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Ocio EM, Richardson PG, Rajkumar SV, Palumbo A, Mateos MV, Orlowski R, Kumar S, Usmani S, Roodman D, Niesvizky R, Einsele H, Anderson KC, Dimopoulos MA, Avet-Loiseau H, Mellqvist UH, Turesson I, Merlini G, Schots R, McCarthy P, Bergsagel L, Chim CS, Lahuerta JJ, Shah J, Reiman A, Mikhael J, Zweegman S, Lonial S, Comenzo R, Chng WJ, Moreau P, Sonneveld P, Ludwig H, Durie BGM, Miguel JFS. New drugs and novel mechanisms of action in multiple myeloma in 2013: a report from the International Myeloma Working Group (IMWG). Leukemia 2014; 28:525-42. [PMID: 24253022 PMCID: PMC4143389 DOI: 10.1038/leu.2013.350] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/23/2013] [Accepted: 11/07/2013] [Indexed: 01/08/2023]
Abstract
Treatment in medical oncology is gradually shifting from the use of nonspecific chemotherapeutic agents toward an era of novel targeted therapy in which drugs and their combinations target specific aspects of the biology of tumor cells. Multiple myeloma (MM) has become one of the best examples in this regard, reflected in the identification of new pathogenic mechanisms, together with the development of novel drugs that are being explored from the preclinical setting to the early phases of clinical development. We review the biological rationale for the use of the most important new agents for treating MM and summarize their clinical activity in an increasingly busy field. First, we discuss data from already approved and active agents (including second- and third-generation proteasome inhibitors (PIs), immunomodulatory agents and alkylators). Next, we focus on agents with novel mechanisms of action, such as monoclonal antibodies (MoAbs), cell cycle-specific drugs, deacetylase inhibitors, agents acting on the unfolded protein response, signaling transduction pathway inhibitors and kinase inhibitors. Among this plethora of new agents or mechanisms, some are specially promising: anti-CD38 MoAb, such as daratumumab, are the first antibodies with clinical activity as single agents in MM. Moreover, the kinesin spindle protein inhibitor Arry-520 is effective in monotherapy as well as in combination with dexamethasone in heavily pretreated patients. Immunotherapy against MM is also being explored, and probably the most attractive example of this approach is the combination of the anti-CS1 MoAb elotuzumab with lenalidomide and dexamethasone, which has produced exciting results in the relapsed/refractory setting.
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Affiliation(s)
- E M Ocio
- Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain
| | - P G Richardson
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - S V Rajkumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - A Palumbo
- Department of Hematology, University of Torino, Torino, Italy
| | - M V Mateos
- Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain
| | - R Orlowski
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - S Kumar
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - S Usmani
- M.I.R.T. UAMS, Little Rock, AR, USA
| | - D Roodman
- Director of Hematology/Oncology, Indiana University, Indianapolis, IN, USA
| | - R Niesvizky
- Department of Hematology, Weill Cornell Medical College, New York, NY, USA
| | - H Einsele
- Department of Internal Medicine, University of Wurzburg, Wurzburg, Germany
| | - K C Anderson
- Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M A Dimopoulos
- School of Medicine, University of Athens, Athens, Greece
| | - H Avet-Loiseau
- Department of Hematology, University of Toulouse, Toulouse, France
| | - U-H Mellqvist
- Department of Medicine, Section of Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - I Turesson
- Department of Medicine, Section of Hematology, Skane University Hospital, Malmo, Sweden
| | - G Merlini
- Department of Molecular Medicine, Univeristy of Pavia, Pavia, Italy
| | - R Schots
- Department of Clinical Hematology and Stem Cell Laboratory, University Ziekenhuis, Brussels, Belgium
| | - P McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - L Bergsagel
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - C S Chim
- Department of Hematology, Queen Mary Hospital, Hong Kong
| | - J J Lahuerta
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Shah
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - A Reiman
- Department of Oncology, University of New Brunswick, Saint John Regional Hospital, St John, NB, Canada
| | - J Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Lonial
- Department of Hematology and Medical Oncology, Shanghai Chang Zheng Hospital, Atlanta, GA, USA
| | - R Comenzo
- Department of Hematology, Tufts Medical School, Boston, MA, USA
| | - W J Chng
- Department of Hematology Oncology, National University Cancer Institute, Singapore
| | - P Moreau
- Department of Hematology, University Hospital, Nantes, France
| | - P Sonneveld
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
| | - H Ludwig
- Department of Medicine, Center for Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria
| | | | - J F S Miguel
- 1] Department of Hematology, University Hospital and Cancer Research Center, University of Salamanca-IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain [2] Department of Clinical and Translational Medicine, University of Navarra, Pamplona, Spain
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Naing A, LoRusso P, Fu S, Hong DS, Anderson P, Benjamin RS, Ludwig J, Chen HX, Doyle LA, Kurzrock R. Insulin growth factor-receptor (IGF-1R) antibody cixutumumab combined with the mTOR inhibitor temsirolimus in patients with refractory Ewing's sarcoma family tumors. Clin Cancer Res 2012; 18:2625-31. [PMID: 22465830 PMCID: PMC3875297 DOI: 10.1158/1078-0432.ccr-12-0061] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Temsirolimus was combined with cixutumumab, a fully human IgG1 monoclonal antibody directed at the insulin growth factor-1 receptor (IGF-1R). EXPERIMENTAL DESIGN Patients received cixutumumab, 6 mg/kg i.v. weekly, and temsirolimus, 25 to 37.5 mg i.v. weekly (4-week cycles), with restaging after 8 weeks. Median follow-up was 8.9 months. RESULTS Twenty patients [17 with Ewing's sarcoma (EWS), 3 with desmoplastic small-round cell tumor (DSRCT)] were enrolled. Twelve patients (60%) were men with a median age of 24 years and six median prior systemic therapies in a metastatic setting. The most frequent toxicities were thrombocytopenia (85%), mucositis (80%), hypercholesterolemia (75%), hypertriglyceridemia (70%), and hyperglycemia (65%; mostly grade I-II). Seven of 20 patients (35%) achieved stable disease (SD) for more than 5 months or complete/partial (CR/PR) responses. Tumor regression of more than 20% (23%, 23%, 27%, 100%, 100%) occurred in five of 17 (29%) patients with EWS, and they remained on study for 8 to 27 months. One of six patients with EWS who previously developed resistance to a different IGF-1R inhibitor antibody achieved a CR. Four of the seven best responders developed grade III mucositis, myelosuppression, or hyperglycemia, which were controlled while maintaining drug dose. CONCLUSION Cixutumumab combined with temsirolimus was well-tolerated and showed preliminary evidence of durable antitumor activity in heavily pretreated EWS family tumors.
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Affiliation(s)
- Aung Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Abstract
The cell cycle governs the transition from quiescence through cell growth to proliferation. The key parts of the cell cycle machinery are the cyclin-dependent kinases (CDKS) and the regulatory proteins called cyclins. The CDKS are rational targets for cancer therapy because their expression in cancer cells is often aberrant and their inhibition can induce cell death. Inhibitors of CDKS can also block transcription.Several drugs targeting the cell cycle have entered clinical trials. These agents include flavopiridol, indisulam, AZD5438, SNS-032, bryostatin-1, seliciclib, PD 0332991, and SCH 727965. Phase i studies have demonstrated that these drugs can generally be administered safely. Phase ii studies have shown little single-agent activity in solid tumors, but combination studies with cytotoxic chemotherapy have been more promising. In hematologic malignancies, reports have shown encouraging single-agent and combination activity. Pharmacodynamic studies show that the dose and schedule of these drugs are crucial to permit maximum therapeutic effect.
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Affiliation(s)
- M.A. Dickson
- Department of Medicine, Division of Solid Tumor Oncology, Melanoma and Sarcoma Service, and Laboratory of New Drug Development, Memorial Sloan–Kettering Cancer Center, New York, NY, U.S.A
| | - G.K. Schwartz
- Department of Medicine, Division of Solid Tumor Oncology, Melanoma and Sarcoma Service, and Laboratory of New Drug Development, Memorial Sloan–Kettering Cancer Center, New York, NY, U.S.A
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Van Der Heyden SA, Highley MS, De Bruijn EA, Tjaden UR, Reeuwijk HJ, Van Slooten H, Van Oosterom AT, Maes RA. Pharmacokinetics and bioavailability of oral 5'-deoxy-5-fluorouridine in cancer patients. Br J Clin Pharmacol 1999; 47:351-6. [PMID: 10233196 PMCID: PMC2014244 DOI: 10.1046/j.1365-2125.1999.00899.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIMS Oral administration of 5-fluorouracil (FUra), an important cytotoxic agent, is limited by a wide variation in bioavailability. 5'-deoxy-5-fluorouridine (dFUrd), a masked form of FUra, has shown promise clinically when given intravenously or orally as a solution or tablet. This study investigates the efficacy of an oral capsule formulation of dFUrd in generating continuous systemic levels of this compound in cancer patients. METHODS Six patients with advanced intestinal or ovarian malignancies were given three cycles of dFUrd, days 1-5, at intervals of 4 weeks. The doses of dFUrd were 600 mg m-2 three times daily, 800 mg m-2 three times daily, and 1000 mg m-2 three times daily, on cycles one, two and three, respectively (total dose 36 g m-2 ). The initial dose in each cycle was given as a slow intravenous injection over 10 min, and the remainder orally. Plasma and urine levels of dFUrd and two of its metabolites, FUra and 5,6-dihydro-5-fluorouracil (FUraH2 ), were monitored in six patients at each dose level. RESULTS All six patients completed the study, receiving three different doses over a 3 month period, following which one had achieved a partial response, one had stable disease, and four had developed progressive disease. Side-effects were negligible, and only two instances of transient diarrhoea WHO grade 1 were seen. Total body clearance (CLtot) of intravenous dFUrd decreased with increasing dose; 2.7, 2.0 and 1.3 l min-1 m-2, following doses of 600, 800 and 1000 mg m-2, respectively. The mean elimination half-life of intravenous dFUrd increased with the dose from 15 to 22 min. Oral dFUrd was rapidly absorbed with a lag time of less than 20 min. The mean elimination half-life (t1/2, z ) of oral dFUrd was 32-45 min in the dose range 600-1000 mg m-2. The AUC of FUra and FUraH2 increased overproportionally with increasing intravenous doses of dFUrd. The mean systemic bioavailability of oral dFUrd was 34-47%. CONCLUSIONS dFUrd, which selectively releases the antimetabolite FUra in tumour cells, can be given orally at doses of 600-1000 mg m-2 three times daily for 5 days. The systemic levels achieved are equivalent to those seen following continuous infusions of dFUrd or FUra. Toxicity is tolerable, and further clinical investigation of oral dFUrd is warranted.
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Affiliation(s)
- S A Van Der Heyden
- Laboratory for Experimental Oncology, University of Leuven, B-3000 Leuven, Belgium
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