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Rea D, Fodil S, Lengline E, Raffoux E, Cayuela JM. Tyrosine Kinase Inhibitor Discontinuation in Chronic Myeloid Leukemia: Strategies to Optimize Success and New Directions. Curr Hematol Malig Rep 2024; 19:104-110. [PMID: 38393431 DOI: 10.1007/s11899-024-00728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE OF REVIEW The discovery that patients suffering from chronic myeloid leukemia who obtain deep and long-lasting molecular responses upon treatment with tyrosine kinase inhibitors may maintain their disease silent for many years after therapy discontinuation launched the era of treatment-free remission as a key management goal in clinical practice. The purpose of this review on treatment-free remission is to discuss clinical advances, highlight knowledge gaps, and describe areas of research. RECENT FINDINGS Patients in treatment-free remission are a minority, and it is believed that some may still retain a reservoir of leukemic stem cells; thus, whether they can be considered as truly cured is uncertain. Strengthening BCR::ABL1 inhibition increases deep molecular responses but is not sufficient to improve treatment-free remission, and we lack biomarkers to identify and specifically target residual cells with aggressive potential. Another level of complexity resides in the intra- and inter-patient clonal heterogeneity of minimal residual disease and characteristics of the bone marrow environment. Finding determinants of deep molecular responses achievement and elucidating varying biological mechanisms enabling either post-tyrosine kinase inhibitor chronic myeloid leukemia control or relapse may help develop innovative and safe therapies. In the light of the increasing prevalence of CML, targeting the residual leukemic stem cell pool is thought to be the key.
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Affiliation(s)
- Delphine Rea
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, 75010, Paris, France.
- France Intergroupe Des Leucémies Myéloïdes Chroniques FiLMC, Paris, France.
| | - Sofiane Fodil
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, 75010, Paris, France
| | - Etienne Lengline
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, 75010, Paris, France
| | - Emmanuel Raffoux
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, 75010, Paris, France
| | - Jean-Michel Cayuela
- France Intergroupe Des Leucémies Myéloïdes Chroniques FiLMC, Paris, France
- Laboratoire Central d'Hématologie, Hôpital Saint-Louis APHP, Paris, France
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2
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Cortes JE, Sasaki K, Kim DW, Hughes TP, Etienne G, Mauro MJ, Hochhaus A, Lang F, Heinrich MC, Breccia M, Deininger M, Goh YT, Janssen JJWM, Talpaz M, de Soria VGG, le Coutre P, DeAngelo DJ, Damon A, Cacciatore S, Polydoros F, Agrawal N, Rea D. Asciminib monotherapy in patients with chronic-phase chronic myeloid leukemia with the T315I mutation after ≥1 prior tyrosine kinase inhibitor: 2-year follow-up results. Leukemia 2024:10.1038/s41375-024-02278-8. [PMID: 38755421 DOI: 10.1038/s41375-024-02278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
Asciminib targets the BCR::ABL1 myristoyl pocket, maintaining activity against BCR::ABL1T315I, which is resistant to most approved adenosine triphosphate-competitive tyrosine kinase inhibitors. We report updated phase I results (NCT02081378) assessing safety/tolerability and antileukemic activity of asciminib monotherapy 200 mg twice daily in 48 heavily pretreated patients with T315I-mutated chronic-phase chronic myeloid leukemia (CML-CP; data cutoff: January 6, 2021). With 2 years' median exposure, 56.3% of patients continued receiving asciminib. Overall, 62.2% of evaluable patients achieved BCR::ABL1 ≤1% on the International Scale (IS); 47.6% and 81.3% of ponatinib-pretreated and -naive patients, respectively, achieved BCR::ABL1IS ≤1%. Of 45 evaluable patients, 48.9% achieved a major molecular response (MMR, BCR::ABL1IS ≤0.1%), including 34.6% and 68.4% of ponatinib-pretreated and -naive patients, respectively. MMR was maintained until data cutoff in 19 of 22 patients who achieved it. The most common grade ≥3 adverse events (AEs) included increased lipase level (18.8%) and thrombocytopenia (14.6%). Five (10.4%) patients experienced AEs leading to discontinuation, including 2 who discontinued asciminib and died due to COVID-19; these were the only deaths reported. These results show asciminib's effectiveness, including in almost 50% of ponatinib pretreated patients, and confirm its risk-benefit profile, supporting its use as a treatment option for T315I-mutated CML-CP.
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Affiliation(s)
- Jorge E Cortes
- Georgia Cancer Center at Augusta University, Augusta, GA, USA.
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dong-Wook Kim
- Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si, South Korea
| | - Timothy P Hughes
- South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia
| | - Gabriel Etienne
- Department of Hematology, Institut Bergonié, Bordeaux, France
| | - Michael J Mauro
- Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Fabian Lang
- Department of Medicine, Hematology and Oncology, Goethe University Hospital, Frankfurt, Germany
| | - Michael C Heinrich
- Portland VA Health Care System and OHSU Department of Medicine, Division of Hematology and Oncology, Knight Cancer Institute, Portland, OR, USA
| | - Massimo Breccia
- Department of Translational and Precision Medicine-Az., Policlinico Umberto I-Sapienza University, Rome, Italy
| | | | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Bukit Merah, Singapore
| | | | - Moshe Talpaz
- Division of Hematology-Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | | | - Philipp le Coutre
- Department of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Andrea Damon
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Delphine Rea
- Department of Hématologie, Hôpital Saint-Louis, Paris, France
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Leyte-Vidal A, Garrido Ruiz D, DeFilippis R, Leske IB, Rea D, Phan S, Miller KB, Hu F, Mase A, Shan Y, Hantschel O, Jacobson MP, Shah NP. BCR::ABL1 Kinase N-lobe Mutants Confer Moderate to High Degrees of Resistance to Asciminib. Blood 2024:blood.2023022538. [PMID: 38643492 DOI: 10.1182/blood.2023022538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/23/2024] Open
Abstract
Secondary kinase domain mutations in BCR::ABL1 represent the most common cause of resistance to tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia patients. The first five approved BCR::ABL1 TKIs target the ATP-binding pocket. Mutations confer resistance to these ATP-competitive TKIs and those approved for other malignancies by decreasing TKI affinity and/or increasing ATP affinity. Asciminib, the first highly active allosteric TKI approved for any malignancy, targets an allosteric regulatory pocket in the BCR::ABL1 kinase C-lobe. As a non-ATP-competitive inhibitor, the activity of asciminib is predicted to be impervious to increases in ATP affinity. Here we report several known mutations that confer resistance to ATP-competitive TKIs in the BCR::ABL1 kinase N-lobe that are distant from the asciminib binding pocket yet unexpectedly confer in vitro resistance to asciminib. Among these is BCR::ABL1 M244V, which confers clinical resistance even to escalated asciminib doses. We demonstrate that BCR::ABL1 M244V does not impair asciminib binding, thereby invoking a novel mechanism of resistance. Molecular dynamics simulations of the M244V substitution implicate stabilization of an active kinase conformation through impact on the -C helix as a mechanism of resistance. These N-lobe mutations may compromise the clinical activity of ongoing combination studies of asciminib with ATP-competitive TKIs.
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Affiliation(s)
| | - Diego Garrido Ruiz
- University of California, San Francisco, San Francisco, California, United States
| | - RosaAnna DeFilippis
- University of California at San Francisco, San Francisco, California, United States
| | | | | | - Stacey Phan
- University of California, San Francisco, San Francisco, California, United States
| | - Kaeli B Miller
- University of California, San Francisco, San Francisco, California, United States
| | - Feifei Hu
- University of California, San Francisco, San Francisco, California, United States
| | - Anjeli Mase
- University of California, San Francisco, San Francisco, California, United States
| | - Yibing Shan
- Antidote Health Foundation for Cure of Cancer, Morristown, Massachusetts, United States
| | | | - Matthew P Jacobson
- University of California, San Francisco, San Francisco, California, United States
| | - Neil P Shah
- University of California, San Francisco, San Francisco, California, United States
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4
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Chelysheva E, Apperley J, Turkina A, Yassin MA, Rea D, Nicolini FE, Barraco D, Kazakbaeva K, Saliev S, Abulafia AS, Al-Kindi S, Byrne J, Robertson HF, Cerrano M, Shmakov R, Polushkina E, de Fabritiis P, Trawinska MM, Abruzzese E. Chronic myeloid leukemia diagnosed in pregnancy: management and outcome of 87 patients reported to the European LeukemiaNet international registry. Leukemia 2024; 38:788-795. [PMID: 38388649 DOI: 10.1038/s41375-024-02183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
The management of chronic myeloid leukemia (CML) diagnosed during pregnancy is a rare and challenging situation. We report the treatment and outcome of 87 cases diagnosed in chronic phase from 2001-2022 derived from the largest international observational registry, supported by the European LeukemiaNet (ELN), of 400 pregnancies in 299 CML women. Normal childbirth occurred in 76% without an increased rate of birth abnormalities or life-threatening events, including in patients untreated or treated with interferon-α and/or imatinib in 2nd-3rd trimester. The low birth weight rate of 12% was comparable to that seen in the normal population. Elective and spontaneous abortions occurred in 21% and 3%, respectively. The complete hematologic response rate before labor was 95% with imatinib and 47% with interferon only. No disease progression during pregnancy was observed, 28% of the patients switched their therapy at varying times after delivery. Treatment options balance the efficacy and safety for mother and infant: interferon-α can commence in the 1st trimester and continued throughout in cases of good disease control and tolerability. Because of limited placental crossing, selected tyrosine kinase inhibitors (imatinib and nilotinib) seem to be safe and effective options in 2nd and 3rd trimester while hydroxycarbamide offers few benefits.
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Affiliation(s)
| | - Jane Apperley
- Centre for Haematology, Imperial College London, London, UK
| | - Anna Turkina
- National Medical Research Center for Hematology, Moscow, Russian Federation
| | - Mohamed A Yassin
- Department of Medical Oncology/ Hematology Section, National Centre For Cancer Care & Research, Doha, Qatar
| | - Delphine Rea
- Service d'hématologie Adulte and FiLMC Hôpital Saint-Louis, Paris, France
| | - Franck E Nicolini
- Hematology department and INSERM 1052 CRCL, Centre Léon Bérard, Lyon, France
| | - Daniela Barraco
- Division of Hematology, University Hospital "Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi", Varese, Italy
| | - Khamida Kazakbaeva
- Republician Specilized Scientific and Practical Medical Centre of Hematology, Tashkent, Uzbekistan
| | - Sukhrob Saliev
- Republician Specilized Scientific and Practical Medical Centre of Hematology, Tashkent, Uzbekistan
| | - Adi Shacham Abulafia
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel
| | - Salam Al-Kindi
- Department of Haematology, Sultan Qaboos University, Muscat, Oman
| | - Jennifer Byrne
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, England, UK
| | | | - Marco Cerrano
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roman Shmakov
- FSBI «National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov» Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Evgenia Polushkina
- FSBI «National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov» Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Paolo de Fabritiis
- Hematology, S. Eugenio Hospital, Tor Vergata University, ASL Roma2, Rome, Italy
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5
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Alcazer V, Morisset S, Rea D, Legros L, Dulucq S, Hayette S, Cayuela JM, Huguet F, Mahon FX, Etienne G, Nicolini FE. Kinetics of molecular recurrence after tyrosine kinase inhibitor cessation in chronic phase chronic myelogenous leukaemia patients. Br J Haematol 2024; 204:1536-1539. [PMID: 38323384 DOI: 10.1111/bjh.19330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Vincent Alcazer
- Department of Haematology, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- French Group of CML, Centre Léon Bérard, Lyon, France
| | - Stéphane Morisset
- Department of Haematology, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Delphine Rea
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Hôpital Saint Louis, Paris, France
| | - Laurence Legros
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Stéphanie Dulucq
- French Group of CML, Centre Léon Bérard, Lyon, France
- Laboratory of Haematology, CHU de Bordeaux, Pessac, France
| | - Sandrine Hayette
- French Group of CML, Centre Léon Bérard, Lyon, France
- Laboratory of Haematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Jean-Michel Cayuela
- French Group of CML, Centre Léon Bérard, Lyon, France
- Laboratory of Haematology, Hôpital Saint Louis, Paris, France
| | - Françoise Huguet
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Institut Universitaire du Cancer de Toulouse, CHU de Toulouse, France
| | - François-Xavier Mahon
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Institut Bergonié, Bordeaux, France
| | - Gabriel Etienne
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Institut Bergonié, Bordeaux, France
| | - Franck E Nicolini
- Department of Haematology, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Clinical Haematology and INSERM U1052, CRCL, Centre Leon Bérard, Lyon, France
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6
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Jabbour E, Apperley J, Cortes J, Rea D, Deininger M, Abruzzese E, Chuah C, DeAngelo DJ, Hochhaus A, Lipton JH, Mauro M, Nicolini F, Pinilla-Ibarz J, Rosti G, Rousselot P, Shah NP, Talpaz M, Vorog A, Ren X, Kantarjian H. Dose modification dynamics of ponatinib in patients with chronic-phase chronic myeloid leukemia (CP-CML) from the PACE and OPTIC trials. Leukemia 2024; 38:475-481. [PMID: 38287132 PMCID: PMC10912029 DOI: 10.1038/s41375-024-02159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/03/2023] [Revised: 12/22/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
Ponatinib, the only approved all known-BCR::ABL1 inhibitor, is a third-generation tyrosine-kinase inhibitor (TKI) designed to inhibit BCR::ABL1 with or without any single resistance mutation, including T315I, and induced robust and durable responses at 45 mg/day in patients with CP-CML resistant to second-generation TKIs in the PACE trial. However, cardiovascular toxicities, including arterial occlusive events (AOEs), have emerged as treatment-related AEs within this class of TKIs. The OPTIC trial evaluated the efficacy and safety of ponatinib using a novel, response-based, dose-reduction strategy in patients with CP-CML whose disease is resistant to ≥2 TKIs or who harbor T315I. To assess the dose-response relationship and the effect on the safety of ponatinib, we examined the outcomes of patients with CP-CML enrolled in PACE and OPTIC who received 45 mg/day of ponatinib. A propensity score analysis was used to evaluate AOEs across both trials. Survival rates and median time to achieve ≤1% BCR::ABL1IS in OPTIC were similar or better than in PACE. The outcomes of patients with T315I mutations were robust in both trials. Patients in OPTIC had a lower exposure-adjusted incidence of AOEs compared with those in PACE. This analysis demonstrates that response-based dosing for ponatinib improves treatment tolerance and mitigates cardiovascular risk.
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MESH Headings
- Humans
- Drug Resistance, Neoplasm
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Imidazoles/therapeutic use
- Imidazoles/pharmacology
- Pyridazines/therapeutic use
- Pyridazines/pharmacology
- Fusion Proteins, bcr-abl/genetics
- Protein Kinase Inhibitors/pharmacology
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents/pharmacology
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Affiliation(s)
- Elias Jabbour
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | | | - Michael Deininger
- Versiti Blood Research Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Charles Chuah
- Singapore General Hospital, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore, Singapore
| | | | | | | | | | | | | | | | - Philippe Rousselot
- Hospital Mignot University de Versailles Saint-Quentin-en-Yvelines, Paris, France
| | - Neil P Shah
- University of California San Francisco, San Francisco, CA, USA
| | - Moshe Talpaz
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Vorog
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Xiaowei Ren
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Hagop Kantarjian
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Rea D, Cayssials E, Charbonnier A, Coiteux V, Etienne G, Goldwirt L, Guerci-Bresler A, Huguet F, Legros L, Roy L, Nicolini FE. [Optimizing the use of bosutinib in patients with chronic-phase chronic myeloid leukemia: Recommendations of a panel of experts from the Fi-LMC (French CML working group)]. Bull Cancer 2024; 111:87-96. [PMID: 38087729 DOI: 10.1016/j.bulcan.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 10/29/2023] [Indexed: 01/22/2024]
Abstract
The treatment of chronic myeloid leukemia relies on orally available tyrosine kinase inhibitors targeting the BCR::ABL1 oncoprotein. Bosutinib is a second generation adenosine triphosphate-competitive inhibitor approved for use in frontline adult chronic phase-chronic myeloid leukemia and all phases-chronic myeloid leukemia in the second line setting or beyond. Its efficacy was demonstrated in several pivotal clinical trials at 400mg once daily in the first line context and at 500mg once daily beyond first line. Bosutinib-related adverse events frequently occur early after treatment initiation and include gastro-intestinal symptoms and cytolytic hepatitis. These drug-related adverse events must be properly managed in order to preserve safety, efficacy and treatment acceptability. The French chronic myeloid leukemia study group gathered a panel of experts in hematology, pharmacology and hepatology in order to elaborate practical recommendations on the management of bosutinib treatment. These recommendations aim at optimizing the short and long-term tolerance and benefit/risk balance of bosutinib, mainly focusing at gastro-intestinal and liver toxicities.
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Affiliation(s)
- Delphine Rea
- DMU d'hématologie, hôpital universitaire Saint-Louis, Paris, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France.
| | - Emilie Cayssials
- CHU de Poitiers, département d'hématologie, Poitiers, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
| | - Aude Charbonnier
- Institut Paoli-Calmettes, hematology department, Marseille, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
| | - Valérie Coiteux
- CHU Claude-Huriez, département d'hématologie, Lille, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
| | - Gabriel Etienne
- Institut Bergonié, département d'hématologie, Bordeaux, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
| | | | - Agnès Guerci-Bresler
- CHRU Brabois, service d'hématologie, Vandœuvre-lès-Nancy, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
| | - Françoise Huguet
- CHU de Toulouse, institut universitaire du cancer, département d'hématologie, Toulouse, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
| | - Laurence Legros
- Hôpital Paul-Brousse, département d'hématologie, Villejuif, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
| | - Lydia Roy
- AP-HP, hôpital universitaire Henri-Mondor, université Paris Est Créteil (UPEC), service d'hématologie clinique, Créteil, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
| | - Franck Emmanuel Nicolini
- Centre Léon-Bérard, hématologie clinique, Inserm U1052, Lyon, France; France Intergroupe de la leucémie myéloïde chronique Fi-LMC, France
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8
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Shah NP, García-Gutiérrez V, Jiménez-Velasco A, Larson SM, Saussele S, Rea D, Mahon FX, Levy MY, Gómez-Casares MT, Mauro MJ, Sy O, Martin-Regueira P, Lipton JH. Treatment-free remission after dasatinib in patients with chronic myeloid leukaemia in chronic phase with deep molecular response: Final 5-year analysis of DASFREE. Br J Haematol 2023; 202:942-952. [PMID: 37246588 PMCID: PMC10524617 DOI: 10.1111/bjh.18883] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023]
Abstract
Patients with chronic myeloid leukaemia in chronic phase (CML-CP) who have a sustained deep molecular response (DMR) are eligible to discontinue treatment and attempt treatment-free remission (TFR). In the DASFREE study (ClinicalTrials.gov; NCT01850004), the 2-year TFR rate after dasatinib discontinuation was 46%; here we present the 5-year update. Patients with a stable DMR after ≥2 years of dasatinib therapy discontinued treatment and were followed for 5 years. At a minimum follow-up of 60 months, in 84 patients discontinuing dasatinib, the 5-year TFR rate was 44% (n = 37). No relapses occurred after month 39 and all evaluable patients who relapsed and restarted dasatinib (n = 46) regained a major molecular response in a median of 1.9 months. The most common adverse event during the off-treatment period was arthralgia (18%, 15/84); a total of 15 withdrawal events were reported in nine patients (11%). At the 5-year final follow-up, almost half of the patients who discontinued dasatinib after a sustained DMR maintained TFR. All evaluable patients who experienced a relapse quickly regained a DMR after restarting dasatinib, demonstrating that dasatinib discontinuation is a viable and potentially long-term option in patients with CML-CP. The safety profile is consistent with the previous report.
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Affiliation(s)
- Neil P. Shah
- UCSF School of Medicine, San Francisco, California, USA
| | - Valentín García-Gutiérrez
- Servicio Hematología y Hemoterapia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Antonio Jiménez-Velasco
- Servicio de Hematología y Hemoterapia, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Sarah M. Larson
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Susanne Saussele
- Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Delphine Rea
- Adult Hematology Department, Hôpital Saint-Louis, Paris, France
| | | | | | | | | | - Oumar Sy
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Jeffrey H. Lipton
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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9
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Cortes JE, Rea D, Mauro MJ, Tran D, Wang P, Jadhav K, Yocolly A, Sasaki K. Health care resource utilization in 3L + patients with chronic phase chronic myeloid leukemia receiving asciminib or bosutinib. J Med Econ 2023:1-26. [PMID: 37431294 DOI: 10.1080/13696998.2023.2234776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To assess and compare health care resource utilization (HCRU) rates of asciminib and bosutinib at the Week 24, Week 48, and Week 96 cutoffs among 3L + patients with chronic myeloid leukemia in chronic phase (CML-CP) in the randomized ASCEMBL trial. METHODS Patients in the ASCEMBL trial (Clinicaltrials.gov: NCT03106779) were randomized to receive asciminib 40 mg twice daily (n = 157) or bosutinib 500 mg once daily (n = 76). At each scheduled visit, investigators conducted HCRU assessment on hospitalization, emergency room visit, general practitioner visit, specialist visit and urgent care visit; duration and type of hospitalization for the hospitalized patients; and reasons for HCRU. The number of patients with HCRU, rate of HCRU per patient-year, and length of hospital stay by ward type were compared at Week 24, Week 48 and Week 96 analyses. RESULTS Lower proportions of patients receiving asciminib versus bosutinib used any resources including hospitalizations, emergency room visits, general practitioner visits, specialist visits, and urgent care visits (23.6% versus 36.8%, 26.1% versus 39.5%, and 28.6% versus 42.6% at Week 24, Week 48, and Week 96 analyses respectively). After normalizing for treatment exposure, rates of HCRU for any resource per patient-year were significantly lower for asciminib versus bosutinib: 0.25 (95% CI: 0.18-0.34) versus 0.80 (95% CI: 0.55-1.16) at the Week 24 analysis, 0.20 (95% CI: 0.15-0.27) versus 0.47 (95% CI: 0.32-0.66) at the Week 48 analysis, and 0.17 (95% CI: 0.12-0.22) versus 0.40 (95% CI: 0.27-0.55) at the Week 96 analysis. Among the hospitalized patients, mean length of hospital stay was lower for asciminib than bosutinib for most wards at all three timepoints. CONCLUSIONS In the ASCEMBL trial, asciminib-treated patients with CML-CP in 3L + maintained lower resource utilization compared to bosutinib over the long-term.
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Affiliation(s)
- Jorge E Cortes
- Georgia Cancer Center at Augusta University, Augusta, GA, USA
| | | | | | | | | | | | | | - Koji Sasaki
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
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10
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Dekker SE, Rea D, Cayuela JM, Arnhardt I, Leonard J, Heuser M. Using Measurable Residual Disease to Optimize Management of AML, ALL, and Chronic Myeloid Leukemia. Am Soc Clin Oncol Educ Book 2023; 43:e390010. [PMID: 37311155 DOI: 10.1200/edbk_390010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this review, we discuss the use of measurable residual disease (MRD) in AML, ALL, and chronic myeloid leukemia (CML). Our aims were to review the different methodologies for MRD assessment; describe the clinical relevance and medical decision making on the basis of MRD; compare and contrast the usage of MRD across AML, ALL, and CML; and discuss what patients need to know about MRD as it relates to their disease status and treatment. Finally, we discuss ongoing challenges and future directions with the goal of optimizing MRD usage in leukemia management.
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Affiliation(s)
- Simone E Dekker
- Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Delphine Rea
- France Intergroupe des Leucémies Myéloïdes chroniques FiLMC, Hôpital Saint-Louis APHP, Paris, France
- Service d'Hématologie Adulte, Hôpital Saint-Louis APHP, Paris, France
| | - Jean-Michel Cayuela
- France Intergroupe des Leucémies Myéloïdes chroniques FiLMC, Hôpital Saint-Louis APHP, Paris, France
- Laboratoire de Biologie Moléculaire, Hôpital Saint-Louis APHP, Paris, France
| | - Isabell Arnhardt
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Jessica Leonard
- Division of Hematology-Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
- Comprehensive Cancer Center Lower Saxony, Hannover, Germany
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11
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Balsat M, Alcazer V, Etienne G, Huguet F, Berger M, Cayssials E, Charbonnier A, Escoffre-Barbe M, Johnson-Ansah H, Legros L, Roy L, Delmer A, Ianotto JC, Orvain C, Larosa F, Meunier M, Amé S, Andreoli A, Cony-Makhoul P, Morisset S, Tigaud I, Rea D, Nicolini FE. First-line second generation tyrosine kinase inhibitors in patients with newly diagnosed accelerated phase chronic myeloid leukemia. Leuk Res 2023; 130:107308. [PMID: 37230027 DOI: 10.1016/j.leukres.2023.107308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
Accelerated phase (AP) CML at onset and have poorer prognosis than CP-CML. We hypothesize that off-license use of second generation TKI (TKI2) as front-line therapy might counterbalance this poor prognosis, with limited toxicity. In "real-life" conditions, newly diagnosed patients meeting the ELN cytological criteria for AP-CML or harboring ACA and treated with first-line TKI2 were included in this retrospective multicenter observational study. We enrolled 69 patients [69.5 % male, median age 49.5 years, median follow-up 43.5 months], segregated into hematologic AP [HEM-AP (n = 32)] and cytogenetically defined AP [ACA-AP (n = 37)]. Hematologic parameters were worse in HEM-AP [spleen size (p = 0.014), PB basophils (p < .001), PB blasts (p < .001), PB blasts+promyelocytes (p < .001), low hemoglobin levels (p < .001)]. Dasatinib was initiated in 56 % patients in HEM-AP and in 27 % in ACA-AP, nilotinib in 44 % and 73 % respectively. Response and survival do not differ, regardless of the TKI2: 81 % vs 84.3 % patients achieved CHR, 88 % vs 84 % CCyR, 73 % vs 75 % MMR respectively. The estimated 5-year PFS 91.5 % (95%CI: 84.51-99.06 %) and 5-year OS 96.84 % (95%CI: 92.61-100 %). Only BM blasts (p < 0.001) and BM blasts+promyelocytes (p < 0.001) at diagnosis negatively influenced OS. TKI2 as front-line therapy in newly diagnosed AP-CML induce excellent responses and survival, and counterbalance the negative impact of advanced disease phase.
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Affiliation(s)
- Marie Balsat
- Hematology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France; French Group of CML (Fi-LMC), Lyon, France
| | - Vincent Alcazer
- Hematology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Gabriel Etienne
- Hematology Department, Institut Bergonié, Bordeaux, France; French Group of CML (Fi-LMC), Lyon, France
| | - Françoise Huguet
- Hematology Department, Institut Universitaire du Cancer, Toulouse, France; French Group of CML (Fi-LMC), Lyon, France
| | - Marc Berger
- Hematology Department, CHU Estaing, Clermont-Ferrand, France; French Group of CML (Fi-LMC), Lyon, France
| | - Emilie Cayssials
- Hematology Department, Hôpital Jean Bernard, Poitiers, France; French Group of CML (Fi-LMC), Lyon, France
| | - Aude Charbonnier
- Hematology Department, Institut Paoli Calmettes, Marseilles, France; French Group of CML (Fi-LMC), Lyon, France
| | - Martine Escoffre-Barbe
- Hematology Department, Hôpital de Pontchaillou, Rennes, France; French Group of CML (Fi-LMC), Lyon, France
| | - Hyacinthe Johnson-Ansah
- Hematology Department, Hôpital Clémenceau, Caën, France; French Group of CML (Fi-LMC), Lyon, France
| | - Laurence Legros
- Hematology Department, Hôpital Paul Brousse, Villejuif, France; French Group of CML (Fi-LMC), Lyon, France
| | - Lydia Roy
- Hematology department, Hôpital Universitaire Henri Mondor - AP-HP & Faculté de Santé - UPEC, Créteil, France; French Group of CML (Fi-LMC), Lyon, France
| | | | - Jean-Christophe Ianotto
- Hematology Department, Hôpital Morvan, Brest, France; French Group of CML (Fi-LMC), Lyon, France
| | - Corentin Orvain
- Hematology Department, Hôpital universitaire, Angers, France; French Group of CML (Fi-LMC), Lyon, France
| | - Fabrice Larosa
- Gerontology Department, Hôpital du Bocage, Dijon, France; French Group of CML (Fi-LMC), Lyon, France
| | - Mathieu Meunier
- Hematology Department, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France; French Group of CML (Fi-LMC), Lyon, France
| | - Shanti Amé
- Hematology Department, Institut de Cancérologie Strasbourg Europe, Strasbourg, France; French Group of CML (Fi-LMC), Lyon, France
| | - Annalisa Andreoli
- Hematology Department, CH d'Argenteuil, Argenteuil, France; French Group of CML (Fi-LMC), Lyon, France
| | - Pascale Cony-Makhoul
- Hematology Department, Centre Hospitalier Annecy Genevois, Pringy, France; French Group of CML (Fi-LMC), Lyon, France
| | | | - Isabelle Tigaud
- Laboratory for Cytogenetics, Centre Hospitalier Lyon Sud, Pierre Bénite, France; French Group of CML (Fi-LMC), Lyon, France
| | - Delphine Rea
- Hematology Department, Hôpital Saint Louis, Paris, France; French Group of CML (Fi-LMC), Lyon, France
| | - Franck Emmanuel Nicolini
- Hematology Department, Centre Léon Bérard, Lyon, France; INSERM U1052, CRCL, Lyon, France; French Group of CML (Fi-LMC), Lyon, France.
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12
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Mauro MJ, Hughes TP, Kim DW, Rea D, Cortes JE, Hochhaus A, Sasaki K, Breccia M, Talpaz M, Ottmann O, Minami H, Goh YT, DeAngelo DJ, Heinrich MC, Gómez-García de Soria V, le Coutre P, Mahon FX, Janssen JJWM, Deininger M, Shanmuganathan N, Geyer MB, Cacciatore S, Polydoros F, Agrawal N, Hoch M, Lang F. Asciminib monotherapy in patients with CML-CP without BCR::ABL1 T315I mutations treated with at least two prior TKIs: 4-year phase 1 safety and efficacy results. Leukemia 2023; 37:1048-1059. [PMID: 36949155 PMCID: PMC10169635 DOI: 10.1038/s41375-023-01860-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 12/02/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
Asciminib is approved for patients with Philadelphia chromosome-positive chronic-phase chronic myeloid leukemia (CML-CP) who received ≥2 prior tyrosine kinase inhibitors or have the T315I mutation. We report updated results of a phase 1, open-label, nonrandomized trial (NCT02081378) assessing the safety, tolerability, and antileukemic activity of asciminib monotherapy 10-200 mg once or twice daily in 115 patients with CML-CP without T315I (data cutoff: January 6, 2021). After ≈4-year median exposure, 69.6% of patients remained on asciminib. The most common grade ≥3 adverse events (AEs) included increased pancreatic enzymes (22.6%), thrombocytopenia (13.9%), hypertension (13.0%), and neutropenia (12.2%); all-grade AEs (mostly grade 1/2) included musculoskeletal pain (59.1%), upper respiratory tract infection (41.7%), and fatigue (40.9%). Clinical pancreatitis and arterial occlusive events (AOEs) occurred in 7.0% and 8.7%, respectively. Most AEs occurred during year 1; the subsequent likelihood of new events, including AOEs, was low. By data cutoff, among patients without the indicated response at baseline, 61.3% achieved BCR::ABL1 ≤ 1%, 61.6% achieved ≤0.1% (major molecular response [MMR]), and 33.7% achieved ≤0.01% on the International Scale. MMR was maintained in 48/53 patients who achieved it and 19/20 who were in MMR at screening, supporting the long-term safety and efficacy of asciminib in this population.
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Affiliation(s)
| | - Timothy P Hughes
- South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia
| | - Dong-Wook Kim
- Uijeongbu Eulji Medical Center, Geumo-dong, Uijeongbu-si, South Korea
| | - Delphine Rea
- Adult Hematology and INSERM CIC1427, Hôpital Saint-Louis, Paris, France
| | | | | | - Koji Sasaki
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Massimo Breccia
- Department of Translational and Precision Medicine-Az., Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Moshe Talpaz
- Division of Hematology-Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | | | | | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Bukit Merah, Singapore
| | | | - Michael C Heinrich
- Department of Medicine, Division of Hematology and Oncology, Portland VA Health Care System and Oregon Health & Science University, Knight Cancer Institute, Portland, OR, USA
| | | | | | | | | | | | | | - Mark B Geyer
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Fabian Lang
- Department for Hematology/Oncology, Goethe University Hospital, Frankfurt am Main, Germany
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13
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Dulucq S, Rigal-Huguet F, Nicolini FE, Cony-Makhoul P, Escoffre-Barbe M, Gardembas M, Legros L, Rousselot P, Liu J, Rea D, De Mas V, Hayette S, Raynaud S, Lacoste-Roussillon C, Robbesyn F, Klein E, Morisset S, Mahon FX, Etienne G. Efficacy and safety of nilotinib in chronic myeloid leukaemia patients who failed to achieve a treatment-free remission period after imatinib discontinuation: Results of the French Nilo post-STIM study. Br J Haematol 2023. [PMID: 37004981 DOI: 10.1111/bjh.18796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
Molecular recurrence (MRec) occurs in about half of all patients with chronic myeloid leukaemia (CML) who discontinue tyrosine kinase inhibitors (TKI) in sustained deep molecular response. A second TKI discontinuation has been attempted in some patients who regain the discontinuation criteria after resuming treatment. Nilotinib treatment affords faster and deeper molecular responses than imatinib as first-line therapy. We prospectively evaluated the efficacy and safety of nilotinib (300 mg twice daily) in chronic-phase CML patients who experienced MRec, after imatinib discontinuation and analysed the probability of TFR after a new attempt in patients treated for 2 years with sustained MR4.5 for at least 1 year. A total of 31 patients were included in the study between 2013 and 2018. Seven (23%) patients experienced serious adverse events after a median of 2 months of nilotinib treatment leading to discontinuation of treatment. One patient was excluded from the study for convenience. Among the 23 patients treated for 2 years with nilotinib, 22 maintained their molecular response for at least 1 year (median: 22 months) and stopped nilotinib. The TFR rates at 24 and 48 months after nilotinib discontinuation were 59.1% (95% confidence interval [CI]: 41.7%-83.7%) and 42.1% (95% CI: 25%-71%) respectively (NCT #01774630).
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Françoise Rigal-Huguet
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse, France
| | - Franck E Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- INSERM U590, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Léon Bérard, Lyon, France
| | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
| | - Martine Escoffre-Barbe
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, CHU de Pontchaillou, Rennes, France
| | - Martine Gardembas
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, CHU, Angers, France
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Rousselot
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Jixing Liu
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology & Oncology Department, Centre Hospitalier de Valence, Valence, France
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Adult Hematology Department, Hôpital Saint Louis, Paris, France
| | - Véronique De Mas
- Laboratory of Hematology, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse, France
| | - Sandrine Hayette
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Laboratory of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Sophie Raynaud
- Laboratory of Hematology, University Hospital of Nice, Nice, France
| | - Caroline Lacoste-Roussillon
- Clinical Research and Innovation Department, Safety and Vigilance Unit, Bordeaux University Hospital, Bordeaux, France
| | - Fanny Robbesyn
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
| | - Emilie Klein
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Stéphane Morisset
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- INSERM U590, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
| | - François-Xavier Mahon
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Bergonié, Bordeaux, France
- Hematology Department, CHU Bordeaux, Pessac, France
| | - Gabriel Etienne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Bergonié, Bordeaux, France
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14
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Roy L, Chomel JC, Guilhot J, Guerci-Bresler A, Escoffre-Barbe M, Giraudier S, Charbonnier A, Dubruille V, Huguet F, Johnson-Ansah H, Lenain P, Ame S, Etienne G, Nicolini FE, Rea D, Cony-Makhoul P, Courby S, Ianotto JC, Legros L, Machet A, Coiteux V, Hermet E, Cayssials E, Bouchet S, Mahon FX, Rousselot P, Guilhot F. Dasatinib plus Peg-Interferon alpha 2b combination in newly diagnosed chronic phase chronic myeloid leukaemia: Results of a multicenter phase 2 study (DASA-PegIFN study). Br J Haematol 2023; 200:175-186. [PMID: 36214090 DOI: 10.1111/bjh.18486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 01/14/2023]
Abstract
Superior rates of deep molecular response (DMR) have been reported with the combination of tyrosine kinase inhibitors and pegylated-interferon-alpha (Peg-IFN) in patients with newly diagnosed chronic phase-chronic myeloid leukaemia (CP-CML). In this setting, this study investigated the efficacy and safety of dasatinib combined to Peg-IFN-α2b (Dasa-PegIFN, NCT01872442). A total of 79 patients (age ≤65 years) started dasatinib; 61 were eligible for Peg-IFNα-2b add-on therapy at month 3 for a maximum 21-months duration. Dasatinib was continued thereafter. The primary endpoint was the cumulative rate of molecular response 4.5 log (MR4.5 ) by 12 months. The results are reported for the 5-year duration of the study. Grade 3 neutropenia was frequent with the combination but did not induce severe infection (one of grade 3). Other adverse events were generally low grade (4% of grade 3-4) and expected. Seventy-nine per cent and 61% of patients continued the Peg-IFN until months 12 and 24, respectively. Overall, at these time points, MR4.5 rates were 25% and 38%, respectively. Thereafter, 32% and 46% of patients achieved a sustained (≥2 years) MR4.5 or MR4 , respectively. This work established the feasibility and high rates of achievement of early and sustained DMR (a prerequisite for treatment-free-remission) with dasatinib and Peg-IFNα-2b combination as initial therapy.
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Affiliation(s)
- Lydia Roy
- Hôpital Universitaire Henri Mondor, APHP, Faculté de Santé, UPEC, Service d'Hématologie Clinique, Créteil, France
| | | | | | | | | | - Stéphane Giraudier
- Hôpital Saint-Louis, APHP et INSERM Université de Paris, Service de biologie cellulaire, Paris, France
| | - Aude Charbonnier
- Institut Paoli-Calmettes, Service d'Hématologie Clinique, Marseille, France
| | | | - Françoise Huguet
- Service d'Hématologie Clinique, CHU Toulouse, I.U.C.T.O, Toulouse, France
| | | | - Pascal Lenain
- Centre Henri Becquerel, Service d'Hématologie Clinique, Rouen, France
| | - Shanti Ame
- CHU Strasbourg, Service d'Hématologie Clinique, Strasbourg, France
| | - Gabriel Etienne
- Institut Bergonié, Service d'Hématologie Clinique, Bordeaux, France
| | - Franck E Nicolini
- Centre Léon Bérard, Service d'Hématologie Clinique & INSERM U1052 CRC, Lyon, France
| | - Delphine Rea
- Hôpital St Louis, APHP, Service d'Hématologie Clinique, Paris, France
| | | | - Stéphane Courby
- CHU Grenoble Service d'Hématologie Clinique, Grenoble, France
| | | | - Laurence Legros
- Hôpital Paul Brousse, AP-HP, Service d'Hématologie Clinique, INSERM UMRS-MD1197, Villejuif, France
| | - Antoine Machet
- Hôpital Bretonneau, CHRU Tours Service d'Hématologie Clinique, Tours, France
| | - Valérie Coiteux
- Hôpital Claude Huriez, CHRU Lille Service d'Hématologie Clinique, Lille, France
| | - Eric Hermet
- CHU d'Estaing, Clermont-Ferrand, Service d'Hématologie Clinique, Clermont-Ferrand, France
| | - Emilie Cayssials
- INSERM CIC 1402, CHU Poitiers, Poitiers, France.,CHU de Poitiers, Service d'Hématologie Clinique, Poitiers, France
| | - Stéphane Bouchet
- Hôpital Pellegrin, CHU Bordeaux, Laboratoire de pharmacologie, Bordeaux, France
| | | | - Philippe Rousselot
- Centre Hospitalier de Versailles, Université Paris Saclay UMR 1184, Service d'Hématologie Clinique, Le Chesnay, France
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- French CML group (Fi-LMC), Centre Léon Bérard, Lyon, France
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15
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Kantarjian HM, Jabbour E, Deininger M, Abruzzese E, Apperley J, Cortes J, Chuah C, DeAngelo DJ, DiPersio J, Hochhaus A, Lipton J, Nicolini FE, Pinilla‐Ibarz J, Rea D, Rosti G, Rousselot P, Shah NP, Talpaz M, Srivastava S, Ren X, Mauro M. Ponatinib after failure of second-generation tyrosine kinase inhibitor in resistant chronic-phase chronic myeloid leukemia. Am J Hematol 2022; 97:1419-1426. [PMID: 36054756 PMCID: PMC9804741 DOI: 10.1002/ajh.26686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 01/28/2023]
Abstract
Ponatinib, the only third-generation pan-BCR::ABL1 inhibitor with activity against all known BCR::ABL1 mutations including T315I, has demonstrated deep and durable responses in patients with chronic-phase chronic myeloid leukemia (CP-CML) resistant to prior second-generation (2G) TKI treatment. We present efficacy and safety outcomes from the Ponatinib Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) and CML Evaluation (PACE) and Optimizing Ponatinib Treatment in CP-CML (OPTIC) trials for this patient population. PACE (NCT01207440) evaluated ponatinib 45 mg/day in CML patients with resistance to prior TKI or T315I. In OPTIC (NCT02467270), patients with CP-CML and resistance to ≥2 prior TKIs or T315I receiving 45 or 30 mg/day reduced their doses to 15 mg/day upon achieving ≤1% BCR::ABL1IS or received 15 mg/day continuously. Efficacy and safety outcomes from patients with CP-CML treated with ≥1 2G TKI (PACE, n = 257) and OPTIC (n = 93), 45-mg starting dose cohort, were analyzed for BCR::ABL1IS response rates, overall survival (OS), progression-free survival (PFS), and safety. By 24 months, the percentages of patients with ≤1% BCR::ABL1IS response, PFS, and OS were 46%, 68%, and 85%, respectively, in PACE and 57%, 80%, and 91%, respectively, in OPTIC. Serious treatment-emergent adverse events and serious treatment-emergent arterial occlusive event rates were 63% and 18% in PACE and 34% and 4% in OPTIC. Ponatinib shows high response rates and robust survival outcomes in patients whose disease failed prior to 2G TKIs, including patients with T315I mutation. The response-based dosing in OPTIC led to improved safety and similar efficacy outcomes compared with PACE.
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MESH Headings
- Clinical Trials as Topic
- Drug Resistance, Neoplasm/genetics
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imidazoles/adverse effects
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/genetics
- Protein Kinase Inhibitors/adverse effects
- Pyridazines/adverse effects
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Affiliation(s)
- Hagop M. Kantarjian
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Elias Jabbour
- Department of LeukemiaThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Michael Deininger
- Division of Hematology and Oncology, Department of MedicineUniversity of Utah Huntsman Cancer InstituteSalt Lake CityUtahUSA
| | | | - Jane Apperley
- Centre for HaematologyImperial College LondonLondonUK
| | | | - Charles Chuah
- Department of HaematologySingapore General Hospital, Duke‐NUS Medical SchoolSingaporeSingapore
| | - Daniel J. DeAngelo
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - John DiPersio
- Division of OncologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Andreas Hochhaus
- Department of Hematology/OncologyUniversitätsklinikum JenaJenaGermany
| | | | - Franck E. Nicolini
- Centre Leon Berard, Department d'Hématologie & INSERM U1052Equipe BMP, Niche Tumorale et Resistance, CRCLLyonFrance
| | | | - Delphine Rea
- Department of HematologyHopital Saint‐LouisParisFrance
| | | | - Philippe Rousselot
- Hospital Mignot University de Versailles Saint‐Quentin‐en‐YvelinesParisFrance
| | - Neil P. Shah
- Department of Medicine (Hematology/Oncology)University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Moshe Talpaz
- Comprehensive Cancer CenterUniversity of MichiganAnn ArborMichiganUSA
| | | | - Xiaowei Ren
- Takeda Development Center Americas, Inc.LexingtonMassachusettsUSA
| | - Michael Mauro
- Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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16
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Rea D. EXABS-157-CML Immunotherapy: The Way Forward to Maximize TFR. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S64. [PMID: 36164234 DOI: 10.1016/s2152-2650(22)00664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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17
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Bartlett J, Xu K, Wong J, Pond G, Zhang Y, Spears M, Salunga R, Mallon E, Taylor K, Hasenburg A, Markopoulos C, Dirix L, Seynaeve C, van de Velde C, Rea D, Schnabel C, Treuner K, Bayani J. 138MO Prognostic performance of Breast Cancer Index (BCI) in postmenopausal women with early-stage HR+ breast cancer in the TEAM trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Dulucq S, Hayette S, Cayuela JM, Bauduer F, Chabane K, Chevallier P, Cony-Makhoul P, Flandrin-Gresta P, Le Jeune C, Le Bris Y, Legros L, Maisonneuve H, Roy L, Mahon FX, Sloma I, Rea D, Nicolini FE. Onset of blast crisis in chronic myeloid leukemia patients in treatment-free remission. Haematologica 2022; 107:2944-2949. [PMID: 35924576 PMCID: PMC9713569 DOI: 10.3324/haematol.2022.280740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Stephanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Pessac,Groupe Fi-LMC, Centre Léon Bérard, Lyon,Groupe GBMHM, Hôpital Saint Louis, Paris
| | - Sandrine Hayette
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Groupe GBMHM, Hôpital Saint Louis, Paris,Laboratory of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite
| | - Jean-Michel Cayuela
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Groupe GBMHM, Hôpital Saint Louis, Paris,Laboratory of Hematology, Hôpital Saint Louis, Paris
| | - Frédéric Bauduer
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Department of Hematology, Côte Basque Hospital, Bayonne
| | - Kaddour Chabane
- Laboratory of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite
| | | | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Department of Hematology, Annecy-Genevois Hospital, Pringy
| | - Pascale Flandrin-Gresta
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Groupe GBMHM, Hôpital Saint Louis, Paris,Laboratory of Hematology, University Hospital of Saint-Etienne, Saint Etienne
| | - Caroline Le Jeune
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Department of Hematology, Institut de Cancérologie Lucien Neuwirth, Saint Etienne
| | - Yannick Le Bris
- Groupe GBMHM, Hôpital Saint Louis, Paris,Laboratory of Hematology, Hôtel Dieu, Nantes
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Department of Hematology, Hôpital Paul Brousse, Villejuif
| | - Hervé Maisonneuve
- Department of Hematology aqnd Oncology, La Roche sur Yon Hospital, La Roche sur Yon
| | - Lydia Roy
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Department of Hematology, Hôpital Henri Mondor, Créteil
| | - Francois-Xavier Mahon
- Groupe GBMHM, Hôpital Saint Louis, Paris,Cancer Center of Bordeaux, lnstitut Bergonié, Bordeaux
| | - Ivan Sloma
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Groupe GBMHM, Hôpital Saint Louis, Paris,Laboratory of Hematology, Hôpital Henri Mondor, Créteil
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Department of Hematology, Hôpital Saint Louis, Paris and
| | - Franck Emmanuel Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Department of Hematology and CRCL, INSERM U1052, Centre Léon Bérard, Lyon, France,F.E. NICOLINI -
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19
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Rea D, Mauro MJ, Hochhaus A, Boquimpani C, Lomaia E, Voloshin S, Turkina AG, Kim DW, Apperley J, Cortes JE, Sasaki K, Kapoor S, Allepuz A, Quenet S, Bédoucha V, Minami Y. Efficacy and safety results from ASCEMBL, a phase 3 study of asciminib versus bosutinib (BOS) in patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP) after ≥2 prior tyrosine kinase inhibitors (TKIs): Week 96 update. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7004 Background: Asciminib is the first BCR::ABL1 inhibitor to specifically target the ABL Myristoyl Pocket (STAMP). In the ASCEMBL primary analysis, asciminib had superior efficacy and better safety/tolerability than BOS in pts with CML-CP after ≥2 prior TKIs. After a median follow-up of 2.3 years (16.5 months’ additional follow-up since primary analysis), we report efficacy and safety results (cutoff: October 6, 2021). Methods: Eligible pts were adults with CML-CP after ≥2 prior TKIs, with intolerance or lack of efficacy per 2013 European LeukemiaNet. Pts were randomized 2:1 to asciminib 40 mg twice daily or BOS 500 mg once daily, stratified by major cytogenetic response (MCyR) status (Ph+ metaphases ≤35%) at baseline. The key secondary endpoint was major molecular response (MMR) rate at wk 96. Results: 233 pts were randomized to asciminib (n=157) or BOS (n=76). At cutoff, treatment was ongoing in 84 (53.5%) and 15 (19.7%) pts, respectively; the most common reason for discontinuation was lack of efficacy in 38 (24.2%) and 27 (35.5%) pts, respectively. MMR rate at wk 96 (per ITT) was higher on asciminib (37.6%) than BOS (15.8%). The difference, adjusting for baseline MCyR, was 21.7% (95% CI, 10.5%-33.0%; 2-sided P=.001). More pts on asciminib than BOS, respectively, had BCR::ABL1IS ≤1% (45.1% vs 19.4%) at wk 96. The probability of maintaining MMR and BCR::ABL1IS ≤1% for ≥72 wk was 96.7% (95% CI, 87.4%-99.2%) and 94.6% (95% CI, 86.2%-97.9%), respectively, on asciminib and 92.9% (95% CI, 59.1%-99.0%) and 95.0% (95% CI, 69.5%-99.3%), respectively, on BOS. Median duration of exposure was 103.1 (range, 0.1-201.1) wk on asciminib and 30.5 (range, 1.0-188.3) wk on BOS. Despite the longer duration of asciminib exposure, safety/tolerability of asciminib continued to be better than that of BOS (Table). No new on-treatment deaths were reported since the primary analysis. Most frequent (>10%) grade ≥3 adverse events (AEs) on asciminib vs BOS were thrombocytopenia (22.4%, 9.2%), neutropenia (18.6%, 14.5%), diarrhea (0%, 10.5%), and increased alanine aminotransferase (0.6%, 14.5%). Conclusions: After >2 years of follow-up, asciminib continued to show superior efficacy and better safety/tolerability vs BOS. Responses were durable, with more pts on asciminib in MMR. Additionally, more pts on asciminib had BCR::ABL1IS ≤1%, a milestone response in later lines associated with improved survival. These results continue to support the use of asciminib as a new CML therapy, with the potential to transform standard of care. Clinical trial information: NCT03106779. [Table: see text]
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Affiliation(s)
| | | | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Carla Boquimpani
- HEMORIO, State Institute of Hematology Arthur de Siquiera Cavalcanti, Rio De Janeiro, Brazil
| | - Elza Lomaia
- Almazov National Medical Research Centre of Ministry of Health of Russian Federation, Saint Petersburg, Russian Federation
| | - Sergey Voloshin
- Russian Research Institute of Hematology and Transfusiology, St. Petersburg, Russian Federation
| | - Anna G. Turkina
- National Research Center for Hematology, Moscow, Russian Federation
| | - Dong-Wook Kim
- Uijeongbu Eulji Medical Center, Uijeongbu-Si, South Korea
| | - Jane Apperley
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Jorge E. Cortes
- Georgia Cancer Center, Medical College of Georgia at Augusta University, Augusta, GA
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Yosuke Minami
- Department of Transfusion Medicine and Cell Therapy, Kobe University Hospital, Kobe, Japan
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20
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Dulucq S, Nicolini FE, Rea D, Cony-Makhoul P, Charbonnier A, Escoffre-Barbe M, Coiteux V, Lenain P, Rigal-Huguet F, Liu J, Guerci-Bresler A, Legros L, Ianotto JC, Gardembas M, Turlure P, Dubruille V, Rousselot P, Martiniuc J, Jardel H, Johnson-Ansah H, Joly B, Henni T, Cayssials E, Zunic P, Berger MG, Villemagne B, Robbesyn F, Morisset S, Mahon FX, Etienne G. Kinetics of early and late molecular recurrences after first-line imatinib cessation in chronic myeloid leukemia: updated results from the STIM2 trial. Haematologica 2022; 107:2859-2869. [PMID: 35615931 PMCID: PMC9713567 DOI: 10.3324/haematol.2022.280811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Discontinuation of tyrosine kinase inhibitors in chronic phase chronic myeloid leukemia is feasible in clinical practice based on recently published international recommendations. Nevertheless, factors predictive of molecular recurrence have not been fully elucidated and long-term follow-up of patients enrolled in clinical studies are required in order to update knowledge on discontinuation attempts particularly in terms of the safety and durability of treatment-free remission (TFR). In the current study, we updated results from the STIM2 study in the light of the consensual criterion of molecular recurrence reported in different international recommendations. Among the 199 patients included in the perprotocol study, 108 patients lost a major molecular response. With a median follow-up of 40.8 months (5.5-111 months), the probability of treatment-free remission was 43.4% [36.3-50.4] at 5 years, 40.9% [32.8-47.3] at 7 years and 34.5% [25.6- 43.3] at 9 years. Molecular recurrence occurred between 0 to 6 months, 6 to 24 months and after 24 months in 75 patients (69%), 15 patients (14%) and 18 patients (17%), respectively. Notably, the kinetics of molecular recurrence differed significantly between these three subgroups with a median time from loss of MR4 (BCR::ABL1 IS≤0.01%) to loss of major molecular response of 1, 7 and 22 months, respectively. Predictive factors of molecular recurrence differed according to the time of occurrence of the molecular recurrence. Durations of imatinib treatment and deep molecular response as well as BCR::ABL1/ABL1 levels at cessation of tyrosine kinase inhibitor treatment, as quantified by reverse transcriptase droplet digital polymerase chain reaction, are involved in molecular recurrence occurring up to 24 months but not beyond. (ClinicalTrial. gov Identifier NCT#0134373).
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac,Groupe Fi-LMC, Centre Léon Bérard, Lyon,S. Dulucq
| | - Franck E. Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon,Hematology Department, Centre Léon Bérard, Lyon
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Adult Hematology Department, Hôpital Saint Louis, Paris
| | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department & Clinical Investigation Center, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy
| | - Aude Charbonnier
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Paoli-Calmettes, Marseilles
| | - Martine Escoffre-Barbe
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU de Pontchaillou, Rennes
| | - Valérie Coiteux
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU Huriez, Lille
| | - Pascal Lenain
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Henri Becquerel, Rouen
| | - Françoise Rigal-Huguet
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse
| | - Jixing Liu
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology & Oncology Department, Centre Hospitalier de Valence, Valence
| | - Agnès Guerci-Bresler
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHRU Brabois, Nancy
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | | | - Martine Gardembas
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU, Angers
| | - Pascal Turlure
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU Dupuytren, Limoges
| | - Viviane Dubruille
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Hôtel Dieu, Nantes
| | - Philippe Rousselot
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Versailles, Le Chesnay
| | - Juliana Martiniuc
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc
| | - Henry Jardel
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Bretagne, Vannes
| | - Hyacinthe Johnson-Ansah
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Institute of Normandy, CHU de la Côte de Nacre, Caën
| | - Bertrand Joly
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CH Sud Francilien, Corbeil-Essonne
| | - Tawfiq Henni
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHR La Réunion
| | - Emilie Cayssials
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU de Poitiers, Poitiers
| | - Patricia Zunic
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier, Saint Pierre de La Réunion
| | - Marc G. Berger
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology (Biology) Department, CHU Estaing, Clermont-Ferrand
| | - Bruno Villemagne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Internal Medicine and Onco-hematology Department, La Roche sur Yon and
| | - Fanny Robbesyn
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac
| | - Stephane Morisset
- INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon
| | - François-Xavier Mahon
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Bergonié, Bordeaux, France,F-XM and GE contributed equally as co-senior authors
| | - Gabriel Etienne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Bergonié, Bordeaux, France,F-XM and GE contributed equally as co-senior authors
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21
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Buske C, Dreyling M, Alvarez-Larrán A, Apperley J, Arcaini L, Besson C, Bullinger L, Corradini P, Giovanni Della Porta M, Dimopoulos M, D'Sa S, Eich HT, Foà R, Ghia P, da Silva MG, Gribben J, Hajek R, Harrison C, Heuser M, Kiesewetter B, Kiladjian JJ, Kröger N, Moreau P, Passweg JR, Peyvandi F, Rea D, Ribera JM, Robak T, San-Miguel JF, Santini V, Sanz G, Sonneveld P, von Lilienfeld-Toal M, Wendtner C, Pentheroudakis G, Passamonti F. Managing hematological cancer patients during the COVID-19 pandemic: an ESMO-EHA Interdisciplinary Expert Consensus. ESMO Open 2022; 7:100403. [PMID: 35272130 PMCID: PMC8795783 DOI: 10.1016/j.esmoop.2022.100403] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created enormous challenges for the clinical management of patients with hematological malignancies (HMs), raising questions about the optimal care of this patient group. METHODS This consensus manuscript aims at discussing clinical evidence and providing expert advice on statements related to the management of HMs in the COVID-19 pandemic. For this purpose, an international consortium was established including a steering committee, which prepared six working packages addressing significant clinical questions from the COVID-19 diagnosis, treatment, and mitigation strategies to specific HMs management in the pandemic. During a virtual consensus meeting, including global experts and lead by the European Society for Medical Oncology and the European Hematology Association, statements were discussed and voted upon. When a consensus could not be reached, the panel revised statements to develop consensual clinical guidance. RESULTS AND CONCLUSION The expert panel agreed on 33 statements, reflecting a consensus, which will guide clinical decision making for patients with hematological neoplasms during the COVID-19 pandemic.
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Affiliation(s)
- C Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.
| | - M Dreyling
- Department of Medicine III at LMU Hospital, Munich, Germany
| | - A Alvarez-Larrán
- Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - J Apperley
- Centre for Haematology, Imperial College London, Hammersmith Hospital, London, UK
| | - L Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - C Besson
- Service d'Hématologie Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France; UVSQ, Inserm, CESP, Villejuif, France
| | - L Bullinger
- Department of Hematology, Oncology, and Tumorimmunology, Campus Virchow Klinikum, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - P Corradini
- Hematology Division, University of Milan, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - M Giovanni Della Porta
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - M Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - S D'Sa
- UCLH Centre for Waldenström and Neurohaematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Münster, Germany
| | - R Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - P Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia and Laboratory of B Cell Neoplasia, Division of Molecular Oncology, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - M G da Silva
- Department Of Hematology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - J Gribben
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - R Hajek
- Department of Hematooncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - C Harrison
- Clinical Director - Haematology, Haemostasis, Palliative Care, Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hanover, Germany
| | - B Kiesewetter
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - J J Kiladjian
- Université de Paris, APHP, Hôpital Saint-Louis, Centre d'Investigations Cliniques, Paris, France
| | - N Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - P Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - J R Passweg
- Hematology Division, Basel University Hospital, Basel, Switzerland
| | - F Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - D Rea
- University Medical Department of Hematology and Immunology, France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, Paris, France
| | - J-M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - T Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - J F San-Miguel
- Clínica Universidad de Navarra (CUN), Centro de Investigación Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), CIBERONC, Pamplona, Spain
| | - V Santini
- MDS Unit, Hematology, DMSC, AOUC, University of Florence, Florence, Italy
| | - G Sanz
- Hematology Department, Hospital Univesitario y Politecnico La Fe, Valencia; CIBERONC, IS Carlos III, Madrid, Spain
| | - P Sonneveld
- Erasmus MC Cancer Institute, Department of Haematology, Rotterdam, The Netherlands
| | - M von Lilienfeld-Toal
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - C Wendtner
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilian University, Munich, Germany
| | - G Pentheroudakis
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| | - F Passamonti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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22
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Quagliariello V, Buccolo S, Iovine M, Maurea C, Rea D, Barbieri A, Maurea N. Sacubitril-valsartan improves radial and longitudinal strain and ejection fraction in C57Bl/6 mice treated with doxorubicin through NLRP3 mediated pathways and reduction of cytokine storm. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Ricerca Corrente grant, Ministero della Salute (it)
Background
Doxorubicin-mediated adverse cardiovascular events are among the leading causes of morbidity and mortality in breast cancer patients. Sacubitril-valsartan (LCZ 696) is a combination drug, made up of neprilysin inhibitor sacubitril and angiotensin II receptor blocker valsartan, used for the treatment of heart failure in patients with a reduced ejection fraction.
Hypothesis
we hypothesized that LCZ 696, administered during doxorubicin, could improve cardiac functions in preclinical models
Methods
C57Bl/6 mice were untreated (Sham, n = 6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n = 6), LCZ-696 at 60 mg/kg (LCZ, n = 6) or doxorubicin combined to LCZ-696 (DOXO-LCZ, n = 6). Before and after treatments, ejection fraction (EF) and radial and longitudinal strain were analyzed through transthoracic echocardiography (Vevo 2100). After treatment, mice were sacrificed and cardiac tissues were treated for determination of NLRP3 inflammasome, Myd88, NF-kB and cytokines involved in heart failure and arrhythmias (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL17-α, IL-18, IFN-γ, TNF-α, G-CSF, and GM-CSF).
Results
LCZ 696 improved significantly the EF and prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin. No significant differences were observed for IVS;d-D, LVID;d-D, LVPW;d-D, LV Mass, LV Vol; d, LV Vol;s between the experimental groups. A reduced expression of NLRP3, MyD88 and NF-kB in cardiac tissues was seen in DOXO-LCZ group compared to DOXO mice (p < 0.001). Cardiac expression of IL-1β, IL-6, TNF-α, G-CSF and GM-CSF were significantly reduced (p < 0.001) after treatment with LCZ-696 indicating anti-inflammatory and cardioprotective properties.
Conclusion
LCZ-696 improves cardiac functions in mice treated with doxorubicin. Biochemically, these effects are mediated by the downregulation of NLRP3 inflammasome-related pathways and cytokines involved in doxorubicin-mediated heart failure and cardiomyopathies.
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Affiliation(s)
- V Quagliariello
- National Cancer Institute G.Pascale Foundation IRCCS, Naples, Italy
| | - S Buccolo
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - M Iovine
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - C Maurea
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - D Rea
- National Cancer Institute G.Pascale Foundation IRCCS, Naples, Italy
| | - A Barbieri
- National Cancer Institute G.Pascale Foundation IRCCS, Naples, Italy
| | - N Maurea
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
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Quagliariello V, Passariello M, Rea D, Barbieri A, Buccolo S, Iovine M, Bonelli A, Caronna A, Botti G, De Lorenzo C, Maurea N. Ipilimumab and Nivolumab exertes cardiotoxic and pro-fibrotic effects in mice through the overexpression of NLRP3 inflammasome, chemokines and leukotrienes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Several strategies based on immune checkpoint inhibitors (ICIs) have been developed for cancer therapy, opening to advantages in cancer outcomes. However, several ICIs-induced side effects emerged in these patients, especially a rare but clinically significant cardiotoxicity with high rate of mortality.
Purpose
We studied cytotoxic and pro-inflammatory properties of Ipilimumab and Nivolumab in cellular and preclinical models
Methods
Co-cultures of human cardiomyocytes and hPBMCs were exposed to Ipilimumab or Nivolumab at 100 nM; cell viability and expression of leukotrienes, NLRP3 inflammasome, MyD88 (myddosome) and p65/NF-kB were performed. C57 mice were untreated (Sham; n=6) or treated with Ipilimumab (IPI, n=6) (15 mg/kg); analysis of fractional shortening, ejection fraction, radial and longitudinal strain were made before and after treatments through 2D-echocardiography (Vevo 2100). Expression of NLRP3, MyD88, p65/NF-kB, leukotrienes and 12 cytokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL17-α, IFN-γ, TNF-α, G-CSF, and GM-CSF) have been analyzed in murine myocardium.
Results
Nivolumab and Ipilimumab induced cell death and apoptosis in cardiomyocutes. Both ICIs increased NLRP3, MyD88 and p65/NF-kB expression compared to untreated cells, however the most pro-inflammatory and cardiotoxic effects were seen after exposure to Ipilimumab. Mice treated with Ipilimumab showed a significant decrease of fractional shortening and radial strain compared to untreated mice. Metabolic studies clearly indicates that ipilimumab increases leukotrienes production and NLRP3 expression in heart tissues, probably due to increased iROS content (iROS are key inductors of leukotrienes expression). High expression of IL-6, IL-1 and IL-17 were also seein in mice treated with ipilimumab (p<0,001).
Conclusions
Nivolumab and Ipilimumab exert cytotoxic effects mediated by NLRP3 inflammasome, leukotrienes and pro-inflammatory cytokines in heart tissues.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministero della Salute, Ricerca Corrente Project
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Affiliation(s)
- V Quagliariello
- National Cancer Institute G.Pascale Foundation IRCCS, Naples, Italy
| | | | - D Rea
- National Cancer Institute G.Pascale Foundation IRCCS, Naples, Italy
| | - A Barbieri
- National Cancer Institute G.Pascale Foundation IRCCS, Naples, Italy
| | - S Buccolo
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - M Iovine
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - A Bonelli
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - A Caronna
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - G Botti
- National Cancer Institute G.Pascale Foundation IRCCS, Scientific Direction, Naples, Italy
| | | | - N Maurea
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
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24
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Quagliariello V, Bonelli A, Paccone A, Buccolo S, Iovine M, Rea D, Cerrone F, Botti G, Maurea N. The combination of a neprilysin inhibitor (sacubitril) and angiotensin-II receptor blocker (valsartan) improves ejection fraction and longitudinal strain in mice treated with doxorubicin through NLRP3. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Doxorubicin-mediated- adverse cardiovascular events are among the leading causes of morbidity and mortality in breast cancer patients. Sacubitril-valsartan (LCZ 696) is a combination drug, made up of neprilysin inhibitor sacubitril and angiotensin II receptor blocker valsartan, used for the treatment of heart failure in patients with a reduced ejection fraction.
Purpose
Here, we aim to assess whether LCZ 696, administered during doxorubicin, reduces in vitro anticancer drugs-related cardiotoxicity compared to Valsartan (V), used as a control drug.
Methods
Human fetal cardiomyocytes (HFC cell line) were exposed to subclinical concentration of doxorubicin (at 200 nM) alone or in combination with LCZ-696 (100 mM) for 72 h. After the incubation period, we performed the following tests: determination of cell viability, through analysis of mitochondrial dehydrogenase activity, study of lipid peroxidation (quantifying cellular Malondialdehyde and 4-hydroxynonenal), intracellular Ca2+ homeostasis. Moreover, pro-inflammatory studied were also performed (activation of NLRP3 inflammasome; expression of TLR4/MyD88; mTORC1 Fox01/3a; transcriptional activation of p65/NF-κB and secretion of cytokines involved in cardiotoxicity (Interleukins 1β, 8, 6). C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin (DOXO, n=6), LCZ-696 (LCZ, n=6) or doxorubicin combined to LCZ-696 (DOXO-LCZ, n=6). DOXO was injected intraperitoneally. Ejection fraction, radial and longitudinal strain were analyzed through transthoracic echocardiography (Vevo 2100). Cardiac tissue expression of NLRP3 inflammasome, Myd8, NF-kB and chemokines and cytokines were quantified after treatments through ELISA method.
Results
LCZ 696 co-incubated with doxorubicin exerts cardioprotective effects, enhancing cell viability of 48–54.6% compared to only doxorubicin-treated cells (p<0,001 for all); LCZ 696 reduced significantly the cardiotoxicity through MyD88/NF-KB/cytokines axis and mTORC1 Fox01/3α mediated mechanisms. In preclinical study, LCZ 696 improved significantly the EF and prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin. A reduced expression of pro-inflammatory cytokines, NLRP3, MyD88 and NF-kB in heart tissues was also seen in DOXO-LCZ group compared to DOXO mice (p<0.001)
Conclusion
We demonstrated, for the first time, that the LCZ696 exerts direct effects in cardiomyocytes and preclinical models during doxorubicin exposure, turning on a new light on its possible use in cancer patients to reduce cardiovascular side effects.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministero della Salute, Ricerca Corrente project
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Affiliation(s)
- V Quagliariello
- National Cancer Institute G.Pascale Foundation IRCCS, Naples, Italy
| | - A Bonelli
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - A Paccone
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - S Buccolo
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - M Iovine
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - D Rea
- National Cancer Institute G.Pascale Foundation IRCCS, Naples, Italy
| | - F Cerrone
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
| | - G Botti
- National Cancer Institute G.Pascale Foundation IRCCS, Scientific Direction, Naples, Italy
| | - N Maurea
- National Cancer Institute G.Pascale Foundation IRCCS, Division of Cardiology, Naples, Italy
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25
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Guilhot F, Rigal-Huguet F, Guilhot J, Guerci-Bresler AP, Maloisel F, Rea D, Coiteux V, Gardembas M, Berthou C, Vekhoff A, Jourdan E, Berger M, Fouillard L, Alexis M, Legros L, Rousselot P, Delmer A, Lenain P, Escoffre Barbe M, Gyan E, Bulabois CE, Dubruille V, Joly B, Pollet B, Cony-Makhoul P, Johnson-Ansah H, Mercier M, Caillot D, Charbonnier A, Kiladjian JJ, Chapiro J, Penot A, Dorvaux V, Vaida I, Santagostino A, Roy L, Zerazhi H, Deconinck E, Maisonneuve H, Plantier I, Lebon D, Arkam Y, Cambier N, Ghomari K, Miclea JM, Glaisner S, Cayuela JM, Chomel JC, Muller M, Lhermitte L, Delord M, Preudhomme C, Etienne G, Mahon FX, Nicolini FE. Long-term outcome of imatinib 400 mg compared to imatinib 600 mg or imatinib 400 mg daily in combination with cytarabine or pegylated interferon alpha 2a for chronic myeloid leukaemia: results from the French SPIRIT phase III randomised trial. Leukemia 2021; 35:2332-2345. [PMID: 33483613 DOI: 10.1038/s41375-020-01117-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 11/20/2020] [Accepted: 12/15/2020] [Indexed: 01/29/2023]
Abstract
The STI571 prospective randomised trial (SPIRIT) French trial is a four-arm study comparing imatinib (IM) 400 mg versus IM 600 mg, IM 400 mg + cytarabine (AraC), and IM 400 mg + pegylated interferon alpha2a (PegIFN-α2a) for the front-line treatment of chronic-phase chronic myeloid leukaemia (CML). Long-term analyses included overall and progression-free survival, molecular responses to treatment, and severe adverse events. Starting in 2003, the trial included 787 evaluable patients. The median overall follow-up of the patients was 13.5 years (range 3 months to 16.7 years). Based on intention-to-treat analyses, at 15 years, overall and progression-free survival were similar across arms: 85%, 83%, 80%, and 82% and 84%, 87%, 79%, and 79% for the IM 400 mg (N = 223), IM 600 mg (N = 171), IM 400 mg + AraC (N = 172), and IM 400 mg + PegIFN-α2a (N = 221) arms, respectively. The rate of major molecular response at 12 months and deep molecular response (MR4) over time were significantly higher with the combination IM 400 mg + PegIFN-α2a than with IM 400 mg: p = 0.0001 and p = 0.0035, respectively. Progression to advanced phases and secondary malignancies were the most frequent causes of death. Toxicity was the main reason for stopping AraC or PegIFN-α2a treatment.
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Affiliation(s)
| | | | | | | | | | - Delphine Rea
- Department of Hematology, Hopital Saint-Louis, APHP, Paris, France
| | - Valérie Coiteux
- Clinical Hematology Department, Hospital Claude Huriez, CHRU, Lille, France
| | | | | | - Anne Vekhoff
- Clinical Hematology Department, Hospital St Antoine, APHP. Sorbonne Université, Paris, France
| | - Eric Jourdan
- Hématologie Clinique, Institut de Cancérologie du Gard, CHU de Nîmes, Nîmes, France
| | - Marc Berger
- Hematologie Biologique, CHU Estaing, Clermont Ferrand, France
| | | | - Magda Alexis
- Hématologie et Thérapie Cellulaire, Grand Hôpital de l'EST Francilien, Meaux, France
| | - Laurence Legros
- Department of Haematology, Hopital Paul Brousse, AP-HP, INSERM UMRS-MD1197, Villejuif, France
| | - Philippe Rousselot
- Hematology Department, Division of Innovative Therapies, Centre Hospitalier de Versailles, Versailles and Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Alain Delmer
- Clinical Hematology Department, CHU, Reims, France
| | - Pascal Lenain
- Clinical Hematology Department, Centre Henri Becquerel, Rouen, France
| | | | - Emmanuel Gyan
- Hematology and Cell Therapy Department, University of Tours, Tours, France
| | | | | | - Bertrand Joly
- Hématologie Clinique, CH Sud Francilien, Corbeil-Essonnes, France
| | - Bertrand Pollet
- Hématologie Clinique, CH Boulogne sur mer, Boulogne sur mer, France
| | | | | | - Melanie Mercier
- Service d'Dématologie Médecine Interne Maladies Infectieuses, Centre Hospitalier Bretagne Atlantique Vannes, Vannes, France
| | - Denis Caillot
- Hématologie Clinique, CHU Dijon Bourgogne, Dijon, France
| | - Aude Charbonnier
- Clinical Hematology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Jacques Chapiro
- Service Hématologie Clinique, Hopitaux Civiles de Colmar, Colmar, France
| | - Amélie Penot
- Service Hématologie et Thérapie Cellulaire, CHU Limoges, Limoges, France
| | | | - Iona Vaida
- Hématologie Clinique, Centre Hospitalier René-Dubois, Cergy-Pontoise, France
| | | | - Lydia Roy
- Clinical Hematology Department, Hop Henri Mondor, APHP, UPEC, Créteil, France
| | - Hacene Zerazhi
- Service Oncologie Médicale et Hématologie Clinique, Centre Hospitalier Henri Duffaut, Avignon, France
| | | | | | | | - Delphine Lebon
- Service d'Hématologie Clinique CHU Amiens-Picardie, Amiens-Picardie, France
| | - Yazid Arkam
- Service d'Hématologie GHR Mulhouse, Mulhouse, France
| | | | - Kamel Ghomari
- Service d'Hématologie-Oncologie CH Beauvais, Beauvais, France
| | | | | | | | | | - Marc Muller
- Laboratoire de Génétique, CHRU Nancy, Nancy, France
| | - Ludovic Lhermitte
- Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Marc Delord
- Clinical Research Department, Hôpital André Mignot, Versailles, France
| | | | - Gabriel Etienne
- Clinical Hematology Department, Institut Bergonié, Bordeaux, France
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Ewies A, Ahmed I, Al-Azzawi F, Pitkin J, Gupta P, Persic M, Sahu B, Elgobashy A, Barraclough L, Woodman J, Babrah J, Bowden S, Stocken D, Billingham L, Sundar S, Rea D. Folic acid supplementation in postmenopausal women with hot flushes: phase III randomised double-blind placebo-controlled trial. BJOG 2021; 128:2024-2033. [PMID: 33982872 DOI: 10.1111/1471-0528.16739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/30/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether folic acid supplementation ameliorates hot flushes. DESIGN Double-blind, placebo-controlled randomised trial. SETTING Nine hospitals in England. POPULATION Postmenopausal women experiencing ≥50 hot flushes weekly. METHODS Women (n = 164) were randomly assigned in a 1:1 ratio to receive folic acid 5 mg tablet or placebo daily for 12 weeks. Participants recorded frequency and severity of hot flushes in a Sloan Diary daily and completed Greene Climacteric and Utian Quality of Life (UQoL) Scales at 4-week intervals. MAIN OUTCOME MEASURES The change in daily Hot Flush Score at week 12 from randomisation based on Sloan Diary Composite Score B calculation. RESULTS Data of 143 (87%) women were available for the primary outcome. The mean change (SD) in Hot Flush Score at week 12 was -6.98 (10.30) and -4.57 (9.46) for folic acid and placebo group, respectively. The difference between groups in the mean change was -2.41 (95% CI -5.68 to 0.87) (P = 0.149) and in the adjusted mean change -2.61 (95% CI -5.72 to 0.49) (P = 0.098). Analysis of secondary outcomes indicated an increased benefit in the folic acid group regarding changes in total and emotional UQoL scores at week 8 when compared with placebo. The difference in the mean change from baseline was 5.22 (95% CI 1.16-9.28) and 1.88 (95% CI 0.23-3.52) for total and emotional score, respectively. CONCLUSIONS The study was not able to demonstrate that folic acid had a statistically significant greater benefit in reducing Hot Flush Score over 12 weeks in postmenopausal women when compared with placebo. TWEETABLE ABSTRACT Folic acid may ameliorate hot flushes in postmenopausal women but confirmation is required from a larger study.
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Affiliation(s)
- Aaa Ewies
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - I Ahmed
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - F Al-Azzawi
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Pitkin
- London Northwest University Healthcare NHS Trust, Harrow, UK.,Imperial College London, London, UK
| | - P Gupta
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Persic
- University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Sahu
- Princess Royal Hospital, Shrewsbury and Telford NHS Trust, Shrewsbury, UK
| | - A Elgobashy
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - J Woodman
- University Hospital Coventry and Warwickshire, Coventry, UK
| | - J Babrah
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - S Bowden
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - L Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - S Sundar
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - D Rea
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,University Hospitals of Birmingham, Birmingham, UK
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27
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Etienne G, Rea D, Coiteux V, Guerci-Bresler A, Huguet F, Legros L, Rousselot P, Nicolini FE. Ponatinib long-term follow-up of efficacy and safety in CP-CML patients in real world settings in France: The POST-PACE study. Leuk Res 2021; 104:106541. [PMID: 33689921 DOI: 10.1016/j.leukres.2021.106541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Gabriel Etienne
- Institut Bergonié, Bordeaux, France; Fi-LMC, Centre Léon Bérard, Lyon, France.
| | - Delphine Rea
- Hôpital Saint Louis, Paris, France; Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Valerie Coiteux
- CHU Lille, Hôpital Claude Huriez, Lille, France; Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Agnès Guerci-Bresler
- CHRU Brabois, Vandoeuvre-lès-Nancy, France; Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Françoise Huguet
- IUCT-Oncopôle, Toulouse, France; Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Laurence Legros
- Hôpital Paul-Brousse, Villejuif, France; Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Philippe Rousselot
- Département d'hématologie et oncologie, Centre Hospitalier de Versailles, Le Chesnay, France; Unité Mixte de Recherche (UMR) 1184, Institut de Biologie François Jacob, Commissariat à l'Energie Atomique (CEA), University of Versailles-Saint-Quentin-en-Yvelines and Paris-Saclay, France; Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Franck-Emmanuel Nicolini
- Département d'hématologie et and INSERM U1052, Centre Léon Bérard, CRCL, Lyon, France; Fi-LMC, Centre Léon Bérard, Lyon, France
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28
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Earl HM, Hiller L, Dunn J, Macpherson I, Rea D, Hughes-Davies L, McAdam K, Hall P, Mansi J, Wheatley D, Abraham JE, Caldas C, Gasson S, O'Riordan E, Wilcox M, Miles D, Cameron DA, Wardley A. Optimising the Duration of Adjuvant Trastuzumab in Early Breast Cancer in the UK. Clin Oncol (R Coll Radiol) 2021; 33:15-19. [PMID: 32723485 PMCID: PMC7382576 DOI: 10.1016/j.clon.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/04/2020] [Accepted: 07/06/2020] [Indexed: 12/26/2022]
Affiliation(s)
- H M Earl
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
| | - L Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - I Macpherson
- University of Glasgow, Institute of Cancer Sciences, Glasgow, UK
| | - D Rea
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - L Hughes-Davies
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K McAdam
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - P Hall
- Edinburgh University Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - J Mansi
- Department of Medical Oncology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust and King's College Medical School, London, UK
| | - D Wheatley
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - J E Abraham
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - C Caldas
- Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK; Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - S Gasson
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - E O'Riordan
- Independent Cancer Patients' Voice, London, UK
| | - M Wilcox
- Independent Cancer Patients' Voice, London, UK
| | - D Miles
- Mount Vernon Cancer Centre, Northwood, UK
| | - D A Cameron
- Edinburgh University Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - A Wardley
- The NIHR Manchester Clinical Research Facility at The Christie, Manchester, UK; University of Manchester, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, UK
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29
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Rea D. Handling challenging questions in the management of chronic myeloid leukemia: when is it safe to stop tyrosine kinase inhibitors? Hematology Am Soc Hematol Educ Program 2020; 2020:243-247. [PMID: 33275744 PMCID: PMC7727570 DOI: 10.1182/hematology.2020002538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The paradigm for managing patients with chronic myeloid leukemia is evolving. In the recent past, restoring a normal life expectancy while patients are receiving never-ending targeted therapy with BCR-ABL1 tyrosine kinase inhibitors through prevention of progression to blast phase and mitigation of iatrogenic risks was considered the best achievable outcome. Now, long-term treatment-free remission with continued response off tyrosine kinase inhibitor therapy is recognized as the most optimal benefit of treatment. Indeed, numerous independent clinical trials provided solid proof that tyrosine kinase inhibitor discontinuation was feasible in patients with deep and sustained molecular responses. This article discusses when tyrosine kinase inhibitors may be safely stopped in clinical practice on the basis of the best and latest available evidence.
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Affiliation(s)
- Delphine Rea
- Département Médico-Universitaire d'Hématologie, Paris, France; and France Intergroupe des Leucémies Myéloïdes Chroniques, Lyon, France
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30
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Fontana D, Mauri M, Renso R, Docci M, Crespiatico I, Røst LM, Jang M, Niro A, D'Aliberti D, Massimino L, Bertagna M, Zambrotta G, Bossi M, Citterio S, Crescenzi B, Fanelli F, Cassina V, Corti R, Salerno D, Nardo L, Chinello C, Mantegazza F, Mecucci C, Magni F, Cavaletti G, Bruheim P, Rea D, Larsen S, Gambacorti-Passerini C, Piazza R. ETNK1 mutations induce a mutator phenotype that can be reverted with phosphoethanolamine. Nat Commun 2020; 11:5938. [PMID: 33230096 PMCID: PMC7684297 DOI: 10.1038/s41467-020-19721-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/27/2020] [Indexed: 11/09/2022] Open
Abstract
Recurrent somatic mutations in ETNK1 (Ethanolamine-Kinase-1) were identified in several myeloid malignancies and are responsible for a reduced enzymatic activity. Here, we demonstrate in primary leukemic cells and in cell lines that mutated ETNK1 causes a significant increase in mitochondrial activity, ROS production, and Histone H2AX phosphorylation, ultimately driving the increased accumulation of new mutations. We also show that phosphoethanolamine, the metabolic product of ETNK1, negatively controls mitochondrial activity through a direct competition with succinate at mitochondrial complex II. Hence, reduced intracellular phosphoethanolamine causes mitochondria hyperactivation, ROS production, and DNA damage. Treatment with phosphoethanolamine is able to counteract complex II hyperactivation and to restore a normal phenotype.
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Affiliation(s)
- Diletta Fontana
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Mario Mauri
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Rossella Renso
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Mattia Docci
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Ilaria Crespiatico
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Lisa M Røst
- Department of Biotechnology and Food Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mi Jang
- Department of Biotechnology and Food Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Antonio Niro
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Deborah D'Aliberti
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Luca Massimino
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Mayla Bertagna
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Giovanni Zambrotta
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Mario Bossi
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Stefania Citterio
- Department of Biotechnology and Biosciences, University of Milano - Bicocca, Milano, Italy
| | - Barbara Crescenzi
- Centro Ricerche Emato-Oncologiche, University of Perugia, Perugia, Italy
| | - Francesca Fanelli
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Cassina
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Roberta Corti
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Domenico Salerno
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Luca Nardo
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Clizia Chinello
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Francesco Mantegazza
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Cristina Mecucci
- Centro Ricerche Emato-Oncologiche, University of Perugia, Perugia, Italy
| | - Fulvio Magni
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Guido Cavaletti
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Per Bruheim
- Department of Biotechnology and Food Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Delphine Rea
- Service d'Hématologie adulte, Hôpital Saint-Louis, Paris, France
| | - Steen Larsen
- X-lab, Center for Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Rocco Piazza
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy. .,Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy. .,Bicocca Bioinformatics, Biostatistics and Bioimaging Centre (B4), University of Milano - Bicocca, Milan, Italy.
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31
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Fontana D, Ramazzotti D, Aroldi A, Redaelli S, Magistroni V, Pirola A, Niro A, Massimino L, Mastini C, Brambilla V, Bombelli S, Bungaro S, Morotti A, Rea D, Stagno F, Martino B, Campiotti L, Caocci G, Usala E, Merli M, Onida F, Bregni M, Elli EM, Fumagalli M, Ciceri F, Perego RA, Pagni F, Mologni L, Piazza R, Gambacorti-Passerini C. Integrated Genomic, Functional, and Prognostic Characterization of Atypical Chronic Myeloid Leukemia. Hemasphere 2020; 4:e497. [PMID: 33196013 PMCID: PMC7655091 DOI: 10.1097/hs9.0000000000000497] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023] Open
Abstract
Supplemental Digital Content is available for this article. Atypical chronic myeloid leukemia (aCML) is a BCR-ABL1-negative clonal disorder, which belongs to the myelodysplastic/myeloproliferative group. This disease is characterized by recurrent somatic mutations in SETBP1, ASXL1 and ETNK1 genes, as well as high genetic heterogeneity, thus posing a great therapeutic challenge. To provide a comprehensive genomic characterization of aCML we applied a high-throughput sequencing strategy to 43 aCML samples, including both whole-exome and RNA-sequencing data. Our dataset identifies ASXL1, SETBP1, and ETNK1 as the most frequently mutated genes with a total of 43.2%, 29.7 and 16.2%, respectively. We characterized the clonal architecture of 7 aCML patients by means of colony assays and targeted resequencing. The results indicate that ETNK1 variants occur early in the clonal evolution history of aCML, while SETBP1 mutations often represent a late event. The presence of actionable mutations conferred both ex vivo and in vivo sensitivity to specific inhibitors with evidence of strong in vitro synergism in case of multiple targeting. In one patient, a clinical response was obtained. Stratification based on RNA-sequencing identified two different populations in terms of overall survival, and differential gene expression analysis identified 38 significantly overexpressed genes in the worse outcome group. Three genes correctly classified patients for overall survival.
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Affiliation(s)
- Diletta Fontana
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Daniele Ramazzotti
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Andrea Aroldi
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Sara Redaelli
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Vera Magistroni
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | | | - Antonio Niro
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Luca Massimino
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Cristina Mastini
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Virginia Brambilla
- Department of Medicine and Surgery, Pathology, University of Milano - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Silvia Bombelli
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Silvia Bungaro
- Centro Ricerca Tettamanti, Pediatria, University of Milano - Bicocca, Monza, Italy
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Delphine Rea
- Service d'Hématologie adulte, Hôpital Saint-Louis, Paris, France
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Bruno Martino
- Division of Hematology, Azienda Ospedaliera 'Bianchi Melacrino Morelli', Reggio Calabria, Italy
| | - Leonardo Campiotti
- Department of Medicine and Surgery, Università degli Studi dell'Insubria, Varese, Italy
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Emilio Usala
- Hematology Unit, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Michele Merli
- Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Francesco Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marco Bregni
- Oncology-Hematology Unit, ASST Valle Olona, Busto Arsizio, Italy
| | - Elena Maria Elli
- Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Monica Fumagalli
- Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto A Perego
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Luca Mologni
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Rocco Piazza
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
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32
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Conefrey C, Donovan JL, Stein RC, Paramasivan S, Marshall A, Bartlett J, Cameron D, Campbell A, Dunn J, Earl H, Hall P, Harmer V, Hughes-Davies L, Macpherson I, Makris A, Morgan A, Pinder S, Poole C, Rea D, Rooshenas L. Strategies to Improve Recruitment to a De-escalation Trial: A Mixed-Methods Study of the OPTIMA Prelim Trial in Early Breast Cancer. Clin Oncol (R Coll Radiol) 2020; 32:382-389. [PMID: 32089356 PMCID: PMC7246331 DOI: 10.1016/j.clon.2020.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/13/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022]
Abstract
AIMS De-escalation trials are challenging and sometimes may fail due to poor recruitment. The OPTIMA Prelim randomised controlled trial (ISRCTN42400492) randomised patients with early stage breast cancer to chemotherapy versus 'test-directed' chemotherapy, with a possible outcome of no chemotherapy, which could confer less treatment relative to routine practice. Despite encountering challenges, OPTIMA Prelim reached its recruitment target ahead of schedule. This study reports the root causes of recruitment challenges and the strategies used to successfully overcome them. MATERIALS AND METHODS A mixed-methods recruitment intervention (QuinteT Recruitment Intervention) was used to investigate the recruitment difficulties and feedback findings to inform interventions and optimise ongoing recruitment. Quantitative site-level recruitment data, audio-recorded recruitment appointments (n = 46), qualitative interviews (n = 22) with trialists/recruiting staff (oncologists/nurses) and patient-facing documentation were analysed using descriptive, thematic and conversation analyses. Findings were triangulated to inform a 'plan of action' to optimise recruitment. RESULTS Despite best intentions, oncologists' routine practices complicated recruitment. Discomfort about deviating from the usual practice of recommending chemotherapy according to tumour clinicopathological features meant that not all eligible patients were approached. Audio-recorded recruitment appointments revealed how routine practices undermined recruitment. A tendency to justify chemotherapy provision before presenting the randomised controlled trial and subtly indicating that chemotherapy would be more/less beneficial undermined equipoise and made it difficult for patients to engage with OPTIMA Prelim. To tackle these challenges, individual and group recruiter feedback focussed on communication issues and vignettes of eligible patients were discussed to address discomforts around approaching patients. 'Tips' documents concerning structuring discussions and conveying equipoise were disseminated across sites, together with revisions to the Patient Information Sheet. CONCLUSIONS This is the first study illuminating the tension between oncologists' routine practices and recruitment to de-escalation trials. Although time and resources are required, these challenges can be addressed through specific feedback and training as the trial is underway.
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Affiliation(s)
- C Conefrey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - J L Donovan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - R C Stein
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - S Paramasivan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - A Marshall
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - D Cameron
- The University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, EH4 University Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - A Campbell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H Earl
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - P Hall
- The University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, EH4 University Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - V Harmer
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - I Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Makris
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, UK
| | - A Morgan
- Independent Cancer Patients' Voice, London, UK
| | - S Pinder
- King's College London, Comprehensive Cancer Centre at Guy's Hospital, London, UK
| | - C Poole
- Arden Cancer Centre, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - D Rea
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - L Rooshenas
- Population Health Sciences, University of Bristol, Bristol, UK
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33
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Hochhaus A, Baccarani M, Silver RT, Schiffer C, Apperley JF, Cervantes F, Clark RE, Cortes JE, Deininger MW, Guilhot F, Hjorth-Hansen H, Hughes TP, Janssen JJWM, Kantarjian HM, Kim DW, Larson RA, Lipton JH, Mahon FX, Mayer J, Nicolini F, Niederwieser D, Pane F, Radich JP, Rea D, Richter J, Rosti G, Rousselot P, Saglio G, Saußele S, Soverini S, Steegmann JL, Turkina A, Zaritskey A, Hehlmann R. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia 2020; 34:966-984. [PMID: 32127639 PMCID: PMC7214240 DOI: 10.1038/s41375-020-0776-2] [Citation(s) in RCA: 728] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
The therapeutic landscape of chronic myeloid leukemia (CML) has profoundly changed over the past 7 years. Most patients with chronic phase (CP) now have a normal life expectancy. Another goal is achieving a stable deep molecular response (DMR) and discontinuing medication for treatment-free remission (TFR). The European LeukemiaNet convened an expert panel to critically evaluate and update the evidence to achieve these goals since its previous recommendations. First-line treatment is a tyrosine kinase inhibitor (TKI; imatinib brand or generic, dasatinib, nilotinib, and bosutinib are available first-line). Generic imatinib is the cost-effective initial treatment in CP. Various contraindications and side-effects of all TKIs should be considered. Patient risk status at diagnosis should be assessed with the new EUTOS long-term survival (ELTS)-score. Monitoring of response should be done by quantitative polymerase chain reaction whenever possible. A change of treatment is recommended when intolerance cannot be ameliorated or when molecular milestones are not reached. Greater than 10% BCR-ABL1 at 3 months indicates treatment failure when confirmed. Allogeneic transplantation continues to be a therapeutic option particularly for advanced phase CML. TKI treatment should be withheld during pregnancy. Treatment discontinuation may be considered in patients with durable DMR with the goal of achieving TFR.
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MESH Headings
- Aniline Compounds/therapeutic use
- Antineoplastic Agents/therapeutic use
- Clinical Decision-Making
- Consensus Development Conferences as Topic
- Dasatinib/therapeutic use
- Disease Management
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Life Expectancy/trends
- Monitoring, Physiologic
- Nitriles/therapeutic use
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- Quality of Life
- Quinolines/therapeutic use
- Survival Analysis
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Affiliation(s)
- A Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany.
| | - M Baccarani
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - R T Silver
- Weill Cornell Medical College, New York, NY, USA
| | - C Schiffer
- Karmanos Cancer Center, Detroit, MI, USA
| | - J F Apperley
- Hammersmith Hospital, Imperial College, London, UK
| | | | - R E Clark
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - J E Cortes
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - M W Deininger
- Huntsman Cancer Center Salt Lake City, Salt Lake City, UT, USA
| | - F Guilhot
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - H Hjorth-Hansen
- Norwegian University of Science and Technology, Trondheim, Norway
| | - T P Hughes
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - J J W M Janssen
- Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
| | | | - D W Kim
- St. Mary´s Hematology Hospital, The Catholic University, Seoul, Korea
| | | | | | - F X Mahon
- Institut Bergonie, Université de Bordeaux, Bordeaux, France
| | - J Mayer
- Department of Internal Medicine, Masaryk University Hospital, Brno, Czech Republic
| | | | | | - F Pane
- Department Clinical Medicine and Surgery, University Federico Secondo, Naples, Italy
| | - J P Radich
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - D Rea
- Hôpital St. Louis, Paris, France
| | | | - G Rosti
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - P Rousselot
- Centre Hospitalier de Versailles, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - G Saglio
- University of Turin, Turin, Italy
| | - S Saußele
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - S Soverini
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | - A Turkina
- National Research Center for Hematology, Moscow, Russian Federation
| | - A Zaritskey
- Almazov National Research Centre, St. Petersburg, Russian Federation
| | - R Hehlmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.
- ELN Foundation, Weinheim, Germany.
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34
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Hughes TP, Mauro MJ, Cortes JE, Minami H, Rea D, DeAngelo DJ, Breccia M, Goh YT, Talpaz M, Hochhaus A, le Coutre P, Ottmann O, Heinrich MC, Steegmann JL, Deininger MWN, Janssen JJWM, Mahon FX, Minami Y, Yeung D, Ross DM, Tallman MS, Park JH, Druker BJ, Hynds D, Duan Y, Meille C, Hourcade-Potelleret F, Vanasse KG, Lang F, Kim DW. Asciminib in Chronic Myeloid Leukemia after ABL Kinase Inhibitor Failure. N Engl J Med 2019; 381:2315-2326. [PMID: 31826340 PMCID: PMC7724923 DOI: 10.1056/nejmoa1902328] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Asciminib is an allosteric inhibitor that binds a myristoyl site of the BCR-ABL1 protein, locking BCR-ABL1 into an inactive conformation through a mechanism distinct from those for all other ABL kinase inhibitors. Asciminib targets both native and mutated BCR-ABL1, including the gatekeeper T315I mutant. The safety and antileukemic activity of asciminib in patients with Philadelphia chromosome-positive leukemia are unknown. METHODS In this phase 1, dose-escalation study, we enrolled 141 patients with chronic-phase and 9 with accelerated-phase chronic myeloid leukemia (CML) who had resistance to or unacceptable side effects from at least two previous ATP-competitive tyrosine kinase inhibitors (TKIs). The primary objective was to determine the maximum tolerated dose or the recommended dose (or both) of asciminib. Asciminib was administered once or twice daily (at doses of 10 to 200 mg). The median follow-up was 14 months. RESULTS Patients were heavily pretreated; 70% (105 of 150 patients) had received at least three TKIs. The maximum tolerated dose of asciminib was not reached. Among patients with chronic-phase CML, 34 (92%) with a hematologic relapse had a complete hematologic response; 31 (54%) without a complete cytogenetic response at baseline had a complete cytogenetic response. A major molecular response was achieved or maintained by 12 months in 48% of patients who could be evaluated, including 8 of 14 (57%) deemed to have resistance to or unacceptable side effects from ponatinib. A major molecular response was achieved or maintained by 12 months in 5 patients (28%) with a T315I mutation at baseline. Clinical responses were durable; a major molecular response was maintained in 40 of 44 patients. Dose-limiting toxic effects included asymptomatic elevations in the lipase level and clinical pancreatitis. Common adverse events included fatigue, headache, arthralgia, hypertension, and thrombocytopenia. CONCLUSIONS Asciminib was active in heavily pretreated patients with CML who had resistance to or unacceptable side effects from TKIs, including patients in whom ponatinib had failed and those with a T315I mutation. (Funded by Novartis Pharmaceuticals; ClinicalTrials.gov number, NCT02081378.).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/pharmacokinetics
- Dose-Response Relationship, Drug
- Drug Resistance, Neoplasm
- Female
- Follow-Up Studies
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Logistic Models
- Male
- Middle Aged
- Mutation
- Niacinamide/administration & dosage
- Niacinamide/adverse effects
- Niacinamide/analogs & derivatives
- Niacinamide/pharmacokinetics
- Protein Kinase Inhibitors/therapeutic use
- Pyrazoles/administration & dosage
- Pyrazoles/adverse effects
- Pyrazoles/pharmacokinetics
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Affiliation(s)
- Timothy P Hughes
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Michael J Mauro
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Jorge E Cortes
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Hironobu Minami
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Delphine Rea
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Daniel J DeAngelo
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Massimo Breccia
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Yeow-Tee Goh
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Moshe Talpaz
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Andreas Hochhaus
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Philipp le Coutre
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Oliver Ottmann
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Michael C Heinrich
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Juan L Steegmann
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Michael W N Deininger
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Jeroen J W M Janssen
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Francois-Xavier Mahon
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Yosuke Minami
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - David Yeung
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - David M Ross
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Martin S Tallman
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Jae H Park
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Brian J Druker
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - David Hynds
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Yuyan Duan
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Christophe Meille
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Florence Hourcade-Potelleret
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - K Gary Vanasse
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Fabian Lang
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
| | - Dong-Wook Kim
- From the South Australian Health and Medical Research Institute and the University of Adelaide, Adelaide, SA, Australia (T.P.H., D.Y., D.M.R.); Memorial Sloan Kettering Cancer Center, New York (M.J.M., M.S.T., J.H.P.); University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Kobe University Graduate School of Medicine, Kobe (H.M.), and the National Cancer Center Hospital East, Chiba (Y.M.) - both in Japan; Hôpital Saint-Louis, Paris (D.R.), and the University of Bordeaux, Bordeaux (F.-X.M.) - both in France; Dana-Farber Cancer Institute, Boston (D.J.D.); Sapienza University, Rome (M.B.); Singapore General Hospital, Singapore (Y.-T.G.); University of Michigan Comprehensive Cancer Center, Ann Arbor (M.T.); Universitätsklinikum Jena, Jena (A.H.), Charité Hospital, Berlin (P.C.), and the Department for Hematology-Oncology, Goethe University Hospital, Frankfurt am Main (F.L.) - all in Germany; University of Cardiff, Cardiff, United Kingdom (O.O.); Veterans Affairs Portland Health Care System (M.C.H.) and Oregon Health and Science University Knight Cancer Institute (M.C.H., B.J.D.), Portland; Hospital de la Princesa and Instituto de Investigación Sanitaria Princesa, Madrid (J.L.S.); Huntsman Cancer Institute, University of Utah, Salt Lake City (M.W.N.D.); Amsterdam University Medical Centers, VU University Medical Center, Amsterdam (J.J.W.M.J.); Novartis Pharma, Basel, Switzerland (D.H., Y.D., C.M., F.H.-P., K.G.V.); and Seoul St. Mary's Hematology Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.)
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Abstract
PURPOSE OF REVIEW Treatment goals and ambitions have even been upwardly revised since demonstration was made that under certain conditions, treatment-free remission was possible. Herein, we will discuss on how to try tailoring treatment choices to the unique characteristics of each patient. RECENT FINDINGS Since the first-generation ATP-competitive TKI imatinib was made available in the clinic in 2001, second-generation drugs such as dasatinib, nilotinib and bosutinib and the third-generation TKI ponatinib have broadened the therapeutic armamentarium, providing effective salvage against intolerance and different types of resistance, or as frontline options. Management and outcomes of patients with chronic myeloid leukemia have been revolutionized by the discovery, development, and approval of BCR-ABL tyrosine kinase inhibitors (TKIs). Most patients can now expect a near-to normal life expectancy and acceptable quality of life on life-long treatment, providing awareness and avoidance of harmful adverse events, which depend on each TKI safety profile and patient personal background.
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MESH Headings
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Clinical Decision-Making
- Disease Management
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Molecular Targeted Therapy/methods
- Precision Medicine/methods
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Retreatment
- Treatment Outcome
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Affiliation(s)
- Florence Rabian
- Service Hématologie Adolescents et Jeunes Adultes, Hôpital Saint-Louis, Avenue Claude Vellefaux, 75010, Paris, France.
| | - Etienne Lengline
- Service d'Hématologie Adultes, Hôpital Saint-Louis, APHP, Paris, France
| | - Delphine Rea
- Service d'Hématologie Adultes, Hôpital Saint-Louis, APHP, Paris, France
- INSERM UMR 1160, Hôpital Saint-Louis, APHP, Paris, France
- France Intergroupe des Leucémies Myéloïdes chroniques (FI-LMC), Institut Bergonié, Bordeaux, France
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Shah NP, García-Gutiérrez V, Jiménez-Velasco A, Larson S, Saussele S, Rea D, Mahon FX, Levy MY, Gómez-Casares MT, Pane F, Nicolini FE, Mauro MJ, Sy O, Martin-Regueira P, Lipton JH. Dasatinib discontinuation in patients with chronic-phase chronic myeloid leukemia and stable deep molecular response: the DASFREE study. Leuk Lymphoma 2019; 61:650-659. [PMID: 31647335 DOI: 10.1080/10428194.2019.1675879] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treatment-free remission (TFR) in patients with chronic myeloid leukemia in chronic phase (CML-CP) is considered a feasible option, especially with the ability of second-generation tyrosine kinase inhibitors to induce higher rates of sustained deep molecular response (DMR). DASFREE is an open-label, single-arm, multicenter phase II trial assessing TFR after dasatinib discontinuation in patients with CML-CP (N = 84). At 2 years, TFR was 46% in all patients. Multivariate analyses revealed statistically significant associations between 2-year TFR and duration of prior dasatinib (≥median; p = .0051), line of therapy (first line; p = .0138), and age (>65 years; p = .0012). No disease transformation occurred, and the most common adverse events experienced off treatment were musculoskeletal (observed in 30 patients); however, dasatinib withdrawal events were reported in nine patients (11%) by the investigator. Overall, these findings support the feasibility of discontinuing dasatinib for patients with CML-CP in sustained DMR in the first line and beyond.
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Affiliation(s)
- Neil P Shah
- Department of Medicine/Hematology-Oncology, UCSF School of Medicine, San Francisco, CA, USA
| | | | | | - Sarah Larson
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Susanne Saussele
- III, Med. Clinic, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Delphine Rea
- Department of Hématologie, Hôpital Saint-Louis, Paris, France
| | - François-Xavier Mahon
- Department of Hématologie, Institut Bergonié, University of Bordeaux, Bordeaux, France
| | | | | | - Fabrizio Pane
- Dipartimento di Medicina clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Michael J Mauro
- Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oumar Sy
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Jeffrey H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Eide CA, Zabriskie MS, Savage Stevens SL, Antelope O, Vellore NA, Than H, Schultz AR, Clair P, Bowler AD, Pomicter AD, Yan D, Senina AV, Qiang W, Kelley TW, Szankasi P, Heinrich MC, Tyner JW, Rea D, Cayuela JM, Kim DW, Tognon CE, O'Hare T, Druker BJ, Deininger MW. Combining the Allosteric Inhibitor Asciminib with Ponatinib Suppresses Emergence of and Restores Efficacy against Highly Resistant BCR-ABL1 Mutants. Cancer Cell 2019; 36:431-443.e5. [PMID: 31543464 PMCID: PMC6893878 DOI: 10.1016/j.ccell.2019.08.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/03/2019] [Accepted: 08/13/2019] [Indexed: 12/15/2022]
Abstract
BCR-ABL1 point mutation-mediated resistance to tyrosine kinase inhibitor (TKI) therapy in Philadelphia chromosome-positive (Ph+) leukemia is effectively managed with several approved drugs, including ponatinib for BCR-ABL1T315I-mutant disease. However, therapy options are limited for patients with leukemic clones bearing multiple BCR-ABL1 mutations. Asciminib, an allosteric inhibitor targeting the myristoyl-binding pocket of BCR-ABL1, is active against most single mutants but ineffective against all tested compound mutants. We demonstrate that combining asciminib with ATP site TKIs enhances target inhibition and suppression of resistant outgrowth in Ph+ clinical isolates and cell lines. Inclusion of asciminib restores ponatinib's effectiveness against currently untreatable compound mutants at clinically achievable concentrations. Our findings support combining asciminib with ponatinib as a treatment strategy for this molecularly defined group of patients.
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MESH Headings
- Allosteric Regulation/drug effects
- Animals
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Binding Sites/drug effects
- Binding Sites/genetics
- Cell Line, Tumor/transplantation
- Disease Models, Animal
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- Female
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Imidazoles/pharmacology
- Imidazoles/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Mice
- Molecular Docking Simulation
- Molecular Dynamics Simulation
- Molecular Targeted Therapy/methods
- Mutation
- Niacinamide/analogs & derivatives
- Niacinamide/pharmacology
- Niacinamide/therapeutic use
- Primary Cell Culture
- Pyrazoles/pharmacology
- Pyrazoles/therapeutic use
- Pyridazines/pharmacology
- Pyridazines/therapeutic use
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Affiliation(s)
- Christopher A Eide
- OHSU Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, LBRB 513, Portland, OR 97239, USA; Howard Hughes Medical Institute, Portland, OR 97239, USA; Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Matthew S Zabriskie
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Samantha L Savage Stevens
- OHSU Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, LBRB 513, Portland, OR 97239, USA; Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Orlando Antelope
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Nadeem A Vellore
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Hein Than
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Anna Reister Schultz
- OHSU Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, LBRB 513, Portland, OR 97239, USA; Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Phillip Clair
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Amber D Bowler
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Anthony D Pomicter
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Dongqing Yan
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Anna V Senina
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA
| | - Wang Qiang
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Todd W Kelley
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | | | - Michael C Heinrich
- OHSU Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, LBRB 513, Portland, OR 97239, USA; Portland VA Health Care System, Portland, OR, USA; Department of Cell, Developmental, & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jeffrey W Tyner
- OHSU Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, LBRB 513, Portland, OR 97239, USA; Department of Cell, Developmental, & Cancer Biology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Delphine Rea
- Service d'Hematologie Adulte, INSERM UMR 1160, Hospital Saint-Louis, 75010 Paris, France
| | - Jean-Michel Cayuela
- Laboratory of Hematology, University Hospital Saint-Louis, AP-HP and EA3518, University Paris Diderot, Paris, France
| | - Dong-Wook Kim
- Leukemia Research Institute, The Catholic University of Korea, Seoul, Republic of Korea; Department of Hematology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cristina E Tognon
- OHSU Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, LBRB 513, Portland, OR 97239, USA; Howard Hughes Medical Institute, Portland, OR 97239, USA; Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Thomas O'Hare
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA; Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT 84112, USA
| | - Brian J Druker
- OHSU Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, LBRB 513, Portland, OR 97239, USA; Howard Hughes Medical Institute, Portland, OR 97239, USA; Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA.
| | - Michael W Deininger
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Room 4280, Salt Lake City, UT 84112, USA; Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT 84112, USA.
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Quagliariello V, Coppola C, Rea D, Maurea C, Barbieri A, Botti G, Maurea N. Cardioprotective and anti-inflammatory effects of empagliflozin during treatment with doxorubicin: A cellular and preclinical study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Detriche G, Zhang Y, Esposito B, Rea D, Messas E, Mirault T, Ait Oufella H. P3110Tyrosine kinase inhibitor nilotinib increases atherosclerosis burden in ApoE knock-out mice. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In 2001, imatinib, the 1st generation tyrosine kinase inhibitor (TKI), dramatically improved the treatment and survival of the patients with chronic myeloid leukemia (CML). However, the emergence of imatinib-resistant patients led to the development of 2nd generation TKIs. Nilotinib demonstrated increased efficacy to control CML disease over imatinib and is now recommended as first-line therapy. But arterial occlusive adverse events (AOE) occurs in patients treated with nilotinib and not with imatinib. Mechanisms leading to AOE with nilotinib is not well understood. AOE are dominated by ischemic heart disease and lower extremity arterial disease. Moreover, we demonstrated that CML patients with cardiovascular risk factors are at high risk to rapidly develop AOE with nilotinib.
Purpose
To evaluate the impact of nilotinib in a pre-clinical model of atherosclerosis.
Methods
ApoE Knock-Out mice (8-week-old) were treated with either placebo (N=10), imatinib (IMA) 200mg/kg/day (N=10) or nilotinib (NILO) 100mg/kg/day (N=10) by daily feeding and a high-fat diet for 12 weeks. Heart and aorta were harvested after sacrifice, for histology staining and immunochemistry. Splenocytes were cultured from collected spleens, and Interleukin (IL) 12p70 and IL10 measured by ELISA.
Results
Mice treated with nilotinib showed an increase of atherosclerotic plaque size at the aortic sinus level: 462.1x103 μm2 vs. 344.4x103 μm2 with imatinib or 394.9x103 μm2 with placebo (p<0.05) and at the thoracoabdominal aorta level (p<0.05). Plaques had greater infiltration of macrophages: 33.0±3.4% with nilotinib vs. 7.3±1.3% with imatinib and 12.6±1.1% with placebo (p<0.001) and a larger necrotic nucleus 33.0±3.4% with nilotinib vs. 7.3±1.3% with imatinib or 12.6±1.1% with placebo (p<0.001). Nilotinib modulated the systemic immune response by increasing IL-12p70 and by decreasing IL-10 production by splenocytes after stimulation by LPS-IFNγ whereas IL10 increase was observed with imatinib.
Plaque size (aortic sinus)
Conclusion
Nilotinib has a pro-atherogenic effect in a pre-clinical model of atherosclerosis and increases the monocyte/macrophage pro-inflammatory response. Further experiments are required to identify pathways activated by nilotinib.
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Affiliation(s)
- G Detriche
- European Hospital Georges Pompidou, Vascular medicine department, Paris Descartes university, Sorbone Paris Cité, APHP, Paris, France
| | - Y Zhang
- Paris Cardiovascular Research Center (PARCC), INSERM UMR-S970, Paris, France
| | - B Esposito
- Paris Cardiovascular Research Center (PARCC), INSERM UMR-S970, Paris, France
| | - D Rea
- Hopital Saint-Louis, Hematology department, Paris, France
| | - E Messas
- European Hospital Georges Pompidou, Vascular medicine department, Paris Descartes university, Sorbone Paris Cité, APHP, Paris, France
| | - T Mirault
- European Hospital Georges Pompidou, Vascular medicine department, Paris Descartes university, Sorbone Paris Cité, APHP, Paris, France
| | - H Ait Oufella
- Paris Cardiovascular Research Center (PARCC), INSERM UMR-S970, Paris, France
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Rea D. New BCR-ABL inhibitors in chronic myeloid leukemia. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maurea N, Quagliariello V, Coppola C, Rea D, Barbieri A, Arra C, Botti G. P5716Cardioprotective anti inflammatory effects of empaglifozin in doxorubicin induced cardiotoxicity: the role of leukotriene B4 and interleukin 1. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Empagliflozin (EMPA), a selective inhibitor of the sodium glucose co-transporter 2 (SGLT2), reduces the risk of hospitalization for heart failure or cardiovascular death in type 2 diabetic patients.
Purpose
We studied the putative cardioprotective and anti-inflammatory effects of EMPA in Doxorubicin (DOXO)-Induced cardiotoxicity.
Methods
For this purpose, we tested the effects of EMPA (at 100 or 500 nM) alone or in combination with DOXO (20 μM) in HL-1 adult cardiomyocytes evaluating: mitochondrial viability, lipid peroxidation (quantifying cellular Malondialdehyde [MDA] and 4-hydroxynonenal [4-HNA]), Leukotriene-B4 expression, p65-NF-κB activation and Interleukin 1β, 8 and 6 secretion. Preclinical studies were also performed in C57BL6 mice, dividing them in 4 groups (n=6): Sham (untreated mice), EMPA (mice treated with EMPA at 10 mg/kg/day, administrated orally for 7 days); DOXO (mice treated with DOXO at 2.25 mg/kg/day, intraperitoneally administered for 7 days); EMPA-DOXO (pre-treatment with EMPA for 3 days and 7 days of co-administration EMPA and DOXO). As predictor of cardiotoxicity, the Global Longitudinal Strain (GLS) was measured using 2D speckle tracking echocardiography. Cardiac lysates were processed for analysis of pro-inflammatory interleukins.
Results
We demonstrated that EMPA, co-incubated with DOXO, increases cardiomyocyte viability of 33,6 and 82% at 100 and 500 nM, respectively (compared to only DOXO treated cells). EMPA inhibits the lipid peroxidation by decreasing MDA and 4-HNA production of around 23,6 and 28,7%, at 100 nM and of 47,8 and 52,1% at 500 nM, respectively, compared to untreated cells (p<0,01 for all). Moreover, EMPA has anti-inflammatory activity reducing the Leukotriene B4 and p65-NFkb expression of 37,4% and 31% at 100 nM and of 58,4 and 64,3% at 500 nM, respectively (all compared to only DOXO treated cells). EMPA also decreased the expression of Interleukin 1β (of 28,5 and 68,8%), Interleukin-8 (of 21,2 and 57,3%) and Interleukin-6 (of 28,1 and 49,8%) at 100 and 500 nM, respectively, compared to only DOXO exposed cells (p<0,05 for all). In our in vivo studies, after 7 days with DOXO, the GLS decreased. Interestingly, in mice treated with EMPA/DOXO, we observed that EMPA prevents the GLS's reduction: GLS was −19.24±1.5 (p<0,01) vs DOXO alone, indicating cardioprotective effects. In DOXO-EMPA groups the cardiac IL-1β, IL-6 and IL-8 were reduced of 48, 54,4 and 58%, compared to only DOXO group (p<0,001 for all).
Conclusion
EMPA has strong anti-inflammatory and cardioprotective effects in DOXO-Induced cardiotoxicity and these effects are mainly mediated by a reduction of the lipid peroxidation, Leukotriene-B4 and NF-κB activation bringing to a strong inhibition of the Interleukin 1β, 8 and 6 production.
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Affiliation(s)
- N Maurea
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - V Quagliariello
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - C Coppola
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - D Rea
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - A Barbieri
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - C Arra
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - G Botti
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
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Maurea N, Quagliariello V, Passariello M, Coppola C, Rea D, Barbieri A, Arra C, Scherillo M, Iaffaioli RV, Botti G, De Lorenzo C. P1537Cardiotoxicity induced by the combinatorial treatment based on the immune checkpoint inhibitor pembrolizumab associated to trastuzumab. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The immunotherapy has revolutionized the world of oncology in the last decades with considerable advantages in terms of overall survival in cancer patients. A combination therapy based on the co-administration of Pembrolizumab (an antibody against PD-1) and Trastuzumab (the humanized anti-Her2 mAb) was recently proposed in clinical trials for the treatment of Trastuzumab-resistant advanced HER2-positive breast cancer. Although immunotherapies are frequently associated with a wide spectrum of immune-related adverse events, the cardiac toxicity has not been properly studied.
Purpose
We studied, for the first time, the putative cardiotoxic effects of Pembrolizumab associated to Trastuzumab turning the light on the pro-inflammatory effects of this novel combined therapy
Methods
Cell viability, intracellular calcium quantification and pro-inflammatory assays (analyzing the production of Interleukin 1β, 6 and 8 as well as the expression of p65/NFkB and Leukotriene B4) were performed in human fetal cardiomyocytes in vitro. Preclinical studies were also performed in vivo on C57BL6 mice untreated (Sham) or treated with Pembrolizumab and Trastuzumab alone or in combination by analyzing (in cardiac tissue extracts) the same markers of inflammation used in cellular studies.
Results
Combination therapy leads to an increase of the intracellular calcium overload (more than 3 times compared to untreated cells) and to a reduction of the cardiomyocytes viability (of more than 65 and 20–25%, compared to untreated and Pembrolizumab or Trastuzumab treated cells, respectively) thus indicating cardiotoxic effects. Notably, combination therapy increases the inflammation of cardiomyocytes enhancing significantly the production of p65/NFkB and Interleukins. Moreover, in in vivo studies on mice, the association of Pembrolizumab and Trastuzumab shows pro-inflammatory effects in cardiac tissue by stimulating the Interleukin 1β, 8 and 6 expression of 40–50% more than the single treatments; the expression of p65/NFkB and Leukotriene B4 was also increased indicating pro-inflammatory effects.
Conclusion
Combination therapy based on Pembrolizumab associated to Trastuzumab leads to significant cardiac pro-inflammatory effects mediated by overexpression of NFkB/p65 and Leukotriene B4 related pathways
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Affiliation(s)
- N Maurea
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - V Quagliariello
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - M Passariello
- Federico II University of Naples, Department of Molecular Medicine and Medical Biotechnology, Naples, Italy
| | - C Coppola
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - D Rea
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - A Barbieri
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - C Arra
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - M Scherillo
- Azienda Ospedaliera “G. Rummo”, Azienda ospedaliera San Pio, Cardiologia Interventistica, Naples, Italy
| | - R V Iaffaioli
- Association for Multidisciplinary Studies in Oncology and Mediterranean Diet, Naples, Italy
| | - G Botti
- Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - C De Lorenzo
- Federico II University of Naples, Department of Molecular Medicine and Medical Biotechnology, Naples, Italy
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Maurea N, Quagliariello V, Passariello M, Coppola C, Rea D, Barbieri A, De Lorenzo C, Monti G, De Laurentiis M, Ascierto P, Botti G. Cardiotoxic and pro-inflammatory effects induced by the association of immune checkpoint inhibitor pembrolizumab and trastuzumab in preclinical models. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44
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Morgan J, Potter S, Sharma N, McIntosh SA, Coles CE, Dodwell D, Elder K, Gaunt C, Lyburn ID, McIntosh SA, Morgan J, Paramasivan S, Pinder S, Pirrie S, Potter S, Rea D, Roberts T, Sharma N, Stobart H, Taylor-Phillips S, Wallis M, Wilcox M. The SMALL Trial: A Big Change for Small Breast Cancers. Clin Oncol (R Coll Radiol) 2019; 31:659-663. [PMID: 31160130 DOI: 10.1016/j.clon.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Affiliation(s)
- J Morgan
- University of Sheffield, FU32, The Medical School, Sheffield, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK; Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - N Sharma
- Breast Unit, St James Hospital, Leeds, UK
| | - S A McIntosh
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK.
| | | | | | - K Elder
- Western General Hospital, Edinburgh, UK
| | - C Gaunt
- CRCTU, University of Birmingham, UK
| | | | | | | | | | | | - S Pirrie
- CRCTU, University of Birmingham, UK
| | | | - D Rea
- University of Birmingham, UK
| | | | - N Sharma
- St James's University Hospital, Leeds, UK
| | - H Stobart
- Independent Cancer Patients' Voice, UK
| | | | - M Wallis
- Addenbrooke's Hospital, Cambridge, UK
| | - M Wilcox
- Independent Cancer Patients' Voice, UK
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Shah NP, García-Gutiérrez JV, Jiménez-Velasco A, Larson S, Saussele S, Rea D, Mahon FX, Levy MY, Gómez-Casares MT, Luciano L, Nicolini FE, Mauro MJ, Sy O, Martin-Regueira P, Lipton JH. DASFREE: Treatment-Free Remission (TFR) After Discontinuation of Dasatinib in Patients with Chronic Myeloid Leukemia in Chronic Phase (CML-CP) and Deep Molecular Response (DMR). Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.07.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cheng VWT, Heetun A, Robinson T, Coles CE, Palmieri C, Rea D, Copson ER. The Breast Cancer Trainees Research Collaborative Group: A New Multidisciplinary Network to Facilitate Breast Cancer Research. Clin Oncol (R Coll Radiol) 2019; 32:e16-e18. [PMID: 31358346 DOI: 10.1016/j.clon.2019.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- V W T Cheng
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Heetun
- Cancer Sciences Academic Unit, University of Southampton, Somers Cancer Sciences Building, Southampton General Hospital, Southampton, UK
| | | | - C E Coles
- Oncology Centre, CRUK Cambridge Centre, University of Cambridge, Cambridge, UK
| | - C Palmieri
- Institute of Translational Medicine, Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK; The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - D Rea
- University of Birmingham, Birmingham, UK
| | - E R Copson
- Cancer Sciences Academic Unit, University of Southampton, Somers Cancer Sciences Building, Southampton General Hospital, Southampton, UK.
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Chander G, Rea D, Shaaban A, Jafri M. The Use of Pertuzumab for Breast Cancer Patients in the Neoadjuvant Setting Presenting to a Tertiary Centre. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Quagliariello V, Passariello M, Coppola C, Rea D, Barbieri A, Scherillo M, Monti MG, Iaffaioli RV, De Laurentiis M, Ascierto PA, Botti G, De Lorenzo C, Maurea N. Cardiotoxicity and pro-inflammatory effects of the immune checkpoint inhibitor Pembrolizumab associated to Trastuzumab. Int J Cardiol 2019; 292:171-179. [PMID: 31160077 DOI: 10.1016/j.ijcard.2019.05.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/19/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The immunotherapy has revolutionized the world of oncology in the last decades with considerable advantages in terms of overall survival in cancer patients. The association of Pembrolizumab and Trastuzumab was recently proposed in clinical trials for the treatment of Trastuzumab-resistant advanced HER2-positive breast cancer. Although immunotherapies are frequently associated with a wide spectrum of immune-related adverse events, the cardiac toxicity has not been properly studied. PURPOSE We studied, for the first time, the putative cardiotoxic and pro-inflammatory effects of Pembrolizumab associated to Trastuzumab. METHODS Cell viability, intracellular calcium quantification and pro-inflammatory studies (analyses of the production of Interleukin 1β, 6 and 8, the expression of NF-kB and Leukotriene B4) were performed in human fetal cardiomyocytes. Preclinical studies were also performed in C57BL6 mice by analyzing fibrosis and inflammation in heart tissues. RESULTS The combination of Pembrolizumab and Trastuzumab leads to an increase of the intracellular calcium overload (of 3 times compared to untreated cells) and to a reduction of the cardiomyocytes viability (of 65 and 20-25%, compared to untreated and Pembrolizumab or Trastuzumab treated cells, respectively) indicating cardiotoxic effects. Notably, combination therapy increases the inflammation of cardiomyocytes by enhancing the expression of NF-kB and Interleukins. Moreover, in preclinical models, the association of Pembrolizumab and Trastuzumab increases the Interleukins expression of 40-50% compared to the single treatments; the expression of NF-kB and Leukotriene B4 was also increased. CONCLUSION Pembrolizumab associated to Trastuzumab leads to strong cardiac pro-inflammatory effects mediated by overexpression of NF-kB and Leukotriene B4 related pathways.
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Affiliation(s)
- V Quagliariello
- Division of Cardiology, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - M Passariello
- CEINGE - Biotecnologie Avanzate S.C.a.R.L., Naples, Italy
| | - C Coppola
- Division of Cardiology, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - D Rea
- Animal Facility, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - A Barbieri
- Animal Facility, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - M Scherillo
- Azienda ospedaliera San Pio, Cardiologia Interventistica ed UTIC, Azienda Ospedaliera "G.Rummo" di Benevento, Napoli, Italy
| | - M G Monti
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - R V Iaffaioli
- Association for Multidisciplinary Studies in Oncology and Mediterranean Diet, Piazza Nicola Amore, Naples, Italy
| | - M De Laurentiis
- Breast Unit, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - P A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - G Botti
- Scientific Direction, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy
| | - C De Lorenzo
- CEINGE - Biotecnologie Avanzate S.C.a.R.L., Naples, Italy; Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Napoli, Italy.
| | - N Maurea
- Division of Cardiology, Istituto Nazionale Tumori- IRCCS- Fondazione G. Pascale, Napoli, Italy.
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Kleinhenz MD, Gorden PJ, Smith JS, Schleining JA, Kleinhenz KE, Juarez JR, Rea D, Coetzee JF. Effects of transdermal flunixin meglumine on experimentally induced lameness in adult dairy cattle. J Dairy Sci 2019; 102:6418-6430. [PMID: 31030917 DOI: 10.3168/jds.2018-15091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 03/10/2019] [Indexed: 11/19/2022]
Abstract
Lameness is a common animal health condition with significant production and welfare implications. The transdermal formulation of flunixin meglumine is the only approved drug for pain control in cattle in the United States. Thirty adult dairy cows were enrolled in a study to determine the effect of transdermal flunixin on cattle with induced lameness. Cows were allocated to 1 of 3 treatment groups, with 10 cows per group: lameness and flunixin (L+F), lameness and placebo (L+P), or sham induction and placebo (S+P). An arthritis-synovitis was induced in the distal interphalangeal joint of the left hind lateral digit, using 20 mg of amphotericin B, 6 h before the application of treatment. Cows enrolled into the sham induction group had 4 mL of isotonic saline injected into the joint. Cows were dosed with transdermal flunixin at 3.33 mg/kg (1 mL/15 kg), or a placebo at 1 mL/15 kg, every 24 h for 3 d. The first treatment of flunixin or placebo was considered the start of the study, identified as time 0 h. Data were collected from all cows for 120 h following the initial treatment application. Outcome measures included plasma cortisol; substance P; visual lameness assessment; mechanical nociception threshold (MNT), presented as difference between left and right feet; infrared thermography (IRT), presented as difference between left and right feet; and gait analysis using a pressure mat. Cortisol concentrations were lower for the L+F group starting at 1.5 h after drug administration. Substance P levels showed no evidence for treatment differences among groups. Differences between the left hind MNT and right hind MNT were detected, with S+P having the lowest difference at -0.04 kilograms-force (kgf; 95% CI: -1.86 to 1.78 kgf), and L+P having the highest at -2.96 kgf (95% CI: 1.55 to 4.36 kgf). The L+F group was intermediate at -2.08 kgf (95% CI: 0.89 to 3.27 kgf). Similarly, when the difference between the maximum temperatures of the coronary band were examined via IRT, the L+P group had the highest difference at 1.64°C (95% CI: 1.02 to 2.26°C), with the L+F and S+P groups measuring 0.57°C (95% CI: 0.06 to 1.08°C) and 0.53°C (95% CI: -0.2 to 1.25°C) respectively. We found no evidence for differences among treatment groups when analyzing force, contact pressure, step impulse, or stride length. Based on differences in MNT, IRT, and cortisol, transdermal flunixin is an effective analgesic agent for induced lameness. Multiple doses of transdermal flunixin may be required to be clinically effective, based on MNT and IRT data. Further investigation of transdermal flunixin and its analgesic effects is warranted in naturally occurring lameness.
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Affiliation(s)
- M D Kleinhenz
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames 50011
| | - P J Gorden
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames 50011
| | - J S Smith
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames 50011
| | - J A Schleining
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames 50011
| | - K E Kleinhenz
- Department of Animal Science, Iowa State University, Ames 50011
| | - J R Juarez
- Department of Animal Science, Iowa State University, Ames 50011
| | - D Rea
- Castle Veterinary Group, Downpatrick, Northern Ireland BT30 9JF
| | - J F Coetzee
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames 50011.
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50
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Cortes J, Rea D, Lipton JH. Treatment-free remission with first- and second-generation tyrosine kinase inhibitors. Am J Hematol 2019; 94:346-357. [PMID: 30394563 PMCID: PMC6587857 DOI: 10.1002/ajh.25342] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022]
Abstract
Chronic myeloid leukemia (CML) has become a chronic disease, for which the chronic phase is manageable with tyrosine kinase inhibitor (TKI) therapy. Patients with optimal responses to TKIs have achieved long-term survival, and treatment-free remission (TFR) has since become an additional treatment goal in CML. In this review, we discuss important factors to consider prior to stopping treatment. In addition, published and presented data with the first-generation TKI imatinib, as well as current clinical trials evaluating TFR with the second-generation TKIs dasatinib and nilotinib, are examined. Results obtained outside of clinical trials have been included as well. Because successful TKI discontinuation depends upon accurate BCR-ABL1 monitoring, emerging technologies are also discussed. Clinical data obtained to date indicate that for many patients who achieve deep molecular response (DMR) on TKI therapy, TFR is a safe treatment goal, and, if the response is lost, patients can expect to regain their responses immediately upon reinitiation of TKI. It is also clear that there remains much room for improvement to make TFR a successful reality for most patients. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation with safe monitoring in place.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Clinical Trials as Topic
- Dasatinib/therapeutic use
- Disease Management
- Drug Administration Schedule
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Monitoring, Physiologic
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- Remission Induction
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Jorge Cortes
- Department of LeukemiaUniversity of Texas MD Anderson Cancer CenterHoustonTexas
| | | | - Jeffrey H. Lipton
- Department of Medicine, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
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