, Pecherstorfer M. Current and developing synthetic pharmacotherapy for treating relapsed/refractory multiple myeloma. Expert Opin Pharmacother 2017; 18:1061-1079. [PMID: 28604120 DOI: 10.1080/14656566.2017.1340942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The introduction of novel agents has significantly improved multiple myeloma (MM) patient outcome during the last two decades. MM received the most drug approvals for any one malignancy during this time period, both in the United States as well as in Europe. Areas covered: Proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies are prototype drug classes, which target both specific MM cell functions, as well as the tumor supportive bone marrow microenvironment, and represent current cornerstones of MM therapy. Importantly, the unprecedented extent and frequency of durable responses, in relapsed/refractory multiple myeloma (RRMM), in particular, is predominantly based on the combinatorial use of these agents with conventional chemotherapeutics or representatives of other drug classes. This article will summarize past landmark discoveries in MM that led to the dramatic progress of today's clinical practice. Moreover, developing strategies will be discussed that are likely to yet improve patient outcome even further. Expert opinion: Despite significant therapeutic advancements, MM remains an incurable disease. With several novel agents in the preclinical and early clinical pipeline, among those novel CD38 and BCMA mAbs, immune checkpoint inhibitors, as well as ricolinostat, selinexor, venetoclax, CAR-T cells, and vaccines, further advances in MM patient outcome are expected in the near future.
Collapse
Affiliation(s)
- Klaus Podar
- a Department of Internal Medicine , Karl Landsteiner University of Health Sciences, University Hospital , Krems , Austria
| | - Martin Pecherstorfer
- a Department of Internal Medicine , Karl Landsteiner University of Health Sciences, University Hospital , Krems , Austria
| |
Collapse
|
36
|
Noonan K, Colson K. Immunomodulatory Agents and Proteasome Inhibitors in the Treatment of Multiple Myeloma. Semin Oncol Nurs 2017; 33:279-291. [PMID: 28666621 DOI: 10.1016/j.soncn.2017.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review the current evidence on the use of immunomodulatory agents (IMiDs) and proteasome inhibitors (PIs) in the treatment of multiple myeloma (MM). DATA SOURCES Journal articles, research reports, state of the science papers, and clinical guidelines. CONCLUSION There has been a tremendous increase of new agents to treat multiple myeloma in the last 15 years. The IMiDs and PIs remain essential components of many anti-myeloma regimens. IMPLICATIONS FOR NURSING PRACTICE With these advances in the therapeutic landscape, knowledge of these drugs, side effects and nursing implications are essential to improve outcomes. Patient education is also of vital importance in achieving optimal responses to treatment.
Collapse
|
37
|
Moreau P, Dimopoulos MA, Richardson PG, Siegel DS, Cavo M, Corradini P, Weisel K, Delforge M, O'Gorman P, Song K, Chen C, Bahlis N, Oriol A, Hansson M, Kaiser M, Anttila P, Raymakers R, Joao C, Cook G, Sternas L, Biyukov T, Slaughter A, Hong K, Herring J, Yu X, Zaki M, San-Miguel J. Adverse event management in patients with relapsed and refractory multiple myeloma taking pomalidomide plus low-dose dexamethasone: A pooled analysis. Eur J Haematol 2017; 99:199-206. [DOI: 10.1111/ejh.12903] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2015] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | - David S. Siegel
- John Theurer Cancer Center; Hackensack University Medical Center; Hackensack NJ USA
| | - Michele Cavo
- Bologna University School of Medicine; Bologna Italy
| | - Paolo Corradini
- University of Milano, Fondazione IRCCS Istituto Nazionale de Tumori; Milano Italy
| | - Katja Weisel
- University Hospital of Tuebingen; Tuebingen Germany
| | | | - Peter O'Gorman
- Mater Misericordiae University Hospital; University College Dublin; Dublin Ireland
| | - Kevin Song
- Vancouver General Hospital; Vancouver British Columbia Canada
| | | | - Nizar Bahlis
- Tom Baker Cancer Center; University of Calgary; Calgary Canada
| | - Albert Oriol
- Institut Català d'Oncologia, Institut Josep Carreras; Hospital Germans Trias i Pujol; Barcelona Spain
| | | | | | - Pekka Anttila
- Helsinki University and Helsinki University Hospital Comprehensive Cancer; Helsinki Finland
| | | | - Cristina Joao
- Hemato-Oncology Department; Champalimaud Foundation for the Unknown and Faculdade de Ciências Médicas-NOVA University; Lisbon Portugal
| | - Gordon Cook
- St James's Institute of Oncology; St James's University Hospital; Leeds UK
| | | | | | | | | | | | - Xin Yu
- Celgene Corporation; Summit NJ USA
| | | | | |
Collapse
|
38
|
Zou Y, Ma X, Yu H, Hu C, Fan L, Ran X. Carfilzomib/pomalidomide single-agent or in combination with other agents for the management of relapsed/refractory multiple myeloma: a meta-analysis of 37 trials. Oncotarget 2017; 8:39805-39817. [PMID: 27458170 PMCID: PMC5503655 DOI: 10.18632/oncotarget.10768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/10/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The use of carfilzomib/pomalidomide single-agent or in combination with other agents in patients with refractory/relapsed multiple myeloma (RRMM) was not clearly clarified in clinical practice. We sought to compile the available clinical reports to better understand the efficacy and safety of carfilzomib (CFZ) and pomalidomide (POM). RESULTS Based on our research criteria, we identified 37 prospective studies that evaluated 1160 patients. Analysis of subgroup differences between carfilzomib single-agent and CFZ/DEX dual combination showed significantly(P < 0.001, I2 = 96.3%), suggesting the overall response rate (ORR) of 66% attained from CFZ/DEX dual combination seemed to be higher than that of 28% from carfilzomib single-agent. And, the same trend favoring CFZ/DEX dual combination was found in ≥VGPR and CBR analysis. The ORR of 31% attained from POM/DEX dual combination was superior to that of 19% from pomalidomide single-agent(P < 0.001, I2 = 94.4%). And, the same trend favoring POM/DEX dual combination was found in ≥VGPR and CBR analysis. However, the ORR of 83% attained from POM/BOR/DEX triplet combination was superior to that of 31% from POM/DEX dual combination(P < 0.001, I2 = 99.1%). And, the same trend favoring POM/BOR/DEX triplet combination was found in ≥VGPR analysis. METHODS We searched published reports including carfilzomib and (or) pomalidomide therapy for RRMM who had received bortezomib and (or) lenalidomide. CONCLUSION Pomalidomide/Carfilzomib plus dexamethasone seemed to attain a superior response rate compared with pomalidomide/carfilzomib single-agent. Furthermore, the combination of pomalidomide, bortezomib and dexamethasone resulted in a much higher response rate compared with pomalidomide plus dexamethasone regimen. These results needed more validation in future trials.
Collapse
Affiliation(s)
- Yandun Zou
- Internal Medicine, Guang Dong Women and Children Hospital, Guang Zhou, China
| | - Xiaoyan Ma
- Department of I.C.U, Weifang People's Hospital, Weifang, China
| | - Haiying Yu
- Department of Pediatrics, Weifang People's Hospital, Weifang, China
| | - Chunling Hu
- Internal Medicine, Guang Dong Women and Children Hospital, Guang Zhou, China
| | - Limei Fan
- Internal Medicine, Guang Dong Women and Children Hospital, Guang Zhou, China
| | - Xuehong Ran
- Department of Hematology, Weifang People's Hospital, Weifang, China
| |
Collapse
|
39
|
Dougé A, Lemal R, Chaleteix C. [Pomalidomide for multiple myeloma]. Bull Cancer 2017; 104:707-713. [PMID: 28583668 DOI: 10.1016/j.bulcan.2017.04.005] [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: 12/19/2016] [Revised: 04/15/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
Pomalidomide is a second-generation immunomodulatory drug (IMID). Its efficiency overtakes its predecessors' (thalidomide, lenalidomide), with less toxicity. It is indicated in the treatment of refractory or relapsed multiple myeloma, associated to dexamethasone. It is available in France since 2013, following the results of different studies.
Collapse
Affiliation(s)
- Aurore Dougé
- CHU de Clermont-Ferrand, service d'hématologie clinique adulte et de thérapie cellulaire, 63003 Clermont-Ferrand, France; Clermont université, université d'Auvergne, EA7283, CIC501, BP 10448, 63000 Clermont-Ferrand, France.
| | - Richard Lemal
- CHU de Clermont-Ferrand, service d'hématologie clinique adulte et de thérapie cellulaire, 63003 Clermont-Ferrand, France; Clermont université, université d'Auvergne, EA7283, CIC501, BP 10448, 63000 Clermont-Ferrand, France
| | - Carine Chaleteix
- CHU de Clermont-Ferrand, service d'hématologie clinique adulte et de thérapie cellulaire, 63003 Clermont-Ferrand, France
| |
Collapse
|
40
|
A novel agent SL-401 induces anti-myeloma activity by targeting plasmacytoid dendritic cells, osteoclastogenesis and cancer stem-like cells. Leukemia 2017; 31:2652-2660. [PMID: 28479592 DOI: 10.1038/leu.2017.135] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/17/2017] [Accepted: 04/20/2017] [Indexed: 11/08/2022]
Abstract
Novel therapies for multiple myeloma (MM) can target mechanism(s) in the host-MM bone marrow (BM) microenvironment mediating MM progression and chemoresistance. Our studies showed increased numbers of tumor-promoting, immunosuppressive and drug-resistant plasmacytoid dendritic cells (pDCs) in the MM BM microenvironment. pDC-MM cell interactions upregulate interleukin-3 (IL-3), which stimulates both pDC survival and MM cell growth. Since IL-3 R is highly expressed on pDCs in the MM BM milieu, we here targeted pDCs using a novel IL-3 R-targeted therapeutic SL-401. In both in vitro and in vivo models of MM in its BM milieu, SL-401 decreases viability of pDCs, blocks pDC-induced MM cell growth, and synergistically enhances anti-MM activity of bortezomib and pomalidomide. Besides promoting pDC survival and MM cell growth, IL-3 also mediates progression of osteolytic bone disease in MM. Osteoclast (OCL) progenitor cells express IL-3 R, and we show that SL-401 abrogates monocyte-derived OCL formation and bone resorption. Finally, we show that SL-401 also decreases the viability of IL-3 R-expressing cancer stem-like cells in MM. Overall, our study provides the preclinical basis for clinical trials of SL-401 to block pDC-induced MM cell growth, inhibit osteoclastogenesis and target MM stem-like cell subpopulations to improve patient outcome in MM.
Collapse
|
41
|
Holstein SA, McCarthy PL. Immunomodulatory Drugs in Multiple Myeloma: Mechanisms of Action and Clinical Experience. Drugs 2017; 77:505-520. [PMID: 28205024 PMCID: PMC5705939 DOI: 10.1007/s40265-017-0689-1] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Over the last two decades, the outcomes for patients with multiple myeloma, a plasma cell malignancy, have dramatically improved. The development of the immunomodulatory drugs (IMiDs), which include thalidomide, lenalidomide, and pomalidomide, has contributed significantly to these improved outcomes. While thalidomide is now less commonly prescribed, lenalidomide is widely used in the treatment of newly diagnosed transplant-eligible and transplant-ineligible patients, in the maintenance setting post-transplant and in the relapsed/refractory setting, while pomalidomide is currently utilized in the relapsed/refractory setting. The IMiDs have been reported to have a multitude of activities, including anti-angiogenic, cytotoxic, and immunomodulatory. However, the more recent discoveries that the IMiDs bind to cereblon and thus regulate the ubiquitination of key transcription factors including IKZF1 and IKZF3 have provided greater insight into their mechanism of action. Here, the clinical efficacy of these agents in myeloma is reviewed and the structure-function relationship, the molecular mechanisms of action, and the association of IMiDs with second primary malignancies and thrombosis are discussed.
Collapse
Affiliation(s)
- Sarah A Holstein
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Philip L McCarthy
- Department of Medicine, Blood and Marrow Transplant Center, Roswell Park Cancer Institute, Buffalo, NY, USA.
| |
Collapse
|
42
|
Maciocia N, Melville A, Cheesman S, Sharpley F, Ramasamy K, Streetly M, Jenner M, Benjamin R, Schey S, Maciocia P, Popat R, D'sa S, Rismani A, Cerner A, Yong K, Rabin N. Real-world use of pomalidomide and dexamethasone in double refractory multiple myeloma suggests benefit in renal impairment and adverse genetics: a multi-centre UK experience. Br J Haematol 2017; 176:908-917. [PMID: 28211054 DOI: 10.1111/bjh.14547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/03/2016] [Indexed: 01/19/2023]
Abstract
Myeloma patients who become refractory to immunomodulatory agents (IMiDs) and bortezomib have poor survival, with limited therapeutic options. Pomalidomide has shown improved survival and good tolerability in this patient cohort in clinical trials, but real world data are scarce. We retrospectively analysed all patients treated with pomalidomide at five UK centres between 2013 and 2016. Of 85 patients identified, 70 had sufficient information for response assessments. Median age was 66 years [40-89], 96·5% were refractory to IMiDs, 72·9% were refractory to both an IMiD and bortezomib and 92·9% were refractory to their last treatment. Of 45 patients with fluorescence in situ hybridization results 64% had adverse risk, 19 patients (22·4%) had an estimated glomerular filtration rate <45 ml/min. Grade ≥3 non-haematological toxicities occurred in 42·4%, and grade ≥3 neutropenia and thrombocytopenia in 38% and 24% respectively, but only 18·8% had dose reductions. The overall response rate was 52·9%. At a median follow-up of 13·2 months, median progression-free survival was 5·2 months [95% confidence interval (CI) 4·150-6·238], and median overall survival was 13·7 months (95% CI 11·775-15·707). No significant difference was seen in response, survival or tolerability by renal function, age or cytogenetic risk. This real-world data support the results seen in published clinical trials.
Collapse
Affiliation(s)
- Nicola Maciocia
- Department of Haematology, University College London Hospitals, London, UK
| | - Andrew Melville
- Department of Haematology, University College London Hospitals, London, UK
| | - Simon Cheesman
- Department of Pharmacy, University College London Hospitals, London, UK
| | - Faye Sharpley
- Department of Haematology, Oxford University Hospitals, Oxford, UK
| | - Karthik Ramasamy
- Department of Haematology, Oxford University Hospitals, Oxford, UK
| | - Matthew Streetly
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew Jenner
- Department of Haematology, University Hospital Southampton, Southampton, UK
| | - Reuben Benjamin
- Department of Haematology, King's College Hospital, London, UK
| | - Steve Schey
- Department of Haematology, King's College Hospital, London, UK
| | - Paul Maciocia
- Department of Haematology, University College London Hospitals, London, UK
| | - Rakesh Popat
- Department of Haematology, University College London Hospitals, London, UK
| | - Shirley D'sa
- Department of Haematology, University College London Hospitals, London, UK
| | - Ali Rismani
- Department of Haematology, The Whittington Hospital NHS Trust, London, UK
| | - Aviva Cerner
- Department of Haematology, University College London Hospitals, London, UK
| | - Kwee Yong
- Department of Haematology, University College London Hospitals, London, UK
| | - Neil Rabin
- Department of Haematology, University College London Hospitals, London, UK
| |
Collapse
|
43
|
Di Raimondo F, Conticello C. Pomalidomide: when expectations are understated. Future Oncol 2017; 13:1-2. [PMID: 28116940 DOI: 10.2217/fon-2016-0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Francesco Di Raimondo
- Department of Clinical & Molecular Biomedicine, Haematology Section, University of Catania, Catania, Italy
| | - Concetta Conticello
- Department of Clinical & Molecular Biomedicine, Haematology Section, University of Catania, Catania, Italy
| |
Collapse
|
44
|
Uccello G, Petrungaro A, Mazzone C, Recchia AG, Greco R, Mendicino F, Lucia E, Vigna E, Morabito F, Gentile M. Pomalidomide in multiple myeloma. Expert Opin Pharmacother 2016; 18:133-137. [PMID: 28002973 DOI: 10.1080/14656566.2016.1274973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Giuseppina Uccello
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy
| | - Annamaria Petrungaro
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy
| | - Carla Mazzone
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy
| | - Anna Grazia Recchia
- b Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano , Italy
| | - Rosa Greco
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy
| | - Francesco Mendicino
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy
| | - Eugenio Lucia
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy
| | - Ernesto Vigna
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy
| | - Fortunato Morabito
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy.,b Biotechnology Research Unit , Azienda Sanitaria Provinciale di Cosenza , Aprigliano , Italy
| | - Massimo Gentile
- a Dipartimento di Onco-Ematologia , Unità Operativa di Ematologia Azienda Ospedaliera di Cosenza , Cosenza , Italy
| |
Collapse
|
45
|
Polizzotto MN, Uldrick TS, Wyvill KM, Aleman K, Peer CJ, Bevans M, Sereti I, Maldarelli F, Whitby D, Marshall V, Goncalves PH, Khetani V, Figg WD, Steinberg SM, Zeldis JB, Yarchoan R. Pomalidomide for Symptomatic Kaposi's Sarcoma in People With and Without HIV Infection: A Phase I/II Study. J Clin Oncol 2016; 34:4125-4131. [PMID: 27863194 PMCID: PMC5477825 DOI: 10.1200/jco.2016.69.3812] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Kaposi's sarcoma (KS) is a multicentric tumor caused by Kaposi's sarcoma-associated herpesvirus. Unmet needs include therapies that are oral, anthracycline sparing, and deliverable in resource-limited settings. We evaluated pomalidomide, an oral immune modulatory agent, in patients with symptomatic KS. Methods The primary objectives were to assess tolerability, pharmacokinetics, and activity. Initial dosage level was 5 mg once per day for 21 days per 28-day cycle, with a de-escalated level of 3 mg if not tolerable, and aspirin 81 mg once per day thromboprophylaxis. HIV-infected patients required controlled viremia with either persistent KS despite 3 months of antiretroviral therapy (ART) or progressive KS despite 2 months of ART. Evaluations included tumor response and health-related quality of life (HRQL). Results Twenty-two patients were treated; 15 (68%) were HIV infected, 17 (77%) had advanced (T1) disease, and 19 (86%) previous KS therapy excluding ART. All were treated with 5 mg because no dose-limiting toxicities occurred. Over 156 cycles, the grade 3/4 adverse events possibly attributable to therapy were neutropenia (23 cycles, 10 patients), infection (1 cycle), and edema (1 cycle). Sixteen patients responded (73%; 95% CI, 50% to 89%): nine of 15 HIV-infected patients (60%; 95% CI, 32% to 84%) and all seven HIV-uninfected patients (100%; 95% CI, 59% to 100%). Median time to response was 4 weeks (range, 4 to 36 weeks). HRQL showed no impairment during therapy and improved satisfaction with appearance at end therapy ( P = .03). Significant increases in CD4+ and CD8+ cells were seen in patients with and without HIV, together with a transient increase in Kaposi's sarcoma-associated herpesvirus viral load at week 4 ( P = .05). Conclusion Pomalidomide is well tolerated and active in KS regardless of HIV status. Responses were rapid, with improved self-reported outcomes, and occurred in advanced and heavily pretreated disease. Correlative studies support, at least in part, an immunologic mechanism of activity.
Collapse
Affiliation(s)
- Mark N. Polizzotto
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Thomas S. Uldrick
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Kathleen M. Wyvill
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Karen Aleman
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Cody J. Peer
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Margaret Bevans
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Irini Sereti
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Frank Maldarelli
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Denise Whitby
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Vickie Marshall
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Priscila H. Goncalves
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Vikram Khetani
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - William D. Figg
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Seth M. Steinberg
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Jerome B. Zeldis
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| | - Robert Yarchoan
- Mark N. Polizzotto, Thomas S. Uldrick, Kathleen M. Wyvill, Karen Aleman, Cody J. Peer, Frank Maldarelli, Priscila H. Goncalves, William D. Figg, Seth M. Steinberg, and Robert Yarchoan, National Cancer Institute; Margaret Bevans, National Institutes of Health; Irini Sereti, National Institute of Allergy and Infectious Diseases, Bethesda, MD; Denise Whitby and Vickie Marshall, Frederick National Cancer Laboratory for Cancer Research, Frederick, MD; and Vikram Khetani and Jerome B. Zeldis, Celgene Corporation, Summit, NJ
| |
Collapse
|
46
|
Salvini M, Bonello F, Boccadoro M, Larocca A. Management of adverse events induced by next-generation immunomodulatory drug and proteasome inhibitors in multiple myeloma. Expert Rev Anticancer Ther 2016; 17:75-87. [PMID: 27894203 DOI: 10.1080/14737140.2017.1266264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In the last decade the introduction of novel agents has strongly improved multiple myeloma prognosis by doubling median overall survival. Unfortunately disease relapse is very common and patients may become refractory to previous drugs. Therefore, new therapeutic strategies are urgently needed. Areas covered: We have reviewed the available data on next generation novel agents, particularly immunomodulatory drug pomalidomide and proteasome inhibitors carfilzomib and ixazomib, the latter being the first-in-class orally available. We focused on adverse events associated with such agents and described how they should be managed. The main grade ≥3 adverse events correlated with these drugs are hematologic, myelosuppression-related and reversible; non-hematologic grade ≥3 toxicities are less frequent, with an incidence of <10%. Expert commentary: These agents showed to have a good tolerability. The great majority of adverse events are easily manageable with dose-adjustment and appropriate treatment, and drug discontinuation is not frequent. Favorable safety profile and high efficacy, especially in combination, confer to these drugs a central role in development of new lines of therapy against multiple myeloma. Further investigation is certainly needed to determine the best combinations including these agents.
Collapse
Affiliation(s)
- Marco Salvini
- a Myeloma Unit, Division of Hematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Francesca Bonello
- a Myeloma Unit, Division of Hematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Mario Boccadoro
- a Myeloma Unit, Division of Hematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| | - Alessandra Larocca
- a Myeloma Unit, Division of Hematology , University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino , Torino , Italy
| |
Collapse
|
47
|
Garderet L, Cook G, Auner HW, Bruno B, Lokhorst H, Perez-Simon JA, Sahebi F, Scheid C, Morris C, van Biezen A, Sobh M, Michallet M, Gahrton G, Schönland S, Kröger N. Treatment options for relapse after autograft in multiple myeloma – report from an EBMT educational meeting. Leuk Lymphoma 2016; 58:797-808. [DOI: 10.1080/10428194.2016.1228926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
48
|
Touzeau C, Moreau P. Pomalidomide in the management of relapsed multiple myeloma. Future Oncol 2016; 12:1975-83. [DOI: 10.2217/fon-2016-0184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Pomalidomide, a very potent member of the immunomodulatory drug family, is considered a standard of care for patients with relapsed and refractory myeloma, who have previously been treated with bortezomib and lenalidomide. Pomalidomide induces both direct myeloma cell death, and indirect antimyeloma response through its impact on the microenvironment (modulation of immune response, inhibition of angiogenesis, inhibition of bone resorption). Pomalidomide in combination with dexamethasone is an approved regimen in Europe and USA based on the results of a Phase III randomized trial. In order to improve response rate and patient survival, pomalidomide is currently being assessed in triplet combinations with other antimyeloma agents. The present review addresses current knowledge regarding the clinical use of pomalidomide in relapsed myeloma patients.
Collapse
Affiliation(s)
- Cyrille Touzeau
- Department of Hematology, University hospital, Nantes, France INSERM UMR892, CNRS UMR6299, University of Nantes, France
| | - Philippe Moreau
- Department of Hematology, University hospital, Nantes, France INSERM UMR892, CNRS UMR6299, University of Nantes, France
| |
Collapse
|
49
|
Gonsalves WI, Milani P, Derudas D, Buadi FK. The next generation of novel therapies for the management of relapsed multiple myeloma. Future Oncol 2016; 13:63-75. [PMID: 27513456 DOI: 10.2217/fon-2016-0200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The advent of various novel therapies such as immunomodulators and proteasome inhibitors has transformed the treatment paradigm for patients with multiple myeloma (MM). As a result, the overall survival has improved dramatically over the last decade. Despite these advances, MM remains mostly incurable and most patients experience disease relapse after enjoying a period of disease control or remission. Fortunately, the scientific community continues to make strides in developing 'next-generation' therapies for the management of patients with relapsed MM. This review will summarize the efficacy of some of the newest therapeutic agents available for the treatment of patients with relapsed MM after their upfront treatment with the original novel agents such as thalidomide, lenalidomide and bortezomib.
Collapse
Affiliation(s)
- Wilson I Gonsalves
- The Divisions of Hematology & Blood & Marrow Transplantation, Mayo Clinic, Rochester, MN, USA
| | - Paolo Milani
- Amyloidosis Research & Treatment Center, Department of Molecular Medicine, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo & University of Pavia, Pavia, Italy
| | - Daniel Derudas
- Department of Hematology, Businco Hospital, Cagliari, Italy
| | - Francis K Buadi
- The Divisions of Hematology & Blood & Marrow Transplantation, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
50
|
Polizzotto MN, Chen G, Tressler RL, Godfrey C. Leveraging Cancer Therapeutics for the HIV Cure Agenda: Current Status and Future Directions. Drugs 2016. [PMID: 26224205 DOI: 10.1007/s40265-015-0426-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite effective antiretroviral therapy (ART) and undetectable HIV RNA in the plasma, latent replication-competent HIV persists indefinitely in long-lived cells. Cessation of ART results in rebound of HIV from these persistent reservoirs. While this was thought to be an insurmountable obstacle to viral eradication, recent cases suggest otherwise. To date one patient has been "cured" of HIV and several others have been able to interrupt ART without viral rebound for prolonged periods. These events have sparked renewed interest in developing strategies that will allow eradication of HIV in infected individuals. We review the current knowledge of HIV latency and the viral reservoir, describe the potential utility of emerging cancer therapeutics in HIV cure research with an emphasis on pathways implicated in reservoir persistence, and outline opportunities and challenges in the context of the current clinical trial and regulatory environment.
Collapse
Affiliation(s)
- Mark N Polizzotto
- HIV and AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, 5601 Fishers Lane, Bethesda, MD, 20892, USA,
| | | | | | | |
Collapse
|