1
|
An H, Chen S, Zhang X, Ke S, Ke J, Lu Y. PHF19 before and post induction treatment possess favorable potency of reflecting treatment response to protease inhibitors, event-free survival, and overall survival in multiple myeloma patients. Hematology 2024; 29:2331389. [PMID: 38511642 DOI: 10.1080/16078454.2024.2331389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE Plant homeodomain finger protein 19 (PHF19) regulates hematopoietic stem cell differentiation and promotes multiple myeloma (MM) progression. This study intended to explore the potency of PHF19 at baseline and post induction treatment in estimating treatment response to protease inhibitors and survival in MM patients. METHODS This retrospective study screened 69 MM patients who received protease inhibitors with bone marrow (BM) samples available at both baseline and post induction treatment. Twenty healthy BM donors were included as healthy controls (HCs). PHF19 in plasma cells from BM was quantified by reverse transcription-quantitative polymerase chain reaction. RESULTS PHF19 at baseline and post induction treatment in MM patients were increased than in HCs. In MM patients, PHF19 was declined post induction treatment. Elevated PHF19 at baseline and post induction treatment were correlated with renal impairment, beta-2-microglobulin ≥5.5 mg/L, t (4; 14), higher international staging system (ISS) stage, and higher revised ISS (R-ISS) stage. Concerning treatment response, PHF19 at baseline and post induction treatment were negatively associated with complete response and overall response rate. Notably, abnormal PHF19 (above 95% quantile value of PHF19 in HCs) at baseline and post induction treatment were linked with shortened event-free survival (EFS) and overall survival (OS). After adjustment, abnormal PHF19 post induction treatment was independently related to shortened EFS (hazard ratio = 2.474) and OS (hazard ratio = 3.124). CONCLUSION PHF19 is aberrantly high and declines post induction therapy, which simultaneously reflects unfavorable treatment response to protease inhibitors as well as shorter EFS and OS in MM patients.
Collapse
Affiliation(s)
- Hongyu An
- Department of Hematology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, 435000, People's Republic of China
| | - Shiming Chen
- Department of Hematology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, 435000, People's Republic of China
| | - Xin Zhang
- Department of Hematology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, 435000, People's Republic of China
| | - Shandong Ke
- Department of Hematology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, 435000, People's Republic of China
| | - Jinyong Ke
- Department of Hematology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, 435000, People's Republic of China
| | - Yalan Lu
- Department of Hematology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, 435000, People's Republic of China
| |
Collapse
|
2
|
Ailawadhi S, Cheng M, Cherepanov D, DerSarkissian M, Stull DM, Hilts A, Chun J, Duh MS, Sanchez L. Comparative effectiveness of lenalidomide/dexamethasone-based triplet regimens for treatment of relapsed and/or refractory multiple myeloma in the United States: An analysis of real-world electronic health records data. Curr Probl Cancer 2024; 50:101078. [PMID: 38547609 DOI: 10.1016/j.currproblcancer.2024.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND This retrospective longitudinal study compared the effectiveness of dexamethasone+lenalidomide (Rd)-based triplet regimens containing proteasome inhibitors (PIs) ixazomib (IRd), carfilzomib (KRd), and bortezomib (VRd) or monoclonal antibodies (MABs) elotuzumab (ERd) and daratumumab (DRd) in patients with relapsed/refractory multiple myeloma (RRMM)-including those with high cytogenetic risk-primarily treated at community oncology clinics in the United States. METHODS Electronic health records of adult RRMM patients in a deidentified real-world database (01/01/2014-09/30/2020) who initiated IRd, KRd, VRd, ERd, or DRd in the second or later line of therapy (LOT) were analyzed. The index date was the date of initiation of each LOT and baseline was the 6-month pre-index period. Duration of therapy (DOT), time to next therapy (TTNT), progression-free survival (PFS), and overall survival (OS) were compared across regimens with multivariable Cox proportional hazards models. RESULTS Of the 1,185 patients contributing 1,332 LOTs, 985 had standard cytogenetic risk (median age, 71 years) and 180 had high risk (median age, 69 years). Compared with other regimens, DRd was associated with longer DOT overall (adjusted hazard ratio [95 % confidence interval]: 1.84 [1.42, 2.38] vs. KRd, 1.65 [1.20, 2.28] vs. ERd, 1.58 [1.23, 2.04] vs. IRd, and 1.54 [1.18, 2.00] vs. VRd), and longer TTNT and PFS. KRd was associated with shorter OS compared with DRd (1.45 [1.01, 2.08]) and VRd (1.32 [1.01, 1.73]). High-risk patients had similar outcomes with all triplet regimens. CONCLUSION Although DRd improved clinical outcomes overall, Rd-based triplet regimens containing a PI or MAB are similarly effective in high-risk RRMM.
Collapse
Affiliation(s)
| | - Mu Cheng
- Analysis Group, Inc., Boston, MA 02199, USA.
| | - Dasha Cherepanov
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | | - Dawn Marie Stull
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | | | | | | - Larysa Sanchez
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| |
Collapse
|
3
|
Kumar L, Melinkeri S, Ganesan P, Kumar J, Biswas G, Kilara N, Pathalingappa H, Prasad S, Jain M, Mishra SK, Prasad S, Boyella PK, Sahoo RK, Bondarde S, Shah S, Rege M, Deb U, Korde T, Dixit J. Daratumumab in Indian patients with relapsed and refractory multiple myeloma: a prospective, multicenter, phase IV study. Future Oncol 2024; 20:191-205. [PMID: 38116642 DOI: 10.2217/fon-2023-0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Aim: To assess the safety and effectiveness of daratumumab monotherapy in Indian patients with relapsed/refractory multiple myeloma. Methods: In this prospective, multicenter, phase IV study, patients (aged ≥18 years) received intravenous daratumumab (16 mg/kg) in six cycles. Safety was the primary end point. Results: Of the 139 patients included, 121 (87.1%) experienced ≥1 treatment-emergent adverse events (TEAEs; 53 [38.1%] drug-related), 32 (23%) had ≥1 serious TEAEs (five [3.6%] drug-related) and 16 (11.5%) deaths were reported (one death [0.7%] was drug-related). Overall response rate was 26.3%; 62.7% of patients had stable disease. Median time to first response and median progression-free survival were 5.2 and 5.9 months, respectively. Functional status and well-being were improved. Conclusion: Daratumumab showed an acceptable and expected safety profile with consistent efficacy, providing a novel therapeutic option for relapsed/refractory multiple myeloma management in India.
Collapse
Affiliation(s)
- Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, 110608, India
| | - Sameer Melinkeri
- Department of Hematology, Deenanath Mangeshkar Hospital & Research Center, Pune, Maharashtra, 411004, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, 605006, India
| | - Jeevan Kumar
- Department of Clinical Hematology & HCT, Tata Medical Center, Kolkata, West Bengal, 700156, India
| | - Ghanashyam Biswas
- Department of Oncology, Sparsh Superspeciality Hospital & Critical Care, Bhubaneswar, 751007, Odisha, India
| | - Nalini Kilara
- Department of Medical Oncology, MS Ramaiah Medical College, Bengaluru, Karnataka, 560054, India
| | - Harish Pathalingappa
- Department of Medical Oncology, Cytecare Cancer Hospitals, Bangalore, Karnataka, 560063, India
| | - Svss Prasad
- Division of Medical Oncology, Apollo Cancer Hospitals, Hyderabad, Telangana,500033, India
| | - Minish Jain
- Department of Oncology, Noble Hospital, Pune, Maharashtra, 411013, India
| | - Sourav Kumar Mishra
- Department of Medical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India
| | - Saurabh Prasad
- Department of Cancer & Immunotherapy & Research, Kims Kingsway Hospitals, Nagpur, Maharashtra, 440001, India
| | - Pavan Kumar Boyella
- Department of Medical Oncology, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, Telangana, 500034, India
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, IRCH, All India Institute of Medical Sciences, New Delhi, 110608, India
| | - Shailesh Bondarde
- Department of Oncology, Apex Wellness's Rishikesh Hospital, Nashik, Maharashtra, 422009, India
| | - Sandip Shah
- Department of Hemato-Oncology, Avron Hospitals Private Limited, Ahmedabad, Gujarat, 380014, India
| | - Milind Rege
- Medical Affairs Operations, Johnson & Johnson Private Limited, Mumbai, Maharashtra, 400080, India
| | - Uttiya Deb
- Medical Affairs, Johnson & Johnson Private Limited, Mumbai, Maharashtra, 400080, India
| | - Tanuja Korde
- Medical Affairs Operations, Johnson & Johnson Private Limited, Mumbai, Maharashtra, 400080, India
| | - Jitendra Dixit
- Medical Affairs, Johnson & Johnson Private Limited, Mumbai, Maharashtra, 400080, India
| |
Collapse
|
4
|
Noori M, Fayyaz F, Rezaei N. Safety and efficacy of Elotuzumab combination therapy for patients with multiple myeloma: A systematic review and meta-analysis. Expert Rev Anticancer Ther 2023; 23:327-338. [PMID: 36638778 DOI: 10.1080/14737140.2023.2169139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE We evaluate the efficacy and safety of Elotuzumab, an immunostimulatory monoclonal antibody, in combination with concomitant treatment regimens for multiple myeloma (MM) patients. RESEARCH DESIGN AND METHODS PubMed, Scopus, Web of Science, and EMBASE databases were searched systematically up to 2 August 2022. RESULTS Five randomized control trials with a total of 1,763 participants were included. Elotuzumab combination therapy improved PFS and OS by 14% (hazard ratio [HR] 0.86) and 20% (HR 0.80), respectively, relative to the non-Elotuzumab regimen. Adding Elotuzumab to Lenalidomide plus Dexamethasone regimen (HR 0.82) or Pomalidomide plus Dexamethasone regimen (HR 0.54) were considered to improve the PFS. Meanwhile, the risk of disease progression was only reduced for patients with relapsed/refractory MM (HR 0.70) but not for newly diagnosed/untreated MM (HR 0.93). Finally, the risk of serious adverse events (RR 1.12) and the risk of infection (RR 1.09) and cardiac disorders (RR 1.32) were higher for the experimental group compared to the control group. CONCLUSIONS Our findings showed that Elotuzumab combination therapy prolonged OS and PFS compared to non-Elotuzumab treatments in patients with MM. However, further investigations are required to establish the most effective combination of the Elotuzumab regimen.
Collapse
Affiliation(s)
- Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Urology Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Farimah Fayyaz
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Shi H, Ren H, Tian Y, Chen Z, Xu C, Lu L, Ma X, Li X, Chen W, Guo T, Fan C, Gao W. Pain as a risk factor of depression and anxiety symptoms with multiple myeloma during maintenance therapy. Front Psychol 2022; 13:1015497. [DOI: 10.3389/fpsyg.2022.1015497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
ObjectiveTo investigate the prevalence of depression or anxiety in patient with multiple myeloma (MM) in China during maintenance treatment and its associated influencing factors.MethodsPatients with MM (n = 160) received maintenance therapy, and control subjects (without MM, n = 160) matched on age, sex, and BMI were recruited. Patients completed questionnaires, including the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Verbal Pain Rating Scale (VPRS). Data on the Clinical characteristics, biochemical indicators of de novo MM were from the database of the Hematology Department of Beijing Chao-yang Hospital. Multiple linear regression model analysis was used to compare the differences in PHQ-9 and GAD-7 scale scores between the control group and the case group after correction for relevant variables. Multiple logistic regression models were subsequently used to analyze the correlation between the presence or absence of anxiety and depression and clinical indicators in the MM groups.ResultsDepression symptoms was present in 33.33% and anxiety symptoms in 24.68% of first-episode MM in the maintenance phase of treatment, and depression symptoms in the index-corrected MM group was significantly different from that in the control group (t = 2.54, P < 0.05). Analyses of multiple logistic regressions: biochemical indicators and clinical typing were not significantly associated with anxiety and depression. Compared to the pain rating 1, the risk of depressive mood was greater in the case group with the pain rating 2 (OR = 2.38) and the pain rating ≥ 3 (OR = 4.32). The risk of anxiety was greater in the case group with the pain rating ≥ 3 than the pain rating 1 (OR = 2.89).ConclusionDespite being in clinical remission, depressive mood problems in patients with MM remain prominent. Clinicians should enhance mood assessment and management in patients with concomitant pain.
Collapse
|
6
|
Musto P, La Rocca F. Monoclonal antibodies in relapsed/refractory myeloma: updated evidence from clinical trials, real-life studies, and meta-analyses. Expert Rev Hematol 2021; 13:331-349. [PMID: 32153224 DOI: 10.1080/17474086.2020.1740084] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: In the last few years, monoclonal antibodies have rapidly modified the therapeutic strategies for treating patients with multiple myeloma.Areas covered: In this review, the most recent literature data regarding indications for which monoclonal antibodies are currently or will be shortly approved as salvage therapies in relapsed/refractory myeloma are discussed. In particular, updated results until March 22, 2020 of antibodies directed against CD38 (daratumumab and isatuximab), SLAMF7 (elotuzumab), BCMA (GSK2857916/belantamab mafodotin), and PD-1/PD-1 L axis (nivolumab and pembrolizumab) will be analyzed in detail.Expert opinion: Monoclonal antibodies represent a new, very effective approach that will open novel and dynamic treatment scenarios for myeloma patients in the coming years. Optimal positioning and selection of different antibodies that are or will be soon available, appropriate combinations and careful evaluation of possible new toxicities should be considered in the future management of these patients.
Collapse
Affiliation(s)
- Pellegrino Musto
- Chair of Hematology and Unit of Hematology and Stem Cell Transplantation, AOU Consorziale Policlinico, "Aldo Moro" University, School of Medicine, Bari, Italy
| | - Francesco La Rocca
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| |
Collapse
|
7
|
Borrelli EP, McGladrigan CG. Differences in safety profiles of newly approved medications for multiple myeloma in real-world settings versus randomized controlled trials. J Oncol Pharm Pract 2020; 27:887-896. [PMID: 32686617 DOI: 10.1177/1078155220941937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Four new agents (elotuzumab, ixazomib, panobinostat, and daratumumab) were approved by the US Food and Drug Administration (FDA) in 2015 for the treatment of multiple myeloma. Our objective was to compare the safety profiles of these new medications in real-world settings and their randomized controlled trial(s). MATERIAL AND METHODS An analysis was conducted of the FDA Adverse Event Reporting System (FAERS) for each drug consisting of the quarter that the drug received its FDA approval and the eight subsequent quarters. Reporting odds ratios and corresponding 95% confidence intervals were then calculated for each drug for each of the 10 most frequent adverse drug reactions. The randomized controlled trials that led to initial FDA approval for these medications were subsequently reviewed to assess the 10 most frequently reported adverse drug reactions in these trials. RESULTS There were only two adverse drug reactions in the top 10 of both FAERS and its randomized controlled trials for elotuzumab (anaemia, diarrhoea) and for daratumumab (cough, back pain), five for ixazomib (diarrhoea, constipation, fatigue, nausea, peripheral neuropathy), and four panobinostat (diarrhoea, fatigue, nausea, constipation). Ixazomib had two adverse drug reactions with a significant reporting odds ratios greater than a 10-fold increased risk (plasma cell myeloma, peripheral neuropathy); elotuzumab had three adverse drug reactions (infusion site reaction, malignant neoplasm progression, deep vein thrombosis); daratumumab had three adverse drug reactions (infusion site reaction, bronchospasm, chills), while panobinostat had four (malignant neoplasm progression, decreased platelet count, diarrhoea, increased blood creatinine). CONCLUSION This analysis helps to highlight the importance of conducting postmarketing pharmacovigilance studies to better understand the potential adverse reactions of these medications.
Collapse
Affiliation(s)
- Eric P Borrelli
- Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Conor G McGladrigan
- Department of Pharmacy, Mass General/North Shore Cancer Center, Danvers, MA, USA
| |
Collapse
|
8
|
Li Z, Guo SL, Wang WL. Efficacy of ixazomib for the treatment of relapsed/refractory multiple myeloma: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20211. [PMID: 32443346 PMCID: PMC7253538 DOI: 10.1097/md.0000000000020211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Over the past years, ixazomib has been increasingly explored for the treatment of relapsed/refractory multiple myeloma (RRMM). However, its results are still contradictory. This study will explore the efficacy and safety of ixazomib for patients with RRMM. METHODS A systematic records search of Cochrane Library, PUBMED, EMBASE, CINAHL, ACMD, PsycINFO, WANGFANG, and China National Knowledge Infrastructure will be carried out from their origin to March 31, 2020 with no limitations of language and publication status. Trials will be selected by titles/abstracts, and full manuscripts by 2 independent authors. Data collection will be carried out from eligible trials based on the previous designed criteria. Study quality will be checked using Cochrane risk of bias, and statistical analysis will be administered by RevMan 5.3 software. RESULTS This study will summarize the current high-quality trials investigating the efficacy and safety of ixazomib for the treatment of patients with RRMM. CONCLUSION The results of this study may provide convinced evidence on the evidence-based medicine level, and guidance for clinical practice and future studies. INPLASY REGISTRATION NUMBER INPLASY202040027.
Collapse
|
9
|
Shah M, Rajha E, DiNardo C, Muckey E, Wierda WG, Yeung SCJ. Adverse Events of Novel Therapies for Hematologic Malignancies: What Emergency Physicians Should Know. Ann Emerg Med 2020; 75:264-286. [PMID: 31561995 DOI: 10.1016/j.annemergmed.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
In the past decade, rapid advances in therapeutic target discovery in hematologic malignancies have led to many clinical studies demonstrating efficacy of novel agents. Between 2014 and 2018, Food and Drug Administration approvals of new drugs and agents have increased, with greater than 2 dozen novel agents. Rapidly identifying the risk profiles of these cancer therapeutics that may present with acute toxicities and understanding the timing, sequence, duration, and treatment of disease processes are the most important challenges faced by practitioners in emergency medicine, even in nononcologic centers. The emergency medicine literature lags behind rapid advances in oncology, and guidelines for rapid recognition and management of these emerging entities are not familiar. In this Review Article, we discuss the most recent and clinically relevant developments in the arena of hematologic malignancies, further expanding on drug toxicities and their clinical presentations and offering suggestions for management. Specifically, we discuss immune-related adverse events after immune checkpoint inhibitor therapy (including myocarditis and hemophagocytic lymphohistiocytosis), chimeric antigen receptor-T cell therapy, cytokine release syndrome, chimeric antigen receptor-T cell-related encephalopathy syndrome, differentiation syndrome, sinusoid occlusion syndrome, QT-interval prolongation, and tumor lysis syndrome. Rapid advances in hematology and oncology will bring many new challenges for emergency health care providers in the near future; thus, the urgency to raise awareness among this community.
Collapse
Affiliation(s)
- Mohsin Shah
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eva Rajha
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erin Muckey
- Department of Emergency Medicine, NYU Langone Health, Bellevue Hospital Center, New York, NY
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
10
|
Immunotherapy for Multiple Myeloma. Cancers (Basel) 2019; 11:cancers11122009. [PMID: 31842518 PMCID: PMC6966649 DOI: 10.3390/cancers11122009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/08/2023] Open
Abstract
Despite therapeutic advances over the past decades, multiple myeloma (MM) remains a largely incurable disease with poor prognosis in high-risk patients, and thus new treatment strategies are needed to achieve treatment breakthroughs. MM represents various forms of impaired immune surveillance characterized by not only disrupted antibody production but also immune dysfunction of T, natural killer cells, and dendritic cells, although immunotherapeutic interventions such as allogeneic stem-cell transplantation and dendritic cell-based tumor vaccines were reported to prolong survival in limited populations of MM patients. Recently, epoch-making immunotherapies, i.e., immunomodulatory drug-intensified monoclonal antibodies, such as daratumumab combined with lenalidomide and chimeric antigen receptor T-cell therapy targeting B-cell maturation antigen, have been developed, and was shown to improve prognosis even in advanced-stage MM patients. Clinical trials using other antibody-based treatments, such as antibody drug-conjugate and bispecific antigen-directed CD3 T-cell engager targeting, are ongoing. The manipulation of anergic T-cells by checkpoint inhibitors, including an anti-T-cell immunoglobulin and ITIM domains (TIGIT) antibody, also has the potential to prolong survival times. Those new treatments or their combination will improve prognosis and possibly point toward a cure for MM.
Collapse
|
11
|
Works M, Soni N, Hauskins C, Sierra C, Baturevych A, Jones JC, Curtis W, Carlson P, Johnstone TG, Kugler D, Hause RJ, Jiang Y, Wimberly L, Clouser CR, Jessup HK, Sather B, Salmon RA, Ports MO. Anti-B-cell Maturation Antigen Chimeric Antigen Receptor T cell Function against Multiple Myeloma Is Enhanced in the Presence of Lenalidomide. Mol Cancer Ther 2019; 18:2246-2257. [PMID: 31395689 DOI: 10.1158/1535-7163.mct-18-1146] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/11/2019] [Accepted: 08/02/2019] [Indexed: 11/16/2022]
Abstract
Anti-B-cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T cells have shown promising clinical responses in patients with relapsed/refractory multiple myeloma. Lenalidomide, an immunomodulatory drug, potentiates T cell functionality, drives antimyeloma activity, and alters the suppressive microenvironment; these properties may effectively combine with anti-BCMA CAR T cells to enhance function. Using an anti-BCMA CAR T, we demonstrated that lenalidomide enhances CAR T cell function in a concentration-dependent manner. Lenalidomide increased CAR T effector cytokine production, particularly under low CAR stimulation or in the presence of inhibitory ligand programmed cell death 1 ligand 1. Notably, lenalidomide also enhanced CAR T cytokine production, cytolytic activity, and activation profile relative to untreated CAR T cells in chronic stimulation assays. This unique potentiation of both short-term CAR T activity and long-term functionality during chronic stimulation prompted investigation of the molecular profile of lenalidomide-treated CAR T cells. Signatures from RNA sequencing and assay for transposase-accessible chromatin using sequencing indicated that pathways associated with T-helper 1 response, cytokine production, T cell activation, cell-cycle control, and cytoskeletal remodeling were altered with lenalidomide. Finally, study of lenalidomide and anti-BCMA CAR T cells in a murine, disseminated, multiple myeloma model indicated that lenalidomide increased CAR T cell counts in blood and significantly prolonged animal survival. In summary, preclinical studies demonstrated that lenalidomide potentiated CAR T activity in vivo in low-antigen or suppressive environments and delayed onset of functional exhaustion. These results support further investigation of lenalidomide and anti-BCMA CAR T cells in the clinic.
Collapse
Affiliation(s)
- Melissa Works
- Juno Therapeutics, A Celgene Company, Seattle, Washington.
| | - Neha Soni
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | | | | | | | - Jon C Jones
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | - Wendy Curtis
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | | | | | - David Kugler
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | - Ronald J Hause
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | - Yue Jiang
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | | | | | - Heidi K Jessup
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | - Blythe Sather
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | - Ruth A Salmon
- Juno Therapeutics, A Celgene Company, Seattle, Washington
| | | |
Collapse
|
12
|
Cao Y, Wan N, Liang Z, Xie J, Wang S, Lin T, Zhang T, Jiang J. Treatment Outcomes in Patients With Newly Diagnosed Multiple Myeloma Who Are Ineligible for Stem-Cell Transplantation: Systematic Review and Network Meta-analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e478-e488. [DOI: 10.1016/j.clml.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/22/2019] [Accepted: 04/19/2019] [Indexed: 12/12/2022]
|
13
|
Mikhael J, Ismaila N, Cheung MC, Costello C, Dhodapkar MV, Kumar S, Lacy M, Lipe B, Little RF, Nikonova A, Omel J, Peswani N, Prica A, Raje N, Seth R, Vesole DH, Walker I, Whitley A, Wildes TM, Wong SW, Martin T. Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline. J Clin Oncol 2019; 37:1228-1263. [PMID: 30932732 DOI: 10.1200/jco.18.02096] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations on the treatment of multiple myeloma to practicing physicians and others. METHODS ASCO and Cancer Care Ontario convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and some phase II studies published from 2005 through 2018. Outcomes of interest included survival, progression-free survival, response rate, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 124 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed for patients with multiple myeloma who are transplantation eligible and those who are ineligible and for patients with relapsed or refractory disease.
Collapse
Affiliation(s)
- Joseph Mikhael
- 1 City of Hope Cancer Center, Phoenix, AZ.,2 International Myeloma Foundation, North Hollywood, CA
| | | | | | | | | | | | | | - Brea Lipe
- 8 University of Rochester Medical Center, Rochester, NY
| | | | - Anna Nikonova
- 10 Juravinski Cancer Center, Hamilton, Ontario, Canada
| | - James Omel
- 11 Education and Advocacy, Grand Island, NE
| | | | - Anca Prica
- 13 Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Noopur Raje
- 14 Massachusetts General Hospital, Boston, MA
| | - Rahul Seth
- 15 Upstate Medical University, Syracuse, NY
| | - David H Vesole
- 16 Hackensack University Medical Center, Hackensack, NJ.,17 Georgetown University, Washington, DC
| | - Irwin Walker
- 18 McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sandy W Wong
- 21 University of California San Francisco, San Francisco, CA
| | - Tom Martin
- 21 University of California San Francisco, San Francisco, CA
| |
Collapse
|
14
|
Stewart AK, Krishnan AY, Singhal S, Boccia RV, Patel MR, Niesvizky R, Chanan-Khan AA, Ailawadhi S, Brumm J, Mundt KE, Hong K, McBride J, Shon-Nguyen Q, Xiao Y, Ramakrishnan V, Polson AG, Samineni D, Leipold D, Humke EW, McClellan JS, Berdeja JG. Phase I study of the anti-FcRH5 antibody-drug conjugate DFRF4539A in relapsed or refractory multiple myeloma. Blood Cancer J 2019; 9:17. [PMID: 30718503 PMCID: PMC6362066 DOI: 10.1038/s41408-019-0178-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/06/2018] [Accepted: 08/17/2018] [Indexed: 12/14/2022] Open
Abstract
FcRH5 is a cell surface marker enriched on malignant plasma cells when compared to other hematologic malignancies and normal tissues. DFRF4539A is an anti-FcRH5 antibody-drug conjugated to monomethyl auristatin E (MMAE), a potent anti-mitotic agent. This phase I study assessed safety, tolerability, maximum tolerated dose (MTD), anti-tumor activity, and pharmacokinetics of DFRF4539A in patients with relapsed/refractory multiple myeloma. DFRF4539A was administered at 0.3-2.4 mg/kg every 3 weeks or 0.8-1.1 mg/kg weekly as a single-agent by intravenous infusion to 39 patients. Exposure of total antibody and antibody-conjugate-MMAE analytes was linear across the doses tested. There were 37 (95%) adverse events (AEs), 8 (21%) serious AEs, and 15 (39%) AEs ≥ grade 3. Anemia (n = 10, 26%) was the most common AE considered related to DFRF4539A. Two cases of grade 3 acute renal failure were attributed to DFRF4539A. There were no deaths; the MTD was not reached. DFRF4539A demonstrated limited activity in patients at the doses tested with 2 (5%) partial response, 1 (3%) minimal response, 18 (46%) stable disease, and 16 (41%) progressive disease. FcRH5 was confirmed to be expressed and occupied by antibody post-treatment and thus remains a valid myeloma target. Nevertheless, this MMAE-based antibody-drug-conjugate targeting FcRH5 was unsuccessful for myeloma.
Collapse
Affiliation(s)
- A Keith Stewart
- Division of Hematology-Oncology, Mayo Clinic, Phoenix, AZ, USA.
| | - Amrita Y Krishnan
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Medical Center, Duarte, CA, USA
| | - Seema Singhal
- Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Ralph V Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD, USA
| | - Manish R Patel
- Florida Cancer Specialists, Sarasota, FL, USA.,Sarah Cannon Research Institute, Nashville, TN, USA
| | - Ruben Niesvizky
- Multiple Myeloma Center, New York Presbyterian Hospital-Cornell Medical Center, New York, NY, USA
| | | | | | | | | | - Kyu Hong
- Genentech, Inc., South San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Xie J, Wan N, Liang Z, Zhang T, Jiang J. Ixazomib – the first oral proteasome inhibitor. Leuk Lymphoma 2019; 60:610-618. [DOI: 10.1080/10428194.2018.1523398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jingmei Xie
- College of Pharmacy, Jinan University, Guangzhou, PR China
| | - Ning Wan
- Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command, PR China
- Guangzhou Huabo Biopharmaceutical Research Institute, PR China
| | - Zhuoru Liang
- College of Pharmacy, Jinan University, Guangzhou, PR China
| | - Tiantian Zhang
- College of Pharmacy, Jinan University, Guangzhou, PR China
| | - Jie Jiang
- College of Pharmacy, Jinan University, Guangzhou, PR China
- Dongguan Institute of Jinan University, Dongguan, PR China
| |
Collapse
|
16
|
Abramson HN. Monoclonal Antibodies for the Treatment of Multiple Myeloma: An Update. Int J Mol Sci 2018; 19:E3924. [PMID: 30544512 PMCID: PMC6321340 DOI: 10.3390/ijms19123924] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022] Open
Abstract
The past two decades have seen a revolution in multiple myeloma (MM) therapy with the introduction of several small molecules, mostly orally effective, whose mechanisms are based on proteasome inhibition, histone deacetylase (HDAC) blockade, and immunomodulation. Immunotherapeutic approaches to MM treatment using monoclonal antibodies (mAbs), while long in development, began to reap success with the identification of CD38 and SLAMF7 as suitable targets for development, culminating in the 2015 Food and Drug Administration (FDA) approval of daratumumab and elotuzumab, respectively. This review highlights additional mAbs now in the developmental pipeline. Isatuximab, another anti-CD38 mAb, currently is under study in four phase III trials and may offer certain advantages over daratumumab. Several antibody-drug conjugates (ADCs) in the early stages of development are described, including JNJ-63723283, which has attained FDA breakthrough status for MM. Other mAbs described in this review include denosumab, recently approved for myeloma-associated bone loss, and checkpoint inhibitors, although the future status of the latter combined with immunomodulators has been clouded by unacceptably high death rates that caused the FDA to issue clinical holds on several of these trials. Also highlighted are the therapies based on the B Cell Maturation Antigen (BCMA), another very promising target for anti-myeloma development.
Collapse
Affiliation(s)
- Hanley N Abramson
- Department of Pharmaceutical Sciences, Wayne State University, Detroit, MI 48202, USA.
| |
Collapse
|
17
|
Du H, Wang L, Liu B, Wang J, Su H, Zhang T, Huang Z. Analysis of the Metabolic Characteristics of Serum Samples in Patients With Multiple Myeloma. Front Pharmacol 2018; 9:884. [PMID: 30186161 PMCID: PMC6113671 DOI: 10.3389/fphar.2018.00884] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/20/2018] [Indexed: 12/31/2022] Open
Abstract
Aims: This study aimed to identify potential, non-invasive biomarkers for diagnosis and monitoring of the progress in multiple myeloma (MM) patients. Methods: MM patients and age-matched healthy controls (HC) were recruited in Discovery phase and Validation phase, respectively. MM patients were segregated into active group (AG) and responding group (RG). Serum samples were collected were conducted to non-targeted metabolomics analyses. Metabolites which were significantly changed (SCMs) among groups were identified in Discovery phase and was validated in Validation phase. The signaling pathways of these SCMs were enriched. The ability of SCMs to discriminate among groups in Validation phase was analyzed through receiver operating characteristic curve. The correlations between SCMs and clinical features, between SCMs and survival period of MM patients were analyzed. Results: Total of 23 SCMs were identified in AG compared with HC both in Discovery phase and Validation phase. Those SCMs were significantly enriched in arginine and proline metabolism and glycerophospholipid metabolism. 4 SCMs had the discriminatory ability between MM patients and healthy controls in Validation phase. Moreover, 12 SCMs had the ability to discriminate between the AG patients and RG patients in Validation phase. 10 out of 12 SCMs correlated with advanced features of MM. Moreover, 8 out of 12 SCMs had the negative impact on the survival of MM. 5'-Methylthioadenosine may be the only independent prognostic factor in survival period of MM. Conclusion: 10 SCMs identified in our study, which correlated with advanced features of MM, could be potential, novel, non-invasive biomarkers for active disease in MM.
Collapse
Affiliation(s)
- Haiwei Du
- MOH Key Laboratory of Systems Biology of Pathogen, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Linyue Wang
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Bo Liu
- MOH Key Laboratory of Systems Biology of Pathogen, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinying Wang
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Haoxiang Su
- MOH Key Laboratory of Systems Biology of Pathogen, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ting Zhang
- MOH Key Laboratory of Systems Biology of Pathogen, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhongxia Huang
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
18
|
Towards Molecular Profiling in Multiple Myeloma: A Literature Review and Early Indications of Its Efficacy for Informing Treatment Strategies. Int J Mol Sci 2018; 19:ijms19072087. [PMID: 30021955 PMCID: PMC6073692 DOI: 10.3390/ijms19072087] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 12/26/2022] Open
Abstract
Multiple myeloma (MM), the second most common hematologic malignancy, is characterized by the clonal expansion of plasma cells. Despite dramatic improvements in patients′ survival over the past decade due to advances in therapy exploiting novel molecular targets (immunomodulatory drugs, proteasome inhibitors and monoclonal antibodies), the treatment of relapsed and refractory disease remains challenging. Recent studies confirmed complex, dynamic, and heterogeneous genomic alterations without unifying gene mutations in MM patients. In the current review, we survey recent therapeutic strategies, as well as molecular profiling data on MM, with emphasis on relapsed and refractory cases. A critical appraisal of novel findings and of their potential therapeutic implications will be discussed in detail, along with the author’s own experiences/views.
Collapse
|
19
|
Cost-effectiveness of Daratumumab-based Triplet Therapies in Patients With Relapsed or Refractory Multiple Myeloma. Clin Ther 2018; 40:1122-1139. [DOI: 10.1016/j.clinthera.2018.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 12/20/2022]
|
20
|
Monoclonal Antibodies versus Histone Deacetylase Inhibitors in Combination with Bortezomib or Lenalidomide plus Dexamethasone for the Treatment of Relapsed or Refractory Multiple Myeloma: An Indirect-Comparison Meta-Analysis of Randomized Controlled Trials. J Immunol Res 2018; 2018:7646913. [PMID: 30050957 PMCID: PMC6040277 DOI: 10.1155/2018/7646913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022] Open
Abstract
During the past decades, agents with novel mechanisms of action, such as monoclonal antibodies (MAbs) and histone deacetylase inhibitors (HDACis) have been applied to treat relapsed or refractory multiple myeloma (RRMM). The treatment outcomes of MAbs versus HDACi in combination with bortezomib or lenalidomide plus dexamethasone remain unknown. We conducted this meta-analysis to compare indirectly the efficacy and safety of MAbs and HDACis in combination with bortezomib or lenalidomide plus dexamethasone. Six trials (eight articles) were included in the meta-analysis with 3270 RRMM patients enrolled. We synthesized hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), risk ratios (RRs) for complete response (CR),very good partial response (VGPR), overall response (OR), progressive disease plus stable disease (PD + SD) and common at least grade 3 adverse events, and their corresponding 95%confidence intervals (95% CI). Treatment with MAbs in combination with bortezomib or lenalidomide plus dexamethasone resulted in longer PFS (HR 0.83, 95% CI: 0.66-0.98), fewer incidences of at least grade 3 thrombocytopenia (RR 0.35, 95% CI: 0.23-0.53), neutropenia (RR 0.70, 95% CI: 0.51-0.96), and sense of fatigue (RR 0.37, 95% CI: 0.17-0.82) than HDACis. The daratumumab plus bortezomib or lenalidomide and dexamethasone might significantly improve PFS in comparison with HDACis plus bortezomib or lenalidomide and dexamethasone (HR 0.55, 95% CI: 0.40-0.74). In conclusion, MAbs may be superior to HDACis in achieving longer PFS and may be better tolerated when in combination therapy with bortezomib or lenalidomide plus dexamethasone.
Collapse
|
21
|
Nadeem T, Khan MA, Ijaz B, Ahmed N, Rahman ZU, Latif MS, Ali Q, Rana MA. Glycosylation of Recombinant Anticancer Therapeutics in Different Expression Systems with Emerging Technologies. Cancer Res 2018; 78:2787-2798. [DOI: 10.1158/0008-5472.can-18-0032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/22/2018] [Accepted: 04/03/2018] [Indexed: 11/16/2022]
|
22
|
Musto P. Monoclonal Antibodies and Multiple Myeloma: All in All It's Just Another Brick in the Wall? Oncologist 2018; 23:511-515. [PMID: 29700211 PMCID: PMC5947460 DOI: 10.1634/theoncologist.2018-0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/28/2018] [Indexed: 01/20/2023] Open
Abstract
This commentary offers insight about the recent review by the European Medicines Agency on the approval of daratumumab for the treatment of adult patients with multiple myeloma.
Collapse
Affiliation(s)
- Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| |
Collapse
|
23
|
Wallington-Beddoe CT, Sobieraj-Teague M, Kuss BJ, Pitson SM. Resistance to proteasome inhibitors and other targeted therapies in myeloma. Br J Haematol 2018; 182:11-28. [PMID: 29676460 DOI: 10.1111/bjh.15210] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The number of novel therapies for the treatment of myeloma is rapidly increasing, as are the clinical trials evaluating them in combination with other novel and established therapies. Proteasome inhibitors, immunomodulatory agents and monoclonal antibodies are the most well known and studied classes of novel agents targeting myeloma, with histone deacetylase inhibitors, nuclear export inhibitors and several other approaches also being actively investigated. However, in parallel with the development and clinical use of these novel myeloma therapies is the emergence of novel mechanisms of resistance, many of which remain elusive, particularly for more recently developed agents. Whilst resistance mechanisms have been best studied for proteasome inhibitors, particularly bortezomib, class effects do not universally apply to all class members, and within-class differences in efficacy, toxicity and resistance mechanisms have been observed. Although immunomodulatory agents share the common cellular target cereblon and thus resistance patterns relate to cereblon expression, the unique cell surface antigens to which monoclonal antibodies are directed means these agents frequently exhibit unique within-class differences in clinical efficacy and resistance patterns. This review describes the major classes of novel therapies for myeloma, highlights the major clinical trials within each class and discusses known resistance mechanisms.
Collapse
Affiliation(s)
- Craig T Wallington-Beddoe
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, South Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - Magdalena Sobieraj-Teague
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia.,SA Pathology, Adelaide, Australia
| | - Bryone J Kuss
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia.,SA Pathology, Adelaide, Australia
| | - Stuart M Pitson
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| |
Collapse
|
24
|
Wang Y, Lv B, Li K, Zhang A, Liu H. Adjuvant immunotherapy of dendritic cells and cytokine-induced killer cells is safe and enhances chemotherapy efficacy for multiple myeloma in China: a meta-analysis of clinical trials. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:3245-3256. [PMID: 29180849 PMCID: PMC5695269 DOI: 10.2147/dddt.s146959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective The aim of this study was to systematically evaluate the efficacy and safety of the combination of dendritic cells and cytokine-induced killer cells (DC–CIK) adjuvant immunotherapy and chemotherapy in the treatment of multiple myeloma (MM). Methods Clinical trials were gathered by searching Web of Science, PubMed, Embase, Cochrane Library, Wanfang, and CNKI database. Outcome measurements including therapeutic efficacy, prognosis, immune function, and adverse events were extracted and evaluated. Results A total of 12 trials including 594 MM patients were involved in this study for statistical analysis. Results indicated that compared to chemotherapy alone, the combination of DC–CIK immunotherapy with chemotherapy significantly improved patients’ overall response rate (ORR, odds ratio [OR] =2.77, 95% confidence interval [CI] =1.88–4.10, P<0.00001), disease control rate (DCR, OR =2.90, CI =1.72–4.90, P<0.0001), and life quality (P<0.00001). The combined therapy showed advantages over chemotherapy alone in prognostic indicators including percentage of tumor cells (P=0.04), serum levels of β2-microglobin (P<0.0001), M protein (P<0.00001), and creatinine (P<0.0001), and 24 h urine light chains (P<0.00001). After combined treatment, CD4+ lymphocyte subsets’ percentages, CD4+/CD8+ ratio, and cytokines levels of AgNOR, IFN-γ, IL-2, and IL-12 were significantly increased (P<0.05), whereas CD8+ and CD4+CD25+ percentages and IL-4, IL-6, IL-10, and TGF-β levels were obviously decreased (P<0.01), indicating a recovered immune condition. Conclusion Adjuvant DC–CIK immunotherapy enhances the efficacy of chemotherapy for MM and improves prognosis probably by reconstructing immune function.
Collapse
Affiliation(s)
- Yan Wang
- Department of Clinical Laboratory
| | | | - Ke Li
- Department of Central Laboratory, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong Province, China
| | - Anqi Zhang
- Department of Central Laboratory, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong Province, China
| | - Hong Liu
- Department of Central Laboratory, Liaocheng People's Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong Province, China
| |
Collapse
|
25
|
Cho SF, Lin L, Xing L, Yu T, Wen K, Anderson KC, Tai YT. Monoclonal Antibody: A New Treatment Strategy against Multiple Myeloma. Antibodies (Basel) 2017; 6:antib6040018. [PMID: 31548533 PMCID: PMC6698817 DOI: 10.3390/antib6040018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 12/22/2022] Open
Abstract
2015 was a groundbreaking year for the multiple myeloma community partly due to the breakthrough approval of the first two monoclonal antibodies in the treatment for patients with relapsed and refractory disease. Despite early disappointments, monoclonal antibodies targeting CD38 (daratumumab) and signaling lymphocytic activation molecule F7 (SLAMF7) (elotuzumab) have become available for patients with multiple myeloma in the same year. Specifically, phase 3 clinical trials of combination therapies incorporating daratumumab or elotuzumab indicate both efficacy and a very favorable toxicity profile. These therapeutic monoclonal antibodies for multiple myeloma can kill target cells via antibody-dependent cell-mediated cytotoxicity, complement-dependent cytotoxicity, and antibody-dependent phagocytosis, as well as by direct blockade of signaling cascades. In addition, their immunomodulatory effects may simultaneously inhibit the immunosuppressive bone marrow microenvironment and restore the key function of immune effector cells. In this review, we focus on monoclonal antibodies that have shown clinical efficacy or promising preclinical anti-multiple myeloma activities that warrant further clinical development. We summarize mechanisms that account for the in vitro and in vivo anti-myeloma effects of these monoclonal antibodies, as well as relevant preclinical and clinical results. Monoclonal antibody-based immunotherapies have already and will continue to transform the treatment landscape in multiple myeloma.
Collapse
Affiliation(s)
- Shih-Feng Cho
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
| | - Liang Lin
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
| | - Lijie Xing
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan 250021, China.
| | - Tengteng Yu
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
| | - Kenneth Wen
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
| | - Kenneth C Anderson
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
| | - Yu-Tzu Tai
- LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
| |
Collapse
|
26
|
Wallington-Beddoe CT, Pitson SM. Novel therapies for multiple myeloma. Aging (Albany NY) 2017; 9:1857-1858. [PMID: 28854147 PMCID: PMC5611977 DOI: 10.18632/aging.101284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/25/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Craig T Wallington-Beddoe
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia
- School of Medicine, The Flinders University of South Australia, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Stuart M Pitson
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
27
|
Golay J. Direct targeting of cancer cells with antibodies: What can we learn from the successes and failure of unconjugated antibodies for lymphoid neoplasias? J Autoimmun 2017; 85:6-19. [PMID: 28666691 DOI: 10.1016/j.jaut.2017.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/11/2017] [Indexed: 12/26/2022]
Abstract
Following approval in 1997 of the anti-CD20 antibody rituximab for the treatment of B-NHL and CLL, many other unconjugated IgG1 MAbs have been tested in pre-clinical and clinical trials for the treatment of lymphoid neoplasms. Relatively few have been approved however and these are directed against a limited number of target antigens (CD20, CD52, CCR4, CD38, CD319). We review here the known biological properties of these antibodies and discuss which factors may have led to their success or may, on the contrary, limit their clinical application. Common factors of the approved MAbs are that the target antigen is expressed at relatively high levels on the neoplastic targets and their mechanism of action is mostly immune-mediated. Indeed most of these MAbs induce ADCC and phagocytosis by macrophages, and many also activate complement, leading to target cell lysis. In contrast direct cell death induction is not a common feature but may enhance efficacy in some cases. Interestingly, a key factor for the success of several MAbs appears to be their capacity to skew immunity towards an anti-tumour mode, by inhibiting/depleting suppressor cells and/or activating immune cells within the microenvironment, independently of FcγRs. We also expose here some of the strategies employed by industry to expand the clinical use of these molecules beyond their original indication. Interestingly, due to the central role of lymphocytes in the control of the immune response, several of the antibodies are now successfully used to treat many different autoimmune diseases and have also been formally approved for some of these new indications. There is little doubt that this trend will continue and that the precise mechanisms of therapeutic MAbs will be further dissected and better understood in the context of both tumour immunology and autoimmunity.
Collapse
Affiliation(s)
- Josée Golay
- Center of Cellular Therapy "G. Lanzani", USC Haematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Via Garibaldi 11-13, 24128, Bergamo, Italy.
| |
Collapse
|