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Terzi H, Altun A, Şencan M. In vitro comparison of the cytotoxic effects of statins on U266 myeloma cell line. Indian J Med Res 2020; 150:630-634. [PMID: 32048627 PMCID: PMC7038803 DOI: 10.4103/ijmr.ijmr_672_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background & objectives: Statins are one of the most widely used drugs and have antilipidemic effects as well as antioxidant, anti-inflammatory, anti-angiogenic and anti-tumorigenic effects. It has been shown that the synergistic combinations of statins which can provide better clinical benefit in the treatment of cancer and if administered with other anticancer agents, may be an alternative treatment modality. The aim of this study was to assess the efficacy of administrating statin in multiple myeloma (MM) cell line on cell proliferation. Methods: U266 myeloma cells were cultured in 25 or 75 cm2 flasks by using cell culture medium mixtures obtained with the supplementation of 10 per cent foetal bovine serum and one per cent of penicillin-streptomycin into RPMI 1640 medium. When the cells reached confluence (reached to the density of 70%), they were reproduced by passaging. Cytotoxicity was evaluated by using the XTT test. Results: Statins (atorvastatin and simvastatin), were administered to the U266 myeloma cell line at 100, 50, 25, 12.5, 6.25 and 3.12 μM concentrations. Inhibitor concentration 50 (IC50) values calculated for atorvastatin and simvastatin were determined as 94 and 38 μM, respectively. While 100, 50, 25, 12.5, 6.25 and 3.12 μM concentrations were used for bortezomib, the IC50 value calculated for this agent was 18.2 nM. When six concentrations of bortezomib used in the study were combined with 12.5 μM inactive concentrations of statins that did not cause inhibition in cell proliferation, both atorvastatin and simvastatin increased the effect of bortezomib at all the concentrations used, and simvastatin showed a stronger efficacy than atorvastatin. Interpretation & conclusions: Our in vitro results indicated that atorvastatin and simvastatin when used along with the conventional treatment in myeloma patients, may improve the effectiveness of the standard therapy and prevent the bortezomib-induced cytotoxic and neurotoxic side effects when used at a low dose. Further studies need to be done in MM patints to confirm these findings.
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Affiliation(s)
- Hatice Terzi
- Department of Hematology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ahmet Altun
- Department of Pharmacology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Mehmet Şencan
- Department of Hematology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Liu X, Li C, Fu Y, Liu J. PHLPP Sensitizes Multiple Myeloma Cells to Bortezomib Through Regulating LAMP2. Onco Targets Ther 2020; 13:401-411. [PMID: 32021285 PMCID: PMC6969690 DOI: 10.2147/ott.s237343] [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: 11/05/2019] [Accepted: 12/24/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction Treatment of bortezomib (BTZ) improves the clinical outcomes of patients with multiple myeloma (MM). However, primary resistance and acquired resistance to BTZ frequently develop in patients with MM. PH domain leucine-rich repeat protein phosphatase (PHLPP) plays an important role in chemoresistance in a number of cancers. However, the role of PHLPP on MM remains unclear. In this study, we investigated the role of PHLPP in BTZ-resistant MM cells. Methods BrdU assays, immunoprecipitation, flow cytometry analyses, and immunofluorescence assays were performed. Results PHLPP and lysosome-associated membrane protein 2 (LAMP2) levels were downregulated in BTZ-resistant MM cells compared with BTZ-sensitive MM cells, accompanied by inactivation of autophagy pathway evaluated by a reduction in Beclin1, Atg5 and LC3B and increase in p62. Gain- and loss-of-function experiments revealed that PHLPP partially re-sensitized MM cells to BTZ. In addition, PHLPP overexpression increased whereas PHLPP knockdown reduced LAMP2 expression, subsequently regulating the autophagy pathway in MM cells. Further findings demonstrated that LAMP2 knockdown reversed PHLPP-mediated cell apoptosis and autophagy activation in MM cells. Conclusion This study demonstrated that PHLPP is a potential strategy for overcoming BTZ resistance in patients with MM.
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Affiliation(s)
- Xiao Liu
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha 410013, People's Republic of China
| | - Chengyuan Li
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha 410013, People's Republic of China
| | - Yunfeng Fu
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha 410013, People's Republic of China
| | - Jing Liu
- Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha 410013, People's Republic of China
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Zhang K, Desai A, Zeng D, Gong T, Lu P, Wang M. Magic year for multiple myeloma therapeutics: Key takeaways from the ASH 2015 annual meeting. Oncotarget 2017; 8:10748-10759. [PMID: 27863374 PMCID: PMC5354697 DOI: 10.18632/oncotarget.13314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 10/19/2016] [Indexed: 02/04/2023] Open
Abstract
Despite the availability of various anticancer agents, Multiple Myeloma (MM) remains incurable in most cases, along with high relapse rate in the patients treated with these agents. The year 2015 saw major advancements in our battle against multiple myeloma. In 2015, the U.S. Food and Drug Administration (FDA) approved three new therapies for multiple myeloma, namely Ixazomib (an oral proteasome inhibitor), Daratumumab and Elotuzumab (monoclonal antibodies against CD38 and SLAMF7 respectively). The purpose of this review is to provide a detailed analysis of these aforementioned breakthrough therapies and two other newer agents, Filanesib (kinesis spindle inhibitor) and selinexor (SINE inhibitor), presented at the 2015 annual meeting of American Society of Hematology (ASH). We also describe the role of agents targeting PD-1 axis and chimeric antigen receptor T (CAR-T) cells in the treatment of MM.
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Affiliation(s)
- Kejie Zhang
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, China
| | - Aakash Desai
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- University of Texas Health Science Center, Houston, Texas, USA
| | - Dongfeng Zeng
- Department of Hematology, Xinqiao hospital, Third Military Medical University, Chongqing, China
| | - Tiejun Gong
- Institute of Hematology and Oncology, Harbin first Hospital, Harbin, China
| | - Peihua Lu
- Department of Hematology, Hebei Yanda Ludaopei Hospital, Beijing, China
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Robinson D, Esseltine DL, Regnault A, Meunier J, Liu K, van de Velde H. The influence of baseline characteristics and disease stage on health-related quality of life in multiple myeloma: findings from six randomized controlled trials. Br J Haematol 2016; 174:368-81. [PMID: 27265837 PMCID: PMC5089628 DOI: 10.1111/bjh.14058] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/22/2016] [Indexed: 12/19/2022]
Abstract
This descriptive, cross-sectional analysis evaluated the impact of baseline characteristics on health-related quality of life (HR-QoL) at different stages of multiple myeloma (MM). The bortezomib clinical-trial programme evaluated HR-QoL early and consistently, producing a large multi-study dataset. Baseline data, captured using the European Organization for Research and Treatment of Cancer (EORTC) quality-of-life questionnaire (QLQ-C30), were pooled from six bortezomib randomized trials conducted in different disease-stage categories: 'New' (previously untreated; n = 753), 'Early' (1-3 prior therapies; n = 1569) and 'Late' (≥4 prior therapies; n = 239) disease. Mean EORTC global health scores were similar across the three stages. Unexpectedly, emotional, physical and role functioning were higher in the later stages, indicating better perceived health. Symptom scores, including pain, were largely similar or lower in the later versus earlier stages, signifying a lower symptom burden/better symptom control with more advanced disease. Notable variation in HR-QoL was observed by age and clinical parameters within and across stages. Multivariate modelling indicated that opioid use and performance status were key factors driving overall HR-QoL across stages. Using an age-restricted analysis, transplant eligibility had little impact on HR-QoL in New disease patients. Thus, changes in HR-QoL over the treatment course of MM are complex and impacted by baseline factors. A prospective observational international inception cohort study that captures key clinical, HR-QoL and demographic characteristics, along with safety and supportive care information, is needed.
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Affiliation(s)
| | - Dixie-Lee Esseltine
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | | | | | - Kevin Liu
- Janssen Research & Development, Raritan, NJ, USA
| | - Helgi van de Velde
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
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Muz B, Ghazarian RN, Ou M, Luderer MJ, Kusdono HD, Azab AK. Spotlight on ixazomib: potential in the treatment of multiple myeloma. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:217-26. [PMID: 26811670 PMCID: PMC4714737 DOI: 10.2147/dddt.s93602] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite the significant therapeutic advances achieved with proteasome inhibitors (PIs) such as bortezomib and carfilzomib in prolonging the survival of patients with multiple myeloma, the development of drug resistance, peripheral neuropathy, and pharmacokinetic limitations continue to pose major challenges when using these compounds. Ixazomib is a second-generation PI with improved activity over other PIs. Unlike bortezomib and carfilzomib, which are administered by injection, ixazomib is the first oral PI approved by US Food and Drug Administration. This review discusses the biochemical properties, mechanisms of action, preclinical efficacy, and clinical trial results leading to the US Food and Drug Administration approval of ixazomib.
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Affiliation(s)
- Barbara Muz
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Rachel Nicole Ghazarian
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Pharmaceutical and Administrative Sciences, St Louis College of Pharmacy, St Louis, MO, USA
| | - Monica Ou
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Biology, St Louis University, St Louis, MO, USA
| | - Micah John Luderer
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Hubert Daniel Kusdono
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St Louis School of Medicine, St Louis, MO, USA; Department of Pharmaceutical and Administrative Sciences, St Louis College of Pharmacy, St Louis, MO, USA
| | - Abdel Kareem Azab
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St Louis School of Medicine, St Louis, MO, USA
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Follin-Arbelet V, Misund K, Naderi EH, Ugland H, Sundan A, Blomhoff HK. The natural compound forskolin synergizes with dexamethasone to induce cell death in myeloma cells via BIM. Sci Rep 2015; 5:13001. [PMID: 26306624 PMCID: PMC4549684 DOI: 10.1038/srep13001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 06/30/2015] [Indexed: 12/19/2022] Open
Abstract
We have previously demonstrated that activation of the cyclic adenosine monophosphate (cAMP) pathway kills multiple myeloma (MM) cells both in vitro and in vivo. In the present study we have investigated the potential of enhancing the killing of MM cell lines and primary MM cells by combining the cAMP-elevating compound forskolin with the commonly used MM therapeutic drugs melphalan, cyclophosphamide, doxorubicin, bortezomib and dexamethasone. We observed that forskolin potentiated the killing induced by all the tested agents as compared to treatment with the single agents alone. In particular, forskolin had a synergistic effect on the dexamethasone-responsive cell lines H929 and OM-2. By knocking down the proapoptotic BCL-2 family member BIM, we proved this protein to be involved in the synergistic induction of apoptosis by dexamethasone and forskolin. The ability of forskolin to maintain the killing of MM cells even at lower concentrations of the conventional agents suggests that forskolin may be used to diminish treatment-associated side effects. Our findings support a potential role of forskolin in combination with current conventional agents in the treatment of MM.
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Affiliation(s)
- Virginie Follin-Arbelet
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, PO Box 1112-Blindern, N-0317 Oslo, Norway
| | - Kristine Misund
- KG Jebsen Center for Myeloma Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, N-7489 Trondheim, Norway
| | - Elin Hallan Naderi
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, PO Box 1112-Blindern, N-0317 Oslo, Norway
| | - Hege Ugland
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, PO Box 1112-Blindern, N-0317 Oslo, Norway
| | - Anders Sundan
- KG Jebsen Center for Myeloma Research and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, N-7489 Trondheim, Norway
| | - Heidi Kiil Blomhoff
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, PO Box 1112-Blindern, N-0317 Oslo, Norway
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Aouali N, Broukou A, Bosseler M, Keunen O, Schlesser V, Janji B, Palissot V, Stordeur P, Berchem G. Epigenetic Activity of Peroxisome Proliferator-Activated Receptor Gamma Agonists Increases the Anticancer Effect of Histone Deacetylase Inhibitors on Multiple Myeloma Cells. PLoS One 2015; 10:e0130339. [PMID: 26091518 PMCID: PMC4474836 DOI: 10.1371/journal.pone.0130339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/19/2015] [Indexed: 02/07/2023] Open
Abstract
Epigenetic modifications play a major role in the development of multiple myeloma. We have previously reported that the PPARγ agonist pioglitazone (PIO) enhances, in-vitro, the cytotoxic effect of the Histone deacetylase inhibitor (HDACi), valproic acid (VPA), on multiple myeloma cells. Here, we described the development of a new multiple myeloma mouse model using MOLP8 cells, in order to evaluate the effect of VPA/PIO combination on the progression of myeloma cells, by analyzing the proliferation of bone marrow plasma cells. We showed that VPA/PIO delays the progression of the disease and the invasion of myeloma cells in the bone marrow. Mechanistically, we demonstrated that VPA/PIO increases the cleavage of caspase 3 and PARP, and induces the acetylation of Histone 3 (H3). Furthermore, we provided evidence that PPARγ agonist is able to enhance the action of other HDACi such as Vorinostat or Mocetinostat. Using PPARγ antagonist or siPPARγ, we strongly suggest that, as described during adipogenesis, PIO behaves as an epigenetic regulator by improving the activity of HDACi. This study highlights the therapeutic benefit of PIO/VPA combination, compared to VPA treatment as a single-arm therapy on multiple myeloma and further highlights that such combination may constitute a new promising treatment strategy which should be supported by clinical trials.
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Affiliation(s)
- Nassera Aouali
- Laboratory of Experimental Hemato-Oncology, LHCE, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- * E-mail:
| | - Angeliki Broukou
- Laboratory of Experimental Hemato-Oncology, LHCE, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Manon Bosseler
- Laboratory of Experimental Hemato-Oncology, LHCE, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Olivier Keunen
- Laboratory Neuro-Oncology, Norlux, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Vincent Schlesser
- Laboratory of Hematology, Centre Hospitalier de Luxembourg (CHL), Strassen, Luxembourg
| | - Bassam Janji
- Laboratory of Experimental Hemato-Oncology, LHCE, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Valerie Palissot
- Laboratory of Experimental Hemato-Oncology, LHCE, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Philippe Stordeur
- Biotechnology Department, Experimental Infectious Diseases Platform, CER Group, Marloie, Belgium
| | - Guy Berchem
- Laboratory of Experimental Hemato-Oncology, LHCE, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Laboratory of Hematology, Centre Hospitalier de Luxembourg (CHL), Strassen, Luxembourg
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Iyer SP, Beck JT, Stewart AK, Shah J, Kelly KR, Isaacs R, Bilic S, Sen S, Munshi NC. A Phase IB multicentre dose-determination study of BHQ880 in combination with anti-myeloma therapy and zoledronic acid in patients with relapsed or refractory multiple myeloma and prior skeletal-related events. Br J Haematol 2014; 167:366-75. [PMID: 25139740 DOI: 10.1111/bjh.13056] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/05/2014] [Indexed: 12/17/2022]
Abstract
Dickkopf-1 (DKK1), expressed by myeloma cells, suppresses osteoblast function and plays a key role in bone disease in multiple myeloma. BHQ880, a human neutralizing IgG1 anti-DKK1 monoclonal antibody, is being investigated for its impact on multiple myeloma-related bone disease and as an agent with potential anti-myeloma activity. The primary objectives of this Phase IB study were to determine the maximum tolerated dose (MTD) of BHQ880 and to characterize the dose-limiting toxicity (DLT) of escalating doses in combination with anti-myeloma therapy and zoledronic acid. Twenty-eight patients were enrolled and received BHQ880 at doses of 3-40 mg/kg. No DLTs were reported, therefore, the MTD was not determined. The recommended Phase II dose was declared as 10 mg/kg, based mainly on saturation data. There was a general trend towards increased bone mineral density (BMD) observed over time; specific increases in spine BMD from Cycle 12 onwards irrespective of new skeletal-related events on study were observed, and increases in bone strength at the spine and hip were also demonstrated in some patients. BHQ880 in combination with zoledronic acid and anti-myeloma therapy was well tolerated and demonstrated potential clinical activity in patients with relapsed or refractory multiple myeloma.
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Affiliation(s)
- Swaminathan P Iyer
- Houston Methodist Cancer Center, Weill Cornell Medical College, Houston, TX, USA
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Kumar SK, Bensinger WI, Zimmerman TM, Reeder CB, Berenson JR, Berg D, Hui AM, Gupta N, Di Bacco A, Yu J, Shou Y, Niesvizky R. Phase 1 study of weekly dosing with the investigational oral proteasome inhibitor ixazomib in relapsed/refractory multiple myeloma. Blood 2014; 124:1047-55. [PMID: 24904120 PMCID: PMC4468583 DOI: 10.1182/blood-2014-01-548941] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/12/2014] [Indexed: 02/06/2023] Open
Abstract
Proteasome inhibition is an effective treatment strategy for multiple myeloma. With improving survival, attention is increasingly focusing on ease of administration and toxicity profile. Ixazomib is an investigational, orally bioavailable 20S proteasome inhibitor. Sixty patients with relapsed and/or refractory multiple myeloma were enrolled on this phase 1 trial to evaluate safety and tolerability and determine the maximum tolerated dose (MTD) of single-agent, oral ixazomib given weekly for 3 of 4 weeks. Upon MTD determination, patients were enrolled to 4 different cohorts based on relapsed/refractory status and prior bortezomib and carfilzomib exposure. The MTD was determined to be 2.97 mg/m(2). Dose-limiting toxicities were grade 3 nausea, vomiting, and diarrhea in 2 patients, and grade 3 skin rash in 1 patient. Common drug-related adverse events were thrombocytopenia (43%), diarrhea (38%), nausea (38%), fatigue (37%), and vomiting (35%). The observed rate of peripheral neuropathy was 20%, with only 1 grade 3 event reported. Nine (18%) patients achieved a partial response or better, including 8 of 30 (27%) evaluable patients treated at the MTD. Pharmacokinetic studies suggested a long terminal half-life of 3.6 to 11.3 days, supporting once-weekly dosing. This trial was registered at www.clinicaltrials.gov as #NCT00963820.
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Affiliation(s)
| | | | | | - Craig B Reeder
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ
| | - James R Berenson
- Institute for Myeloma and Bone Cancer Research, West Hollywood, CA
| | - Deborah Berg
- Takeda Pharmaceuticals International Co., Cambridge, MA
| | - Ai-Min Hui
- Takeda Pharmaceuticals International Co., Cambridge, MA
| | - Neeraj Gupta
- Takeda Pharmaceuticals International Co., Cambridge, MA
| | | | - Jiang Yu
- Takeda Pharmaceuticals International Co., Cambridge, MA
| | - Yaping Shou
- Takeda Pharmaceuticals International Co., Cambridge, MA
| | - Ruben Niesvizky
- Center of Excellence for Lymphoma and Myeloma, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY
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Moreau P. The emerging role of carfilzomib combination therapy in the management of multiple myeloma. Expert Rev Hematol 2014; 7:265-90. [PMID: 24521249 DOI: 10.1586/17474086.2014.873699] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Carfilzomib is a proteasome inhibitor that selectively and irreversibly binds to its target, resulting in sustained inhibition absent of off-target effects relative to bortezomib. Single-agent carfilzomib has produced robust and durable responses in clinical trials and it has been approved in the US for treating relapsed and refractory multiple myeloma (MM). Due to its favorable safety profile, carfilzomib is particularly suitable for use in combination strategies. Promising data have been reported from studies that investigated the use of carfilzomib in combination with immunomodulators, alkylating agents, glucocorticoids, histone deacetylase inhibitors and kinesin spindle protein inhibitors. Ongoing pivotal randomized Phase III studies are investigating the efficacy and safety of carfilzomib combinations in patients with relapsed MM and transplant ineligible patients.
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Affiliation(s)
- Philippe Moreau
- Hematology Department, University Hospital Hôtel-Dieu, 44093, Nantes Cedex 01, France
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