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Prakash TC, Enkemann S. Current Progress on the Influence Human Genetics Has on the Efficacy of Tyrosine Kinase Inhibitors Used to Treat Chronic Myeloid Leukemia. Cureus 2024; 16:e56545. [PMID: 38646295 PMCID: PMC11027790 DOI: 10.7759/cureus.56545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
The use of tyrosine kinase inhibitors (TKIs) has become the mainstay of treatment in patients suffering from chronic myeloid leukemia (CML), an adult leukemia caused by a reciprocal translocation between chromosomes 9 and 22, which creates an oncogene resulting in a myeloproliferative neoplasm. These drugs function by inhibiting the ATP-binding site on the fusion oncoprotein and subsequently halting proliferative activity. The goal of this work is to investigate the current state of research into genetic factors that influence the efficacy of four FDA-approved TKIs used to treat CML. This overview attempts to identify genetic criteria that could be considered when choosing one drug over the others and to identify where more research is needed. Our results suggest that the usual liver enzymes impacting patient response may not be a major factor affecting the efficacy of imatinib, nilotinib, and bosutinib, and yet, that is where most of the past research has focused. More research is warranted on the impact that human polymorphisms of the CYP enzymes have on dasatinib. The impact of polymorphisms in UGT1A1 should be investigated thoroughly in other TKIs, not only nilotinib. The role of influx and efflux transporters has been inconsistent thus far, possibly due to failures to account for the multiple proteins that can transport TKIs and the impact that tumors have on transporter expression. Because physicians cannot currently use a patient's genetic profile to better target their treatment with TKIs, it is critical that more research be conducted on auxiliary pathways or off-target binding effects to generate new leads for further study. Hopefully, new avenues of research will help explain treatment failures and improve patient outcomes.
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Affiliation(s)
- Tara C Prakash
- Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Steven Enkemann
- Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine, Spartanburg, USA
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Marin AM, Wosniaki DK, Sanchuki HBS, Munhoz EC, Nardin JM, Soares GS, Espinace DC, de Holanda Farias JS, Veroneze B, Becker LF, Costa GL, Beltrame OC, de Oliveira JC, Cambri G, Zanette DL, Aoki MN. Molecular BCR::ABL1 Quantification and ABL1 Mutation Detection as Essential Tools for the Clinical Management of Chronic Myeloid Leukemia Patients: Results from a Brazilian Single-Center Study. Int J Mol Sci 2023; 24:10118. [PMID: 37373266 DOI: 10.3390/ijms241210118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a well-characterized oncological disease in which virtually all patients possess a translocation (9;22) that generates the tyrosine kinase BCR::ABL1 protein. This translocation represents one of the milestones in molecular oncology in terms of both diagnostic and prognostic evaluations. The molecular detection of the BCR::ABL1 transcription is a required factor for CML diagnosis, and its molecular quantification is essential for assessing treatment options and clinical approaches. In the CML molecular context, point mutations on the ABL1 gene are also a challenge for clinical guidelines because several mutations are responsible for tyrosine kinase inhibitor resistance, indicating that a change may be necessary in the treatment protocol. So far, the European LeukemiaNet and the National Comprehensive Cancer Network (NCCN) have presented international guidelines on CML molecular approaches, especially those related to BCR::ABL1 expression. In this study, we show almost three years' worth of data regarding the clinical treatment of CML patients at the Erasto Gaertner Hospital, Curitiba, Brazil. These data primarily comprise 155 patients and 532 clinical samples. BCR::ABL1 quantification by a duplex-one-step RT-qPCR and ABL1 mutations detection were conducted. Furthermore, digital PCR for both BCR::ABL1 expression and ABL1 mutations were conducted in a sub-cohort. This manuscript describes and discusses the clinical importance and relevance of molecular biology testing in Brazilian CML patients, demonstrating its cost-effectiveness.
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Affiliation(s)
- Anelis Maria Marin
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Denise Kusma Wosniaki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Heloisa Bruna Soligo Sanchuki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | | | | | - Gabriela Silva Soares
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Dhienifer Caroline Espinace
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | | | | | | | | | | | | | - Geison Cambri
- Instituto de Biologia Molecular do Paraná (IBMP), Curitiba 81350-010, Brazil
| | - Dalila Luciola Zanette
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
| | - Mateus Nóbrega Aoki
- Laboratory for Applied Science and Technology in Health, Carlos Chagas Institute, Oswaldo Cruz Foundation (Fiocruz), Curitiba 81350-010, Brazil
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Bhuyan S, Pal B, Pathak L, Saikia PJ, Mitra S, Gayan S, Mokhtari RB, Li H, Ramana CV, Baishya D, Das B. Targeting hypoxia-induced tumor stemness by activating pathogen-induced stem cell niche defense. Front Immunol 2022; 13:933329. [PMID: 36248858 PMCID: PMC9559576 DOI: 10.3389/fimmu.2022.933329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Tumor hypoxia and oxidative stress reprograms cancer stem cells (CSCs) to a highly aggressive and inflammatory phenotypic state of tumor stemness. Previously, we characterized tumor stemness phenotype in the ATP Binding Cassette Subfamily G Member 2 (ABCG2)–positive migratory side population (SPm) fraction of CSCs exposed to extreme hypoxia followed by reoxygenation. Here, we report that post-hypoxia/reoxygenation SPm+/ABCG2+ CSCs exerts defense against pathogen invasion that involves bystander apoptosis of non-infected CSCs. In an in vitro assay of cancer cell infection by Bacillus Calmette Guerin (BCG) or mutant Mycobacterium tuberculosis (Mtb) strain 18b (Mtb-m18b), the pathogens preferentially replicated intracellular to SPm+/ABCG2+ CSCs of seven cell lines of diverse cancer types including SCC-25 oral squamous cancer cell line. The conditioned media (CM) of infected CSCs exhibited direct anti-microbial activity against Mtb and BCG, suggesting niche defense against pathogen. Importantly, the CM of infected CSCs exhibited marked in vitro bystander apoptosis toward non-infected CSCs. Moreover, the CM-treated xenograft bearing mice showed 10- to 15-fold reduction (p < 0.001; n = 7) in the number of CSCs residing in the hypoxic niches. Our in vitro studies indicated that BCG-infected SPm+/ABCG2+ equivalent EPCAM+/ABCG2+ CSCs of SCC-25 cells underwent pyroptosis and released a high mobility group box protein 1 (HMGB1)/p53 death signal into the tumor microenvironment (TME). The death signal can induce a Toll-like receptor 2/4–mediated bystander apoptosis in non-infected CSCs by activating p53/MDM2 oscillation and subsequent activation of capase-3–dependent intrinsic apoptosis. Notably, SPm+/ABCG2+ but not SP cells undergoing bystander apoptosis amplified the death signal by further release of HMGB1/p53 complex into the TME. These results suggest that post-hypoxia SPm+/ABCG2+ CSCs serve a functional role as a tumor stemness defense (TSD) phenotype to protect TME against bacterial invasion. Importantly, the CM of TSD phenotype undergoing bystander apoptosis may have therapeutic uses against CSCs residing in the hypoxic niche.
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Affiliation(s)
- Seema Bhuyan
- Department of Cancer and Stem Cell Biology, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
- Department of Bioengineering and Technology, Gauhati University, Guwahati, India
| | - Bidisha Pal
- Department of Cancer and Stem Cell Biology, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
- Department of Stem Cell and Infectious Diseases, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
- Department of Immunology and Infectious Diseases, Forsyth Institute, Cambridge, MA, United States
- Department of Experimental Therapeutics, Thoreau Laboratory for Global Health, M2D2, University of Massachusetts, Lowell, MA, United States
| | - Lekhika Pathak
- Department of Cancer and Stem Cell Biology, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
- Department of Stem Cell and Infectious Diseases, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
| | - Partha Jyoti Saikia
- Department of Cancer and Stem Cell Biology, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
| | - Shirsajit Mitra
- Department of Cancer and Stem Cell Biology, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
| | - Sukanya Gayan
- Department of Cancer and Stem Cell Biology, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
| | - Reza Bayat Mokhtari
- Department of Immunology and Infectious Diseases, Forsyth Institute, Cambridge, MA, United States
- Department of Experimental Therapeutics, Thoreau Laboratory for Global Health, M2D2, University of Massachusetts, Lowell, MA, United States
| | - Hong Li
- Department of Immunology and Infectious Diseases, Forsyth Institute, Cambridge, MA, United States
- Department of Experimental Therapeutics, Thoreau Laboratory for Global Health, M2D2, University of Massachusetts, Lowell, MA, United States
| | - Chilakamarti V. Ramana
- Department of Experimental Therapeutics, Thoreau Laboratory for Global Health, M2D2, University of Massachusetts, Lowell, MA, United States
| | - Debabrat Baishya
- Department of Bioengineering and Technology, Gauhati University, Guwahati, India
| | - Bikul Das
- Department of Cancer and Stem Cell Biology, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
- Department of Stem Cell and Infectious Diseases, KaviKrishna Laboratory, Research Park, Indian Institute of Technology, Guwahati, India
- Department of Immunology and Infectious Diseases, Forsyth Institute, Cambridge, MA, United States
- Department of Experimental Therapeutics, Thoreau Laboratory for Global Health, M2D2, University of Massachusetts, Lowell, MA, United States
- *Correspondence: Bikul Das,
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Analisi di Budget Impact di ponatinib per il management di pazienti affetti da leucemia mieloide cronica. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2021; 8:87-95. [PMID: 36627864 PMCID: PMC9616198 DOI: 10.33393/grhta.2021.2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/28/2021] [Indexed: 01/13/2023] Open
Abstract
Background: The current clinical practice for patients affected by chronic myeloid leukemia (CML) is based on the evaluation of second generation alternatives following therapeutic failure that leads to a lengthening of patients’ management times and a consequent negative impact in terms of quality of life. Objective: To determine the economic absorption of resources associated to the management of patients with CML in a scenario in which an early recourse to ponatinib is considered as compared with a scenario based on the current Italian clinical practice characterized by a cyclical recourse to the available therapies. Methods: A Budget Impact model was developed to compare the resources absorbed in the scenarios under assessment considering a 3-year time horizon and the perspective of the Italian National Health Service. Results are expressed in terms of differential resources absorbed in the alternative scenarios. Results: The increase in the recourse to ponatinib allowed a saving of resources for the Italian NHS over the 3-year time horizon of –€ 1,979,322 (€ 825,104,350 vs € 823,125,028). The parameter affecting the most of the results achieved in the base-case is the monthly cost of bosutinib used as a third-line treatment. Conclusions: The increase in the recourse to ponatinib in patients affected by CML that failed to respond to a previous pharmacological therapy resulted to be associated to a lower level of resources’ absorption in the Italian NHS allowing to re-allocate health founds to other fields of the care sector ensuring greater sustainability of the system.
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Onmaz DE, Abusoglu S, Unlu A, Basturk A, Dagli M, Bagci M, Tok O, Abusoglu G. Determination of serum imatinib and its' metabolite in patients chronic myeloid leukemia. Clin Chim Acta 2019; 497:120-124. [PMID: 31351054 DOI: 10.1016/j.cca.2019.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Imatinib has favorable pharmacokinetic properties, but primary and secondary resistance mechanisms may cause a decrease in clinical response over time. There is a positive correlation between serum imatinib concentrations and treatment response. Our aim was to develop a method for the measurement of imatinib and its' active metabolite N-desmethyl imatinib. METHODS Serum imatinib and N-desmethyl imatinib levels were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and validation studies were carried out according to CLSI (The Clinical & Laboratory Standards Institute) protocols. Serum samples were collected from 40 patients with chronic myeloid leukemia (CML) and analyzed with LC-MS/MS and ultra high-performance liquid chromatography (UHPLC) methods. RESULTS The linearity range and correlation coefficient were 12.2-12,500 ng/mL and 0.9987 for LC-MS/MS method, respectively. Limit of quantitation was determined as 24.4 ng/mL. The retention times of imatinib and N-desmethyl imatinib were 1.66 and 1.60 min, respectively. There was no statistically significant difference between the results of both methods. DISCUSSION This LC-MS/MS method is cost-effective and has adavantages such as using low serum volumes, requiring simple pretreatment steps (only protein precipitation) and reduced turnaround times for analysis.
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Affiliation(s)
- Duygu Eryavuz Onmaz
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey.
| | - Sedat Abusoglu
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Ali Unlu
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Abdulkadir Basturk
- Department of Internal Medicine, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mehmet Dagli
- Department of Internal Medicine, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Metin Bagci
- Department of Internal Medicine, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Oguzhan Tok
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Gulsum Abusoglu
- Department of Medical Laboratory Techniques, Selcuk University Vocational School of Health, Konya, Turkey
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Wolff FC, Dillenburg TL, Venzon Antunes M, Linden R, Comparsi Wagner S, Verza SG. Characterization of imatinib mesylate formulations distributed in South American countries: Determination of genotoxic impurities by UHPLC-MS/MS and dissolution profile. Biomed Chromatogr 2018; 32:e4222. [DOI: 10.1002/bmc.4222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Fernanda Caroline Wolff
- Bioanalysis Laboratory, Instituto de Ciências da Saúde; Universidade Feevale; Novo Hamburgo RS Brazil
| | - Thaís Luise Dillenburg
- Bioanalysis Laboratory, Instituto de Ciências da Saúde; Universidade Feevale; Novo Hamburgo RS Brazil
| | - Marina Venzon Antunes
- Toxicological Analysis Laboratory, Instituto de Ciências da Saúde; Universidade Feevale; Novo Hamburgo RS Brazil
| | - Rafael Linden
- Toxicological Analysis Laboratory, Instituto de Ciências da Saúde; Universidade Feevale; Novo Hamburgo RS Brazil
| | - Sandrine Comparsi Wagner
- Diagnostics Methods Department; Fundação Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre RS Brazil
| | - Simone G. Verza
- Bioanalysis Laboratory, Instituto de Ciências da Saúde; Universidade Feevale; Novo Hamburgo RS Brazil
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8
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Smith BD, Liu J, Latremouille-Viau D, Guerin A, Fernandez D, Chen L. Treatment patterns, overall survival, healthcare resource use and costs in elderly Medicare beneficiaries with chronic myeloid leukemia using second-generation tyrosine kinase inhibitors as second-line therapy. Curr Med Res Opin 2016; 32:817-27. [PMID: 26743563 DOI: 10.1185/03007995.2016.1140030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Though the median age at diagnosis is 64 years, few studies focus on elderly (≥65 years) patients with chronic myeloid leukemia (CML). This study examines healthcare outcomes among elderly Medicare beneficiaries with CML who started nilotinib or dasatinib after imatinib. Research design and methods Patients were identified in the Medicare Research Identifiable Files (2006-2012) and had continuous Medicare Parts A, B, and D coverage. Main outcome measures Treatment patterns, overall survival (OS), monthly healthcare resource utilization and medical costs were measured from the second-line tyrosine kinase inhibitor (TKI) initiation (index date) to end of Medicare coverage. Results Despite similar adherence, dasatinib patients (N = 379) were more likely to start on the recommended dose (74% vs. 53%; p < 0.001), and to have dose reductions (21% vs. 11%, adjusted hazard ratio [HR] = 1.94; p = 0.002) or dose increases (9% vs. 7%; adjusted HR = 1.81; p = 0.048) than nilotinib patients (N = 280). Fewer nilotinib patients discontinued (59% vs. 67%; adjusted HR = 0.80; p = 0.026) or switched to another TKI (21% vs. 29%; adjusted HR = 0.72; p = 0.044) than dasatinib patients. Nilotinib patients had longer median OS (>4.9 years vs. 4.0 years; p = 0.032) and 37% lower mortality risk than dasatinib patients (adjusted HR = 0.63; p = 0.008). Nilotinib patients had 23% fewer inpatient admissions, 30% fewer emergency room visits, 13% fewer outpatient visits (all p < 0.05), and lower monthly medical costs (by $513, p = 0.024) than dasatinib patients. Limitations Lack of clinical assessment (disease phase and response to first-line therapy) and retrospective nature of study (unobservable potential confounding factors, non-randomized treatment choice). Conclusions In the current study of elderly CML patients, initiation of second-line TKIs frequently occurs at doses lower than the recommended starting doses and, despite this, many patients require dose adjustments. Here, nilotinib patients required fewer dose adjustments than dasatinib patients. Further research focusing on elderly CML patients is warranted in order to help define future best clinical practices.
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Affiliation(s)
- B Douglas Smith
- a Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins , Baltimore , MD , USA
| | - Jun Liu
- b Harvard University , Cambridge , MA , USA
| | | | - Annie Guerin
- c Analysis Group Inc. , Montreal, Quebec, Canada
| | | | - Lei Chen
- d Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
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Brehme M, Koschmieder S, Montazeri M, Copland M, Oehler VG, Radich JP, Brümmendorf TH, Schuppert A. Combined Population Dynamics and Entropy Modelling Supports Patient Stratification in Chronic Myeloid Leukemia. Sci Rep 2016; 6:24057. [PMID: 27048866 PMCID: PMC4822142 DOI: 10.1038/srep24057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/17/2016] [Indexed: 12/27/2022] Open
Abstract
Modelling the parameters of multistep carcinogenesis is key for a better understanding of cancer progression, biomarker identification and the design of individualized therapies. Using chronic myeloid leukemia (CML) as a paradigm for hierarchical disease evolution we show that combined population dynamic modelling and CML patient biopsy genomic analysis enables patient stratification at unprecedented resolution. Linking CD34+ similarity as a disease progression marker to patient-derived gene expression entropy separated established CML progression stages and uncovered additional heterogeneity within disease stages. Importantly, our patient data informed model enables quantitative approximation of individual patients’ disease history within chronic phase (CP) and significantly separates “early” from “late” CP. Our findings provide a novel rationale for personalized and genome-informed disease progression risk assessment that is independent and complementary to conventional measures of CML disease burden and prognosis.
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Affiliation(s)
- Marc Brehme
- Joint Research Center for Computational Biomedicine (JRC-COMBINE), RWTH Aachen University, 52062 Aachen, Germany
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Maryam Montazeri
- Joint Research Center for Computational Biomedicine (JRC-COMBINE), RWTH Aachen University, 52062 Aachen, Germany
| | - Mhairi Copland
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 0ZD, United Kingdom
| | - Vivian G Oehler
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Jerald P Radich
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Tim H Brümmendorf
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074 Aachen, Germany
| | - Andreas Schuppert
- Joint Research Center for Computational Biomedicine (JRC-COMBINE), RWTH Aachen University, 52062 Aachen, Germany.,Aachen Institute for Advanced Study in Computational Engineering Science (AICES), RWTH Aachen University, 52062 Aachen, Germany
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Multi-agent chemotherapy overcomes glucocorticoid resistance conferred by a BIM deletion polymorphism in pediatric acute lymphoblastic leukemia. PLoS One 2014; 9:e103435. [PMID: 25090024 PMCID: PMC4121131 DOI: 10.1371/journal.pone.0103435] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/29/2014] [Indexed: 12/03/2022] Open
Abstract
A broad range of anti-cancer agents, including glucocorticoids (GCs) and tyrosine kinase inhibitors (TKIs), kill cells by upregulating the pro-apoptotic BCL2 family member, BIM. A common germline deletion in the BIM gene was recently shown to favor the production of non-apoptotic BIM isoforms, and to predict inferior responses in TKI-treated chronic myeloid leukemia (CML) and EGFR-driven lung cancer patients. Given that both in vitro and in vivo GC resistance are predictive of adverse outcomes in acute lymphoblastic leukemia (ALL), we hypothesized that this polymorphism would mediate GC resistance, and serve as a biomarker of poor response in ALL. Accordingly, we used zinc finger nucleases to generate ALL cell lines with the BIM deletion, and confirmed the ability of the deletion to mediate GC resistance in vitro. In contrast to CML and lung cancer, the BIM deletion did not predict for poorer clinical outcome in a retrospective analysis of 411 pediatric ALL patients who were uniformly treated with GCs and chemotherapy. Underlying the lack of prognostic significance, we found that the chemotherapy agents used in our cohort (vincristine, L-asparaginase, and methotrexate) were each able to induce ALL cell death in a BIM-independent fashion, and resensitize BIM deletion-containing cells to GCs. Together, our work demonstrates how effective therapy can overcome intrinsic resistance in ALL patients, and suggests the potential of using combinations of drugs that work via divergent mechanisms of cell killing to surmount BIM deletion-mediated drug resistance in other cancers.
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Drug resistance: as complex and diverse as the disease itself. Mol Oncol 2013. [DOI: 10.1017/cbo9781139046947.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Eadie LN, Hughes TP, White DL. Interaction of the efflux transporters ABCB1 and ABCG2 with imatinib, nilotinib, and dasatinib. Clin Pharmacol Ther 2013; 95:294-306. [PMID: 24107928 DOI: 10.1038/clpt.2013.208] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/28/2013] [Indexed: 12/16/2022]
Abstract
The efflux transporters adenosine triphosphate (ATP)-binding cassette (ABC)B1 and ABCG2 have been demonstrated to interact with the tyrosine kinase inhibitors (TKIs) imatinib, nilotinib, and dasatinib. However, although some studies conclude that TKIs are substrates of one or both transporters, other studies demonstrate only an inhibitory function. This variation is probably due to differences in the concentration of TKIs assayed and the experimental systems used. This article examines the evidence for clinically relevant interactions between three currently approved TKIs and ABCB1/ABCG2.
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Affiliation(s)
- L N Eadie
- 1] Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia [2] Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - T P Hughes
- 1] Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia [2] Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia [3] Centre for Cancer Biology, Adelaide, South Australia, Australia
| | - D L White
- 1] Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia [2] Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia [3] Centre for Cancer Biology, Adelaide, South Australia, Australia
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Emerging therapeutic strategies for targeting chronic myeloid leukemia stem cells. Stem Cells Int 2013; 2013:724360. [PMID: 23935640 PMCID: PMC3725740 DOI: 10.1155/2013/724360] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/13/2013] [Indexed: 11/17/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder. Current targeted therapies designed to inhibit the tyrosine kinase activity of the BCR-ABL oncoprotein have made a significant breakthrough in the treatment of CML patients. However, CML remains a chronic disease that a patient must manage for life. Although tyrosine kinase inhibitors (TKI) therapy has completely transformed the prognosis of CML, it has made the therapeutic management more complex. The interruption of TKI treatment results in early disease progression because it does not eliminate quiescent CML stem cells which remain a potential reservoir for disease relapse. This highlights the need to develop new therapeutic strategies for CML to achieve a permanent cure, and to allow TKI interruption. This review summarizes recent research done on alternative targeted therapies with a particular focus on some important signaling pathways (such as Alox5, Hedgehog, Wnt/b-catenin, autophagy, and PML) that have the potential to target CML stem cells and potentially provide cure for CML.
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Cho YU, Kim SO, Chi HS, Park SJ, Jang S, Park CJ, Seo EJ, Lee JH, Lee JH, Lee KH, Im HJ, Seo JJ, Hong SP. Detection ofABL1kinase mutations in Philadelphia-positive patients exhibiting an inadequate molecular response using restriction fragment mass polymorphism and its clinical significance: a single-center experience in Korea. Int J Lab Hematol 2013; 35:589-600. [DOI: 10.1111/ijlh.12091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 02/19/2013] [Indexed: 01/03/2023]
Affiliation(s)
- Y.-U. Cho
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - S.-O. Kim
- GeneMatrix Inc.; Yongin; Gyeonggi-do South Korea
| | - H.-S. Chi
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - S.-J. Park
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - S. Jang
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - C.-J. Park
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - E.-J. Seo
- Department of Laboratory Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - J.-H. Lee
- Department of Internal Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - J.-H. Lee
- Department of Internal Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - K.-H. Lee
- Department of Internal Medicine; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - H.-J. Im
- Department of Pediatrics; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - J.-J. Seo
- Department of Pediatrics; University of Ulsan College of Medicine and Asan Medical Center; Seoul South Korea
| | - S. P. Hong
- GeneMatrix Inc.; Yongin; Gyeonggi-do South Korea
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15
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Seong S, Lim M, Sohn S, Moon J, Oh SJ, Kim B, Ryoo H, Chung J, Joo Y, Bang S, Jung C, Kim D, Park S, Yoon S, Kim I, Lee H, Won J, Min Y, Cheong J, Park J, Eom K, Hyun M, Kim M, Kim H, Park M, Park J, Kim C, Kim H, Kim Y, Park E, Zang D, Jo D, Lee H, Yoon YR. Influence of enzyme and transporter polymorphisms on trough imatinib concentration and clinical response in chronic myeloid leukemia patients. Ann Oncol 2013; 24:756-60. [DOI: 10.1093/annonc/mds532] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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16
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Park S, Koh Y, Jung SH, Chung YJ. Application of array comparative genomic hybridization in chronic myeloid leukemia. Methods Mol Biol 2013; 973:55-68. [PMID: 23412783 DOI: 10.1007/978-1-62703-281-0_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chromosomal alteration is one of the hallmarks of chronic myeloid leukemia (CML), and the Philadelphia chromosome is the most important and key example of the chromosomal changes in this disease. Indeed, the BCR-ABL1 fusion product is a target against which many tyrosine kinase inhibitors (TKIs) have been proven to be effective in the treatment of CML. However, the reality is that CML patients show resistance to TKIs both in an acquired and de novo manner, and the mechanism of TKI resistance is still largely unknown. This phenomenon suggests that in addition to the BCR-ABL mutation, further genetic alterations such as copy number aberration may be involved in unexplained TKI resistance. Although the recent array comparative genomic hybridization analyses (array-CGH) across the whole genome have detected multiple genetic aberrations in CML, the detailed feature of chromosomal alterations involved in different clinical phases of CML, such as chronic phase, accelerated phase, and blast crisis, remains unclear. Here we review the methodological aspects of array-CGH analysis for studying CML and its related data analysis.
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Affiliation(s)
- Seonyang Park
- Department of Internal Medicine, Diagnostic DNA Chip Center, Seoul National University College of Medicine, Seoul, South Korea.
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17
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Siddiqui M, Rajkumar SV. The high cost of cancer drugs and what we can do about it. Mayo Clin Proc 2012; 87:935-43. [PMID: 23036669 PMCID: PMC3538397 DOI: 10.1016/j.mayocp.2012.07.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 06/29/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
Affiliation(s)
| | - S. Vincent Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN
- Correspondence: Address to S. Vincent Rajkumar, MD, Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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18
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Nichols L, Pippins J, Castle L, Cassler M, Fuller C. Molecular monitoring of chronic myeloid leukemia: a personalized approach to optimizing treatment response. Per Med 2012; 9:727-737. [PMID: 29776270 DOI: 10.2217/pme.12.81] [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: 11/21/2022]
Abstract
Personalized medicine is rapidly developing a purposeful niche in the field of oncology. Monitoring the activity of the oncogenic fusion gene BCR-ABL1 in chronic myeloid leukemia (CML) is a good example of individualizing CML treatment for patients using patient-specific genetic information. However, the frequency at which molecular monitoring for BCR-ABL1 transcripts occurs during treatment with tyrosine kinase inhibitors (TKIs) for CML in clinical practice is much lower than that recommended by either the National Cancer Center Network or the European LeukemiaNet guidelines. Adherence, one of the most critical factors affecting response to TKIs, is often less than desirable and rarely communicated to physicians by patients or managed by care providers. Less than optimal molecular monitoring and low adherence to TKI treatment can lead to rising transcripts levels, that when not detected, have been shown to contribute to poor outcomes. This review reports the basis for and describes the design of a state-of-the-art program intended to improve communication with physicians through real-time messaging about sequential test results for BCR-ABL1 and patients' adherence to TKI therapy.
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Affiliation(s)
- Linda Nichols
- Department of Clinical Practices & Therapeutics, Express Scripts, 100 Parsons Pond Drive, B3-MS2, Franklin Lakes, NJ 07417, USA.
| | - Julie Pippins
- Department of Clinical Practices & Therapeutics, Express Scripts, 100 Parsons Pond Drive, B3-MS2, Franklin Lakes, NJ 07417, USA
| | - Lon Castle
- Department of Clinical Innovations, Express Scripts, 100 Parsons Pond Drive, Franklin Lakes, NJ 07417, USA
| | - Mary Cassler
- Department of Clinical Innovations, Express Scripts, 100 Parsons Pond Drive, Franklin Lakes, NJ 07417, USA
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19
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Takami A, Ohtake S, Morishita E, Terasaki Y, Fukushima T, Kurokawa T, Sugimori N, Matano S, Ohata K, Saito C, Yamaguchi M, Hosokawa K, Yamazaki H, Kondo Y, Nakao S. Late response to low-dose imatinib in patients with chronic phase chronic myeloid leukemia. Int J Hematol 2012; 96:357-63. [DOI: 10.1007/s12185-012-1155-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/26/2012] [Accepted: 07/26/2012] [Indexed: 11/28/2022]
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20
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O'Hare T, Zabriskie MS, Eiring AM, Deininger MW. Pushing the limits of targeted therapy in chronic myeloid leukaemia. Nat Rev Cancer 2012; 12:513-26. [PMID: 22825216 DOI: 10.1038/nrc3317] [Citation(s) in RCA: 233] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Tyrosine kinase inhibitor (TKI) therapy targeting the BCR-ABL1 kinase is effective against chronic myeloid leukaemia (CML), but is not curative for most patients. Minimal residual disease (MRD) is thought to reside in TKI-insensitive leukaemia stem cells (LSCs) that are not fully addicted to BCR-ABL1. Recent conceptual advances in both CML biology and therapeutic intervention have increased the potential for the elimination of CML cells, including LSCs, through simultaneous inhibition of BCR-ABL1 and other newly identified, crucial targets.
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Affiliation(s)
- Thomas O'Hare
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, Utah 84112, USA.
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21
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Balci TB, Sahin FI, Karakus S, Ozdogu H. AHI1 gene expression levels and BCR-ABL1 T315I mutations in chronic myeloid leukemia patients. ACTA ACUST UNITED AC 2011; 16:357-60. [PMID: 22183070 DOI: 10.1179/102453311x13127324303272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
With the availability of molecular monitoring of BCR-ABL1 and the use of tyrosine kinase inhibitors, treatment in chronic myeloid leukemia (CML) is now molecularly focused. Eighty-three samples taken at different time points from 38 CML patients; were subjected to T315I mutation analysis and gene expression analysis of AHI1; a novel gene that is thought to have a role in both BCR-ABL1 mediated leukemic transformation and response to tyrosine kinase inhibitors. Only one patient (2.63%) harboured the T315I mutation. While no significant difference in AHI1 expression was observed between newly diagnosed CML samples and non-CML controls; CML samples under imatinib therapy had levels significantly higher than both newly diagnosed samples and controls. In the first 6 months of imatinib therapy, AHI1 expression was found to increase and then gradually decrease. There was no significant difference between imatinib responders and non-responders, while dasatinib caused significantly lower AHI1 levels. It is proposed that the change in AHI1 expression during CML therapy might be under the control of mechanisms independent from BCR-ABL1. AHI1 mediated signalling could be better understood by analyzing AHI1 gene expression levels in a greater number of patients and concurrently investigating JAK/STAT and Src family kinases pathways.
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22
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Di Gion P, Kanefendt F, Lindauer A, Scheffler M, Doroshyenko O, Fuhr U, Wolf J, Jaehde U. Clinical Pharmacokinetics of Tyrosine Kinase Inhibitors. Clin Pharmacokinet 2011; 50:551-603. [DOI: 10.2165/11593320-000000000-00000] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Wagle N, Emery C, Berger MF, Davis MJ, Sawyer A, Pochanard P, Kehoe SM, Johannessen CM, MacConaill LE, Hahn WC, Meyerson M, Garraway LA. Dissecting therapeutic resistance to RAF inhibition in melanoma by tumor genomic profiling. J Clin Oncol 2011; 29:3085-96. [PMID: 21383288 PMCID: PMC3157968 DOI: 10.1200/jco.2010.33.2312] [Citation(s) in RCA: 765] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/20/2011] [Indexed: 12/21/2022] Open
Abstract
A detailed understanding of the mechanisms by which tumors acquire resistance to targeted anticancer agents should speed the development of treatment strategies with lasting clinical efficacy. RAF inhibition in BRAF-mutant melanoma exemplifies the promise and challenge of many targeted drugs; although response rates are high, resistance invariably develops. Here, we articulate overarching principles of resistance to kinase inhibitors, as well as a translational approach to characterize resistance in the clinical setting through tumor mutation profiling. As a proof of principle, we performed targeted, massively parallel sequencing of 138 cancer genes in a tumor obtained from a patient with melanoma who developed resistance to PLX4032 after an initial dramatic response. The resulting profile identified an activating mutation at codon 121 in the downstream kinase MEK1 that was absent in the corresponding pretreatment tumor. The MEK1(C121S) mutation was shown to increase kinase activity and confer robust resistance to both RAF and MEK inhibition in vitro. Thus, MEK1(C121S) or functionally similar mutations are predicted to confer resistance to combined MEK/RAF inhibition. These results provide an instructive framework for assessing mechanisms of acquired resistance to kinase inhibition and illustrate the use of emerging technologies in a manner that may accelerate personalized cancer medicine.
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Affiliation(s)
- Nikhil Wagle
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Caroline Emery
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Michael F. Berger
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Matthew J. Davis
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Allison Sawyer
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Panisa Pochanard
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Sarah M. Kehoe
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Cory M. Johannessen
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Laura E. MacConaill
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - William C. Hahn
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Matthew Meyerson
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
| | - Levi A. Garraway
- From the Dana-Farber Cancer Institute, Harvard Medical School, Boston; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA
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24
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Burke AC, Swords RT, Kelly K, Giles FJ. Current status of agents active against the T315I chronic myeloid leukemia phenotype. Expert Opin Emerg Drugs 2011; 16:85-103. [DOI: 10.1517/14728214.2011.531698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Wu EQ, Guerin A, Yu AP, Bollu VK, Guo A, Griffin JD. Retrospective real-world comparison of medical visits, costs, and adherence between nilotinib and dasatinib in chronic myeloid leukemia. Curr Med Res Opin 2010; 26:2861-9. [PMID: 21062136 DOI: 10.1185/03007995.2010.533648] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare healthcare resource utilization, costs, and treatment adherence associated with dasatinib versus nilotinib treatment as second-line therapies in chronic myeloid leukemia (CML) patients. METHODS Two large retrospective claims databases (01/1999-06/2009) were combined to identify CML patients (ICD-9 code 205.1x) who received one or more prescriptions of dasatinib or nilotinib. Studied patients had continuous enrollment ≥ 1 month prior to and after the index date, defined as the first prescription for dasatinib or nilotinib. Patients were followed for up to 6 months from the index date to the earliest of the termination of healthcare plan enrollment or end of data availability. Patients with bone marrow or stem cell transplant during the study period were excluded. Poisson regression models were used to compare healthcare resource utilization between the two groups. Results were reported as incidence rate ratios (IRR). Healthcare cost differences were estimated for each cost component using generalized linear models or two-part models. Treatment adherence was measured by the proportion of days covered (PDC) and compared using generalized linear models. Multivariate regressions were used to control for potential confounding factors. RESULTS A total of 521 CML patients receiving second-line tyrosine kinase inhibitors (TKI) (452 dasatinib and 69 nilotinib) were studied. During the study period, dasatinib patients were estimated to have more than twice as many inpatient days (IRR = 2.44; p < 0.001) and nearly double the number of inpatient admissions (IRR = 1.99; p = 0.047) compared to nilotinib patients. Over the follow-up period, dasatinib patients incurred $8828 more in total medical service costs (p < 0.001); cost differences were mainly driven by an adjusted inpatient cost difference of $8520 (p = 0.003). Dasatinib patients were less adherent, with a PDC value approximately 13% lower compared to nilotinib patients (p = 0.009). CONCLUSIONS Among CML patients treated with second-line TKIs, nilotinib patients were more adherent and experienced lower healthcare resource utilization, resulting in medical service cost savings compared to dasatinib patients.
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MESH Headings
- Adult
- Aged
- Algorithms
- Ambulatory Care/economics
- Ambulatory Care/statistics & numerical data
- Antineoplastic Agents/economics
- Antineoplastic Agents/therapeutic use
- Cohort Studies
- Comorbidity
- Dasatinib
- Databases, Factual
- Female
- Health Care Costs
- Health Resources/economics
- Health Resources/statistics & numerical data
- Humans
- Insurance Claim Review/statistics & numerical data
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/economics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Male
- Medication Adherence/statistics & numerical data
- Middle Aged
- Pyrimidines/adverse effects
- Pyrimidines/economics
- Pyrimidines/therapeutic use
- Retrospective Studies
- Thiazoles/adverse effects
- Thiazoles/economics
- Thiazoles/therapeutic use
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Affiliation(s)
- Eric Q Wu
- Analysis Group, Inc., Boston, Massachusetts, USA.
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26
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Burguillo FJ, Martin J, Barrera I, Bardsley WG. Meta-analysis of microarray data: The case of imatinib resistance in chronic myelogenous leukemia. Comput Biol Chem 2010; 34:184-92. [DOI: 10.1016/j.compbiolchem.2010.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 06/09/2010] [Accepted: 06/10/2010] [Indexed: 01/11/2023]
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27
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Koh Y, Kim I, Yoon SS, Kim BK, Kim DY, Lee JH, Lee KH, Park E, Kim HJ, Sohn SK, Joo YD, Kim SJ, Chung J, Shin HJ, Kim SH, Kim CS, Song HS, Kim MK, Hyun MS, Ahn JS, Jung CW, Park S. Phase IV study evaluating efficacy of escalated dose of imatinib in chronic myeloid leukemia patients showing suboptimal response to standard dose imatinib. Ann Hematol 2010; 89:725-31. [PMID: 20179930 DOI: 10.1007/s00277-010-0910-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 01/27/2010] [Indexed: 10/19/2022]
Abstract
The aim of this phase IV study was to (1) to define efficacy of escalating dose imatinib in chronic myeloid leukemia (CML) patients showing suboptimal response to standard dose imatinib and (2) to find markers that predict the response to escalating doses of imatinib. CML patients in chronic phase (CP) who failed to achieve optimal response with 400 mg/day imatinib or patients in accelerated phase (AP) or blast crisis (BC) who failed to achieve complete hematologic response after 3 months of 400-600 mg/day imatinib were enrolled. CP patients received 600 mg/day, while AP/BC patients received 600-800 mg/day imatinib. Patients received imatinib for at least 12 months or until the disease progression or intolerable toxicity. Along with cytogenetic response (CyR), molecular response was assessed with BCR-ABL/ABL ratio. Baseline BCR-ABL gene mutation test was performed. Seventy-one patients (median age, 49.0 years, M:F = 50:21) received escalated dose imatinib. Grade 3 edema in two patients was the only nonhematologic toxicities more than grade 2. For evaluable patients, 30.8% of patients achieved CCyR at 6 months, and median time to treatment failure (TTFx) was 18.0 months. TTFx was longer in patients who achieved greater than 50% reduction in BCR-ABL/ABL within 6 months (early molecular responder (EMR)) compared with those who did not (non-EMR; p < 0.001). Of 31 patients who had mutational status data, three had mutation. All mutants failed to achieve CCyR. In conclusion, escalated dose imatinib shows considerable efficacy with tolerable toxicity in CML patients showing suboptimal response to standard dose imatinib. EMR is an early predictive marker for positive imatinib response.
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Affiliation(s)
- Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, 28 Yongon-dong, Jongno-gu, Seoul 110-744, Republic of Korea
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28
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Foroni L, Gerrard G, Nna E, Khorashad JS, Stevens D, Swale B, Milojkovic D, Reid A, Goldman J, Marin D. Technical aspects and clinical applications of measuring BCR-ABL1 transcripts number in chronic myeloid leukemia. Am J Hematol 2009; 84:517-22. [PMID: 19544476 DOI: 10.1002/ajh.21457] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by a triphasic clinical course, the morphologic expansion of a terminally differentiated myeloid cell and the presence of the BCR-ABL1 fusion gene, the hallmark of CML. The fusion gene is usually, but not always, associated with a Philadelphia chromosome, the result of a reciprocal exchange of genetic material between chromosome 22 and chromosome 9, which leads to the production of the activated BCR-ABL1 gene and oncoprotein. The breakpoint in the BCR gene occurs commonly downstream of exons e13 or e14 (M-BCR) and less frequently downstream of exons e1 and e2 (m-BCR). Less than 1% of cases carry a breakpoint downstream of exon 6 or 8 ("variant fusion genes") or exon 19 (mu-BCR). Breakpoints in the ABL1 gene cluster upstream of exon a2 (or of exon a3 in less than 5% of patients with CML). Conventional cytogenetic, fluorescence in situ hybridization, and molecular testing for the BCR-ABL1 fusion gene are key investigations for the diagnosis and monitoring of CML. Treatment using tyrosine kinase inhibitors has revolutionized the management of CML with hematologic and cytogenetic response within 12-18 months observed in >85% of patients. Nevertheless, between 15 and 20% of patients may evolve to blastic phase. Measurement of low level or "minimal" residual disease using molecular tests is becoming the gold-standard approach to measure response to therapy due to its higher sensitivity compared to other routine techniques. The technical aspects and clinical applications of molecular monitoring will be the main focus of this article.
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MESH Headings
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 22/metabolism
- Chromosomes, Human, Pair 9/genetics
- Chromosomes, Human, Pair 9/metabolism
- Exons/genetics
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/biosynthesis
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Monitoring, Physiologic/methods
- Neoplasm, Residual
- Philadelphia Chromosome
- Protein Kinase Inhibitors/therapeutic use
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- RNA, Neoplasm/biosynthesis
- RNA, Neoplasm/genetics
- Remission Induction
- Time Factors
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Affiliation(s)
- Letizia Foroni
- Department of Haematology, Imperial College Academic Health Science Centre, Hammersmith Campus, London, W12 ONN United Kingdom.
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