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Imamura M, Nakamura Y, Hidaka D, Ogasawara R, Okada K, Sugita J, Ota S. Long-term follow-up of efficacy and safety in elderly patients with chronic myeloid leukemia treated with intermittent low dose dasatinib therapy. Leuk Res Rep 2024; 21:100452. [PMID: 38444525 PMCID: PMC10912670 DOI: 10.1016/j.lrr.2024.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Intermittent low dose dasatinib therapy brought about a beneficial effect in elderly patients with chronic-phase chronic myeloid leukemia (CML-CP) without inducing severe adverse events (AEs). An 85-year-old male patient, who received twice-weekly, thrice-weekly, or four-times-weekly administration of 20 mg/day dasatinib after once-weekly administration, achieved a major molecular response two years after the start of dasatinib treatment and later sometimes achieved a deep molecular response, maintaining the efficacy for 11 years. The mean daily dose ranged from 5.7 mg to 11.4 mg. Furthermore, a 79-year-old male patient, who received thrice-weekly or every other day administration of 20 mg/day dasatinib after once-weekly administration, achieved a deep molecular response at four and half years after the start of dasatinib treatment. The mean daily dose is 8.6 mg. Intermittent low dose dasatinib therapy appears to be feasible in elderly patients with CML-CP. The goal of treatment in elderly patients with CML-CP appears to be different from that in younger patients, since they often suffer from serious AEs in the case of standard dose tyrosine kinase inhibitor therapy, followed by the dose reduction or cessation of treatment.
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Affiliation(s)
- Masahiro Imamura
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Yusuke Nakamura
- Department of Pharmacy, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Daisuke Hidaka
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Reiki Ogasawara
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Kohei Okada
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Junichi Sugita
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, 5-1, 6 Jyo 5 Chome, Higashi-sapporo, Shiroishi-ku, Sapporo, 003-0006, Japan
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Shin H, Ha JE, Zang DY, Kim SH, Do YR, Lee WS, Kim DW, Lee JI. Appropriate Starting Dose of Dasatinib Based on Analyses of Dose-Limiting Toxicities and Molecular Responses in Asian Patients With Chronic Myeloid Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e521-e529. [PMID: 33632667 DOI: 10.1016/j.clml.2021.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dasatinib is administered at a fixed starting dosage of 100 mg once daily regardless of patient-specific factors. However, such fixed dosing may not be optimal for the treatment of Asian patients with chronic myeloid leukemia in chronic phase (CP-CML). PATIENTS AND METHODS The dose-limiting toxicities (DLTs) and molecular responses (MRs) of dasatinib therapy were evaluated using clinical data obtained from 102 patients newly diagnosed with CP-CML at 17 hospitals in South Korea. RESULTS By 36 months after the initiation of a fixed dose regimen of dasatinib 100 mg once daily as the first-line therapy, 55.9% of patients experienced at least one type of DLT. The 3 most frequent DLTs were thrombocytopenia (45.5%), pericardial or pleural effusion (30.9%), and anemia (7.3%). Patients with higher dasatinib dose adjusted for body weight (Dose/BW) had a greater rate of DLT occurrence (logit [P] = 1.58 × [Dose/BW] - 2.27, P = .03). As median Dose/BW increased from 1.23 to 2.00 mg/kg, the rate of DLT occurrence increased from 43.5% to 66.7% (P = .03). However, Dose/BW did not affect the achievement rate of major MR (60.9% to 69.6%, P = .92). CONCLUSION The starting dosage of dasatinib may need to be reduced (eg, 80 mg once daily or lower) for Asian patients with CP-CML, especially with lighter BW, to alleviate the risk of DLT occurrence without compromising the achievement of MR.
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Affiliation(s)
- Hyejin Shin
- Department of Pharmacy, College of Pharmacy, Seoul National University, Seoul, Korea; Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Jung-Eun Ha
- Department of Pharmacy, College of Pharmacy, Seoul National University, Seoul, Korea; Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University Medical Center, Busan, Korea
| | - Young Rok Do
- Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong-Wook Kim
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea; Department of Hematology, Catholic Hematology Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea.
| | - Jangik I Lee
- Department of Pharmacy, College of Pharmacy, Seoul National University, Seoul, Korea; Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea.
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Evaluation of Medication Adherence and Pharmacokinetics of Dasatinib for Earlier Molecular Response in Japanese Patients With Newly Diagnosed Chronic Myeloid Leukemia: A Pilot Study. Ther Drug Monit 2020; 41:575-581. [PMID: 31008998 DOI: 10.1097/ftd.0000000000000639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tyrosine kinase inhibitors markedly improve the survival for patients with chronic myeloid leukemia (CML). However, a decrease in adherence leads to undesired therapeutic outcomes. In this study, the relationships among adherence, pharmacokinetics, response, and adverse effects for dasatinib treatment were prospectively investigated. METHODS This study was a prospective cohort study of patients with newly diagnosed CML at 4 general hospitals and 1 university hospital. Patients started to receive dasatinib 100 mg once daily. A Medication Event Monitoring System was used to assess medication adherence and the medication possession ratio during the 12 months. Plasma concentrations of dasatinib were measured using liquid chromatograph-tandem mass spectrometry (LC-MS/MS), and therapy responses were assessed at 3, 6, and 12 months after treatment. RESULTS Ten patients were included. An extremely high medication adherence for dasatinib was observed; the median medication possession ratio was 99.4%. All 9 CML patients with breakpoints in the major BCR-ABL achieved major molecular response (MMR; major BCR-ABL transcript level below 0.1% on the International Scale) within 12 months, and 5 achieved MMR within 6 months. The receiver operating characteristic curve analysis revealed that the cutoff value for the dasatinib area under the concentration-time curve was 336.1 ng × h/mL (accuracy 88.9%, sensitivity 80.0%, specificity 100%, and receiver operating characteristic curve-area under the concentration-time curve 0.800) for achieving MMR within 6 months. Two patients had interrupted dasatinib treatment because of pleural effusion and diarrhea with intestinal edema, respectively. These edematous adverse events developed after plasma dasatinib Cmin surpassed 3.0 ng/mL. CONCLUSIONS A Medication Event Monitoring System was applied for the direct evaluation of oral dasatinib adherence for the first time, and the clinical effect of dasatinib was investigated under the strict monitoring of patient adherence. Although this study had a small sample size, the plasma concentration monitoring of dasatinib is considered to be useful to predict an earlier molecular response with fewer edematous adverse events.
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Guo J, Zhao C, Yao R, Sui A, Sun L, Liu X, Wu S, Su Z, Li T, Liu S, Gao Y, Liu J, Feng X, Wang W, Zhao H, Cui Z, Li G, Meng F. 3D culture enhances chemoresistance of ALL Jurkat cell line by increasing DDR1 expression. Exp Ther Med 2019; 17:1593-1600. [PMID: 30783426 PMCID: PMC6364197 DOI: 10.3892/etm.2019.7153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/30/2018] [Indexed: 12/16/2022] Open
Abstract
Three dimensional (3D) culture has gradually become a research hotspot in the field of drug screening, stem cell research, and tissue engineering due to its more physiological-like morphology and function. In this study, we compared the differences of cell proliferation, population, protein expression and chemoresistance profiles between two dimensional (2D) and 3D culture of acute lymphoblastic leukemia (ALL) Jurkat cell line. Polycaprolactone (PCL) is used for 3D culture owing to its biochemical properties and compatibility. Culturing of ALL Jurkat cell line in collagen type I coated polycaprolactone scaffold for 168 h increased cell proliferation, attachment, as well as the drug resistance to cytarabine (Ara-C) and daunorubicin (DNR) without changing the original CD2+CD3+CD4+dimCD8−CD34−CD45+dim phenotype, compared to uncoated PCL scaffold and tissue culture plate systems. Molecularly, increased chemoresistance is associated with the upregulation of discoidin domain receptor 1 (DDR1) and transcription factor STAT3. Inhibition of DDR1 activity by DDR1-specific inhibitor DDR-IN-1 accelerated cell death in the presence of Ara-C, DNR or their combination. These results demonstrated that 3D culture enhances chemoresistance of ALL Jurkat cell line by increasing DDR1 expression. Importantly, the cell adhesion-mediated drug resistance induced by DDR1 in the scaffold was similar to the clinical situation, indicating the 3D culture of cancer cells recapitulate the in vivo tumor environment and this platform can be used as a promising pre-clinic drug-screen system.
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Affiliation(s)
- Jun Guo
- College of Medicine, Qingdao University, Qingdao, Shandong 266071, P.R. China.,Department of Hematology, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Chunting Zhao
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Ruyong Yao
- Central Laboratory, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong 266035, P.R. China
| | - Aihua Sui
- Central Laboratory, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong 266035, P.R. China
| | - Lingjie Sun
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Xiaodan Liu
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Shaoling Wu
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Zhan Su
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Tianlan Li
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Shanshan Liu
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Yan Gao
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Jiaxiu Liu
- Central Laboratory, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong 266035, P.R. China
| | - Xianqi Feng
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Wei Wang
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Hongguo Zhao
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Zhongguang Cui
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Guanglun Li
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Fanjun Meng
- Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
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Djebbari F, Stoner N, Lavender VT. A systematic review of non-standard dosing of oral anticancer therapies. BMC Cancer 2018; 18:1154. [PMID: 30466406 PMCID: PMC6249819 DOI: 10.1186/s12885-018-5066-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/07/2018] [Indexed: 12/03/2022] Open
Abstract
Background The use of oral systemic anticancer therapies (SACT) has increased and led to improved cancer survival outcomes, particularly with the introduction of small molecule targeted agents and immunomodulators. Oral targeted SACT are, however, associated with toxicities, which might result in reduced quality of life and non-adherence. To reduce treatment-related toxicity, the practice of non-standard dosing is increasing; however guidance to govern this practice is limited. A systematic review was conducted to identify evidence of, and outcomes from, non-standard dosing of oral SACT in oncology and malignant haematology. Methods A comprehensive search of 78 oral SACT was conducted in the following databases: MEDLINE®, EMBASE®, Cochrane Library©, and Cumulative Index to Nursing and Allied Health Literature (CINAHL©). Studies were selected based on predefined inclusion/exclusion criteria, and were critically appraised. Extracted data were tabulated to summarise key findings. Due to diversity of study designs and heterogeneity of reported outcomes, studies were categorised and evidence was synthesised in three main themes: dose interruption; dose reduction; and other dosing strategies. Results Thirty-four studies were eligible for inclusion: four clinical trials, fifteen cohort studies and fifteen case reports. Evidence for non-standard dosing was reported for eleven oral SACT. Dose interruptions were the most commonly reported strategy (14 studies); nine studies reported dose reductions; and eleven reported other dosing strategies. Eight retrospective cohort studies reported dose interruption of sunitinib in renal cell carcinoma and showed either similar or improved responses and survival outcomes, and fewer or equivalent high grade toxicities, compared to the standard schedule. Four cohort studies retrospectively evaluated dose reductions of imatinib, gefitinib or erlotinib, for chronic myeloid leukaemia and non-small cell lung cancer, respectively. Other dosing strategies included alternate-day dosing. The quality of the evidence was limited by the small sample size in many studies, retrospective study designs, and lack of reported toxicity and/or QoL outcomes. Conclusions This review identified limited evidence to support current non-standard dosing strategies, but some of findings, e.g. dose interruption of sunitinib, warrant further investigation in large-scale prospective clinical trials. Electronic supplementary material The online version of this article (10.1186/s12885-018-5066-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Faouzi Djebbari
- Oxford Cancer and Haematology Centre & NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK.
| | - Nicola Stoner
- Oxford Cancer and Haematology Centre & Oxford Cancer Research Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, UK
| | - Verna Teresa Lavender
- Faculty of Health and Life Sciences, Oxford Brookes University, Marston Road, Oxford, OX3 0FL, UK
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Talpaz M, Saglio G, Atallah E, Rousselot P. Dasatinib dose management for the treatment of chronic myeloid leukemia. Cancer 2018; 124:1660-1672. [PMID: 29370463 PMCID: PMC5901015 DOI: 10.1002/cncr.31232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/01/2017] [Accepted: 12/15/2017] [Indexed: 11/09/2022]
Abstract
Chronic myeloid leukemia (CML) has evolved into a chronic disease that is managed with tyrosine kinase inhibitor therapy. Now that long-term survival has been achieved in patients with CML, the focus of treatment has shifted to dose optimization, with the goal of maintaining response while improving quality of life. In this review, the authors discuss optimizing the dose of the second-generation tyrosine kinase inhibitor dasatinib. Once-daily dosing regimens for dasatinib in the first and later lines of treatment were established through long-term (5-year and 7-year) trials. Recently published data have indicated that further dose optimization may maintain efficacy while minimizing adverse events. Results obtained from dose optimization and discontinuation trials currently in progress will help practitioners determine the best dose and duration of dasatinib for patients with CML, because treatment decisions will be made through continued discussions between physicians and patients. Cancer 2018;124:1660-72. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Affiliation(s)
- Moshe Talpaz
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of Michigan Cancer CenterAnn ArborMichigan
| | - Giuseppe Saglio
- Department of Clinical and Biological SciencesUniversity of Turin, San Luigi HospitalOrbassano‐TorinoItaly
| | - Ehab Atallah
- Department of Hematology and OncologyMedical College of WisconsinMilwaukeeWisconsin
| | - Philippe Rousselot
- Department of Hematology and Oncology, Versailles Medical Center, INSERM UMR 1173University of Versailles Saint‐Quenti‐en‐YvelinesParis SaclayLe ChesnayFrance
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Purification of nasulysin-1: A new toxin from Porthidium nasutum snake venom that specifically induces apoptosis in leukemia cell model through caspase-3 and apoptosis-inducing factor activation. Toxicon 2016; 120:166-74. [DOI: 10.1016/j.toxicon.2016.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 01/19/2023]
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Abstract
The clinical development of molecularly targeted cancer therapies is enhanced by proof of mechanism of action as well as proof of concept, which relate molecular pharmacodynamics to efficacy via changes in cancer cell biology and physiology resulting from drug action on its intended target. Here, we present an introduction to the field of clinical pharmacodynamics, its medical and laboratory aspects, and its practical incorporation into clinical trials. We also describe key success factors that are useful for judging the quality of clinical pharmacodynamic studies, including biopsy quality and suitability, specimen handling, assay fitness-for-purpose, and reagent quality control. This introduction provides not only context for the following articles in this issue, but also an appreciation of the role of well-conducted clinical pharmacodynamic studies in oncology drug development.
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Affiliation(s)
- Ralph E Parchment
- Clinical Pharmacodynamics Program, Applied/Developmental Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD.
| | - James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
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