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Kang Q, He L, Zhang Y, Zhong Z, Tan W. Immune-inflammatory modulation by natural products derived from edible and medicinal herbs used in Chinese classical prescriptions. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 130:155684. [PMID: 38788391 DOI: 10.1016/j.phymed.2024.155684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/29/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Edible and medicinal herbs1 (EMHs) refer to a class of substances with dual attribution of food and medicine. These substances are traditionally used as food and also listed in many international pharmacopoeias, including the European Pharmacopoeia, the United States Pharmacopoeia, and the Chinese Pharmacopoeia. Some classical formulas that are widely used in traditional Chinese medicine include a series of EMHs, which have been shown to be effective with obvious characteristics and advantages. Notably, these EMHs and Chinese classical prescriptions2 (CCPs) have also attracted attention in international herbal medicine research because of their low toxicity and high efficiency as well as the rich body of experience for their long-term clinical use. PURPOSE Our purpose is to explore the potential therapeutic effect of EMHs with immune-inflammatory modulation for the study of modern cancer drugs. STUDY DESIGN In the present study, we present a detailed account of some EMHs used in CCPs that have shown considerable research potential in studies exploring modern drugs with immune-inflammatory modulation. METHODS Approximately 500 publications in the past 30 years were collected from PubMed, Web of Science and ScienceDirect using the keywords, such as natural products, edible and medicinal herbs, Chinese medicine, classical prescription, immune-inflammatory, tumor microenvironment and some related synonyms. The active ingredients instead of herbal extracts or botanical mixtures were focused on and the research conducted over the past decade were discussed emphatically and analyzed comprehensively. RESULTS More than ten natural products derived from EMHs used in CCPs are discussed and their immune-inflammatory modulation activities, including enhancing antitumor immunity, regulating inflammatory signaling pathways, lowering the proportion of immunosuppressive cells, inhibiting the secretion of proinflammatory cytokines, immunosuppressive factors, and inflammatory mediators, are summarized. CONCLUSION Our findings demonstrate the immune-inflammatory modulating role of those EMHs used in CCPs and provide new ideas for cancer treatment in clinical settings.
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Affiliation(s)
- Qianming Kang
- School of Pharmacy, Lanzhou University, Lanzhou 730000, China
| | - Luying He
- School of Pharmacy, Lanzhou University, Lanzhou 730000, China
| | - Yang Zhang
- School of Pharmacy, Lanzhou University, Lanzhou 730000, China
| | - Zhangfeng Zhong
- Macao Centre for Research and Development in Chinese Medicine, State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR 999078, China.
| | - Wen Tan
- School of Pharmacy, Lanzhou University, Lanzhou 730000, China.
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2
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Palazón-Carrión N, Martín García-Sancho A, Nogales-Fernández E, Jiménez-Cortegana C, Carnicero-González F, Ríos-Herranz E, de la Cruz-Vicente F, Rodríguez-García G, Fernández-Álvarez R, Martínez-Banaclocha N, Gumà-Padrò J, Gómez-Codina J, Salar-Silvestre A, Rodríguez-Abreu D, Gálvez-Carvajal L, Labrador J, Guirado-Risueño M, García-Domínguez DJ, Hontecillas-Prieto L, Espejo-García P, Fernández-Román I, Provencio-Pulla M, Sánchez-Beato M, Navarro M, Marylene L, Álvaro-Naranjo T, Casanova-Espinosa M, Sánchez-Margalet V, Rueda-Domínguez A, de la Cruz-Merino L. Lenalidomide plus R-GDP (R2-GDP) in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Final Results of the R2-GDP-GOTEL Trial and Immune Biomarker Subanalysis. Clin Cancer Res 2022; 28:3658-3668. [PMID: 35727601 PMCID: PMC9433956 DOI: 10.1158/1078-0432.ccr-22-0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/06/2022] [Accepted: 06/17/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE New therapeutic options are needed in relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Lenalidomide-based schedules can reverse rituximab refractoriness in lymphoma. PATIENTS AND METHODS In the phase II R2-GDP trial, 78 patients unsuitable for autologous stem cell transplant received treatment with the following schedule: lenalidomide 10 mg Days (D)1-14, rituximab 375 mg/m2 D1, cisplatin 60 mg/m2 D1, gemcitabine 750 mg/m2 D1 and D8, and dexamethasone 20 mg D1-3, up to 6 cycles (induction phase), followed by lenalidomide 10 mg (or last lenalidomide dose received) D1-21 every 28 days (maintenance phase). Primary endpoint was overall response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), safety, and monitorization of key circulating immune biomarkers (EU Clinical Trials Register number: EudraCT 2014-001620-29). RESULTS After a median follow-up of 37 months, ORR was 60.2% [37.1% complete responses (CR) and 23.1% partial responses (PR)]. Median OS was 12 months (47 vs. 6 months in CR vs. no CR); median PFS was 9 months (34 vs. 5 months in CR vs. no CR). In the primary refractory population, ORR was 45.5% (21.2% CR and 24.3% PR). Most common grade 3-4 adverse events were thrombocytopenia (60.2%), neutropenia (60.2%), anemia (26.9%), infections (15.3%), and febrile neutropenia (14.1%). Complete responses were associated with a sharp decrease in circulating myeloid-derived suppressor cells and regulatory T cells. CONCLUSIONS R2-GDP schedule is feasible and highly active in R/R DLBCL, including the primary refractory population. Immune biomarkers showed differences in responders versus progressors.
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Affiliation(s)
- Natalia Palazón-Carrión
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | | | - Esteban Nogales-Fernández
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | | - Josep Gumà-Padrò
- Department of Clinical Oncology, Hospital Universitari Sant Joan de Reus URV, IISPV, Reus, Spain
| | - José Gómez-Codina
- Department of Clinical Oncology, Hospital Universitario La Fé, Valencia, Spain
| | | | - Delvys Rodríguez-Abreu
- Department of Clinical Oncology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Laura Gálvez-Carvajal
- Department of Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Jorge Labrador
- Department of Hematology, Research Unit, Hospital Universitario de Burgos, Burgos, Spain
| | - María Guirado-Risueño
- Department of Clinical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - Daniel J. García-Domínguez
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Lourdes Hontecillas-Prieto
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Pablo Espejo-García
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | | | - Mariano Provencio-Pulla
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro-Majadahonda, Facultad de Medicina, Universidad Autónoma de Madrid, IDIPHISA, Madrid, Spain
| | - Margarita Sánchez-Beato
- Department of Medical Oncology, Lymphoma Research Group, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, CIBERONC, Madrid, Spain
| | - Marta Navarro
- Department of Medical Oncology, Lymphoma Research Group, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Madrid, Spain
| | - Lejeune Marylene
- Department of Pathology, Plataforma de Estudios Histológicos, Citológicos y de Digitalización, Hospital de Tortosa Verge de la Cinta, IISPV, URV, Tortosa, Tarragona, Spain
| | - Tomás Álvaro-Naranjo
- Department of Pathology, Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Institut d'Investigació Sanitària Pere Virgili (IISPV), Tortosa, Tarragona, Spain
| | | | - Victor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology and Immunology, Medical School, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Antonio Rueda-Domínguez
- Department of Hematology/Clinical Oncology, Hospital Costa del Sol, Marbella, Spain.,Corresponding Authors: Luis de la Cruz-Merino, Hospital Universitario Virgen Macarena and University of Seville, Avenue Doctor Fedriani, 41009 Seville, Spain. Phone: 346-7790-2681; E-mail: ; and Antonio Rueda-Domínguez,
| | - Luis de la Cruz-Merino
- Department of Clinical Oncology, Hospital Universitario Virgen Macarena, University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain.,Corresponding Authors: Luis de la Cruz-Merino, Hospital Universitario Virgen Macarena and University of Seville, Avenue Doctor Fedriani, 41009 Seville, Spain. Phone: 346-7790-2681; E-mail: ; and Antonio Rueda-Domínguez,
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3
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Lakritz S, Forsberg PA, Sherbenou DW, Mark TM. Lenalidomide‐induced autoimmune enteropathy complicating treatment of multiple myeloma with concurrent systemic mastocytosis. Clin Case Rep 2022; 10:e6199. [PMID: 36188028 PMCID: PMC9483819 DOI: 10.1002/ccr3.6199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/07/2022] Open
Abstract
Lenalidomide is an IMiD drug which has been associated with a variety of potential immune related complications. We describe the case of a patient with newly diagnosed multiple myeloma along with a history of systemic mastocytosis who developed evidence of an autoimmune enteropathy shortly after initiating lenalidomide based therapy.
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Affiliation(s)
- Stephanie Lakritz
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
| | - Peter A. Forsberg
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
| | - Daniel W. Sherbenou
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
| | - Tomer M. Mark
- Department of Medicine, Division of Hematology University of Colorado School of Medicine Aurora Colorado USA
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4
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Synergistic Anti-proliferative Effects of Lenalidomide and Dexamethasone on the HT-29 Cell Line Through Apoptotic Genes. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Colorectal cancer (CRC) is the third most common cancer among men and the second most common type of cancer among women worldwide. The resistance of tumor cells to apoptosis is caused by changes in the expression of anti-apoptotic or pro-apoptotic proteins. Histone deacetylase inhibitors (HDACi) are known to cause changes in gene expression. Objectives: The present study aimed at investigating the anti-proliferative effects of lenalidomide (LEN) as HDACi and dexamethasone (DEX) on the human colon cancer HT-29 cell line. Methods: The HT-29 cell line was treated with various concentrations of LEN and DEX individually and in combination for 24, 48, and 72 hours. Cytotoxicity was evaluated by MTT assay. The half-maximal inhibitory concentration (IC50) was measured, and quantitative real-time polymerase chain reaction (qRT-PCR) was also performed to examine the expression of Bcl2, Bax, Fas, and FasL genes. Results: The combination of LEN (1000 µM) with DEX (100 µM) showed potent synergistic anti-proliferative activities in a time- and dose-dependent manner. The combination of these drugs induced cell death by affecting the extrinsic and intrinsic apoptotic gene expression profiles. Conclusions: The combination of LEN with DEX can be proposed as a new therapeutic approach for CRC.
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5
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Jindal N, Lad DP, Malhotra P, Prakash G, Khadwal A, Jain A, Sachdeva MS, Sreedharanunni S, Naseem S, Varma N, Varma S. Randomized controlled trial of individualized, low dose, fixed duration lenalidomide maintenance versus observation after frontline chemo-immunotherapy in CLL. Leuk Lymphoma 2021; 62:1674-1681. [PMID: 33612059 DOI: 10.1080/10428194.2021.1885668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lenalidomide maintenance after frontline chemo-immunotherapy (CIT) in chronic lymphocytic leukemia (CLL) has not been standard due to the availability of novel therapies, though these remain out of reach for most in low-middle income countries. This single-center, open-label study randomized CLL patients (non-deletion 17p) after frontline therapy to lenalidomide maintenance (dose-escalated 2.5-10mg, 20/28 days per cycle for six months) or observation (2:1 allocation). Forty patients were included over 2018-2020. At a median follow-up of 22 months, median progression-free survival (PFS) with lenalidomide was not significantly different than observation (26 vs. 18 months, p = 0.4). Patients with minimal residual disease >10-2 had a trend toward better PFS with lenalidomide (19 vs. 7 months, p = 0.07). Grade 3 neutropenia was seen in 16.7% of patients on lenalidomide. Quality of life was comparable between the two arms. Low dose, fixed duration lenalidomide maintenance is not an effective strategy after frontline CIT in CLL.
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Affiliation(s)
- Nishant Jindal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh P Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manupdesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Ma H, Cheng B, Montanari F, Lue JK, Deng C, Marchi E, O' Connor OA, Sawas A. Low dose continuous lenalidomide in heavily pretreated patients with relapsed or refractory classical Hodgkin lymphoma: a retrospective case series. Ther Adv Hematol 2020; 11:2040620720947340. [PMID: 33062232 PMCID: PMC7534065 DOI: 10.1177/2040620720947340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/25/2020] [Indexed: 11/15/2022] Open
Abstract
Patients with relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL) following autologous stem cell transplant (ASCT) remain a management challenge with few reliably effective treatments. Lenalidomide, an immunomodulatory drug approved for patients with myelodysplastic syndrome with del(5q), multiple myeloma, and mantle cell lymphoma, has demonstrated some activity in patients with R/R cHL, though the toxicity of traditional doses and schedules has been a barrier to consistent use. Low dose continuous (LDC) schedules have emerged as promising, with a more favorable safety profile. We report herein that LDC schedules are associated with a far more tolerable toxicity profile, and exhibit at least equivalent efficacy in this patient population. We report that patients diagnosed with R/R cHL who previously underwent, or were not candidates for, ASCT and/or clinical trials, were administered daily LDC lenalidomide (20 mg orally with dose reduction for toxicity). Among the 19 patients included in this analysis, 11% of patients achieved a partial response (PR), with no documented complete responses (CR). A total of 12 (63%) patients maintained stable disease (SD), with 7 patients (37%) remaining in SD for more than 6 months. The clinical benefit rate (comprised of CR, PR, and SD for greater than 6 months) was 47% (7 out of 19 patients). The median progression-free survival and overall survival of all patients were 9.4 months (range, 4.6–14.4 months) and 90 months (range, 63.6–166.8 months), respectively. In general, the treatment was well tolerated, with grade 3 or 4 adverse events consisting of neutropenia (n = 4), and one case each of thrombocytopenia, fatigue, rash, creatinine elevation, aspartate transaminase/alanine transaminase elevation, and treatment related secondary malignancy. In a heavily treated R/R cHL patient population, daily LDC lenalidomide was associated with a high disease control rate with a favorable toxicity profile.
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Affiliation(s)
- Helen Ma
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Bin Cheng
- Department of Statistics, Columbia University Irving Medical Center, New York, NY, USA
| | - Francesca Montanari
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer K Lue
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Changchun Deng
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Enrica Marchi
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Owen A O' Connor
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Ahmed Sawas
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, 51 West 51st Street Suite 200, New York, NY 10019, USA
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7
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Lang CCV, Ramelyte E, Dummer R. Innovative Therapeutic Approaches in Primary Cutaneous B Cell Lymphoma. Front Oncol 2020; 10:1163. [PMID: 32850331 PMCID: PMC7426470 DOI: 10.3389/fonc.2020.01163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Primary cutaneous B-cell lymphomas (pCBCL) include an infrequent group of non-Hodgkin lymphomas that are limited to skin sites at the time of diagnosis. They comprise roughly 20–25% of all cutaneous lymphomas and are subdivided into primary cutaneous marginal zone lymphoma (PCMZL), primary cutaneous follicle center lymphoma (PCFCL), and primary cutaneous diffuse large cell B cell lymphoma, leg type (PCDLCBCL, LT). The first two show a rather indolent course while PCDLCBCL, LT carries a worse prognosis. Intravascular large cell B-cell lymphoma is the most infrequent subtype, and its therapy is not covered in this review. Topical Therapy: For solitary, single-site PCMZL and PCFCL, several topical treatment options exist. They include, but are not limited to, excision, radiotherapy, and intralesional therapies, discussed in this review. However, in selected cases, even “watchful waiting” is reasonable. Systemic Therapy: Indolent types of pCBCL rarely require systemic treatment. However, in extended cases and more importantly DLCBCL, LT, systemic treatment is the first choice. Monoclonal anti-CD20-antibody rituximab is often used as monotherapy in PCMZL and PCFCL or combined with chemotherapy in PCDLBCL, LT. Newer options are monoclonal anti-CD40 antibody dacetuzumab, anti-PD-1 and anti-PD-L1 checkpoint inhibitors, and Bruton tyrosine kinase inhibitors. Conclusion: Indolent pCBCL are treated with a risk-adapted strategy using intralesional steroids, RT, and interferon-α as first-line treatments. Relapsing cases may profit from rituximab. In aggressive PCDLCBCL, LT, rituximab with polychemotherapy is recommended. Innovative therapies include intralesional oncolytic virotherapy, systemic monoclonal antibodies, and small molecules.
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Affiliation(s)
- Claudia C V Lang
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
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8
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HOVON110/ReBeL Study: Results of the Phase I Part of a Randomized Phase I/II Study of Lenalidomide, Rituximab With or Without Bendamustine in Patients With Relapsed/Refractory Follicular Lymphoma. Hemasphere 2020; 4:e325. [PMID: 32072141 PMCID: PMC7000479 DOI: 10.1097/hs9.0000000000000325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/25/2022] Open
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9
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Petty AJ, Yang Y. Tumor-Associated Macrophages in Hematologic Malignancies: New Insights and Targeted Therapies. Cells 2019; 8:cells8121526. [PMID: 31783588 PMCID: PMC6952752 DOI: 10.3390/cells8121526] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/14/2022] Open
Abstract
The growth of hematologic malignant cells can be facilitated by other non-tumor cells within the same microenvironment, including stromal, vascular, immune and mesenchymal stem cells. Macrophages are an integral part of the human innate immune system and the tumor microenvironment. Complex interplays between the malignant hematologic cells and the infiltrating macrophages promote the formation of leukemia, lymphoma or myeloma-associated macrophages. These pro-tumorigenic macrophages in turn play an important part in facilitating tumor growth, metastasis and chemotherapeutic resistance. Previous reports have highlighted the association between tumor-associated macrophages (TAMs) and disease progression in hematologic malignancies. This review summarizes the role of TAMs in different subtypes of leukemia, lymphoma and myeloma, focusing on new insights and targeted therapies.
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Affiliation(s)
- Amy J. Petty
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27710, USA;
- Division of Hematology, The Ohio State University Wexner Medical Center, 508 BRT, 460 W 12th Avenue, Columbus, OH 43210, OH, USA
| | - Yiping Yang
- Division of Hematology, The Ohio State University Wexner Medical Center, 508 BRT, 460 W 12th Avenue, Columbus, OH 43210, OH, USA
- Correspondence: ; Tel.: +1-(614)-685-0643; Fax: +1-(614)-293-7526
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10
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Efficacy of the novel CDK7 inhibitor QS1189 in mantle cell lymphoma. Sci Rep 2019; 9:7193. [PMID: 31076643 PMCID: PMC6510728 DOI: 10.1038/s41598-019-43760-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/14/2019] [Indexed: 01/05/2023] Open
Abstract
Mantle cell lymphoma (MCL) is typically an aggressive and rare form of non-Hodgkin lymphoma (NHL) with a poor prognosis despite recent advances in immunochemotherapy and targeted therapeutics against NHL. New therapeutic agents are needed for MCL. In this study, we generated a potent inhibitor of cyclin-dependent kinase 7 (CDK7), designated QS1189, and confirmed its anti-cancer effects towards MCL and other lymphomas. QS1189 was highly selective for CDK7 and showed potent anticancer effects in MCL compared to other targeted therapeutic agents, such as ibrutinib and venetoclax. Consistent with a conventional CDK7 inhibitor, QS1189 treatment significantly decreased phosphorylation of the carboxyl-terminal domain of RNA polymerase II and transcription-associated genes. QS1189 induced cell cycle arrest at the G2/M phase and apoptosis. Interestingly, QS1189 overcame the acquired resistance to venetoclax, which is mediated by Bcl-xL. Similarly, QS1189 showed potent tumour cell growth inhibition of various lymphomas. Thus, CDK7 might be a suitable therapeutic target for inhibiting lymphoma, and QS1189 is a promising therapeutic option for various lymphomas and cells with acquired resistance to targeted therapy.
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11
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Mina AA, Vakkalagadda C, Pro B. Novel Therapies and Approaches to Relapsed/Refractory HL Beyond Chemotherapy. Cancers (Basel) 2019; 11:cancers11030421. [PMID: 30934568 PMCID: PMC6468730 DOI: 10.3390/cancers11030421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/20/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022] Open
Abstract
Although Hodgkin lymphoma (HL) is highly curable with first-line therapy, relapses occur in approximately 10–20% of patients with early stage disease and 30–40% of patients with advanced stage disease. The standard approach for relapsed or refractory disease is salvage therapy, followed by consolidation with high dose therapy and autologous stem cell transplant (ASCT). Patients who achieve a complete response to salvage therapy prior to ASCT have better outcomes, thus recent studies have focused on incorporating newer agents in this setting. Major challenges in the management of relapsed patients remain how to choose and sequence the many salvage therapies that are currently available and how to best incorporate novel agents in the current treatment paradigms. In this article, we will summarize the most recent advances in the management of patients with recurrent HL and will mainly focus on the role of new agents approved and under investigation. Aside from brentuximab vedotin and checkpoint inhibitors, other novel agents and therapies are showing promising early results. However, at least with some of the newest targeted strategies, it is important to recognize that we are facing new challenges in terms of toxicities, which require very close monitoring and education of both the patient and treating physician.
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Affiliation(s)
- Alain Antoine Mina
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
| | - Chetan Vakkalagadda
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
| | - Barbara Pro
- Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine Chicago Illinois, Chicago, IL 60611, USA.
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12
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Shahrabi S, Zayeri ZD, Ansari N, Hadad EH, Rajaei E. Flip-flops of natural killer cells in autoimmune diseases versus cancers: Immunologic axis. J Cell Physiol 2019; 234:16998-17010. [PMID: 30864163 DOI: 10.1002/jcp.28421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/03/2019] [Accepted: 02/14/2019] [Indexed: 12/25/2022]
Abstract
Natural killer (NK) cells play an essential role in the immune response to infections, inflammations, and malignancies. Recent studies suggest that NK cell surface receptors and cytokines are the key points of the disease development and protection. We hypothesized that the interactions between NK cell receptors and targeted cells construct an eventual niche, and this niche has an eventual profile in various autoimmune diseases and cancers. The NK cells preactivated with cytokines, such as interleukin-2 (IL-2), IL-12, IL-15, and IL-18 can have higher cytotoxicity; however, the toxic side effect of IL-2 should be considered. The vicissitudes of NK cell profile and its receptors obey the environmental communications and cell interactions. Our vision around the NK cells as an immune axis remained dual, and we still cannot judge the immune responses based on the NK cell flip-flop. A design of eventual niche to monitor the NK cell and targeted cell interaction is needed to strengthen our ability in diagnosis and treatment approaches based on the NK cells. Here, we have reviewed the shifts in the NK cells and their surface receptors in autoimmune diseases, solid tumors, and leukemia, and also discussed the effective chemokines that affect NK cell activation and proliferation. The main aim of this review is to present a broader vision of the NK cell changes in autoimmune disease and cancers.
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Affiliation(s)
- Saeid Shahrabi
- Department of Biochemistry and Hematology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Zeinab D Zayeri
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Narges Ansari
- Isfahan Bone Metabolic Disorders Research Center, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham H Hadad
- Research Center of Thalassemia and Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Rajaei
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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13
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Sabhachandani P, Sarkar S, Mckenney S, Ravi D, Evens AM, Konry T. Microfluidic assembly of hydrogel-based immunogenic tumor spheroids for evaluation of anticancer therapies and biomarker release. J Control Release 2019; 295:21-30. [PMID: 30550941 PMCID: PMC6396303 DOI: 10.1016/j.jconrel.2018.12.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 12/20/2022]
Abstract
Diffuse large B cell lymphoma (DLBCL), the most common subtype of Non-Hodgkin lymphoma, exhibits pathologic heterogeneity and a dynamic immunogenic tumor microenvironment (TME). However, the lack of preclinical in vitro models of DLBCL TME hinders optimal therapeutic screening. This study describes the development of an integrated droplet microfluidics-based platform for high-throughput generation of immunogenic DLBCL spheroids. The spheroids consist of three cell types (cancer, fibroblast and lymphocytes) in a novel hydrogel combination of alginate and puramatrix, which promoted cell adhesion and aggregation. This system facilitates dynamic analysis of cellular interaction, proliferation and therapeutic efficacy via spatiotemporal monitoring and secretome profiling. The immunomodulatory drug lenalidomide had direct anti-proliferative effect on activated B-cell like DLBCL spheroids and reduced several cytokines and other markers (e.g., CCL2, CCL3, CCL4, CD137 and ANG-1 levels) compared with untreated spheroids. Collectively, this novel spheroid platform will enable high-throughput anti-cancer therapeutic screening in a semi-automated manner.
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MESH Headings
- Alginates/chemistry
- Antineoplastic Agents/pharmacology
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/immunology
- Cell Culture Techniques/instrumentation
- Cell Culture Techniques/methods
- Cell Line
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cells, Cultured
- Coculture Techniques/instrumentation
- Coculture Techniques/methods
- Drug Screening Assays, Antitumor/instrumentation
- Drug Screening Assays, Antitumor/methods
- Equipment Design
- Humans
- Hydrogels/chemistry
- Immunologic Factors/pharmacology
- Lab-On-A-Chip Devices
- Lenalidomide/pharmacology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Spheroids, Cellular/drug effects
- Spheroids, Cellular/immunology
- Tumor Cells, Cultured/drug effects
- Tumor Cells, Cultured/immunology
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Affiliation(s)
- Pooja Sabhachandani
- Department of Pharmaceutical Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Saheli Sarkar
- Department of Pharmaceutical Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Seamus Mckenney
- Department of Pharmaceutical Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA
| | - Dashnamoorthy Ravi
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tania Konry
- Department of Pharmaceutical Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA.
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14
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Haseeb M, Anwar MA, Choi S. Molecular Interactions Between Innate and Adaptive Immune Cells in Chronic Lymphocytic Leukemia and Their Therapeutic Implications. Front Immunol 2018; 9:2720. [PMID: 30542344 PMCID: PMC6277854 DOI: 10.3389/fimmu.2018.02720] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/05/2018] [Indexed: 12/15/2022] Open
Abstract
Innate immunity constitutes the first line of host defense against various anomalies in humans, and it also guides the adaptive immune response. The function of innate immune components and adaptive immune components are interlinked in hematological malignancies including chronic lymphocytic leukemia (CLL), and molecular interactions between innate and adaptive immune components are crucial for the development, progression and the therapeutic outcome of CLL. In this leukemia, genetic mutations in B cells and B cell receptors (BCR) are key driving factors along with evasion of cytotoxic T lymphocytes and promotion of regulatory T cells. Similarly, the release of various cytokines from CLL cells triggers the protumor phenotype in macrophages that further edges the CLL cells. Moreover, under the influence of various cytokines, dendritic cells are unable to mature and trigger T cell mediated antitumor response. The phenotypes of these cells are ultimately controlled by respective signaling pathways, the most notables are BCR, Wnt, Notch, and NF-κB, and their activation affects the cytokine profile that controls the pathogenesis of CLL, and challenge its treatment. There are several novel substances for CLL under clinical development, including kinase inhibitors, antibodies, and immune-modulators that offer new hopes. DC-based vaccines and CAR T cell therapy are promising tools; however, further studies are required to precisely dissect the molecular interactions among various molecular entities. In this review, we systematically discuss the involvement, common targets and therapeutic interventions of various cells for the better understanding and therapy of CLL.
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Affiliation(s)
- Muhammad Haseeb
- Department of Molecular Science and Technology, Ajou University, Suwon, South Korea
| | - Muhammad Ayaz Anwar
- Department of Molecular Science and Technology, Ajou University, Suwon, South Korea
| | - Sangdun Choi
- Department of Molecular Science and Technology, Ajou University, Suwon, South Korea
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15
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Tilly H, Morschhauser F, Casasnovas O, Molina TJ, Feugier P, Gouill SL, Haioun C, Tournilhac O, Bouabdallah R, Gabarre J, Lamy T, Cabeçadas J, Becker S, Jardin F, Mounier N, Salles G. Lenalidomide in combination with R-CHOP (R2-CHOP) as first-line treatment of patients with high tumour burden follicular lymphoma: a single-arm, open-label, phase 2 study. LANCET HAEMATOLOGY 2018; 5:e403-e410. [DOI: 10.1016/s2352-3026(18)30131-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022]
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16
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Beylot-Barry M, Mermin D, Maillard A, Bouabdallah R, Bonnet N, Duval-Modeste AB, Mortier L, Ingen-Housz-Oro S, Ram-Wolff C, Barete S, Dalle S, Maubec E, Quereux G, Templier I, Bagot M, Grange F, Joly P, Vergier B, Vially PJ, Gros A, Pham-Ledard A, Frison E, Merlio JP. A Single-Arm Phase II Trial of Lenalidomide in Relapsing or Refractory Primary Cutaneous Large B-Cell Lymphoma, Leg Type. J Invest Dermatol 2018; 138:1982-1989. [DOI: 10.1016/j.jid.2018.03.1516] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/23/2018] [Accepted: 03/12/2018] [Indexed: 12/17/2022]
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17
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Xia AL, Wang XC, Lu YJ, Lu XJ, Sun B. Chimeric-antigen receptor T (CAR-T) cell therapy for solid tumors: challenges and opportunities. Oncotarget 2017; 8:90521-90531. [PMID: 29163850 PMCID: PMC5685771 DOI: 10.18632/oncotarget.19361] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/18/2017] [Indexed: 12/11/2022] Open
Abstract
Chimeric antigen receptor (CAR)-engineered T cells (CAR-T cells) have been shown to have unprecedented efficacy in B cell malignancies, most notably in B cell acute lymphoblastic leukemia (B-ALL) with up to a 90% complete remission rate using anti-CD19 CAR-T cells. However, CAR T-cell therapy for solid tumors currently is faced with numerous challenges such as physical barriers, the immunosuppressive tumor microenvironment and the specificity and safety. The clinical results in solid tumors have been much less encouraging, with multiple cases of toxicity and a lack of therapeutic response. In this review, we will discuss the current stats and challenges of CAR-T cell therapy for solid tumors, and propose possibl e solutions and future perspectives.
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Affiliation(s)
- An-Liang Xia
- Liver Transplantation Center of the First Affiliated Hospital and Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu Province 210029, P.R. China
| | - Xiao-Chen Wang
- Liver Transplantation Center of the First Affiliated Hospital and Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu Province 210029, P.R. China
| | - Yi-Jun Lu
- Liver Transplantation Center of the First Affiliated Hospital and Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu Province 210029, P.R. China
| | - Xiao-Jie Lu
- Liver Transplantation Center of the First Affiliated Hospital and Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu Province 210029, P.R. China
| | - Beicheng Sun
- Liver Transplantation Center of the First Affiliated Hospital and Collaborative Innovation Center For Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu Province 210029, P.R. China
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18
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Rosenthal A, Dueck AC, Ansell S, Gano K, Conley C, Nowakowski GS, Camoriano J, Leis JF, Mikhael JR, Keith Stewart A, Inwards D, Dingli D, Kumar S, Noel P, Gertz M, Porrata L, Russell S, Colgan J, Fonseca R, Habermann TM, Kapoor P, Buadi F, Leung N, Tiedemann R, Witzig TE, Reeder C. A phase 2 study of lenalidomide, rituximab, cyclophosphamide, and dexamethasone (LR-CD) for untreated low-grade non-Hodgkin lymphoma requiring therapy. Am J Hematol 2017; 92:467-472. [PMID: 28230270 DOI: 10.1002/ajh.24693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/15/2017] [Accepted: 02/18/2017] [Indexed: 11/06/2022]
Abstract
Patients with indolent non-Hodgkin lymphoma (NHL) have multiple treatment options yet there is no consensus as to the best initial therapy. Lenalidomide, an immunomodulatory agent, has single agent activity in relapsed lymphoma. This trial was conducted to assess feasibility, efficacy, and safety of adding lenalidomide to rituximab, cyclophosphamide, and dexamethasone (LR-CD) in untreated indolent NHL patients requiring therapy. This was a single institution phase II trial. Treatment consisted of IV rituximab 375 mg/m2 day 1; oral lenalidomide 20 mg days 1-21; cyclophosphamide 250 mg/m2 days 1, 8, and 15; and dexamethasone 40 mg days 1, 8, 15, and 22 of a 28-day cycle. Treatment continued 2 cycles beyond best response for a maximum of 12 cycles without rituximab maintenance. Thirty-three patients were treated. Median age was 68 (43-83 years). 39% had stage IV disease. Histologic subtypes included 8 follicular lymphoma (FL), 7 marginal zone lymphoma (MZL) (1 splenic, 2 extranodal, and 4 nodal), 15 Waldenström's macroglobulinemia (WM), 1 lymphoplasmacytic lymphoma, 1 small lymphocytic lymphoma, and 1 low-grade B-cell lymphoma with plasmacytic differentiation (unable to be classified better as MZL or LPL). Hematologic toxicity was the most common adverse event. Median time of follow-up was 23.4 months (range 1.8-50.9). The overall response rate was 87.9%, with 30.3% complete response. The median duration of response was 38.7 months. The median progression free survival was 39.7 months, while median overall survival (OS) has not yet been reached. Lenalidomide can be safely added to a simple regimen of rituximab, oral cyclophosphamide, and dexamethasone and is an effective combination as initial therapy for low-grade B-cell NHL.
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19
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CAR T-cell therapy of solid tumors. Immunol Cell Biol 2016; 95:356-363. [PMID: 28003642 DOI: 10.1038/icb.2016.128] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 12/18/2016] [Accepted: 12/19/2016] [Indexed: 12/14/2022]
Abstract
The potential for immunotherapy as a treatment option for cancer is clear from remarkable responses of some leukemia patients to adoptive cell transfer using autologous T cells genetically modified to express chimeric antigen receptors (CARs). However, the vast majority of cancers, in particular the more common solid cancers, such as those of the breast, colon and lung, fail to respond significantly to infusions of CAR T cells. Solid cancers present some formidable barriers to adoptive cell transfer, including suppression of T-cell function and inhibition of T-cell localization. In this review, we discuss the current state of CAR T-cell therapy in solid cancers, the variety of concepts being investigated to overcome these barriers as well as approaches aimed at increasing the specificity and safety of adoptive cell transfer.
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20
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Novel Drugs in Follicular Lymphoma. Mediterr J Hematol Infect Dis 2016; 8:e2016061. [PMID: 27872741 PMCID: PMC5111511 DOI: 10.4084/mjhid.2016.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/25/2016] [Indexed: 12/27/2022] Open
Abstract
Follicular lymphoma(FL) is the most common indolent non-Hodgkin lymphoma and constitutes 15% to 30% of lymphoma diagnoses. The natural history of the disease is characterized by recurrent relapses and progressively shorter remissions with a median survival of 10yrs. The impossibility of achieving a definite cure, have prompted investigations into the possible role of more active and less toxic strategies with innovative therapeutic agents. Recently Casulo et al. demonstrated that approximately 20% of patients with FL relapse within two years after achieving remission with R-CHOP and have a poor prognosis. It is conceivable that this particularly chemoresistant population would benefit from specifically targeting the biologic and genetic factors that likely contribute to their poor prognosis. Evolving strategies for difficult to treat FL patients have recently considered immunomodulatory agents, new monoclonal antibodies as well as drugs targeting selective intracellular pathways. The importance of targeting the microenvironment together with the malignant FL cell has been particularly underscored. We review the most promising approaches, such as combining anti-CD20 antibodies with immunomodulatory drugs (Lenalidomide), mAbs directed against other surface antigens such as CD22 and CD23 (Epratuzumab, Lumiliximab), immunomodulatory antibodies such as PD-1, or inhibitors of key steps in the B-cell receptor pathway signaling such as PI3K inhibitors (Idelalisib, Duvelisib). Another highly attractive approach is the application of the bi-specific T-cell engaging (BiTE) antibody blinatumomab which targets both CD19 and CD3 antigens. Moreover, we highlight the potential of these therapies, taking into account their toxicity. Of course, we must wait for Phase III trials results to confirm the benefit of these new treatment strategies toward a new era of chemotherapy-free treatment for follicular lymphoma.
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21
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Galletti G, Caligaris-Cappio F, Bertilaccio MTS. B cells and macrophages pursue a common path toward the development and progression of chronic lymphocytic leukemia. Leukemia 2016; 30:2293-2301. [DOI: 10.1038/leu.2016.261] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/22/2016] [Accepted: 08/30/2016] [Indexed: 12/30/2022]
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22
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Arora M, Gowda S, Tuscano J. A comprehensive review of lenalidomide in B-cell non-Hodgkin lymphoma. Ther Adv Hematol 2016; 7:209-21. [PMID: 27493711 PMCID: PMC4959641 DOI: 10.1177/2040620716652861] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Lenalidomide, an immunomodulatory drug that the US Food and Drug Administration (FDA) approved for the treatment of multiple myeloma, 5q- myelodysplasia and mantle-cell lymphoma (MCL), has encouraging efficacy in other B-cell malignancies. Its unique mechanism of action is in part due to altering the tumor microenvironment and potentiating the activity of T and natural-killer (NK) cells. Impressive clinical activity and excellent tolerability allows broad applicability. Lenalidomide has been used in a wide range of B-cell malignancies for years, but in 2013, the FDA marked its approval as a single agent only in relapsed/refractory mantle-cell lymphoma. Perhaps most impressive is the efficacy of lenalidomide when combined with monoclonal antibodies. Impressive efficacy and toxicity profiles with the combination of lenalidomide and rituximab in B-cell lymphomas in both the upfront and relapsed/refractory setting may allow a shift in our current treatment paradigm in both indolent and aggressive non-Hodgkin lymphoma (NHL). This review will summarize the current data in the relapsed/refractory and front-line setting of NHL with single-agent lenalidomide as well as its use in combination with other agents.
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Affiliation(s)
- Mili Arora
- Division of Hematology and Oncology, Department of Internal Medicine, NC, USA Department of Veterans’ Affairs, Northern Carolina Healthcare System, NC, USA
| | - Sonia Gowda
- Division of Hematology and Oncology, Department of Internal Medicine, NC, USA
| | - Joseph Tuscano
- Division of Hematology and Oncology, Department of Internal Medicine, Department of Veterans’ Affairs, Northern Carolina Healthcare System, UC Davis Medical Center4501 X StreetSacramento, CA 95817, USA
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23
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Einsele H, Schreder M. Treatment of multiple myeloma with the immunostimulatory SLAMF7 antibody elotuzumab. Ther Adv Hematol 2016; 7:288-301. [PMID: 27695618 PMCID: PMC5026292 DOI: 10.1177/2040620716657993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Elotuzumab is a humanized monoclonal antibody targeting the extracellular domain of signaling lymphocytic activation molecule F7 (SLAMF7) highly expressed in multiple myeloma cells. Upon binding to myeloma cells, elotuzumab exerts its cytotoxic effects through antibody-dependent cellular cytotoxicity, the antibody-induced selective lysis of tumor cells by activated natural killer (NK) cells. Furthermore, elotuzumab has been shown to directly induce NK-cell activation by binding to SLAMF7 expressed on NK cells and to indirectly modulate T-cell function by promoting the secretion of cytokines from NK cells. In combination with lenalidomide and low-dose dexamethasone, elotuzumab has shown remarkable effects in patients with relapsed or refractory multiple myeloma. In these patients, the risk of disease progression or death was significantly reduced by 30% on elotuzumab. Currently, elotuzumab is being evaluated in various myeloma patient populations and combination regimens. This review discusses the use of elotuzumab as an antimultiple myeloma agent and provides an update on the results of recent clinical trials evaluating the safety and efficacy of elotuzumab for the treatment of multiple myeloma.
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Affiliation(s)
- Hermann Einsele
- Medizinische Klinik und Poliklinik II, University of Wuerzburg, Oberduerrbacher Straße 6, Haus A3, 97080 Wuerzburg, Germany
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24
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Leuci V, Maione F, Rotolo R, Giraudo E, Sassi F, Migliardi G, Todorovic M, Gammaitoni L, Mesiano G, Giraudo L, Luraghi P, Leone F, Bussolino F, Grignani G, Aglietta M, Trusolino L, Bertotti A, Sangiolo D. Lenalidomide normalizes tumor vessels in colorectal cancer improving chemotherapy activity. J Transl Med 2016; 14:119. [PMID: 27149858 PMCID: PMC4857418 DOI: 10.1186/s12967-016-0872-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 04/20/2016] [Indexed: 12/19/2022] Open
Abstract
Background Angiogenesis inhibition is a promising approach for treating metastatic colorectal cancer (mCRC). Recent evidences support the seemingly counterintuitive ability of certain antiangiogenic drugs to promote normalization of residual tumor vessels with important clinical implications. Lenalidomide is an oral drug with immune-modulatory and anti-angiogenic activity against selected hematologic malignancies but as yet little is known regarding its effectiveness for solid tumors. The aim of this study was to determine whether lenalidomide can normalize colorectal cancer neo-vessels in vivo, thus reducing tumor hypoxia and improving the benefit of chemotherapy. Methods We set up a tumorgraft model with NOD/SCID mice implanted with a patient-derived colorectal cancer liver metastasis. The mice were treated with oral lenalidomide (50 mg/Kg/day for 28 days), intraperitoneal 5-fluorouracil (5FU) (20 mg/Kg twice weekly for 3 weeks), combination (combo) of lenalidomide and 5FU or irrelevant vehicle. We assessed tumor vessel density (CD146), pericyte coverage (NG2; alphaSMA), in vivo perfusion capability of residual vessels (lectin distribution essay), hypoxic areas (HP2-100 Hypoxyprobe) and antitumor activity in vivo and in vitro. Results Treatment with lenalidomide reduced tumor vessel density (p = 0.0001) and enhanced mature pericyte coverage of residual vessels (p = 0.002). Perfusion capability of tumor vessels was enhanced in mice treated with lenalidomide compared to controls (p = 0.004). Accordingly, lenalidomide reduced hypoxic tumor areas (p = 0.002) and enhanced the antitumor activity of 5FU in vivo. The combo treatment delayed tumor growth (p = 0.01) and significantly reduced the Ki67 index (p = 0.0002). Lenalidomide alone did not demonstrate antitumor activity compared to untreated controls in vivo or against 4 different mCRC cell lines in vitro. Conclusions We provide the first evidence of tumor vessel normalization and hypoxia reduction induced by lenalidomide in mCRC in vivo. This effect, seemingly counterintuitive for an antiangiogenic compound, translates into indirect antitumor activity thus enhancing the therapeutic index of chemotherapy. Our findings suggest that further research should be carried out on synergism between lenalidomide and conventional therapies for treating solid tumors that might benefit from tumor vasculature normalization.
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Affiliation(s)
- V Leuci
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - F Maione
- Laboratory of Transgenic Mouse Models, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - R Rotolo
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - E Giraudo
- Laboratory of Transgenic Mouse Models, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy.,Department of Science and Drug Technology, University of Torino, Turin, Italy
| | - F Sassi
- Laboratory of Translational Cancer Medicine, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - G Migliardi
- Laboratory of Translational Cancer Medicine, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - M Todorovic
- Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - L Gammaitoni
- Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - G Mesiano
- Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - L Giraudo
- Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - P Luraghi
- Laboratory of Cancer Stem Cell Research, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - F Leone
- Department of Oncology, University of Torino, Turin, Italy.,Division and Laboratory of Medical Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - F Bussolino
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Vascular Oncology, Candiolo Cancer Institute, Candiolo, Turin, Italy
| | - G Grignani
- Division and Laboratory of Medical Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - M Aglietta
- Department of Oncology, University of Torino, Turin, Italy.,Division and Laboratory of Medical Oncology, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - L Trusolino
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Translational Cancer Medicine, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - A Bertotti
- Department of Oncology, University of Torino, Turin, Italy.,Laboratory of Translational Cancer Medicine, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy
| | - D Sangiolo
- Department of Oncology, University of Torino, Turin, Italy. .,Laboratory of Medical Oncology-Experimental Cell Therapy, Candiolo Cancer Institute-FPO- IRCCS, Candiolo, Turin, Italy.
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25
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Lenalidomide: a review of its continuous use in patients with newly diagnosed multiple myeloma not eligible for stem-cell transplantation. Drugs Aging 2016; 32:409-18. [PMID: 25925941 DOI: 10.1007/s40266-015-0269-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lenalidomide (Revlimid(®)) is a second-generation immunomodulatory drug structurally related to thalidomide, with improved efficacy and tolerability, for which the label in the EU was recently expanded to include continuous therapy in patients with previously untreated multiple myeloma not eligible for stem-cell transplantation. In randomized, controlled clinical trials, continuous lenalidomide therapy, either in combination with dexamethasone (FIRST trial) or as maintenance monotherapy following induction with melphalan/prednisone/lenalidomide (MM-015 trial), significantly improved progression-free survival (PFS) compared with induction therapy alone (with non-lenalidomide- or lenalidomide-containing regimens) in patients with newly diagnosed multiple myeloma not eligible for stem-cell transplantation. The improvements in PFS with continuous lenalidomide were reflected in improved health-related quality-of-life measures. An overall survival benefit was observed in the FIRST trial, but not in the MM-015 trial. Continuous lenalidomide and continuous thalidomide regimens displayed similar efficacy, but lenalidomide was associated with significantly less toxicity than thalidomide. Continuous use of lenalidomide did not appear to negatively impact on the drug's tolerability and did not increase the incidence of neutropenia or second primary malignancy compared with shorter-term use. The incidence of most adverse events began to reduce after about 18 months of therapy. In conclusion, continuous lenalidomide regimens provide an effective longer-term treatment option in patients with newly diagnosed multiple myeloma ineligible for stem-cell transplantation.
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Lenalidomide potentiates CD4+CD25+Treg-related suppression of lymphoma B-cell proliferation. Clin Exp Med 2016; 17:193-207. [DOI: 10.1007/s10238-016-0411-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
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Willenbacher W, Thangavadivel S, Greil R, Willenbacher E, Weger R, Manzl C, Jöhrer K, Brunner A. Low Beclin-1 expression predicts improved overall survival in patients treated with immunomodulatory drugs for multiple myeloma and identifies autophagy inhibition as a promising potentially druggable new therapeutic target: an analysis from The Austrian Myeloma Registry (AMR). Leuk Lymphoma 2016; 57:2330-41. [DOI: 10.3109/10428194.2016.1144880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Mantle Cell Lymphoma: First-line Therapy in Patients Not Eligible for Stem Cell Transplantation. Curr Treat Options Oncol 2016; 16:29. [PMID: 25975443 DOI: 10.1007/s11864-015-0343-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OPINION STATEMENT Mantle cell lymphoma is a distinct subtype of non-Hodgkin's lymphoma, which has historically been associated with a poor prognosis. It is now recognized as a heterogeneous disease with variable biologic and clinical behavior. Treatment paradigms have evolved along two lines. Younger, fit mantle cell lymphoma (MCL) patients are generally treated with intensive strategies and older less fit patients with non-intensive strategies. Most of the published literature has focused on intensive strategies, which appear to result in more durable remissions, but with an unclear impact on overall survival. The literature is more sparse for the roughly 50% of patients who are not candidates for intensive strategies, and no "standard" approach has been established for this patient population. However, clues are emerging. Randomized clinical trials have (a) established that bendamustine-rituximab (BR) is more efficacious and less toxic than rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); (b) established that bortezomib should replace vincristine if using an R-CHOP backbone; and (c) established that maintenance rituximab (MR) is beneficial after an R-CHOP induction. In our opinion, it is reasonable to extrapolate the data supporting MR after R-CHOP and apply MR after a BR induction. In our practice, we recommend BR followed by MR for 2 years to MCL patients not eligible for intensive therapy. An ongoing US intergroup trial is testing the addition of bortezomib to the BR backbone and the addition of lenalidomide to MR. This trial may establish a standard of care in the older MCL population. In addition, exciting options for relapsed MCL have emerged in the last few years, with the introduction of the Bruton tyrosine kinase (BTK) inhibitor ibrutinib and the development of the lenalidomide-rituximab combination. In this article, we will discuss the current available options for these older MCL patients and the evidence supporting those options.
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Trimarco V, Ave E, Facco M, Chiodin G, Frezzato F, Martini V, Gattazzo C, Lessi F, Giorgi CA, Visentin A, Castelli M, Severin F, Zambello R, Piazza F, Semenzato G, Trentin L. Cross-talk between chronic lymphocytic leukemia (CLL) tumor B cells and mesenchymal stromal cells (MSCs): implications for neoplastic cell survival. Oncotarget 2015; 6:42130-49. [PMID: 26517523 PMCID: PMC4747215 DOI: 10.18632/oncotarget.6239] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/05/2015] [Indexed: 02/07/2023] Open
Abstract
Leukemic cells from Chronic Lymphocytic Leukemia (CLL) patients interact with stromal cells of the surrounding microenvironment. Mesenchymal Stromal Cells (MSCs) represent the main population in CLL marrow stroma, which may play a key role for disease support and progression. In this study we evaluated whether MSCs influence in vitro CLL cell survival. MSCs were isolated from the bone marrow of 46 CLL patients and were characterized by flow cytometry analysis. Following co-culture of MSCs and leukemic B cells, we demonstrated that MSCs were able to improve leukemic B cell viability, this latter being differently dependent from the signals coming from MSCs. In addition, we found that the co-culture of MSCs with leukemic B cells induced an increased production of IL-8, CCL4, CCL11, and CXCL10 chemokines.As far as drug resistance is concerned, MSCs counteract the cytotoxic effect of Fludarabine/Cyclophosphamide administration in vivo, whereas they do not protect CLL cells from the apoptosis induced by the kinase inhibitors Bafetinib and Ibrutinib. The evidence that leukemic clones are conditioned by environmental stimuli suggest new putative targets for therapy in CLL patients.
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Affiliation(s)
- Valentina Trimarco
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Elisa Ave
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Monica Facco
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Giorgia Chiodin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Federica Frezzato
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Veronica Martini
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Cristina Gattazzo
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Federica Lessi
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Carlo Alberto Giorgi
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Andrea Visentin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Monica Castelli
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
| | - Filippo Severin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Renato Zambello
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Francesco Piazza
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Gianpietro Semenzato
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Livio Trentin
- Padua University School of Medicine, Department of Medicine, Hematology and Clinical Immunology Branch, Padua, Italy
- Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
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Lenalidomide, an anti-tumor drug, regulates retinal endothelial cell function: Implication for treating ocular neovascular disorder. Biochem Biophys Res Commun 2015; 465:678-84. [DOI: 10.1016/j.bbrc.2015.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022]
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Salihoglu A, Ar MC, Soysal T. Novelties in the management of B-cell malignancies: B-cell receptor signaling inhibitors and lenalidomide. Expert Rev Hematol 2015; 8:765-83. [PMID: 26413907 DOI: 10.1586/17474086.2015.1091301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
B-cell lymphoproliferative disorders comprise 85% of Non-Hodgkin's lymphomas. Despite successful chemoimmunotherapy regimens, responses are not durable and the outcome is fatal in a considerable portion of patients. There is an inevitable need for less toxic and more potent therapeutic agents. Over the recent years, a plethora of agents including monoclonal antibodies, Bcl-2 antagonists, tyrosine kinase inhibitors, cyclin-dependent kinase inhibitors, mTOR inhibitors and immunomodulatory drugs have been developed in B-cell malignancies. The aim of this paper is to focus on B-cell receptor signaling inhibitors and lenalidomide as an immunomodulatory drug and to provide insight on how and when to incorporate these agents into the treatment algorithms.
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Affiliation(s)
- Ayse Salihoglu
- a Department of Internal Medicine, Division of Haematology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Muhlis Cem Ar
- a Department of Internal Medicine, Division of Haematology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Hahn NM, Dinney CP, Sonpavde G. Multi-targeted agents in the treatment of urothelial carcinoma. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Leonard JP, Jung SH, Johnson J, Pitcher BN, Bartlett NL, Blum KA, Czuczman M, Giguere JK, Cheson BD. Randomized Trial of Lenalidomide Alone Versus Lenalidomide Plus Rituximab in Patients With Recurrent Follicular Lymphoma: CALGB 50401 (Alliance). J Clin Oncol 2015; 33:3635-40. [PMID: 26304886 DOI: 10.1200/jco.2014.59.9258] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lenalidomide and rituximab (LR) are active agents in follicular lymphoma (FL). Combination regimens have not been previously assessed in randomized studies. PATIENTS AND METHODS The Cancer and Leukemia Group B (Alliance) 50401 trial is a randomized phase II trial studying rituximab (375 mg/m(2) weekly for 4 weeks), lenalidomide (15 mg per day on days 1 to 21, followed by 7 days of rest, in cycle 1 and then 20 mg per day on days 1 to 21, followed by 7 days of rest, in cycles 2 to 12), or LR. The rituximab-alone arm was discontinued as a result of poor accrual. Eligibility included recurrent FL and prior rituximab with time to progression of ≥ 6 months from last dose. Aspirin or heparin was recommended for patients at high thrombosis risk. RESULTS Ninety-one patients (lenalidomide, n = 45; LR, n = 46) received treatment; median age was 63 years (range, 34 to 89 years), and 58% were intermediate or high risk according to the Follicular Lymphoma International Prognostic Index. In the lenalidomide and LR arms, grade 3 to 4 adverse events occurred in 58% and 53% of patients, with 9% and 11% of patients experiencing grade 4 toxicity, respectively; grade 3 to 4 adverse events included neutropenia (16% v 20%, respectively), fatigue (9% v 13%, respectively), and thrombosis (16% [n = 7] v 4% [n = 2], respectively; P = .157). Thirty-six percent of lenalidomide patients and 63% of LR patients completed 12 cycles. Lenalidomide alone was associated with more treatment failures, with 22% of patients discontinuing treatment as a result of adverse events. Dose-intensity exceeded 80% in both arms. Overall response rate was 53% (20% complete response) and 76% (39% complete response) for lenalidomide alone and LR, respectively (P = .029). At the median follow-up of 2.5 years, median time to progression was 1.1 year for lenalidomide alone and 2 years for LR (P = .0023). CONCLUSION LR is more active than lenalidomide alone in recurrent FL with similar toxicity, warranting further study in B-cell non-Hodgkin lymphoma as a platform for addition of novel agents.
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Affiliation(s)
- John P Leonard
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC.
| | - Sin-Ho Jung
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC
| | - Jeffrey Johnson
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC
| | - Brandelyn N Pitcher
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC
| | - Nancy L Bartlett
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC
| | - Kristie A Blum
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC
| | - Myron Czuczman
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC
| | - Jeffrey K Giguere
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC
| | - Bruce D Cheson
- John P. Leonard, Meyer Cancer Center, Weill Cornell Medical College and New York Presbyterian Hospital, New York; Myron Czuczman, Roswell Park Cancer Institute, Buffalo, NY; Sin-Ho Jung, Jeffrey Johnson, and Brandelyn N. Pitcher, Alliance Statistics and Data Center, Duke University, Durham, NC; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Kristie A. Blum, Ohio State University Medical Center, Columbus, OH; Jeffrey K. Giguere, Greenville Community Clinical Oncology Program, Greenville, SC; and Bruce D. Cheson, Georgetown University Hospital, Washington, DC
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Blumel S, Broadway-Duren J. Approaches to Managing Safety With Lenalidomide in Hematologic Malignancies. J Adv Pract Oncol 2015; 5:269-79. [PMID: 26110071 PMCID: PMC4457182 DOI: 10.6004/jadpro.2014.5.4.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Lenalidomide is an oral immunomodulatory agent approved in relapsed multiple myeloma with dexamethasone, for transfusion-dependent anemia in myelodysplastic syndrome associated with deletion 5q, and in relapsed/progressive mantle cell lymphoma following bortezomib. In recent clinical trials, lenalidomide has shown promising activity in hematologic malignancies, including chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL). Starting doses and dosing schedules vary by malignancy, with lenalidomide started at a lower dose for CLL than for NHL or multiple myeloma. Certain adverse events (AEs) are common across tumor types (e.g., neutropenia, thrombocytopenia, fatigue), whereas others are more often associated with CLL patients (e.g., tumor lysis syndrome and tumor flare reaction). Effective management requires awareness of these differences as well as appropriate prophylaxis, monitoring, and treatment of AEs. This article reviews the efficacy and safety of lenalidomide in CLL and NHL, focusing on approaches for the advanced practitioner to improve patient quality of life through optimal management of side effects. With these steps, lenalidomide can be administered safely, at the best starting doses and with minimal dose interruptions or reductions across hematologic malignancies.
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Affiliation(s)
- Susan Blumel
- University of Nebraska Medical Center, Omaha, Nebraska, and MD Anderson Cancer Center, Houston, Texas
| | - Jackie Broadway-Duren
- University of Nebraska Medical Center, Omaha, Nebraska, and MD Anderson Cancer Center, Houston, Texas
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Abstract
Mantle cell lymphoma accounts for 6% of all non-Hodgkin lymphomas. It is a biologically and clinically heterogeneous disease and treatment may be difficult, since most patients present at an older age, being unable to undergo intensive chemotherapy. Lenalidomide is an approved medication for relapsed mantle cell lymphoma in patients who received at least two lines of therapy, including bortezomib. New insights into the mechanisms of action of lenalidomide provided ground for novel combinations that may be more tolerable, while still efficient, for this patient population. In this review, we evaluate the current paradigm for lenalidomide in mantle cell lymphoma.
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Affiliation(s)
- Alan P Skarbnik
- John Theurer Cancer Center at Hackensack University Medical Center, Department of Lymphoma, Bone and Marrow Transplantation Program, 92 Second Street, Hackensack, NJ 07601, USA
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Morabito F, Recchia AG, Vigna E, De Stefano L, Bossio S, Morabito L, Pellicanò M, Palummo A, Storino F, Caruso N, Gentile M. Promising therapies for the treatment of chronic lymphocytic leukemia. Expert Opin Investig Drugs 2015; 24:795-807. [PMID: 25728009 DOI: 10.1517/13543784.2015.1021920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The combination schedule of fludarabine, cyclophosphamide and rituximab is the gold standard of therapy for younger, physically fit chronic lymphocytic leukemia (CLL) patients; it allows achieving high and durable complete response rates. Although treatment outcome has considerably improved with chemo-immunotherapy, most patients eventually relapse and CLL is still incurable. Thus, newer and more rationally developed drugs are needed to improve CLL therapy, particularly in cases of relapsed/refractory disease. AREAS COVERED The authors review preclinical and clinical data regarding newer CLL agents, currently undergoing examination, such as: signal transduction and cyclin-dependent kinase inhibitors, immunomodulatory agents, B-cell lymphoma 2 inhibitors, next generation mAbs, heat shock protein 90 and histone deacetylase inhibitors, and chimeric antigen receptor T-cell therapy. EXPERT OPINION Newer compounds with different mechanisms of action, such as B-cell receptor signal transduction inhibitors, lenalidomide, next generation mAbs and several pro-apoptotic molecules, have shown efficacy in relapsed or refractory CLL patients. Several studies are under way to investigate the efficacy of combinations of these novel drugs. Hopefully, the combined use of these molecules in risk-adapted treatment strategies will change the therapeutic approach in the near future and will pave the way for a long-term control of CLL.
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Affiliation(s)
- Fortunato Morabito
- Azienda Ospedaliera di Cosenza, Dipartimento Oncoematologico, Unità Operativa Complessa di Ematologia , Viale della Repubblica, Cosenza 87100 , Italy +39 0984 681329 ; +39 0984 681866 ; ;
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Ujjani C, Cheson BD. Advances in the treatment of follicular lymphoma. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1011123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ou DL, Chang CJ, Jeng YM, Lin YJ, Lin ZZ, Gandhi AK, Liao SC, Huang ZM, Hsu C, Cheng AL. Potential synergistic anti-tumor activity between lenalidomide and sorafenib in hepatocellular carcinoma. J Gastroenterol Hepatol 2014; 29:2021-31. [PMID: 25160036 DOI: 10.1111/jgh.12708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The immune modulatory drug lenalidomide has shown promising anti-tumor activity in a clinical trial of patients with advanced hepatocellular carcinoma (HCC). The present study explored whether lenalidomide can enhance the anti-tumor activity of sorafenib, the standard molecular targeted therapy for HCC. METHODS The anti-tumor efficacy of single-agent or combination treatment was measured by change in tumor volume and animal survival using an orthotopic liver cancer model. Distribution of T-cell subpopulations in tumor-infiltrating lymphocytes (TILs) and splenocytes derived from tumor-implanted mice was measured by flow cytometry. Depletion of relevant T-cell subpopulations or cytokines was done by co-administration of relevant antibodies with study drug treatment. Tumor cell apoptosis and tumor angiogenesis were measured by transferase deoxytidyl uridine end labeling assay and immunohistochemical study, respectively. RESULTS Combination of sorafenib and lenalidomide produced significant synergistic anti-tumor efficacy in terms of tumor growth delay and animal survival. This synergistic effect was associated with a significant increase in interferon-γ expressing CD8(+) lymphocytes in TILs and a significantly higher number of granzyme- or perforin-expressing CD8(+) T cells, compared with vehicle- or single-agent treatment groups. Combination treatment significantly increased apoptotic tumor cells and vascular normalization in tumor tissue. The synergistic anti-tumor effect was abolished after CD8 depletion. CONCLUSIONS Lenalidomide can enhance the anti-tumor effects of sorafenib in HCC through its immune modulatory effects, and CD8(+) TILs play an important role in the anti-tumor synergism.
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Affiliation(s)
- Da-Liang Ou
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
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Cosenza M, Civallero M, Pozzi S, Marcheselli L, Bari A, Sacchi S. The combination of bortezomib with enzastaurin or lenalidomide enhances cytotoxicity in follicular and mantle cell lymphoma cell lines. Hematol Oncol 2014; 33:166-75. [PMID: 25394177 DOI: 10.1002/hon.2179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/06/2014] [Accepted: 10/09/2014] [Indexed: 01/19/2023]
Abstract
We analyzed the combination of a proteasome inhibitor (bortezomib) with enzastaurin (PKC/AKT-inhibitor) or lenalidomide (immunomodulatory agent) for the inhibition of proliferation and induction of apoptosis in B-cell lymphoma cell lines and primary malignant cells. The effects of bortezomib, enzastaurin or lenalidomide, alone or in combinations, on cell viability and apoptosis were evaluated using the Cell Proliferation Kit and flow cytometry analysis. The interaction between drugs was examined by the Chou-Talalay method. Cell cycle analysis was performed by flow cytometry. The PI3K/AKT, PKC and MAPK/ERK signaling pathways were analyzed using western blot. Bortezomib with either enzastaurin or lenalidomide synergistically induced anti-proliferative and pro-apoptotic effects in B-cell lymphoma cells, even in the presence of the bone marrow microenvironment. The direct cytotoxicity is mediated by signaling events involving the PI3K/AKT, PKC and MAPK/ERK pathways leading to cell death. The significant increase of apoptosis was mediated by an increased ratio of pro-apoptotic proteins (Bax, Bad and Bim) to anti-apoptotic proteins (Bcl-2, Bcl-xL and Mcl-1), triggering the cleavage of caspases -3, -9, -8 and PARP. Further evaluation of the combination of bortezomib with enzastaurin or lenalidomide for the treatment of B-cell lymphoma is warranted, with the goal to improve the quality of life and survival of patients.
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Affiliation(s)
- Maria Cosenza
- Program of Innovative Therapies in Oncology and Haematology, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Civallero
- Program of Innovative Therapies in Oncology and Haematology, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Samantha Pozzi
- Program of Innovative Therapies in Oncology and Haematology, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Program of Innovative Therapies in Oncology and Haematology, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Bari
- Program of Innovative Therapies in Oncology and Haematology, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Sacchi
- Program of Innovative Therapies in Oncology and Haematology, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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40
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Novel agents in the treatment of chronic lymphocytic leukemia: a review about the future. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:314-22. [PMID: 25445466 DOI: 10.1016/j.clml.2014.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/15/2014] [Accepted: 09/24/2014] [Indexed: 01/15/2023]
Abstract
Half of a century ago, physicians managing chronic lymphocytic leukemia (CLL) recognized some of its presenting features such as lymphocytosis, lymphadenopathy, and splenomegaly. Subsequently, an enhanced understanding of the disease mechanisms involved in CLL led to new, more targeted treatments. There is now a plethora of treatments available for CLL. In this review article we discuss in detail several of the novel agents that are being studied or approved for the treatment of CLL including: phosphatidylinositol 3-kinase inhibitors (idelalisib and IPI-145), Bruton tyrosine kinase inhibitors (ibrutinib), B cell lymphoma 2 inhibitors (ABT-263 and ABT-199), new anti-CD20 monoclonal antibodies (obinutuzumab), cyclin-dependent kinase inhibitors (flavopiridol and dinaciclib), immunomodulators (lenalidomide) and chimeric antigen receptor T-cell therapy.
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41
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Rozovski U, Hazan-Halevy I, Keating MJ, Estrov Z. Personalized medicine in CLL: current status and future perspectives. Cancer Lett 2014; 352:4-14. [PMID: 23879961 PMCID: PMC3871981 DOI: 10.1016/j.canlet.2013.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 01/12/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common hematologic malignancy in the Western Hemisphere. Despite advances in research and the development of effective treatment regimens, CLL is still largely an incurable disease. Although several prognostic factors have been identified in recent years, most of the new prognostic factors are not utilized, and treatment decisions are still based on clinical staging and limited use of cytogenetic analysis. Patients with advanced disease are treated at diagnosis, whereas others, regardless of their prognostic indicators, are offered treatment only at disease progression. Furthermore, treatment guidelines for elderly or "unfit" patients are unavailable because most CLL trials have included mostly younger, healthier patients. Given theheterogeneity of the clinical manifestations and prognosis of CLL, patients are likely to benefit from a personalized therapeutic approach. Recent advances in CLL pathobiology research, the use of high-throughput technologies, and most importantly, the introduction of novel targeted therapies with high efficacy and low toxicity are currently transforming the treatment of CLL. A personalized approach that includes early intervention in selected patients with CLL is likely to bring physicians closer to the goal of attaining cures in most patients with CLL.
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Affiliation(s)
- Uri Rozovski
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Inbal Hazan-Halevy
- Laboratory of Nanomedicine, Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Michael J Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zeev Estrov
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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42
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Desai M, Newberry K, Ou Z, Wang M, Zhang L. Lenalidomide in relapsed or refractory mantle cell lymphoma: overview and perspective. Ther Adv Hematol 2014; 5:91-101. [PMID: 24883181 PMCID: PMC4031905 DOI: 10.1177/2040620714532124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Lenalidomide, a novel immunomodulatory agent, was approved by the US Food and Drug Administration for the treatment of myelodysplastic syndrome and relapsed multiple myeloma. Data from preclinical studies paved the way for clinical trials of lenalidomide in mantle cell lymphoma (MCL). Initial phase I and II clinical trials of lenalidomide alone and as part of combination regimens in patients with relapsed/refractory MCL have shown promising results. Its immunomodulatory, T cell costimulatory, anti-inflammatory and anti-angiogenic actions working together in the tumor cell microenvironment seem to be responsible for its enhanced antitumor efficacy. Lenalidomide's nature of action and safety profile favor it over other agents studied in relapsed/refractory MCL. This review summarizes the data from preclinical and clinical studies of lenalidomide in relapsed/refractory MCL and compares the results with those of other novel agents being used for relapsed/refractory MCL.
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Affiliation(s)
- Madhav Desai
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate Newberry
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhishuo Ou
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liang Zhang
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit Number: 0429, Houston, TX 77030, USA
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43
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Hiddemann W, Cheson BD. How we manage follicular lymphoma. Leukemia 2014; 28:1388-95. [PMID: 24577532 DOI: 10.1038/leu.2014.91] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 02/12/2014] [Indexed: 01/08/2023]
Abstract
Major changes have taken place within the last few years in the management of follicular lymphoma (FL) leading to substantial improvement in prognosis and overall survival. For some patients with limited disease stages I and II, radiotherapy may be associated with durable responses; however, it is unclear whether patients are cured and new approaches such as the combination of irradiation with rituximab or even single-agent rituximab need to be explored. Whereas watch and wait is the current standard for stage III and IV disease with low tumour burden, better indices are warranted to potentially select patients for whom early intervention is preferred. For advanced stages with a high tumour burden, immunochemotherapy followed by 2 years of rituximab maintenance is widely accepted as standard therapy, although re-treatment at recurrence may be an alternative option. Highly attractive new therapeutic options have recently arisen from new antibodies, and from new agents targeting oncogenic pathways such as B-cell receptor signalling pathways or inhibition of bcl 2. Furthermore, immunomodulatory drugs may add to the therapeutic armamentarium and may lead to 'chemotherapy-free' therapies in the near future. Hence, the management of FLs has become a moving target and the hope is justified that the long-term perspectives of patients suffering from the disease will be further improved in the near future.
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Affiliation(s)
- W Hiddemann
- Department of Internal Medicine III, University of Munich, Campus Großhadern, Munich, Germany
| | - B D Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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44
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Nakamura N, Kanemura N, Shibata Y, Matsumoto T, Mabuchi R, Nakamura H, Kitagawa J, Goto N, Hara T, Tsurumi H, Moriwaki H. Lenalidomide-induced cytokine release syndrome in a patient with multiple myeloma. Leuk Lymphoma 2014; 55:1691-3. [PMID: 24138307 DOI: 10.3109/10428194.2013.853300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nobuhiko Nakamura
- First Department of Internal Medicine, Gifu University Graduate School of Medicine , Gifu , Japan
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Jona A, Szodoray P, Illés A. Immunologic pathomechanism of Hodgkin's lymphoma. Exp Hematol 2013; 41:995-1004. [PMID: 24099823 DOI: 10.1016/j.exphem.2013.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/16/2013] [Accepted: 09/29/2013] [Indexed: 12/16/2022]
Abstract
Hodgkin's lymphoma is a lymphoid malignancy of the immune system. The pathognomonic Hodgkin and Reed-Sternberg cells (HRS) are derived mainly from monoclonal, preapoptotic B cells, and they carry rearranged, somatically mutated immunoglobulin heavy chains. In an appropriate microenvironment, HRS cells escape from apoptosis by several mechanisms, including single mutations, aberrant signaling pathways. Eventually, weakened immune surveillance leads to uncontrolled, disproportional B cell proliferation. This review summarizes the latest findings on the pathogenesis of Hodgkin lymphoma, with a special emphasis on immunologic processes, and depicts current and future immunotherapeutic regimens, which improve treatment outcomes and reduce late toxicities.
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Affiliation(s)
- Adam Jona
- Department of Hematology, Institute for Internal Medicine; University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
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46
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Habermann TM. New developments in the management of diffuse large B-cell lymphoma. Hematology 2013; 17 Suppl 1:S93-7. [DOI: 10.1179/102453312x13336169156014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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47
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Immunomodulatory agents changing the landscape of multiple myeloma treatment. Crit Rev Oncol Hematol 2013; 88 Suppl 1:S1-4. [DOI: 10.1016/j.critrevonc.2012.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/05/2012] [Accepted: 12/18/2012] [Indexed: 11/20/2022] Open
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48
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Understanding the immunodeficiency in chronic lymphocytic leukemia: potential clinical implications. Hematol Oncol Clin North Am 2013; 27:207-35. [PMID: 23561470 DOI: 10.1016/j.hoc.2013.01.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. Although significant advances have been made in the treatment of CLL in the last decade, it remains incurable. Treatments may be too toxic for some elderly patients, who constitute most of the individuals with this disease, and there remain subgroups of patients for which this therapy has minimal activity. This article summarizes the current understanding of the immune defects in CLL. It also examines the potential clinical implications of these findings.
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49
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Chanan-Khan AA, Swaika A, Paulus A, Kumar SK, Mikhael JR, Rajkumar SV, Dispenzieri A, Lacy MQ. Pomalidomide: the new immunomodulatory agent for the treatment of multiple myeloma. Blood Cancer J 2013; 3:e143. [PMID: 24013664 PMCID: PMC3789204 DOI: 10.1038/bcj.2013.38] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/17/2013] [Indexed: 01/09/2023] Open
Abstract
In this report, we provide a comprehensive review on the preclinical and clinical investigations conducted in development of the next-generation immunomodulatory drug (IMiD) pomalidomide for the treatment of relapsed/refractory multiple myeloma (MM). We consulted PubMed, MEDLINE, ASH, ASCO annual symposium abstracts and http://clinicaltrials.gov/ for the purpose of this literature review. Twenty-six preclinical and 11 clinical studies were examined. These studies delineate the mechanisms of action of pomalidomide and attest to the robust clinical activity in relapsed/refractory MM. MM is the second most common hematological malignancy in the US. Despite availability of several therapeutic agents, MM remains incurable. Thus, the development of new therapies remains a priority. Pomalidomide is the newest member of the IMiDs class of drugs, and in preclinical and clinical investigations, it has demonstrated an improved efficacy and toxicity profile in comparison to its sister compounds, lenalidomide and thalidomide. Importantly, recent clinical studies have demonstrated its activity in relapsed or refractory myeloma, particularly in lenalidomide and bortezomib-refractory patients. Thus, the addition of pomalidomide to the anti-myeloma armamentarium is widely anticipated to have a significant impact on the overall clinical outcome of advanced stage relapsed and refractory MM patients.
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Affiliation(s)
- A A Chanan-Khan
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
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50
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Targeting inflammatory pathways in chronic lymphocytic leukemia. Crit Rev Oncol Hematol 2013; 88:655-66. [PMID: 23941728 DOI: 10.1016/j.critrevonc.2013.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/01/2013] [Accepted: 07/18/2013] [Indexed: 11/22/2022] Open
Abstract
Despite recent major advances in leukemia research, the pathobiology of chronic lymphocytic leukemia (CLL) remains poorly understood. Herein we review the role chronic inflammation plays in the initiation and progression of CLL. The robust production of inflammatory cytokines and chemokines accompanied by activation of intra-cellular pro-inflammatory pathways, and the presence of somatic mutations that activate pro-inflammatory signaling pathways, suggest that chronic inflammation plays a pathophysiological role in this disease. Indeed, glucocorticoids and non-steroidal anti-inflammatory possess anti-tumor activity, and glucocorticoids have been broadly used to treat CLL and its complications. Recent clinical trials demonstrated that tyrosine kinase inhibitors, such as ibrutinib and the immune-modulatory agent lenalidomide, induced impressive clinical responses in CLL patients with relapsed or refractory disease. As those pro-inflammatory pathway inhibitors and immune modulating drugs proved to be effective in CLL, other agents with similar activities are currently investigated in clinical trials. New insights into the pathobiology of CLL and the development of novel classes of drugs will undoubtedly provide us with effective tools to treat and perhaps cure CLL.
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