1
|
Smirnova SY, Al-Radi LS, Moiseeva TN, Gemdzhian EG, Yakutik IA, Julhakyan HL, Novikov VA, Galstyan GM, Sudarikov AB. Inhibitor of BRAF V600E Mutation as a Treatment Option for Hairy Cell Leukemia With Deep Neutropenia and Infectious Complications. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:427-430. [PMID: 33811006 DOI: 10.1016/j.clml.2021.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
Standard therapy in hairy cell leukemia (HCL) is often impossible at the time of deep neutropenia/agranulocytosis with or without infectious complications; it is thus a complex therapeutic problem. Vemurafenib has been used to treat resistant HCL since 2012. Because vemurafenib does not have a myelotoxic effect, we thought that it could be used to treat HCL associated with deep neutropenia/agranulocytosis with or without the development of infectious complications as a preliminary stage before treatment with cladribine. We conducted a retrospective analysis of treatment with vemurafenib followed by a standard course of cladribine provided to 22 patients with deep neutropenia/agranulocytosis with or without infectious complications at diagnosis. Vemurafenib was provided to 22 patients with HCL. The response to therapy was evaluated by complete blood cell count (absolute neutrophil count [ANC], hemoglobin concentration, platelet count, absence of hairy cells), spleen size (assessed by ultrasound), and reduce infectious complications. After that, a standard course of cladribine was provided. Among the 22 patients, the male/female sex ratio was 2:1, and median (range) age was 52 (24-78) years. There were 7 patients with severe infectious manifestations admitted to the intensive care unit, including 1 patient during extracorporeal membrane oxygenation. The median (range) ANC at diagnosis was 0.3 (0.04-0.7) × 109/L. Vemurafenib was provided at a dosage of 240 mg 1 or 2 times a day. In 20 patients, vemurafenib was provided for 3 months or more. In 1 case, the effect was not obtained during 1 month of treatment, and the patient died from severe infectious complications during prolonged agranulocytosis. In 21 patients treated with vemurafenib, an increase of ANC was observed and the infectious complications resolved, thus allowing the application of cladribine therapy. After a standard course (0.1 mg/kg per day for 7 days) of cladribine chemotherapy, 18 patients (90%) experienced complete clinical remission and 2 patients (10%) experienced partial remission with residual splenomegaly. In 1 patient, vemurafenib therapy was still ongoing 2 months after initiating therapy. In cases of proven BRAFV600E mutation, vemurafenib can be successfully used as an effective preliminary therapy in patients with deep neutropenia/agranulocytosis with or without infectious complications before standard therapy with purine analogs.
Collapse
|
2
|
Feurtado J, Kreitman RJ. Moxetumomab Pasudotox: Clinical Experience in Relapsed/Refractory Hairy Cell Leukemia. Clin J Oncol Nurs 2020; 23:E52-E59. [PMID: 31099793 DOI: 10.1188/19.cjon.e52-e59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Moxetumomab pasudotox is a promising new therapy for the treatment of patients with relapsed/refractory hairy cell leukemia (R/R HCL), but practical guidance relating to its administration is limited. OBJECTIVES This article describes clinical guidelines for the administration of moxetumomab pasudotox to patients with R/R HCL and presents related case studies. METHODS A limited review of the literature on HCL was undertaken. FINDINGS Nursing care of patients prescribed moxetumomab pasudotox includes monitoring clinical and laboratory parameters, managing side effects, being aware of signs of serious side effects, and maintaining patient hydration during administration.
Collapse
Affiliation(s)
- Julie Feurtado
- National Cancer Institute at the National Institutes of Health
| | | |
Collapse
|
3
|
Epperla N, Pavilack M, Olufade T, Bashyal R, Li J, Kabadi SM, Yuce H, Andritsos L. Adverse event rates and economic burden associated with purine nucleoside analogs in patients with hairy cell leukemia: a US population-retrospective claims analysis. Orphanet J Rare Dis 2020; 15:47. [PMID: 32054500 PMCID: PMC7020358 DOI: 10.1186/s13023-020-1325-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/28/2020] [Indexed: 01/03/2023] Open
Abstract
Background Purine nucleoside analogs (PNAs) are the recommended first-line treatment for patients with hairy cell leukemia (HCL), but they are associated with adverse events (AEs). Due to a lack of real-world evidence regarding AEs that are associated with PNAs, we used commercial data to assess AE rates, AE-related health care resource utilization (HCRU), and costs among PNA-treated patients with HCL. Adults aged ≥18 years with ≥2 claims for HCL ≥30 days apart from 1 January 2006 through 31 December 2015 were included. Included patients had ≥1 claim for HCL therapy (cladribine ± rituximab or pentostatin ± rituximab [index date: first claim date]) and continuous enrollment for a ≥ 6-month baseline and ≥ 12-month follow-up period. Patient sub-cohorts were based on the occurrence of myelosuppression and opportunistic infections (OIs). Generalized linear models were used to compare HCRU and costs. Results In total, 647 PNA-treated patients were identified (mean age: 57.1 years). Myelosuppression and OI incidence were 461 and 42 per 1000 patient-years, respectively. Adjusted results indicated that those with myelosuppression had higher rates of hospitalization (47.4% vs 12.4%; P < .0001) and incurred higher mean inpatient costs ($23,517 vs $12,729; P = .011) and total costs ($57,325 vs $34,733; P = .001) as compared with those without myelosuppression. Similarly, patients with OIs had higher rates of hospitalization (53.8% vs 30.8%; P = .025) and incurred higher mean inpatient costs ($21,494 vs $11,229; P < .0001) as compared with those without OIs. Conclusions PNA therapy is highly effective but associated with significant toxicities that increase costs; these findings indicate a need for therapies with improved toxicity profiles and better risk stratification of patients at risk of developing myelosuppression and OIs.
Collapse
Affiliation(s)
- Narendranath Epperla
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, A346 Starling Loving Hall, 320W 10th Ave, Columbus, OH, 43210, USA.
| | | | | | | | - Jieni Li
- STATinMED Research, Plano, TX, USA
| | | | - Huseyin Yuce
- New York City College of Technology, New York, NY, USA
| | - Leslie Andritsos
- Division of Hematology and Oncology, The University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
4
|
Classic hairy cell leukemia complicated by pancytopenia and severe infection: a report of 3 cases treated with vemurafenib. Blood Adv 2020; 3:116-118. [PMID: 30630817 DOI: 10.1182/bloodadvances.2018027466] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/04/2018] [Indexed: 01/04/2023] Open
Abstract
Key Points
Infections are a major cause of morbidity and mortality in HCL patients, and myelosuppressive therapies increase the risk of poor outcomes. Vemurafenib achieves rapid hematologic improvement in HCL and may facilitate management during life-threatening infection.
Collapse
|
5
|
Fancher KM, Lally-Montgomery ZC. Moxetumomab pasudotox: A first-in-class treatment for hairy cell leukemia. J Oncol Pharm Pract 2019; 25:1467-1472. [PMID: 30917739 DOI: 10.1177/1078155219838041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hairy cell leukemia is a rare indolent B-cell lymphoid malignancy. Durable remission can be obtained with purine analogues, but relapse is inevitable, and effective treatment options may be limited. Moxetumomab pasudotox is a recombinant CD22-targeting immunotoxin that has recently been approved by the United States Food and Drug Administration for the treatment of relapsed or refractory hairy cell leukemia. Approval was based on a pivotal phase III study in this unique patient population. Rationale for use, clinical trial data, and current treatment recommendations are detailed. Common adverse effects are reviewed, and management strategies for select adverse effects are suggested. Implications for contemporary practitioners are also provided, as use of this novel agent is likely to increase as follow-up studies are reported.
Collapse
Affiliation(s)
- Karen M Fancher
- 1 Department of Pharmacy Practice, Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania.,2 University of Pittsburgh Medical Center Passavant, Pittsburgh, Pennsylvania
| | | |
Collapse
|
6
|
Eskiocak B, McMillan EA, Mendiratta S, Kollipara RK, Zhang H, Humphries CG, Wang C, Garcia-Rodriguez J, Ding M, Zaman A, Rosales TI, Eskiocak U, Smith MP, Sudderth J, Komurov K, Deberardinis RJ, Wellbrock C, Davies MA, Wargo JA, Yu Y, De Brabander JK, Williams NS, Chin L, Rizos H, Long GV, Kittler R, White MA. Biomarker Accessible and Chemically Addressable Mechanistic Subtypes of BRAF Melanoma. Cancer Discov 2017; 7:832-851. [PMID: 28455392 DOI: 10.1158/2159-8290.cd-16-0955] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/07/2016] [Accepted: 04/26/2017] [Indexed: 12/21/2022]
Abstract
Genomic diversity among melanoma tumors limits durable control with conventional and targeted therapies. Nevertheless, pathologic activation of the ERK1/2 pathway is a linchpin tumorigenic mechanism associated with the majority of primary and recurrent disease. Therefore, we sought to identify therapeutic targets that are selectively required for tumorigenicity in the presence of pathologic ERK1/2 signaling. By integration of multigenome chemical and genetic screens, recurrent architectural variants in melanoma tumor genomes, and patient outcome data, we identified two mechanistic subtypes of BRAFV600 melanoma that inform new cancer cell biology and offer new therapeutic opportunities. Subtype membership defines sensitivity to clinical MEK inhibitors versus TBK1/IKBKε inhibitors. Importantly, subtype membership can be predicted using a robust quantitative five-feature genetic biomarker. This biomarker, and the mechanistic relationships linked to it, can identify a cohort of best responders to clinical MEK inhibitors and identify a cohort of TBK1/IKBKε inhibitor-sensitive disease among nonresponders to current targeted therapy.Significance: This study identified two mechanistic subtypes of melanoma: (1) the best responders to clinical BRAF/MEK inhibitors (25%) and (2) nonresponders due to primary resistance mechanisms (9.9%). We identified robust biomarkers that can detect these subtypes in patient samples and predict clinical outcome. TBK1/IKBKε inhibitors were selectively toxic to drug-resistant melanoma. Cancer Discov; 7(8); 832-51. ©2017 AACR.See related commentary by Jenkins and Barbie, p. 799This article is highlighted in the In This Issue feature, p. 783.
Collapse
Affiliation(s)
- Banu Eskiocak
- Department of Cell Biology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth A McMillan
- Department of Cell Biology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Saurabh Mendiratta
- Department of Cell Biology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rahul K Kollipara
- Eugene McDermott Center for Human Growth and Development, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hailei Zhang
- The Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Caroline G Humphries
- Eugene McDermott Center for Human Growth and Development, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Changguang Wang
- Department of Biochemistry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jose Garcia-Rodriguez
- Department of Biochemistry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ming Ding
- Department of Biochemistry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aubhishek Zaman
- Department of Cell Biology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tracy I Rosales
- Department of Cell Biology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ugur Eskiocak
- Children's Research Institute and the Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael P Smith
- Manchester Cancer Research Centre, Wellcome Trust Centre for Cell-Matrix Research, The University of Manchester, Manchester, United Kingdom
| | - Jessica Sudderth
- Children's Research Institute and the Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kakajan Komurov
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ralph J Deberardinis
- Children's Research Institute and the Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Claudia Wellbrock
- Manchester Cancer Research Centre, Wellcome Trust Centre for Cell-Matrix Research, The University of Manchester, Manchester, United Kingdom
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yonghao Yu
- Department of Biochemistry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jef K De Brabander
- Department of Biochemistry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noelle S Williams
- Department of Biochemistry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lynda Chin
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Helen Rizos
- Melanoma Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Ralf Kittler
- Eugene McDermott Center for Human Growth and Development, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael A White
- Department of Cell Biology, The University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
7
|
Cortazar JM, DeAngelo DJ, Pinkus GS, Morgan EA. Morphological and immunophenotypical features of hairy cell leukaemia involving lymph nodes and extranodal tissues. Histopathology 2017; 71:112-124. [PMID: 28261866 DOI: 10.1111/his.13206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/28/2017] [Indexed: 12/01/2022]
Abstract
AIMS Hairy cell leukaemia (HCL) is a rare B cell neoplasm that mainly affects bone marrow (BM), peripheral blood (PB) and spleen. Involvement of lymph nodes and extranodal structures is considered infrequent. Herein we describe our institutional experience of nodal (n = 10) and extranodal (n = 3) HCL during a 30-year period. METHODS AND RESULTS Ten patients had prior evidence of HCL within the BM or PB at a median 35.8 months before nodal/extranodal diagnosis (range: <1-175 months), and HCL was diagnosed concurrently within the bone marrow of one additional patient. Nodal involvement showed distinct architectural patterns, including diffuse (62% of cases), sinusoidal (25%) and nodular (13%). Extranodal involvement was characterized as diffuse infiltration through underlying structures in all cases. Morphological features ranged from classic 'fried-egg' cytology to a plasmacytoid appearance. Nodal/extranodal disease showed an overlapping immunophenotypical profile with other small B cell lymphomas, including expression of cyclin D1 (70%), CD43 (55%), CD10 (38%) and CD5 (8%). Rates of both CD43 and CD10 reactivity were higher than described previously in leukaemic HCL, suggesting that expression may be enriched in cases with extramedullary extension. CONCLUSIONS Although uncommon, HCL should be considered in the differential diagnosis of small B cell neoplasms involving nodal/extranodal sites, given the therapeutic implications. In particular, recent discoveries including detection of the BRAFV600E mutation in nearly all cases of HCL and the availability of an antibody to CD103 for use in paraffin-embedded tissues will facilitate the distinction of HCL from other small B cell lymphomas in the nodal/extranodal setting.
Collapse
Affiliation(s)
- Jacqueline M Cortazar
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Geraldine S Pinkus
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Jiang M, Bennani NN, Feldman AL. Lymphoma classification update: B-cell non-Hodgkin lymphomas. Expert Rev Hematol 2017; 10:405-415. [DOI: 10.1080/17474086.2017.1318053] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Manli Jiang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew L. Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
9
|
Smith CIE. Enigmas in tumor resistance to kinase inhibitors and calculation of the drug resistance index for cancer (DRIC). Semin Cancer Biol 2016; 45:36-49. [PMID: 27865897 DOI: 10.1016/j.semcancer.2016.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/09/2016] [Indexed: 12/11/2022]
Abstract
Darwinian selection is also applicable when antibiotics, the immune system or other host factors shape the repertoire of microorganisms, and similarly, clonal selection is the hallmark of tumor evolution. The ongoing revolution in new anti-cancer treatment modalities, combined with an unprecedented precision in characterizing malignant clones at the level below one percent, profoundly improves the understanding of repertoire-tuning mechanisms. There is no fundamental difference between selection of the tumor cells in the presence, or absence, of therapy. However, under treatment the influence of a single agent can be measured, simplifying the analysis. Because of their beneficial and selective therapeutic effect, the focus in this review is set on protein kinase inhibitors (PKIs), predominantly tyrosine kinase inhibitors (TKIs). This is one of the most rapidly growing families of novel cancer medicines. In order to limit the number of drugs, the following representative target kinases are included: ALK, BCR-ABL, BRAF, BTK, and EGFR. A key therapeutic challenge is how to reduce tumor growth after treatment, since this is rate-limiting for the generation and expansion of more malignant escape mutants. Thus, upon efficient treatment, tumor cell loss often enables a profoundly increased growth rate among resistant cells. Strategies to reduce this risk, such as concomitant, competitive outgrowth of non-transformed cells, are described. Seven parameters: 1. Drug type, 2. tumor type, 3. presence of metastases or phenotypic change, 4. tumor cell number, 5. net growth rate (proliferation minus cell death), 6. inherited genetic- and 7. epigenetic- variations are crucial for drug responses. It is envisaged that it might become possible to calculate a clinically relevant Drug Resistance Index for Cancer (DRIC) for each patient.
Collapse
Affiliation(s)
- C I Edvard Smith
- Clinical Research Center, Dept. of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-14186, Huddinge, Sweden.
| |
Collapse
|
10
|
McDowell MM, Zhu X, Agarwal N, Nikiforova MN, Lieberman FS, Drappatz J. Response of relapsed central nervous system hairy cell leukemia to vemurafenib. Leuk Lymphoma 2016; 57:2952-2954. [PMID: 27116997 DOI: 10.1080/10428194.2016.1177773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Michael M McDowell
- a Department of Neurological Surgery , University of Pittsburgh , Pittsburgh , PA , USA
| | - Xiao Zhu
- a Department of Neurological Surgery , University of Pittsburgh , Pittsburgh , PA , USA
| | - Nitin Agarwal
- a Department of Neurological Surgery , University of Pittsburgh , Pittsburgh , PA , USA
| | - Marina N Nikiforova
- b Division of Molecular and Genomic Pathology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Frank S Lieberman
- c Division of Neuro-Oncology , Hillman Cancer Center, University of Pittsburgh , Pittsburgh , PA , USA
| | - Jan Drappatz
- c Division of Neuro-Oncology , Hillman Cancer Center, University of Pittsburgh , Pittsburgh , PA , USA
| |
Collapse
|
11
|
Meador CB, Pao W. Old Habits Die Hard: Addiction of BRAF-Mutant Cancer Cells to MAP Kinase Signaling. Cancer Discov 2016; 5:348-50. [PMID: 25847954 DOI: 10.1158/2159-8290.cd-15-0221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dual and triple combination therapies with RAF inhibitors plus other targeted agents have demonstrated promising clinical utility in BRAFV600-mutant solid tumors. However, despite vertical inhibition at multiple nodes on the MAPK signaling pathway, resistant tumors emerge. Ahronian and colleagues show that in BRAF-mutant colorectal cancer, resistance involves reactivation of RAS/RAF/MEK/ERK signaling and may be overcome by newly emerging ERK inhibitors.
Collapse
Affiliation(s)
- Catherine B Meador
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - William Pao
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, Tennessee. Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
| |
Collapse
|