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Aubrais R, Bouabdallah K, Chartier L, Herbaux C, Banos A, Brice P, Sibon D, Schiano JM, Cluzeau T, Laribi K, Le Calloch R, Bellal M, Delapierre B, Daguindau N, Amorim S, Agbetiafa K, Chauchet A, Besson C, Durot E, Bonnet C, Fouillet L, Bijou F, Tournilhac O, Gaulard P, Parrens MC, Damaj G. Salvage therapy with brentuximab-vedotin and bendamustine for patients with R/R PTCL: a retrospective study from the LYSA group. Blood Adv 2023; 7:5733-5742. [PMID: 36477770 PMCID: PMC10539874 DOI: 10.1182/bloodadvances.2022008524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with relapsed or refractory (R/R) peripheral T-cell lymphomas (PTCL) have a poor prognosis. Bendamustine (B) and brentuximab-vedotin (Bv) have shown interesting results in this setting. However, little information is available about their efficacy in combination. This multicenter and retrospective study aimed to evaluate the efficacy and safety of the combination of BBv in patients with noncutaneous R/R PTCL among 21 LYSA centers in France and Belgium. The primary objective was the overall response rate. A total of 82 patients with R/R PTCL were included. The best overall response rate (ORR) was 68%, with 49% of patients in complete response (CR). In multivariable analysis, only the disease status after the last regimen (relapse vs refractory) was associated with the response with an ORR of 83% vs 57%. Median duration of response was 15.4 months for patients in CR. With a median follow-up of 22 months, the median progression free survival (PFS) and overall survival (OS) were 8.3 and 26.3 months respectively. Moreover, patients in CR, who underwent an allogeneic transplant, had a better outcome than patients who did not with a median PFS and OS of 19.3 vs 4.8 months and not reached vs 12.4 months, respectively. Fifty-nine percent of patients experienced grade 3/4 adverse events that were mainly hematologic. BBv is highly active in patients with R/R PTCL and should be considered as a one of the best options of immunochemotherapy salvage combination in this setting and particularly as a bridge to allogeneic transplant for eligible patients.
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Affiliation(s)
- Raphaelle Aubrais
- Department of Hematology, Bordeaux University Hospital, Pessac, France
| | - Krimo Bouabdallah
- Department of Hematology, Bordeaux University Hospital, Pessac, France
| | - Loic Chartier
- Department of Biostatistics, The Lymphoma Academic Research Organization, Pierre-Bénite, France
| | - Charles Herbaux
- Department of Hematology, Montpellier University Hospital, Montpellier, France
| | - Anne Banos
- Department of Hematology, Centre Hospitalier de la Cote Basque Bayonne, Bayonne, France
| | - Pauline Brice
- Department of Hematology, Hôpital Saint-Louis, Paris, France
| | - David Sibon
- Department of Hematology, Hôpital Necker-Enfants maladies, Paris, France
| | - Jean Marc Schiano
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Thomas Cluzeau
- Department of Hematology, Nice University Hospital, Nice, France
| | - Kamel Laribi
- Department of Hematology, Centre Hospitalier du Mans, Le-Mans, France
| | - Ronan Le Calloch
- Department of Hematology, Centre Hospitalier de Cornouaille, Quimper, France
| | - Mathieu Bellal
- Hematology Institute, University Hospital, Normandy University, Caen, France
| | - Baptiste Delapierre
- Hematology Institute, University Hospital, Normandy University, Caen, France
| | - Nicolas Daguindau
- Department of Hematology, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Sandy Amorim
- Department of Hematology, Hopital Saint-Vincent, Lille, France
| | | | - Adrien Chauchet
- Department of Hematology, Besançon University Hospital, Besançon, France
| | - Caroline Besson
- Department of Hematology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Eric Durot
- Department of Hematology, Reims University Hospital, Reims, France
| | - Christophe Bonnet
- Department of Hematology, Liège University Hospital, Liège, Belgique
| | - Ludovic Fouillet
- Department of Hematology, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne, France
| | - Fontanet Bijou
- Department of Hematology, Institut Bergonie, Bordeaux, France
| | - Olivier Tournilhac
- Department of Hematology, Estaing University Hospital, Clermont-Ferrand, France
| | - Philippe Gaulard
- Department of Pathology, Henri Mondor Hospital, Université Paris-Est, Créteil, France
| | | | - Gandhi Damaj
- Hematology Institute, University Hospital, Normandy University, Caen, France
| | - Lymphoma Study Association
- Department of Hematology, Bordeaux University Hospital, Pessac, France
- Department of Biostatistics, The Lymphoma Academic Research Organization, Pierre-Bénite, France
- Department of Hematology, Montpellier University Hospital, Montpellier, France
- Department of Hematology, Centre Hospitalier de la Cote Basque Bayonne, Bayonne, France
- Department of Hematology, Hôpital Saint-Louis, Paris, France
- Department of Hematology, Hôpital Necker-Enfants maladies, Paris, France
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
- Department of Hematology, Nice University Hospital, Nice, France
- Department of Hematology, Centre Hospitalier du Mans, Le-Mans, France
- Department of Hematology, Centre Hospitalier de Cornouaille, Quimper, France
- Hematology Institute, University Hospital, Normandy University, Caen, France
- Department of Hematology, Centre Hospitalier Annecy Genevois, Annecy, France
- Department of Hematology, Hopital Saint-Vincent, Lille, France
- Department of Hematology, Institut Curie, Paris, France
- Department of Hematology, Besançon University Hospital, Besançon, France
- Department of Hematology, Centre Hospitalier de Versailles, Le Chesnay, France
- Department of Hematology, Reims University Hospital, Reims, France
- Department of Hematology, Liège University Hospital, Liège, Belgique
- Department of Hematology, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne, France
- Department of Hematology, Institut Bergonie, Bordeaux, France
- Department of Hematology, Estaing University Hospital, Clermont-Ferrand, France
- Department of Pathology, Henri Mondor Hospital, Université Paris-Est, Créteil, France
- Department of Pathology, Bordeaux University Hospital, Pessac, France
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2
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Costa BA, Mouhieddine TH, Ortiz RJ, Richter J. Revisiting the Role of Alkylating Agents in Multiple Myeloma: Up-to-Date Evidence and Future Perspectives. Crit Rev Oncol Hematol 2023; 187:104040. [PMID: 37244325 DOI: 10.1016/j.critrevonc.2023.104040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023] Open
Abstract
From the 1960s to the early 2000s, alkylating agents (e.g., melphalan, cyclophosphamide, and bendamustine) remained a key component of standard therapy for newly-diagnosed or relapsed/refractory multiple myeloma (MM). Later on, their associated toxicities (including second primary malignancies) and the unprecedented efficacy of novel therapies have led clinicians to increasingly consider alkylator-free approaches. Meanwhile, new alkylating agents (e.g., melflufen) and new applications of old alkylators (e.g., lymphodepletion before chimeric antigen receptor T-cell [CAR-T] therapy) have emerged in recent years. Given the expanding use of antigen-directed modalities (e.g., monoclonal antibodies, bispecific antibodies, and CAR-T therapy), this review explores the current and future role of alkylating agents in different treatment settings (e.g., induction, consolidation, stem cell mobilization, pre-transplant conditioning, salvage, bridging, and lymphodepleting chemotherapy) to ellucidate the role of alkylator-based regimens in modern-day MM management.
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Affiliation(s)
- Bruno Almeida Costa
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo J Ortiz
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Richter
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Shimizu T, Nakagawa K, Hayashi H, Iwasa T, Kawakami H, Watanabe S, Yamamoto N, Yonemori K, Koyama T, Sato J, Tamura K, Kikuchi K, Akaike K, Takeda S, Takeda M. Oral formulation of bendamustine hydrochloride for patients with advanced solid tumors; a phase 1 study. Invest New Drugs 2023; 41:1-12. [PMID: 36331674 PMCID: PMC10030450 DOI: 10.1007/s10637-022-01307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
To determine the maximum tolerated dose (MTD) and recommended dose (RD) of orally-administered bendamustine in Japanese patients with advanced solid tumors. The optimal dosing schedule, safety, pharmacokinetics, and preliminary antitumor effects were also evaluated. A multicenter, open-label trial with a standard 3 + 3 design and dose escalation by dose-limiting toxicity (DLT) was conducted. The treatment schedules were once daily for 7, 14, and 21 days every 3 weeks as one cycle. The total dose per cycle was increased from 175 to 840 mg/m2. Eighteen patients were enrolled in this study. DLT occurred in one of six patients at 75 mg/m2/day × 7 days, and one of three patients at 37.5 mg/m2/day × 14 days and 25 mg/m2/day × 21 days. However, the delayed recovery from a decrease in neutrophil or platelet count hampered the start of subsequent treatment cycles, and the trend was more prominent at 37.5 mg/m2/day × 14 days and 25 mg/m2/day × 21 days than in 75 mg/m2/day × 7 days. MTD was determined as 75 mg/m2/day × 7 days to allow acceptable hematologic recovery. The pharmacokinetics of orally-administered bendamustine were generally dose-dependent; however, the inter-individual variability is relatively large. The major adverse events were hematologic toxicities; gastrointestinal disorders were generally mild. Adverse drug reactions did not lead to the discontinuation of the drug. A partial response was observed in two of six patients (prostatic small cell carcinoma and thymic carcinoma) at 75 mg/m2/day × 7 days. The RD and optimal dosing schedule of orally-administered bendamustine was 75 mg/m2 once daily for 7 days every 3 weeks for the treatment of advanced solid tumors. (Trial registration number ClinicalTrials.gov NCT03604679. Registration date July 27, 2018).
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Affiliation(s)
- Toshio Shimizu
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, Japan.
- Department of Pulmonary Medicine and Medical Oncology, Wakayama Medical University Graduate School of Medicine, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama-City, Wakayama, Japan.
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, 377-2, Osakasayama-city, Osaka, Japan
| | - Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, 377-2, Osakasayama-city, Osaka, Japan
| | - Tsutomu Iwasa
- Department of Medical Oncology, Kindai University Faculty of Medicine, 377-2, Osakasayama-city, Osaka, Japan
| | - Hisato Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, 377-2, Osakasayama-city, Osaka, Japan
| | - Satomi Watanabe
- Department of Medical Oncology, Kindai University Faculty of Medicine, 377-2, Osakasayama-city, Osaka, Japan
| | - Noboru Yamamoto
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, Japan
| | - Kan Yonemori
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, Japan
| | - Takafumi Koyama
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, Japan
| | - Jun Sato
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, Japan
| | - Kenji Tamura
- Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, Japan
- Innovative Cancer Center / Department of Medical Oncology, Faculty of Medicine, Shimane University, 89-1. Enyacho Izumo-city, Shimane, Japan
| | - Keiichi Kikuchi
- SymBio Pharmaceuticals Limited, 3-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Kenichiro Akaike
- SymBio Pharmaceuticals Limited, 3-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Shiho Takeda
- SymBio Pharmaceuticals Limited, 3-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Kindai University Faculty of Medicine, 377-2, Osakasayama-city, Osaka, Japan
- Department of Cancer Genomics and Medical Oncology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, Japan
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Farag S, Bacher U, Jeker B, Legros M, Rhyner G, Lüthi JM, Schardt J, Zander T, Daskalakis M, Mansouri B, Manz C, Pabst T. Adding bendamustine to melphalan before ASCT improves CR rate in myeloma vs. melphalan alone: A randomized phase-2 trial. Bone Marrow Transplant 2022; 57:990-997. [PMID: 35444232 PMCID: PMC9018972 DOI: 10.1038/s41409-022-01681-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
Definite cure remains exceptional in myeloma patients even after high-dose chemotherapy (HDCT) with melphalan (Mel) and autologous stem cell transplantation (ASCT). Thus, improving efficacy of HDCT in MM remains an unresolved issue. This randomized phase II trial compared standard 200 mg/m2 Mel HDCT to experimental HDCT with 200 mg/m2 bendamustine, given both at days −4 and −3, combined with 100 mg/m2 melphalan at days −2 and −1 (BenMel) before ASCT as first-line consolidation in myeloma patients. The primary endpoint aimed to identify at least a 15% improvement in the complete remission rate (stringent CR + CR) after HDCT with BenMel compared with Mel alone. A total of 120 MM patients were 1:1 randomized. The rate of sCR/CR after ASCT was higher in BenMel than in Mel treated patients (70.0% vs. 51.7%; p = 0.039). Three patients in the BenMel group (5.0%) had reversible acute renal insufficiency compared with none in Mel patients. Minimal residual disease negativity (<10-5) by flow cytometry was observed in 26 (45.6%) BenMel patients and 22 (37.9%) in the Mel group (p = 0.375). Our data suggest that BenMel HDCT is safe and improves the sCR/CR rate compared with standard Mel alone.
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Affiliation(s)
- Sarah Farag
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Ulrike Bacher
- Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Barbara Jeker
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Myriam Legros
- Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.,Center of Laboratory Medicine (ZLM), Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Gaelle Rhyner
- Department of Oncology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | | | | | | | - Michael Daskalakis
- Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Behrouz Mansouri
- Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
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5
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Hirata A, Miyashita K, Tanaka T, Hirata K, Narazaki T, Utsunomiya H, Ohno H, Nakashima E, Tachikawa Y, Choi I, Taguchi K, Suehiro Y. Serum immunoglobulin G as a discriminator of infection in follicular lymphoma patients undergoing chemotherapy with bendamustine in combination with rituximab. Hematology 2022; 27:384-395. [PMID: 35344477 DOI: 10.1080/16078454.2022.2051863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Chemotherapy, including bendamustine, usually causes lymphocytopaenia and hypogammaglobulinaemia as side effects in patients with haematological malignancies. Therefore, the possibility has been considered that these immunological adverse events induced by bendamustine may lead to infectious diseases. However, lymphocytopaenia and/or hypogammaglobulinaemia have not yet been shown to have a statistically significant association with infection in cancer patients who receive bendamustine. METHODS We retrospectively studied 27 patients with relapsed or refractory indolent follicular lymphoma who were treated with bendamustine and rituximab (BR). In order to elucidate relationships between immune-related laboratory parameters (i.e. peripheral blood leukocyte, neutrophil, lymphocyte and immunoglobulin G [IgG]) and infectious events, receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were performed. RESULTS Infectious diseases occurred in 11 patients (11/27, 41%), including 3 (3/27, 11%) with severe diseases. The area under the ROC curve (AUC) showed that the lowest IgG level during and after BR discriminated infectious events (cut-off value, 603 mg/dL) with 81.8% sensitivity and 68.8% specificity (AUC, 0.76; 95% CI, 0.52-0.90). Furthermore, a multivariate regression analysis revealed that the minimal serum IgG value during and after BR therapy was the only variable that was significantly associated with infection (odds ratio, 8.29; 95% CI, 1.19-57.62; p value, 0.03). CONCLUSION Serum IgG ≤603 mg/dL during and after BR therapy was independently associated with an increased risk of infection. The monitoring of serum IgG during chemotherapy may help to predict the development of infection in blood cancer patients undergoing chemotherapy with bendamustine in combination with rituximab.
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Affiliation(s)
- Akie Hirata
- Department of Clinical Laboratory Medicine, NHO Kyushu Cancer Center, Fukuoka, Japan.,Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kaname Miyashita
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Takafumi Tanaka
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Kiyoko Hirata
- Department of Cell Therapy, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Taisuke Narazaki
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Hayato Utsunomiya
- Department of Cell Therapy, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Hirofumi Ohno
- Department of Cell Therapy, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Eriko Nakashima
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | | | - Ilseung Choi
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Kenichi Taguchi
- Department of Clinical Laboratory Medicine, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Youko Suehiro
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan.,Department of Cell Therapy, NHO Kyushu Cancer Center, Fukuoka, Japan
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Spini G, Mancini E, Attema T, Abspoel M, de Gier J, Fehr S, Veugen T, van Heesch M, Worm D, De Luca A, Cramer R, Sloot PM. New Approach to Privacy-Preserving Clinical Decision Support Systems for HIV Treatment. J Med Syst 2022; 46:84. [PMID: 36261621 PMCID: PMC9581834 DOI: 10.1007/s10916-022-01851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND HIV treatment prescription is a complex process. Clinical decision support systems (CDSS) are a category of health information technologies that can assist clinicians to choose optimal treatments based on clinical trials and expert knowledge. The usability of some CDSSs for HIV treatment would be significantly improved by using the knowledge obtained by treating other patients. This knowledge, however, is mainly contained in patient records, whose usage is restricted due to privacy and confidentiality constraints. METHODS A treatment effectiveness measure, containing valuable information for HIV treatment prescription, was defined and a method to extract this measure from patient records was developed. This method uses an advanced cryptographic technology, known as secure Multiparty Computation (henceforth referred to as MPC), to preserve the privacy of the patient records and the confidentiality of the clinicians' decisions. FINDINGS Our solution enables to compute an effectiveness measure of an HIV treatment, the average time-to-treatment-failure, while preserving privacy. Experimental results show that our solution, although at proof-of-concept stage, has good efficiency and provides a result to a query within 24 min for a dataset of realistic size. INTERPRETATION This paper presents a novel and efficient approach HIV clinical decision support systems, that harnesses the potential and insights acquired from treatment data, while preserving the privacy of patient records and the confidentiality of clinician decisions.
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Affiliation(s)
- Gabriele Spini
- Applied Cryptography and Quantum Algorithms, TNO, 96800, 2509 JE Postbus, The Hague, The Netherlands
| | - Emiliano Mancini
- Institute for Advanced Study, University of Amsterdam, Oude Turfmarkt 147, 1012 GC Amsterdam, The Netherlands ,Department of Global Health, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands ,Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Thomas Attema
- Applied Cryptography and Quantum Algorithms, TNO, 96800, 2509 JE Postbus, The Hague, The Netherlands ,Cryptology Group, CWI, P.O. Box 94079, 1090 GB Amsterdam, The Netherlands ,Mathematical Institute, Leiden University, P.O. Box 9512, 2300 RA Leiden, The Netherlands
| | - Mark Abspoel
- Cryptology Group, CWI, P.O. Box 94079, 1090 GB Amsterdam, The Netherlands ,Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands
| | - Jan de Gier
- Applied Cryptography and Quantum Algorithms, TNO, 96800, 2509 JE Postbus, The Hague, The Netherlands
| | - Serge Fehr
- Cryptology Group, CWI, P.O. Box 94079, 1090 GB Amsterdam, The Netherlands ,Mathematical Institute, Leiden University, P.O. Box 9512, 2300 RA Leiden, The Netherlands
| | - Thijs Veugen
- Applied Cryptography and Quantum Algorithms, TNO, 96800, 2509 JE Postbus, The Hague, The Netherlands ,Cryptology Group, CWI, P.O. Box 94079, 1090 GB Amsterdam, The Netherlands
| | - Maran van Heesch
- Applied Cryptography and Quantum Algorithms, TNO, 96800, 2509 JE Postbus, The Hague, The Netherlands
| | - Daniël Worm
- Applied Cryptography and Quantum Algorithms, TNO, 96800, 2509 JE Postbus, The Hague, The Netherlands
| | - Andrea De Luca
- Department of Medical Biotechnologies, University of Siena and Siena University Hospital, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Ronald Cramer
- Cryptology Group, CWI, P.O. Box 94079, 1090 GB Amsterdam, The Netherlands ,Mathematical Institute, Leiden University, P.O. Box 9512, 2300 RA Leiden, The Netherlands
| | - Peter M.A. Sloot
- Institute for Advanced Study, University of Amsterdam, Oude Turfmarkt 147, 1012 GC Amsterdam, The Netherlands ,Complexity Institute, Nanyang Technological University, Academic Building North, Level 1 Section B Unit No. 7 (ABN-01B-07), 61 Nanyang Drive, 637335 Singapore, Singapore ,Advanced Computing, ITMO University, Lomonosova street 9, 191002 Saint Petersburg, Russia
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7
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Aksenova AY, Zhuk AS, Lada AG, Zotova IV, Stepchenkova EI, Kostroma II, Gritsaev SV, Pavlov YI. Genome Instability in Multiple Myeloma: Facts and Factors. Cancers (Basel) 2021; 13:5949. [PMID: 34885058 PMCID: PMC8656811 DOI: 10.3390/cancers13235949] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple myeloma (MM) is a malignant neoplasm of terminally differentiated immunoglobulin-producing B lymphocytes called plasma cells. MM is the second most common hematologic malignancy, and it poses a heavy economic and social burden because it remains incurable and confers a profound disability to patients. Despite current progress in MM treatment, the disease invariably recurs, even after the transplantation of autologous hematopoietic stem cells (ASCT). Biological processes leading to a pathological myeloma clone and the mechanisms of further evolution of the disease are far from complete understanding. Genetically, MM is a complex disease that demonstrates a high level of heterogeneity. Myeloma genomes carry numerous genetic changes, including structural genome variations and chromosomal gains and losses, and these changes occur in combinations with point mutations affecting various cellular pathways, including genome maintenance. MM genome instability in its extreme is manifested in mutation kataegis and complex genomic rearrangements: chromothripsis, templated insertions, and chromoplexy. Chemotherapeutic agents used to treat MM add another level of complexity because many of them exacerbate genome instability. Genome abnormalities are driver events and deciphering their mechanisms will help understand the causes of MM and play a pivotal role in developing new therapies.
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Affiliation(s)
- Anna Y. Aksenova
- Laboratory of Amyloid Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Anna S. Zhuk
- International Laboratory “Computer Technologies”, ITMO University, 197101 St. Petersburg, Russia;
| | - Artem G. Lada
- Department of Microbiology and Molecular Genetics, University of California, Davis, CA 95616, USA;
| | - Irina V. Zotova
- Department of Genetics and Biotechnology, St. Petersburg State University, 199034 St. Petersburg, Russia; (I.V.Z.); (E.I.S.)
- Vavilov Institute of General Genetics, St. Petersburg Branch, Russian Academy of Sciences, 199034 St. Petersburg, Russia
| | - Elena I. Stepchenkova
- Department of Genetics and Biotechnology, St. Petersburg State University, 199034 St. Petersburg, Russia; (I.V.Z.); (E.I.S.)
- Vavilov Institute of General Genetics, St. Petersburg Branch, Russian Academy of Sciences, 199034 St. Petersburg, Russia
| | - Ivan I. Kostroma
- Russian Research Institute of Hematology and Transfusiology, 191024 St. Petersburg, Russia; (I.I.K.); (S.V.G.)
| | - Sergey V. Gritsaev
- Russian Research Institute of Hematology and Transfusiology, 191024 St. Petersburg, Russia; (I.I.K.); (S.V.G.)
| | - Youri I. Pavlov
- Eppley Institute for Research in Cancer, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Departments of Biochemistry and Molecular Biology, Microbiology and Pathology, Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE 68198, USA
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8
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Efficacy of first-line treatment options in transplant-ineligible multiple myeloma: A network meta-analysis. Crit Rev Oncol Hematol 2021; 168:103504. [PMID: 34673218 DOI: 10.1016/j.critrevonc.2021.103504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 08/30/2021] [Accepted: 10/10/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite major therapeutic advances, the rational choice of the most appropriate first-line regimen in newly diagnosed transplant-ineligible multiple myeloma (TIE-MM) is currently undefined. AIM We aimed to identify the most effective first-line treatment for TIE-MM patients. METHODS A total of 37 articles, including 34 treatments and 16,681 patients, were included in this Bayesian network meta-analysis. The outcomes of interest were risk ratios (RR) for progression-free survival (PFS) and overall survival (OS). RESULTS Based on surface under cumulative ranking curve values, daratumumab-bortezomib-melphalan-prednisone (Dara-VMP) and daratumumab-lenalidomide-dexamethasone (Dara-Rd28) showed superiority compared to other combinations regarding 12-, 24-, 36-, and 48-month PFS. Dara-VMP also ranked first for 12-, 24-, 36-, and 48-month OS. CONCLUSION Our finding supports the incorporation of daratumumab into first-line regimens. Additionally, these results highlight the relative benefit of incorporating novel agents like monoclonal antibodies, immunomodulatory derivatives, and proteasome inhibitors in combination with the currently existing treatment options.
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9
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Gay F, Günther A, Offidani M, Engelhardt M, Salvini M, Montefusco V, Patriarca F, Aquino S, Pönisch W, Spada S, Schub N, Gentili S, Wäsch R, Corradini P, Straka C, Palumbo A, Einsele H, Boccadoro M, Sonneveld P, Gramatzki M. Carfilzomib, bendamustine, and dexamethasone in patients with advanced multiple myeloma: The EMN09 phase 1/2 study of the European Myeloma Network. Cancer 2021; 127:3413-3421. [PMID: 34181755 DOI: 10.1002/cncr.33647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Combined therapy with carfilzomib, bendamustine, and dexamethasone was evaluated in this multicenter phase 1/2 trial conducted within the European Myeloma Network (EMN09 trial). METHODS Sixty-three patients with relapsed/refractory multiple myeloma who had received ≥2 lines of prior therapy were included. The phase 1 portion of the study determined the maximum tolerated dose of carfilzomib with bendamustine set at 70 mg/m2 on days 1 and 8. After 8 cycles, responding patients received maintenance therapy with carfilzomib and dexamethasone until progression. RESULTS On the basis of the phase 1 results, the recommended phase 2 dose for carfilzomib was 27 mg/m2 twice weekly in weeks 1, 2, and 3. Fifty-two percent of patients achieved a partial response or better, and 32% reached a very good partial response or better. The clinical benefit rate was 93%. After a median follow-up of 21.9 months, the median progression-free survival was 11.6 months, and the median overall survival was 30.4 months. The reported grade ≥3 hematologic adverse events (AEs) were lymphopenia (29%), neutropenia (25%), and thrombocytopenia (22%). The main nonhematologic grade ≥3 AEs were pneumonia, thromboembolic events (10%), cardiac AEs (8%), and hypertension (2%). CONCLUSIONS In heavily pretreated patients who have relapsed/refractory multiple myeloma, combined carfilzomib, bendamustine, and dexamethasone is an effective treatment option administered in the outpatient setting. Infection prophylaxis and attention to patients with cardiovascular predisposition are required.
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Affiliation(s)
- Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Andreas Günther
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
| | - Massimo Offidani
- Hematology Clinic, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Monika Engelhardt
- Department for Hematology and Oncology, University of Freiburg, Faculty of Freiburg, Freiburg, Germany
| | - Marco Salvini
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Vittorio Montefusco
- Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Sara Aquino
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Wolfram Pönisch
- Department of Hematology, University of Leipzig, Leipzig, Germany
| | - Stefano Spada
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Natalie Schub
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
| | | | - Ralph Wäsch
- Department for Hematology and Oncology, University of Freiburg, Faculty of Freiburg, Freiburg, Germany
| | - Paolo Corradini
- Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Christian Straka
- Department of Hematology and Oncology, Munich Clinic Schwabing, Munich, Germany
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Hermann Einsele
- Department of Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Pieter Sonneveld
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Martin Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
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10
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Schjesvold F, Oriol A. Current and Novel Alkylators in Multiple Myeloma. Cancers (Basel) 2021; 13:2465. [PMID: 34070213 PMCID: PMC8158783 DOI: 10.3390/cancers13102465] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/22/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
A large number of novel treatments for myeloma have been developed and approved; however, alkylating drugs continue to be part of standard regimens. Additionally, novel alkylators are currently being developed. We performed a non-systematized literary search for relevant papers and communications at large conferences, as well as exploiting the authors' knowledge of the field, to review the history, current use and novel concepts around the traditional alkylators cyclophosphamide, bendamustine and melphalan and current data on the newly developed pro-drug melflufen. Even in the era of targeted treatment and personalized medicine, alkylating drugs continue to be part of the standard-of-care in myeloma, and new alkylators are coming to the market.
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Affiliation(s)
- Fredrik Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, 0450 Oslo, Norway
- K.G. Jebsen Centre for B-Cell Malignancies, University of Oslo, 4950 Oslo, Norway
| | - Albert Oriol
- Institut Josep Carreras and Institut Català d’Oncologia, Hospital Germans Trias I Pujol, 08916 Badalona, Spain;
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11
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Dimopoulos MA, Moreau P, Terpos E, Mateos MV, Zweegman S, Cook G, Delforge M, Hájek R, Schjesvold F, Cavo M, Goldschmidt H, Facon T, Einsele H, Boccadoro M, San-Miguel J, Sonneveld P, Mey U. Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up †. Ann Oncol 2021; 32:309-322. [PMID: 33549387 DOI: 10.1016/j.annonc.2020.11.014] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M V Mateos
- University Hospital of Salamanca, IBSAL, Cancer Research Center, Salamanca, Spain
| | - S Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - G Cook
- Leeds Cancer Centre and University of Leeds, Leeds, UK
| | - M Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - R Hájek
- Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - F Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo; KG Jebsen Center for B Cell Malignancies, University of Oslo, Oslo, Norway
| | - M Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - H Goldschmidt
- University Hospital Heidelberg, Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - T Facon
- Hôpital Claude Huriez, Lille University Hospital, Lille, France
| | - H Einsele
- Department of Internal Medicine II, University Hospital Wurzburg, Wurzburg, Germany
| | - M Boccadoro
- Division of Hematology, University of Torino, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - J San-Miguel
- Clinica Universidad de Navarra, CIMA, IDISNA, CIBERONC, Pamplona, Spain
| | - P Sonneveld
- Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - U Mey
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
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12
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Multiple Myeloma: EHA-ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up. Hemasphere 2021; 5:e528. [PMID: 33554050 PMCID: PMC7861652 DOI: 10.1097/hs9.0000000000000528] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022] Open
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13
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Yang Y, Li Y, Gu H, Dong M, Cai Z. Emerging agents and regimens for multiple myeloma. J Hematol Oncol 2020; 13:150. [PMID: 33168044 PMCID: PMC7654052 DOI: 10.1186/s13045-020-00980-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/19/2020] [Indexed: 02/08/2023] Open
Abstract
The outcomes of multiple myeloma (MM) have been improved significantly with the therapies incorporating proteasome inhibitors (PI), immunomodulatory drugs, monoclonal antibodies (MoAb) and stem cell transplantation. However, relapsed and refractory MM (RRMM) remains a major challenge. Novel agents and regimens are under active clinical development. These include new PIs such as ixazomib, marizomib, and oprozomib; new MoAbs such as isatuximab and MOR202; novel epigenetic agent ricolinostat and novel cytokines such as siltuximab. Recently, the first XPO-1 inhibitor, selinexor, was approved for RRMM. BCMA-targeted BiTE, antibody-drug conjugates and CAR-T cells have the potential to revolutionize the therapy for RRMM. In this review, we summarized the latest clinical development of these novel agents and regimens.
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Affiliation(s)
- Yang Yang
- Bone Marrow Transplantation Center, Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi Li
- Bone Marrow Transplantation Center, Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Huiyao Gu
- Bone Marrow Transplantation Center, Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mengmeng Dong
- Bone Marrow Transplantation Center, Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhen Cai
- Bone Marrow Transplantation Center, Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China.
- Zhejiang Laboratory for Systems and Precision Medicine, Zhejiang University Medical Center, Hangzhou, Zhejiang, China.
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14
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Long-Term Effectiveness and Cost Effectiveness of Multiple Myeloma Treatment Strategies for Elderly Transplant-Ineligible Patients in Serbia. Zdr Varst 2020; 59:83-91. [PMID: 32952707 PMCID: PMC7478073 DOI: 10.2478/sjph-2020-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/13/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction Evidence on long-term effectiveness and cost effectiveness of treatment sequences for multiple myeloma (MM) is sparse. We used published data and country-specific data to assess the cost effectiveness of four-line treatment sequences for elderly transplant-ineligible patients with MM in Serbia. Method We developed a Markov cohort model to compare long-term effectiveness and cost effectiveness of five sequential MM treatment alternatives from the perspective of the national healthcare provider. Effectiveness parameters on progression, mortality and adverse events were extracted from published clinical trials. Costs were based on price lists of the National Health Insurance Fund. We compared life expectancy, costs, and incremental cost-effectiveness ratios among alternative courses of action. The model was analyzed over a lifelong time horizon applying a 3% annual discount rate for effectiveness outcomes and costs. Robustness of the model was tested in multiple deterministic sensitivity analyses. Results The sequences were defined by the frontline treatment: MPT (melphalan-prednisone-thalidomide), MPV (melphalanprednisone-bortezomib), CTD (cyclophosphamide-thalidomide-dexamethasone), VCD (bortezomib-cyclophosphamidedexamethasone) and BP (bendamustine-prednisone). MPV sequence resulted in the highest remaining life expectancy (4.76 life years). Cost-effectiveness analysis resulted in three non-dominated strategies: MPT, VCD, and MPV sequences, with an incremental cost-effectiveness ratio of EUR 35,300 per life-year gained (LYG) for VCD and EUR 47,200/LYG for MPV relative to MPT. Conclusion MPV sequence was the most effective in terms of life expectancy for elderly transplant-ineligible MM patients in Serbia. Bortezomib-based strategies would be recommended for the frontline treatment of patients with MM in Serbia if the willingness-to-pay threshold is around EUR 35,000-60,000/LYG.
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15
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Knauf W, Dingeldein G, Schlag R, Welslau M, Moehler T, Terzer T, Walter S, Habermehl C, Kunz C, Goldschmidt H, Raab MS. First-line therapy with bendamustine/prednisone/bortezomib-A GMMG trial for non-transplant eligible symptomatic multiple myeloma patients. Eur J Haematol 2020; 105:116-125. [PMID: 32155662 DOI: 10.1111/ejh.13409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The German-speaking Myeloma Multicenter Group (GMMG) conducted this trial to investigate efficacy and safety of the three-drug combination bendamustine/prednisone/bortezomib (BPV) as first-line therapy for elderly patients with multiple myeloma (MM). METHODS Elderly MM patients requiring first-line therapy and not eligible for intensive treatment were enrolled in this phase IIb multicenter study. Patients were treated with BPV regimen for a maximum of nine cycles. RESULTS Forty-six patients were included in the trial with a median age of 76 years. Nineteen patients had renal impairment at baseline. The ORR was 78.8% for patients treated with 3 and more BPV cycles and 71.1% for all evaluable patients. The median progression-free survival was 25 months, and overall survival at 24 months was 83.3%. The clinical benefit rate including MR was 91.2%. In patients with renal impairment at baseline, a renal response was observed in 11 pts. with complete recovery of the renal function in six patients. The most frequent CTC grade 3/4 AEs experienced by patients were hematological (17.5%) and infectious (9.8%) complications. No new safety signals were observed for the study drugs under investigation. CONCLUSIONS Bendamustine/prednisone/bortezomib may serve as a first-line regimen for transplant-ineligible elderly MM patients in particular for patients with renal impairment requiring a fast and durable renal response.
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Affiliation(s)
- Wolfgang Knauf
- Centrum Haematologie & Onkologie Bethanien, Frankfurt, Germany
| | | | - Rudolf Schlag
- Hämatologisch-Onkologische Schwerpunktpraxis, Würzburg, Germany
| | | | | | - Tobias Terzer
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Sarah Walter
- Koordinierungszentrum für klinische Studien Heidelberg, FRG, Heidelberg, Germany
| | - Christina Habermehl
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Christina Kunz
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Marc-Steffen Raab
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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16
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Abstract
The therapeutic landscape of multiple myeloma (MM) has dramatically changed in the last 15 years with the advent of immunomodulatory drugs and proteasome inhibitors. However, majority of MM patients relapse, and new therapies are needed. Various agents with diverse mechanisms of action and distinct targets, including cellular therapies, monoclonal antibodies, and small molecules, are currently under investigation. In this review, we report novel drugs recently approved or under advanced investigation that will likely be incorporated in the future as new standard for MM treatment, focusing on their mechanisms of action, cellular targets, and stage of development.
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Affiliation(s)
- Raphaël Szalat
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Section of Hematology and Oncology, Boston Medical Center, Boston, USA
| | - Nikhil C. Munshi
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- VA Boston Healthcare System, Boston, MA
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17
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DCEP and bendamustine/prednisone as salvage therapy for quad- and penta-refractory multiple myeloma. Ann Hematol 2020; 99:1041-1048. [PMID: 32130471 DOI: 10.1007/s00277-020-03970-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
Multiple myeloma (MM) almost invariably progresses through novel therapies. Patients with quad-refractory MM (refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide) and penta-refractory MM (additional refractoriness to daratumumab) have few treatment options. Two chemotherapy regimens, bendamustine/prednisone (BP) and dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP), are often used in quad- and penta-refractory MM, but there are limited data on outcomes in this heavily pre-treated population. We conducted a single-center retrospective study to identify all patients who received DCEP and/or BP for quad- or penta-refractory MM. Disease response and refractoriness were defined by International Myeloma Working Group criteria. The primary endpoint was overall response rate (ORR). Secondary endpoints included overall survival (OS), progression-free survival (PFS), and duration of response (DOR). We identified 27 patients who received BP for quad- or penta-refractory MM. The median number of prior lines of therapy was 6. The ORR for BP was 26%. The median PFS for BP was 1.4 months (95% CI 1.1-1.6) and median OS was 8.7 months (95% CI 2.3-15.0). Patients treated with cyclophosphamide had less response to BP. Thirty-one patients received DCEP for quad-refractory or penta-refractory MM. The median number of prior treatment regimens was 8. The ORR to DCEP was 35%. The median PFS was 2.7 months (95% CI 1.5-3.8) and median OS was 6.2 months (95% CI 4.4-7.8). DCEP and BP retain efficacy in quad- and penta-refractory MM. Our analysis supports prospective study of these regimens, possibly in combination or in comparison with other agents in this area of unmet need.
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18
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Lentzsch S, Lagos GG, Comenzo RL, Zonder JA, Osman K, Pan S, Bhutani D, Pregja S, Sanchorawala V, Landau H. Bendamustine With Dexamethasone in Relapsed/Refractory Systemic Light-Chain Amyloidosis: Results of a Phase II Study. J Clin Oncol 2020; 38:1455-1462. [PMID: 32083996 DOI: 10.1200/jco.19.01721] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE No established treatments exist for relapsed/refractory systemic light-chain (AL) amyloidosis. Bendamustine has shown potential in the treatment of multiple myeloma. We conducted a phase II, multicenter trial to assess the efficacy and safety of bendamustine with dexamethasone (ben-dex) in patients with persistent or progressive AL amyloidosis after ≥ 1 prior therapy. METHODS The trial enrolled 31 patients who received bendamustine on days 1 and 2 (100 mg/m2 intravenously) with 40 mg of weekly dexamethasone in 28-day cycles until disease progression or up to 6 cycles after complete hematologic response. The primary objective was the rate of partial hematologic response (PR) or better. RESULTS Patients received a median of 4 cycles (range, 2-12 cycles) with 57% of patients achieving a PR or better (11% complete response, 18% very good PR). The overall organ response was 29% among the 24 patients who had measurable organ involvement. Treatment was well tolerated with no grade 5 treatment-related adverse events (AEs). Sixty-five percent of patients had a therapy-related grade 3-4 AE. The most common AEs included myelosuppression, fatigue, and nausea/vomiting. The median overall survival was 18.2 months (95% CI, 11.3 to 43.8 months), and hematologic response was associated with prolonged survival (P = .0291). The median progression-free survival was 11.3 months (95% CI, 5.0 to 15.4 months). CONCLUSION Overall, ben-dex is a viable treatment option with substantial efficacy and limited toxicity for patients with pretreated AL amyloidosis who have limited therapeutic options. This trial was registered at (ClinicalTrials.gov identifier: NCT01222260).
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Affiliation(s)
- Suzanne Lentzsch
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | - Galina G Lagos
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | | | - Jeffrey A Zonder
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Keren Osman
- Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Samuel Pan
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | - Divaya Bhutani
- Division of Hematology/Oncology, Columbia University Medical Center, New York, NY
| | - Silva Pregja
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Heather Landau
- Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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19
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Sarlo KM, Dixon BN, Ni A, Straus DJ. Incidence of infectious complications with the combination of bendamustine and an anti-CD20 monoclonal antibody .. Leuk Lymphoma 2019; 61:364-369. [PMID: 31603363 DOI: 10.1080/10428194.2019.1666378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Combination of bendamustine (B) and rituximab (R) has been associated with opportunistic infections (OI) in case reports. This retrospective analysis evaluated the incidence, risk factors, and types of infectious complications (IC) in adults with CD20+ non-Hodgkin lymphoma who received ≥2 cycles of B and either R or ofatumumab. Infection data were collected up to 1-year post-B-based treatment. Potential risk factors for IC were assessed using univariate analysis with Fisher's exact test. Four-hundred and sixteen patients were included. Incidence of IC and OI was 20 and 6%, respectively. Viral (n = 19), fungal (n = 1), and Pneumocystis jiroveci pneumonia (n = 5) infections occurred. OI was associated with lack of antimicrobial prophylaxis analysis (p = .048). The incidences of IC and OI with B and anti-CD20 antibody combination at our institution appear lower than those previously reported, possibly due to antimicrobial prophylaxis and G-CSF use.
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Affiliation(s)
- Kristen M Sarlo
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Pharmaceutical Company, Daiichi Sankyo, Basking Ridge, NJ, USA
| | - Brianne N Dixon
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ai Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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20
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Gomez-Arteaga A, Mark TM, Guarneri D, Christos PJ, Gergis U, Greenberg JD, Hsu J, Mayer SA, Niesvizky R, Pearse RN, Phillips AA, Rossi A, Coleman M, van Besien K, Shore TB. High-dose bendamustine and melphalan conditioning for autologous stem cell transplantation for patients with multiple myeloma. Bone Marrow Transplant 2019; 54:2027-2038. [PMID: 31190006 DOI: 10.1038/s41409-019-0587-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 11/09/2022]
Abstract
High-dose melphalan (MEL200) followed by autologous stem cell transplantation (ASCT) remains a standard of care for multiple myeloma (MM). Bendamustine induces responses in MM resistant to other alkylators. Our prior Phase I trial adding bendamustine to MEL200 transplant conditioning resulted in no additional toxicity. We now report a single-arm, phase II study that evaluated the efficacy of bendamustine 225 mg/m2 with MEL200 conditioning for ASCT in 18 patients with newly diagnosed MM (NDMM) and 17 with relapsed or refractory MM (RRMM). The primary end point was the complete response (CR/sCR) rate at day+ 100. Sample size was determined according to Simon's two-stage design. At stage 1, sixteen patients entered the study. As there were eight patients with CR/sCR, enrollment increased to 28 patients. Sixteen out of the first 28 evaluable patients achieved CR/sCR, meeting the design criteria. Enrollment was then expanded to a total of 35 patients. 51% achieved a CR/sCR. After a median follow-up of 65 months, 21 patients progressed, including 7 deaths. The median PFS for NDMM and RRMM was 48 and 45 months, respectively. Bendamustine/MEL200 conditioning resulted in excellent overall and depth of response as well as PFS, particularly in the RRMM patients, and is worthy of further investigation (NCT00916058).
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Affiliation(s)
- Alexandra Gomez-Arteaga
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
| | - Tomer M Mark
- Department of Medicine, Division of Hematology, University of Colorado - Anschutz Medical Campus, New York, NY, USA
| | - Danielle Guarneri
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Paul J Christos
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Usama Gergis
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - June D Greenberg
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Jingmei Hsu
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Sebastian A Mayer
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Roger N Pearse
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Adrienne A Phillips
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Adriana Rossi
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Morton Coleman
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Koen van Besien
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Tsiporah B Shore
- Department of Medicine, Division of Hematology/Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
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21
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Farag S, Jeker B, Bacher U, Mansouri Taleghani B, Mueller BU, Novak U, Pabst T. Dose-intensified bendamustine and melphalan (BenMel) conditioning before second autologous transplantation in myeloma patients. Hematol Oncol 2018; 36:671-678. [PMID: 30110717 DOI: 10.1002/hon.2546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 12/13/2022]
Abstract
Consolidation in myeloma patients with high-dose melphalan chemotherapy (Mel HDCT) and autologous transplantation (ASCT) is standard of care since more than 2 decades. However, definite cure remains exceptional despite intensive treatment, and improving effectiveness of HDCT remains an unmet clinical need. Combining intensified bendamustine with melphalan may represent an option. We analyzed safety and efficacy of combining dose-intensified bendamustine (200 mg/m2 on days -4/-3) with high-dose melphalan (100 mg/m2 on days -2/-1) before a second (tandem) ASCT in adverse risk myeloma patients after Mel HDCT/ASCT1. Twelve patients received BenMel conditioning before ASCT2 because of high-risk cytogenetics and/or failure to achieve complete remission (CR) after Mel HDCT/ASCT1. Comparing Mel HDCT/ASCT1 and BenMel HDCT/ASCT2, we observed no differences in hematologic recovery and tolerance. Acute renal injury after BenMel conditioning occurred in 3 (25%) patients, but was reversible in all patients, and there were no treatment related deaths. Complete remission rates were increasing from 42% after Mel/ASCT1 to 75% after BenMel/ASCT2. PFS 1 year after ASCT2 was 67%, and OS was 83%. These data suggest that dose-intensified bendamustine with melphalan conditioning is safe and warrants a prospective randomized comparison to standard melphalan HDCT in myeloma patients.
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Affiliation(s)
- Sarah Farag
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Barbara Jeker
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Ulrike Bacher
- Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Beatrice U Mueller
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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22
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Lee JH, Yu SE, Kim KH, Yu MH, Jeong IH, Cho JY, Park SJ, Lee WJ, Han SS, Kim TH, Hong EK, Woo SM, Yoo BC. Individualized metabolic profiling stratifies pancreatic and biliary tract cancer: a useful tool for innovative screening programs and predictive strategies in healthcare. EPMA J 2018; 9:287-297. [PMID: 30174764 PMCID: PMC6107458 DOI: 10.1007/s13167-018-0147-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/31/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pancreatic cancer (PC) and biliary tract cancer (BTC) are highly aggressive cancers, characterized by their rarity, difficulty in diagnosis, and overall poor prognosis. Diagnosis of PC and BTC is complex and is made using a combination of appropriate clinical suspicion, imaging and endoscopic techniques, and cytopathological examination. However, the late-stage detection and poor prognosis of this tumor have led to an urgent need for biomarkers for early and/or predictive diagnosis and improved personalized treatments. WORKING HYPOTHESIS There are two hypotheses for focusing on low-mass metabolites in the blood. First, valuable information can be obtained from the masses and relative amounts of such metabolites, which present as low-mass ions (LMIs) in mass spectra. Second, metabolic profiling of individuals may provide important information regarding biological changes in disease states that is useful for the early diagnosis of PC and BTC. MATERIALS AND METHODS To assess whether profiling metabolites in serum can serve as a non-invasive screening tool for PC and BTC, 320 serum samples were obtained from patients with PC (n = 51), BTC (n = 39), colorectal cancer (CRC) (n = 100), and ovarian cancer (OVC) (n = 30), and from healthy control subjects (control) (n = 100). We obtained information on the relative amounts of metabolites, as LMIs, via triple time-of-flight mass spectrometry. All data were analyzed according to the peak area ratios of discriminative LMIs. RESULTS AND CONCLUSIONS The levels of the 14 discriminative LMIs were higher in the PC and BTC groups than in the control, CRC and OVC groups, but only two LMIs discriminated between PC and BTC: lysophosphatidylcholine (LysoPC) (16:0) and LysoPC(20:4). The levels of these two LysoPCs were also slightly lower in the PC/BTC/CRC/OVC groups compared with the control group. Taken together, the data showed that metabolic profiling can precisely denote the status of cancer, and, thus, could be useful for screening. This study not only details efficient methods to identify discriminative LMIs for cancer screening but also provides an example of metabolic profiling for distinguishing PC from BTC. Furthermore, the two metabolites [LysoPC(16:0), LysoPC(20:4)] shown to discriminate these diseases are potentially useful when combined with other, previously identified protein or metabolic biomarkers for predictive, preventive and personalized medical approach.
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Affiliation(s)
- Jun Hwa Lee
- Biomarker Branch, Research Institute, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Seung Eun Yu
- Biomarker Branch, Research Institute, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Kyung-Hee Kim
- Biomarker Branch, Research Institute, National Cancer Center, Goyang, 10408 Republic of Korea
- Omics Core Laboratory, Research Institute, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Myung Hyun Yu
- Biomarker Branch, Research Institute, National Cancer Center, Goyang, 10408 Republic of Korea
| | - In-Hye Jeong
- Biomarker Branch, Research Institute, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Jae Youl Cho
- Department of Genetic Engineering, Sungkyunkwan University, Suwon, 16419 Republic of Korea
| | - Sang-Jae Park
- Center for Liver Cancer, Hospital, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Woo Jin Lee
- Center for Liver Cancer, Hospital, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Sung-Sik Han
- Center for Liver Cancer, Hospital, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Tae Hyun Kim
- Center for Liver Cancer, Hospital, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Eun Kyung Hong
- Center for Liver Cancer, Hospital, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Sang Myung Woo
- Biomarker Branch, Research Institute, National Cancer Center, Goyang, 10408 Republic of Korea
- Center for Liver Cancer, Hospital, National Cancer Center, Goyang, 10408 Republic of Korea
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408 Republic of Korea
| | - Byong Chul Yoo
- Biomarker Branch, Research Institute, National Cancer Center, Goyang, 10408 Republic of Korea
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408 Republic of Korea
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23
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Abed H, Burke M, Nizarali N. Oral and dental management for people with multiple myeloma: clinical guidance for dental care providers. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/denu.2018.45.5.383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Hassan Abed
- Special Care Dentist, Department of Sedation and Special Care Dentistry, Floor 26, Tower Wing, Guy'S Hospital, London Bridge, SE1 9RT, UK
| | - Mary Burke
- Consultant in Sedation and Special Care Dentistry, Department of Sedation and Special Care Dentistry, Floor 26, Tower Wing, Guy's Hospital, London Bridge, SE1 9RT, UK
| | - Najla Nizarali
- Consultant in Sedation and Special Care Dentistry, Department of Sedation and Special Care Dentistry, Floor 26, Tower Wing, Guy's Hospital, London Bridge, SE1 9RT, UK
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24
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Pawlyn C, Gay F, Larocca A, Roy V, Ailawadhi S. Nuances in the Management of Older People With Multiple Myeloma. Curr Hematol Malig Rep 2017; 11:241-51. [PMID: 27038805 DOI: 10.1007/s11899-016-0323-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Multiple myeloma is a disease of the elderly, with about a third of patients at diagnosis older than 75 years of age. Yet, the population of elderly patients is heterogeneous: older patients are more likely to have comorbidities and frailties complicating both their initial diagnosis and subsequent management, but these are not consistent across the group. Furthermore, patients with comorbidities and frailty are generally underrepresented in clinical trials. Despite the survival of myeloma patients increasing following the introduction of novel agents, older patients continue to have worse outcomes with increased treatment-related toxicity. Treatment tolerability is not defined by age alone, rather a combination of age, physical function, cognitive function, and comorbidities. These factors all influence patients' tolerability of treatment and therefore treatment efficacy and should also be considered when reviewing the results of clinical trials. It is the nuances of determining how these factors interact that should influence initial treatment and ongoing management decisions and these will be discussed here.
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Affiliation(s)
- Charlotte Pawlyn
- The Institute of Cancer Research, 15, Cotswold Rd, Sutton, Surrey, SM2 5NG, UK.,The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Francesca Gay
- Dipartimento di Oncologia ed Ematologia, SC Ematologia 1, A.O. Citta' della Salute e della Scienza di Torino, P.O. Molinette, C.so Bramante 88/90, 10126, Torino, Italy.,Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - Alessandra Larocca
- Dipartimento di Oncologia ed Ematologia, SC Ematologia 1, A.O. Citta' della Salute e della Scienza di Torino, P.O. Molinette, C.so Bramante 88/90, 10126, Torino, Italy.,Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Torino, Turin, Italy
| | - Vivek Roy
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Sikander Ailawadhi
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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25
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Beck J, Schwarzer A, Gläser D, Mügge LO, Uhlig J, Heyn S, Kragl B, Mohren M, Hoffmann FA, Lange T, Schliwa T, Zehrfeld T, Becker C, Kreibich U, Winkelmann C, Edelmann T, Andrea M, Bill M, Jentzsch M, Schwind S, Niederwieser D, Pönisch W. Lenalidomide in combination with bendamustine and prednisolone in relapsed/refractory multiple myeloma: results of a phase 2 clinical trial (OSHO-#077). J Cancer Res Clin Oncol 2017; 143:2545-2553. [PMID: 28828689 DOI: 10.1007/s00432-017-2504-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/14/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION While lenalidomide monotherapy is established for relapsed and/or refractory multiple myeloma (MM) treatment, combination therapies including lenalidomide are still under investigation in a number of phase 2/3 studies. In the current study, a treatment regime of lenalidomide (Revlimid®), bendamustine and prednisolone (RBP) was tested in patients with relapsed/refractory MM. METHODS In the previously completed phase 1 study RBP with a dose of 75 mg/m2 bendamustine days 1-2, prednisolone 100 mg days 1-4 and 25 mg lenalidomide days 1-21 was well tolerated. RESULTS Between July 2011 and September 2013, 25 patients were included in this analysis. The median number of previous treatments was 1 (range 1-2). Twenty-two patients (88%) responded after at least two cycles of RBP (one sCR, five nCR, eight VGPR and eight PR). The median time to first haematological response was 28 days, and median time to best response was 56 days. Due to increased haematological toxicity a dose reduction in most patients required in subsequent cycles of therapy. The median progression-free and overall survival was 22 and 38 months, respectively. In conclusion RBP is a highly effective therapy for patients with relapsed/refractory MM. In contrast to our phase 1 study, dose reduction was necessary in many patients because of haematological toxicity.
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Affiliation(s)
- Juliane Beck
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany
| | | | - Dietrich Gläser
- Department of Haematology and Oncology, Klinikum Südstadt Rostock, Rostock, Germany
| | - Lars-Olof Mügge
- Department of Haematology and Oncology, University of Jena, Jena, Germany
| | - Jens Uhlig
- Haematology Practice, Schulstrasse 1, Naunhof, Germany
| | - Simone Heyn
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany
| | - Brigitte Kragl
- Department of Haematology and Oncology, University of Rostock, Rostock, Germany
| | - Martin Mohren
- Department of Haematology and Oncology, Johanniter Krankenhaus, Stendal, Germany
| | | | - Thoralf Lange
- Department of Haematology and Oncology, Asklepios Hospital, Weissenfels, Germany
| | - Thomas Schliwa
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany
| | - Thomas Zehrfeld
- Department of Haematology and Oncology, Hospital Johann Kentmann, Torgau, Germany
| | - Cornelia Becker
- Haematology Practice, Biedermannstrasse 84, Leipzig, Germany
| | - Ute Kreibich
- Department of Haematology and Oncology, Heinrich-Braun-Hospital, Zwickau, Germany
| | - Cornelia Winkelmann
- Department of Haematology and Oncology, Paul Gerhardt Stift, Wittenberg, Germany
| | - Thomas Edelmann
- Haematology Practice, Theodor-Heuss-Str. 2, Schkeuditz, Germany
| | - Marc Andrea
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany
| | - Marius Bill
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany
| | - Madlen Jentzsch
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany
| | - Sebastian Schwind
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany
| | - Dietger Niederwieser
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany
| | - Wolfram Pönisch
- Department of Haematology and Oncology, University of Leipzig, Johannisallee 32A, 04103, Leipzig, Germany.
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26
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Yalnız FF, Akkoç N, Salihoğlu A, Ar MC, Öngören Ş, Eşkazan AE, Soysal T, Aydın Y. Clinical Outcomes Related to the Use of Bendamustine Therapy for Multiple Myeloma Patients Relapsed/Refractory to Immunomodulatory Drugs and Proteasome Inhibitors. Turk J Haematol 2017; 34:233-238. [PMID: 28270368 PMCID: PMC5544042 DOI: 10.4274/tjh.2016.0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Multiple myeloma patients who are relapsed or refractory to both proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) have been reported to have poor outcomes. Bendamustine has been reported to have an antitumor effect in newly diagnosed as well as relapsed/refractory multiple myeloma (RRMM). The aim of this retrospective study was to evaluate the efficacy of bendamustine therapy in heavily pretreated MM patients who were refractory to PIs and IMiDs. Materials and Methods: Nineteen RRMM patients treated either with bendamustine and steroids (n=13) or a combination of bendamustine with novel drugs (n=6) were included. The median number of previous treatment lines was 5 (minimum-maximum: 3-8) and median time from diagnosis was 6 years (minimum-maximum: 1-16). All of the patients were resistant to at least one of the IMiDs and one of the PIs. Bendamustine was given at doses ranging from 90 mg/m2 to 120 mg/m2 on days 1 and 2 of 28-day cycles. Results: A median of 2 (minimum-maximum: 1-8) treatment cycles was administered per patient. The toxicity of bendamustine was mild and mostly of hematological origin. No complete remission was achieved. There was partial remission and stable disease in 21% and 11% of the patients, respectively. Sixty-eight percent of patients had progressive disease. The median progression-free survival and overall survival was 2 and 4 months, respectively. Conclusion: Bendamustine therapy was well tolerated but showed limited anti-myeloma activity in heavily pretreated patients who were refractory to IMiDs and PIs.
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Affiliation(s)
- Fevzi Fırat Yalnız
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
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27
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Besse L, Kraus M, Besse A, Bader J, Silzle T, Mehrling T, Driessen C. The first-in-class alkylating HDAC inhibitor EDO-S101 is highly synergistic with proteasome inhibition against multiple myeloma through activation of multiple pathways. Blood Cancer J 2017; 7:e589. [PMID: 28753594 PMCID: PMC5549260 DOI: 10.1038/bcj.2017.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- L Besse
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - M Kraus
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - A Besse
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - J Bader
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - T Silzle
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - T Mehrling
- Mundipharma-EDO GmbH, Basel, Switzerland
| | - C Driessen
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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28
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Gordon MJ, Lewis LD, Brown JR, Danilov AV. Bendamustine hydrochloride in patients with B-cell malignancies who have comorbidities - is there an optimal dose? Expert Rev Hematol 2017; 10:707-718. [PMID: 28664772 DOI: 10.1080/17474086.2017.1350166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The majority of patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) present with comorbidities. Many of them are poor candidates for intensive chemo-immunotherapy regimens, such as FCR (fludarabine, cyclophosphamide, rituximab). Still, most clinical trials aim to enroll 'fit' patients, who poorly represent the community oncology population. Areas covered: In the past decade, bendamustine hydrochloride, a cytotoxic agent with structural similarities to both alkylating agents and purine analogs, has received widespread use in therapy of NHL and CLL, and has demonstrated a relatively favorable toxicity profile. However, bendamustine has not been well studied in patients with hematologic malignancies who have comorbidities. Here we review the clinical data on use of bendamustine in older and unfit patients with NHL and CLL, and analyze whether there is an optimal dose of bendamustine in patients who have significant comorbidities, including renal dysfunction. Expert commentary: Reduced intensity regimens of bendamustine are effective in CLL patients with comorbidities and renal dysfunction. Even with the introduction of targeted therapies, bendamustine will likely continue to be an important therapeutic option in patients with comorbidities because of its tolerability, efficacy and cost.
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Affiliation(s)
- Max J Gordon
- a Department of Internal Medicine , Oregon Health & Science University , Portland , OR , USA
| | - Lionel D Lewis
- b Section of Clinical Pharmacology, Department of Medicine , The Geisel School of Medicine at Dartmouth and The Norris Cotton Cancer Center , Lebanon , NH , USA
| | - Jennifer R Brown
- c Department of Medical Oncology , Dana-Farber Cancer Institute , Boston , MA , USA
| | - Alexey V Danilov
- a Department of Internal Medicine , Oregon Health & Science University , Portland , OR , USA.,d Knight Cancer Institute , Oregon Health & Science University , Portland , OR , USA
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29
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Moreau P, San Miguel J, Sonneveld P, Mateos MV, Zamagni E, Avet-Loiseau H, Hajek R, Dimopoulos MA, Ludwig H, Einsele H, Zweegman S, Facon T, Cavo M, Terpos E, Goldschmidt H, Attal M, Buske C. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv52-iv61. [PMID: 28453614 DOI: 10.1093/annonc/mdx096] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P Moreau
- Haematology Department, University Hospital Hôtel-Dieu, Nantes, France
| | - J San Miguel
- Clinica Universidad de Navarra, CIMA, IDISNA, Pamplona, Spain
| | - P Sonneveld
- Erasmus Medical Center Institute, Rotterdam, The Netherlands
| | - M V Mateos
- University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - E Zamagni
- Seragnoli Institute of Hematology, School of Medicine, Bologna University, Bologna, Italy
| | - H Avet-Loiseau
- The Cancer Research Center of Toulouse, CRCT, INSERM U 1037, Toulouse, France
| | - R Hajek
- Faculty of Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, University of Athens, Athens, Greece
| | - H Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - H Einsele
- Department of Internal Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany
| | - S Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - T Facon
- University Hospital Huriez, Lille, France
| | - M Cavo
- Seragnoli Institute of Hematology, School of Medicine, Bologna University, Bologna, Italy
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, University of Athens, Athens, Greece
| | - H Goldschmidt
- Department of Medicine, University of Heidelberg, Heidelberg
| | - M Attal
- The Cancer Research Center of Toulouse, CRCT, INSERM U 1037, Toulouse, France
| | - C Buske
- Comprehensive Cancer Center Ulm and Department of Internal Medicine III, Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
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30
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López-Iglesias AA, Herrero AB, Chesi M, San-Segundo L, González-Méndez L, Hernández-García S, Misiewicz-Krzeminska I, Quwaider D, Martín-Sánchez M, Primo D, Paíno T, Bergsagel PL, Mehrling T, González-Díaz M, San-Miguel JF, Mateos MV, Gutiérrez NC, Garayoa M, Ocio EM. Preclinical anti-myeloma activity of EDO-S101, a new bendamustine-derived molecule with added HDACi activity, through potent DNA damage induction and impairment of DNA repair. J Hematol Oncol 2017. [PMID: 28633670 PMCID: PMC5477689 DOI: 10.1186/s13045-017-0495-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Despite recent advances in the treatment of multiple myeloma (MM), the prognosis of most patients remains poor, and resistance to traditional and new drugs frequently occurs. EDO-S101 is a novel therapeutic agent conceived as the fusion of a histone deacetylase inhibitor radical to bendamustine, with the aim of potentiating its alkylating activity. Methods The efficacy of EDO-S101 was evaluated in vitro, ex vivo and in vivo, alone, and in combination with standard anti-myeloma agents. The underlying mechanisms of action were also evaluated on MM cell lines, patient samples, and different murine models. Results EDO-S101 displayed potent activity in vitro in MM cell lines (IC50 1.6–4.8 μM) and ex vivo in cells isolated from MM patients, which was higher than that of bendamustine and independent of the p53 status and previous melphalan resistance. This activity was confirmed in vivo, in a CB17-SCID murine plasmacytoma model and in de novo Vk*MYC mice, leading to a significant survival improvement in both models. In addition, EDO-S101 was the only drug with single-agent activity in the multidrug resistant Vk12653 murine model. Attending to its mechanism of action, the molecule showed both, a HDACi effect (demonstrated by α-tubulin and histone hyperacetylation) and a DNA-damaging effect (shown by an increase in γH2AX); the latter being again clearly more potent than that of bendamustine. Using a reporter plasmid integrated into the genome of some MM cell lines, we demonstrate that, apart from inducing a potent DNA damage, EDO-S101 specifically inhibited the double strand break repair by the homologous recombination pathway. Moreover, EDO-S101 treatment reduced the recruitment of repair proteins such as RAD51 to DNA-damage sites identified as γH2AX foci. Finally, EDO-S101 preclinically synergized with bortezomib, both in vitro and in vivo. Conclusion These findings provide rationale for the clinical investigation of EDO-S101 in MM, either as a single agent or in combination with other anti-MM drugs, particularly proteasome inhibitors. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0495-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana-Alicia López-Iglesias
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Ana B Herrero
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Marta Chesi
- Comprehensive Cancer Center, Mayo Clinic, Arizona, USA
| | - Laura San-Segundo
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Lorena González-Méndez
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Susana Hernández-García
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | | | - Dalia Quwaider
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Montserrat Martín-Sánchez
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | | | - Teresa Paíno
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain.
| | | | | | - Marcos González-Díaz
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Jesús F San-Miguel
- Center for Applied Medical Research (CIMA), IDISNA, University Clinic of Navarra, Pamplona, Spain
| | - María-Victoria Mateos
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Norma C Gutiérrez
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Mercedes Garayoa
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
| | - Enrique M Ocio
- University Hospital of Salamanca (IBSAL) & Cancer Research Center (IBMCC-CSIC-USAL), Salamanca, Spain
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Tessenow H, Holzvogt M, Holzvogt B, Andrea M, Heyn S, Schliwa T, Schwarz M, Zehrfeld T, Becker C, Pfrepper C, Franke GN, Krahl R, Jentzsch M, Leiblein S, Schwind S, Bill M, Vucinic V, Lange T, Niederwieser D, Pönisch W. Successful treatment of patients with newly diagnosed/untreated light chain multiple myeloma with a combination of bendamustine, prednisone and bortezomib (BPV). J Cancer Res Clin Oncol 2017; 143:2049-2058. [DOI: 10.1007/s00432-017-2439-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 05/12/2017] [Indexed: 11/29/2022]
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32
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Sonneveld P, De Wit E, Moreau P. How have evolutions in strategies for the treatment of relapsed/refractory multiple myeloma translated into improved outcomes for patients? Crit Rev Oncol Hematol 2017; 112:153-170. [DOI: 10.1016/j.critrevonc.2017.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022] Open
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Soumerai JD, Zelenetz AD, Moskowitz CH, Palomba ML, Hamlin PA, Noy A, Straus DJ, Moskowitz AJ, Younes A, Matasar MJ, Horwitz SM, Portlock CS, Konner JA, Gounder MM, Hyman DM, Voss MH, Fury MG, Gajria D, Carvajal RD, Ho AL, Beumer JH, Kiesel B, Zhang Z, Chen A, Little RF, Jarjies C, Dang TO, France F, Mishra N, Gerecitano JF. The PARP Inhibitor Veliparib Can Be Safely Added to Bendamustine and Rituximab and Has Preliminary Evidence of Activity in B-Cell Lymphoma. Clin Cancer Res 2017; 23:4119-4126. [PMID: 28314788 DOI: 10.1158/1078-0432.ccr-16-3068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
Purpose: The PARP inhibitor veliparib enhances the cytotoxicity of alkylating agents. This phase I study evaluated veliparib with the bifunctional alkylator bendamustine (VB) in patients with relapsed/refractory lymphoma, multiple myeloma, and solid malignancies, with a cohort expansion of VB with rituximab (VBR) in patients with B-cell lymphomas.Experimental Design: This dose-escalation study evaluated safety, pharmacokinetics, and preliminary efficacy of veliparib (20-400 mg twice a day, days 1-7 of 28-day cycle) and bendamustine (70 and 90 mg/m2 intravenously, days 1 and 2). A cohort expansion was conducted, which combined veliparib and bendamustine at the maximum tolerated dose (MTD) with rituximab (375 mg/m2, day 1) in patients with B-cell lymphomas. Thirty-four patients were treated in seven dose-escalation cohorts and seven patients in the dose-expansion cohort.Results: The MTD was veliparib 300 mg twice daily plus bendamustine 90 mg/m2 Dose-limiting toxicities (DLT) were anemia, nausea, hypertension, and hyperhidrosis. Grade ≥3 toxicities included lymphopenia (87.8%), anemia (19.5%), neutropenia (12.2%), thrombocytopenia (9.8%), leukopenia (9.8%), nausea (7.3%), and hypophosphatemia (7.3%). Apparent veliparib clearance was slightly lower than previously reported. Of 14 patients with lymphoma evaluable for response, five of seven (71%) on VB and six of seven (86%) on VBR achieved objective response. One patient with multiple myeloma achieved partial response.Conclusions: VB and VBR were generally well-tolerated. VBR had preliminary clinical activity in patients with B-cell lymphoma, which warrants further investigation in a phase II trial. This trial was registered at www.clinicaltrials.gov as NCT01326702 Clin Cancer Res; 23(15); 4119-26. ©2017 AACR.
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Affiliation(s)
- Jacob D Soumerai
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig H Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - M Lia Palomba
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul A Hamlin
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ariela Noy
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David J Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison J Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anas Younes
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J Matasar
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol S Portlock
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jason A Konner
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mrinal M Gounder
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Hyman
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin H Voss
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew G Fury
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Devika Gajria
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard D Carvajal
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jan H Beumer
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian Kiesel
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alice Chen
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland
| | - Richard F Little
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland
| | | | - Thu O Dang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fallon France
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nishant Mishra
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - John F Gerecitano
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Center for Developmental Therapeutics, Memorial Sloan Kettering Cancer Center, New York, New York
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Berdeja JG, Bauer T, Arrowsmith E, Essell J, Murphy P, Reeves JA, Boccia RV, Donnellan W, Flinn I. Phase II study of bendamustine, bortezomib and dexamethasone (BBD) in the first-line treatment of patients with multiple myeloma who are not candidates for high dose chemotherapy. Br J Haematol 2017; 177:254-262. [PMID: 28169430 DOI: 10.1111/bjh.14536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/23/2016] [Indexed: 12/01/2022]
Abstract
The combination of bendamustine, bortezomib and dexamethasone (BBD) was evaluated as a first-line therapy for multiple myeloma. The original treatment regimen of bendamustine 80 mg/m2 , days 1, 4; bortezomib 1·3 mg/m2 , days 1, 4, 8, 11; dexamethasone 40 mg, days 1, 2, 3, 4 on a 28-day cycle (up to 8 cycles) was efficacious but determined relatively toxic in an interim analysis. The regimen was amended to bendamustine 80 mg/m2 , days 1, 2; bortezomib 1·3 mg/m2 , days 1, 8, 15; dexamethasone 20 mg, days 1, 2, 8, 9, 15, 16 every 28 days (up to 8 cycles), then maintenance 1·3 mg/m2 IV bortezomib every 2 weeks. Fifty-nine patients were enrolled. Primary endpoint was complete response (CR) rate. The original schema was given for a median of 7 cycles (range 1-8); modified schema was given for a median of 8 cycles (range 1-8) plus maintenance. Overall response was 91%, CR was 9%. Median follow-up was 19·1 months; median progression-free survival was 11·1 months and 18·9 months on the original and modified regimens, respectively. The most common Grade 3/4 adverse events were fatigue and neuropathy. The combination of BBD is tolerable and efficacious in this patient population. Modifications to decrease intensity but increase duration translated to better outcomes.
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Affiliation(s)
- Jesus G Berdeja
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Todd Bauer
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Edward Arrowsmith
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Chattanooga, TN, USA
| | - James Essell
- Sarah Cannon Research Institute, Nashville, TN, USA.,Oncology Hematology Care, Inc, Cincinnati, OH, USA
| | - Patrick Murphy
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - James A Reeves
- Sarah Cannon Research Institute, Nashville, TN, USA.,Florida Cancer Specialists, Ft. Myers, FL, USA
| | - Ralph V Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD, USA
| | - William Donnellan
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
| | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology PLLC, Nashville, TN, USA
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35
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Iwamoto K, Uehara Y, Inoue Y, Taguchi K, Muraoka D, Ogo N, Matsuno K, Asai A. Inhibition of STAT3 by Anticancer Drug Bendamustine. PLoS One 2017; 12:e0170709. [PMID: 28125678 PMCID: PMC5268383 DOI: 10.1371/journal.pone.0170709] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/09/2017] [Indexed: 01/05/2023] Open
Abstract
Bendamustine (BENDA), which bears the bis(2-chloroethyl)amino moiety, is an alkylating agent that stops the growth of cancer cells by binding to DNA and interfering with its replication. However, the mechanism of action underlying its excellent clinical efficacy remains unclear. In this work, we report that BENDA inhibits signal transducer and activator of transcription 3 (STAT3). In an AlphaScreen-based biochemical assay using recombinant human STAT3, binding of STAT3-Src homology 2 (SH2) to the phosphotyrosine (pTyr, pY) peptide was inhibited by BENDA but not by the inactive metabolite dihydroxy bendamustine (HP2). When a single point mutation of C550A or C712A was introduced into recombinant human STAT3, its sensitivity to BENDA was substantially reduced, suggesting that these cysteine residues are important for BENDA to inhibit STAT3. Furthermore, BENDA suppressed the function of cellular STAT3 as a transcriptional activator in a human breast cancer cell line, MDA-MB-468, with constitutively activated STAT3. A competitive pull-down assay using biotinylated BENDA (Bio-BENDA) revealed that BENDA bound tightly to cellular STAT3, presumably through covalent bonds. Therefore, our results suggest that the anticancer effects of BENDA may be associated, at least in part, with its inhibitory effect on the SH2 domain of STAT3.
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Affiliation(s)
- Kazunori Iwamoto
- Center for Drug Discovery, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yutaka Uehara
- Center for Drug Discovery, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yukie Inoue
- Center for Drug Discovery, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kyoko Taguchi
- Center for Drug Discovery, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Daisuke Muraoka
- Center for Drug Discovery, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Naohisa Ogo
- Center for Drug Discovery, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kenji Matsuno
- Center for Drug Discovery, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Akira Asai
- Center for Drug Discovery, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
- * E-mail:
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36
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Mey UJM, Brugger W, Schwarb H, Pederiva S, Schwarzer A, Dechow T, Jehner P, Rauh J, Taverna CJ, Schmid M, Schmidt-Hieber M, Doerfel S, Fischer N, Ruefer A, Ziske C, Knauf W, Cathomas R, von Moos R, Hitz F, Sauter R, Hiendlmeyer E, Cantoni N, Bargetzi M, Driessen C. Bendamustine, lenalidomide and dexamethasone (BRd) has high activity as 2nd-line therapy for relapsed and refractory multiple myeloma - a phase II trial. Br J Haematol 2016; 176:770-782. [DOI: 10.1111/bjh.14481] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/10/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Ulrich J. M. Mey
- Medical Oncology and Haematology; Kantonsspital Graubünden; Chur Switzerland
| | - Wolfram Brugger
- Haematology/Oncology; Schwarzwald-Baar-Klinikum; Villingen-Schwenningen Germany
| | - Heike Schwarb
- Department of Oncology; Kantonsspital Baden; Baden Switzerland
| | | | | | | | - Paul Jehner
- Haemato-Onkologische Praxis Moers; Moers Germany
| | - Jacqueline Rauh
- Fachinternistische Gemeinschaftspraxis und Therapiezentrum; Witten Germany
| | | | - Mathias Schmid
- Department of Medical Oncology and Haematology; Stadtspital Triemli; Zuerich Switzerland
| | - Martin Schmidt-Hieber
- Haematology, Oncology and Tumourimmunology; Helios Clinic Berlin-Buch; Berlin Germany
| | | | | | - Axel Ruefer
- Department of Haematology; Kantonsspital Luzern; Luzern Switzerland
| | - Carsten Ziske
- Haemato-Onkologische Schwerpunktpraxis Troisdorf; Troisdorf Germany
| | - Wolfgang Knauf
- Onkologische Gemeinschaftspraxis Frankfurt; Frankfurt Germany
| | - Richard Cathomas
- Medical Oncology and Haematology; Kantonsspital Graubünden; Chur Switzerland
| | - Roger von Moos
- Medical Oncology and Haematology; Kantonsspital Graubünden; Chur Switzerland
| | - Felicitas Hitz
- Department of Medical Oncology; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Rafael Sauter
- Clinical Trials Unit; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Elke Hiendlmeyer
- Clinical Trials Unit; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Nathan Cantoni
- Division of Haematology and Transfusion Medicine; Kantonsspital Aarau; Aarau Switzerland
| | - Mario Bargetzi
- Division of Haematology and Transfusion Medicine; Kantonsspital Aarau; Aarau Switzerland
| | - Christoph Driessen
- Department of Medical Oncology; Kantonsspital St. Gallen; St. Gallen Switzerland
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37
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Gafter-Gvili A, Gurion R, Raanani P, Shpilberg O, Vidal L. Bendamustine-associated infections-systematic review and meta-analysis of randomized controlled trials. Hematol Oncol 2016; 35:424-431. [PMID: 27734524 DOI: 10.1002/hon.2350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/05/2016] [Indexed: 11/06/2022]
Abstract
Data in the literature are lacking regarding the infection-related adverse events of bendamustine-containing regimens. Therefore, we aimed to assess this risk. We conducted a systematic review and meta-analysis of all randomized controlled trials including bendamustine-containing regimens and those administered for any lymphoproliferative disorder or plasma cell dyscrasia compared with any other regimens. A comprehensive search was conducted until December 2015. Two reviewers appraised the quality of trials and extracted data. Primary outcomes were any infections, grade 3 to 4 infections; secondary outcomes were grade 3 to 4 neutropenia and grade 3 to 4 lymphopenia. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated and pooled. A fixed-effect model was used to pool data unless there was significant heterogeneity, in which case a random-effects model was used. Nine trials published between 2006 and 2016 and randomizing 2620 patients were included. There was no statistically significant effect for bendamustine on the rate of any infection (RR 1.09 [95% CI, 0.87-1.36]) or on the rate of grade 3 to 4 infections (RR 1.04 [95% CI, 0.64-1.71]). There was no increase in the rate of grade 3 to 4 neutropenia in the bendamustine arm (RR 0.84 [95% CI, 0.63-1.12]). Our systematic review demonstrates no effect of bendamustine on the rate of infections when compared with either alkylating agents or fludarabine. Thus, bendamustine remains a safe therapeutic option.
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Affiliation(s)
- Anat Gafter-Gvili
- Institute of Hematology, Davidoff Cancer Center, Petah Tikva, Israel.,Medicine A, Rabin Medical Center, Petah-Tikva, Israel.,Sackler School of Medicine, Tel Aviv, Israel
| | - Ronit Gurion
- Institute of Hematology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv, Israel
| | - Ofer Shpilberg
- Department of Hematology, Assuta Medical Centers, Tel Aviv, Israel
| | - Liat Vidal
- Institute of Hematology, Davidoff Cancer Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv, Israel
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38
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Green DJ, Bensinger WI, Holmberg LA, Gooley T, Till BG, Budde LE, Pagel JM, Frayo SL, Roden JE, Hedin L, Press OW, Gopal AK. Bendamustine, etoposide and dexamethasone to mobilize peripheral blood hematopoietic stem cells for autologous transplantation in patients with multiple myeloma. Bone Marrow Transplant 2016; 51:1330-1336. [PMID: 27214069 PMCID: PMC5052091 DOI: 10.1038/bmt.2016.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 12/11/2022]
Abstract
Chemotherapeutic agents without cross-resistance to prior therapies may enhance PBSC collection and improve patient outcomes by exacting a more potent direct antitumor effect before autologous stem cell transplant. Bendamustine has broad clinical activity in transplantable lymphoid malignancies, but concern remains over the potential adverse impact of this combined alkylator-nucleoside analog on stem cell mobilization. We performed a prospective, nonrandomized phase II study including 34 patients with multiple myeloma (MM) (n=34; International Staging System (ISS) stages I (35%), II (29%) and III (24%); not scored (13%)) to evaluate bendamustine's efficacy and safety as a stem cell mobilizing agent. Patients received bendamustine (120 mg/m2 IV days 1, 2), etoposide (200 mg/m2 IV days 1-3) and dexamethasone (40 mg PO days 1- 4) (bendamustine, etoposide and dexamethasone (BED)) followed by filgrastim (10 μg/kg/day SC; through collection). All patients (100%) successfully yielded stem cells (median of 21.60 × 106/kg of body weight; range 9.24-55.5 × 106/kg), and 88% required a single apheresis. Six nonhematologic serious adverse events were observed in 6 patients including: neutropenic fever (1, grade 3), bone pain (1, grade 3) and renal insufficiency (1, grade 1). In conclusion, BED safely and effectively mobilizes hematopoietic stem cells.
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Affiliation(s)
- Damian J. Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - William I. Bensinger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Leona A. Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brian G. Till
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lihua E. Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - John M. Pagel
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shani L. Frayo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jennifer E. Roden
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lacey Hedin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Oliver W. Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ajay K. Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Zagouri F, Terpos E, Kastritis E, Dimopoulos MA. Emerging antibodies for the treatment of multiple myeloma. Expert Opin Emerg Drugs 2016; 21:225-37. [DOI: 10.1080/14728214.2016.1186644] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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40
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Plenis A, Frolow A, Rekowska N, Olędzka I, Kowalski P, Bień E, Krawczyk MA, Adamkiewicz-Drożynska E, Bączek T. Determination of Bendamustine in Human Plasma and Urine by LC-FL Methods: Application in a Drug Monitoring. Chromatographia 2016; 79:861-873. [PMID: 27429473 PMCID: PMC4930483 DOI: 10.1007/s10337-016-3103-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/28/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Abstract
Simple and sensitive liquid chromatography (LC) methods with fluorescence (FL) detection for the determination of bendamustine (BM) in human plasma and urine were developed and validated. The procedure of BM extraction from a plasma sample involved solid-phase extraction with a C18 SPE column, while liquid–liquid extraction with dichloromethane was applied for a urine sample. In both methods, cinoxacin was used as the internal standard. Chromatographic separations were performed on a Synergi Max-RP column, while FL detector was set at the excitation wavelength of 328 nm and the emission wavelength of 420 nm. The LC-FL methods were validated for accuracy, precision, selectivity, linearity, recovery, and stability. The detection limits for BM were 0.5 and 2.5 ng mL−1 in plasma and urine, respectively. The intra-day and inter-day precisions were less than 9.86 %, while the accuracies were higher than 92.63 and 94.29 % for BM in plasma and urine, respectively. The proposed LC-FL methods were sensitive, robust, and specific, allowing reliable drug quantification in plasma and urine samples. The methodologies were successfully applied to monitoring of BM in a child with cancer treated with BM.
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Affiliation(s)
- Alina Plenis
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Agnieszka Frolow
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Natalia Rekowska
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Ilona Olędzka
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Piotr Kowalski
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Ewa Bień
- Department of Pediatris, Hematology and Oncology; Medical University Gdansk, Debinki 7, 80-11 Gdansk, Poland
| | - Małgorzata Anna Krawczyk
- Department of Pediatris, Hematology and Oncology; Medical University Gdansk, Debinki 7, 80-11 Gdansk, Poland
| | | | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
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Abstract
Multiple myeloma (MM) is a disease of the elderly, with a median age at diagnosis of approximately 70 years old, and more than 30 % of patients aged >75 years. This latter and very elderly population is going to significantly rise in the near future given the increase in life expectancy in Western countries, and, most importantly, global health status of elderly patients is improving, justifying appropriate treatments. Changes in treatment paradigm from the old melphalan-prednisone regimen used since the 1970s to its use as a backbone in a nontransplant setting since the late 1990s have highlighted different subgroups in elderly MM. Some "elderly" patients could be treated like transplant eligible patients, more likely those aged between 65 and the early 70; while a second group would rather be referred to current approved treatment regimens for the non-transplant setting. A dose-intensity approach seems reasonable for this group, aiming for the best response, eventually the complete response (CR) or even minimal residual disease (MRD). The advent of novel agents such as thalidomide, bortezomib, and most recently lenalidomide have allowed a major improvement in outcome as compared to historical combinations, and soon the novel class of monoclonal antibodies should help to further improve these patients' survival. Nonetheless, elderly patients are more susceptible to side effects and are often unable to tolerate full drug doses, and thus require lower dose intensity regimens, or novel drugs or combinations with more favourable safety profile. Recent developments in MM have focused on identifying these vulnerable patients through geriatric assessment and novel myeloma scoring system, including the notions of frailty, disability and comorbidities. Eventually, we have reached an era in which we should be able to provide individualized treatment strategies and drug doses-"tailored therapy"-to improve tolerability and optimize efficacy and ultimately survival for most elderly MM patients.
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Gentilini F, Brunetti G, Finsinger P, Chisini M, Cartoni C, Foà R, Petrucci MT. Bendamustine and dexamethasone are an effective salvage regimen for patients with advanced multiple myeloma in a Home Care Unit program. Leuk Lymphoma 2015; 57:1716-8. [PMID: 26694230 DOI: 10.3109/10428194.2015.1106531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Fabiana Gentilini
- a Department of Cellular Biotechnologies and Hematology , "Sapienza" University , Via Benevento 6 , Rome 00153 , Italy
| | - Gregorio Brunetti
- a Department of Cellular Biotechnologies and Hematology , "Sapienza" University , Via Benevento 6 , Rome 00153 , Italy
| | - Paola Finsinger
- a Department of Cellular Biotechnologies and Hematology , "Sapienza" University , Via Benevento 6 , Rome 00153 , Italy
| | - Marta Chisini
- a Department of Cellular Biotechnologies and Hematology , "Sapienza" University , Via Benevento 6 , Rome 00153 , Italy
| | - Claudio Cartoni
- a Department of Cellular Biotechnologies and Hematology , "Sapienza" University , Via Benevento 6 , Rome 00153 , Italy
| | - Robin Foà
- a Department of Cellular Biotechnologies and Hematology , "Sapienza" University , Via Benevento 6 , Rome 00153 , Italy
| | - Maria Teresa Petrucci
- a Department of Cellular Biotechnologies and Hematology , "Sapienza" University , Via Benevento 6 , Rome 00153 , Italy
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Gafter-Gvili A, Polliack A. Bendamustine associated immune suppression and infections during therapy of hematological malignancies. Leuk Lymphoma 2015; 57:512-9. [PMID: 26696321 DOI: 10.3109/10428194.2015.1110748] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bendamustine is being increasingly used in patients with indolent non-Hodgkin lymphoma, mantle cell lymphoma and chronic lymphocytic leukemia. This review summarizes available evidence regarding the effects of bendamustine on the immune system, examines its role in consequent infections as reported in randomized controlled trials, prospective observational investigations, retrospective studies and individual published case reports. Myelosuppression including lymphopenia occurs relatively frequently after therapy with bendamustine. It is mostly CD4 + T cell counts that are suppressed, yet when given in combination with rituximab, both T cell and B cell depletion have been recorded. In addition, hypogammaglobulinemia after bendamustine therapy has also been reported. Variable infection rates have been documented and these include different bacterial, viral and fungal infections. Finally, we also consider issues relating to the use of prophylactic antibiotics in patients receiving the drug.
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Affiliation(s)
- Anat Gafter-Gvili
- a Department of Medicine A , Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel ;,b Sackler School of Medicine , Tel-Aviv , Israel
| | - Aaron Polliack
- c Department of Hematology , Hadassah University Hospital and Hebrew University Medical School , Ein Karem , Jerusalem , Israel
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Kumar SK, Krishnan A, LaPlant B, Laumann K, Roy V, Zimmerman T, Gertz MA, Buadi FK, Stockerl Goldstein K, Birgin A, Fiala M, Duarte L, Maharaj M, Levy J, Vij R. Bendamustine, lenalidomide, and dexamethasone (BRD) is highly effective with durable responses in relapsed multiple myeloma. Am J Hematol 2015; 90:1106-10. [PMID: 26331432 DOI: 10.1002/ajh.24181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 11/05/2022]
Abstract
Bendamustine is a multifunctional alkylating agent with single agent activity in myeloma. We designed the current phase 1/2 trial to determine the maximum tolerated doses (MTD) of bendamustine that can be safely combined with lenalidomide and dexamethasone and to assess the safety and efficacy of the combination. Patients with relapsed MM following at least 1 prior therapy, but no more than four lines of prior therapy and with measurable disease were enrolled. Bendamustine 75 mg/m(2) given on days 1 and 2, lenalidomide 25 mg given days 1-21 and dexamethasone 40 mg on days 1, 8, 15, and 22, was the recommended Phase 2 dose. Seventy-one patients were accrued: 21 on Phase 1 and 50 on Phase 2. The median age was 62.3 years; patients had a median of three prior lines of therapy (range 1-4), with over 70% of the patients having received prior lenalidomide, bortezomib, and/or peripheral blood stem cell transplant. Thirty-four of 70 (49%) patients had a confirmed partial response or better, including 20 patients (29%) with a very good partial response or better. An additional 4 patients had a minor response, translating to an overall 55% clinical benefit rate. Grade 3 or higher toxicity was seen in 96% of patients, with ≥grade 3 hematologic in 94% and nonhematologic in 50%. The median progression free survival was 11.8 months and the median duration of response was 23 months. The combination of bendamustine, lenalidomide, and dexamethasone is very effective in relapsed multiple myeloma with high response rates and durable responses
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Affiliation(s)
- Shaji K Kumar
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Betsy LaPlant
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Vivek Roy
- Division of Hematology and Oncology; Mayo Clinic; Jacksonville Florida
| | - Todd Zimmerman
- Division of Hematology; Univerity of Chicago; Chicago Illinois
| | - Morie A Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Keith Stockerl Goldstein
- Division of Hematology; Washington University; St.Louis Missouri
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Ann Birgin
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Mark Fiala
- Division of Hematology; Washington University; St.Louis Missouri
| | - Lupe Duarte
- Division of Hematology; City of Hope; Duarte California
| | - Michelle Maharaj
- Division of Hematology and Oncology; Mayo Clinic; Jacksonville Florida
| | - Joan Levy
- Multiple Myeloma Research Consortium; Norwalk Connecticut
| | - Ravi Vij
- Division of Hematology; Washington University; St.Louis Missouri
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Cheson BD, Brugger W, Damaj G, Dreyling M, Kahl B, Kimby E, Ogura M, Weidmann E, Wendtner CM, Zinzani PL. Optimal use of bendamustine in hematologic disorders: Treatment recommendations from an international consensus panel - an update. Leuk Lymphoma 2015; 57:766-82. [PMID: 26592922 PMCID: PMC4840280 DOI: 10.3109/10428194.2015.1099647] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Bendamustine has achieved widespread international regulatory approval and is a standard agent for the treatment for chronic lymphocytic leukemia (CLL), indolent non-Hodgkin lymphoma and multiple myeloma. Since approval, the number of indications for bendamustine has expanded to include aggressive non-Hodgkin lymphoma and Hodgkin lymphoma and novel targeted therapies, based on new bendamustine regimens/combinations, are being developed against CLL and lymphomas. In 2010, an international panel of bendamustine experts met and published a set of recommendations on the safe and effective use of bendamustine in patients suffering from hematologic disorders. In 2014, this panel met again to update these recommendations since the clarification of issues including optimal dosing and management of bendamustine-related toxicities. The aim of this report is to communicate the latest consensus on the use of bendamustine, permitting the expansion of its safe and effective administration, particularly in new combination therapies.
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Affiliation(s)
- Bruce D Cheson
- a Lombardi Comprehensive Cancer Center, Georgetown University Hospital , Washington , DC , USA
| | - Wolfram Brugger
- b Schwarzwald-Baar Clinic, University of Freiburg , Villingen-Schwenningen , Germany
| | - Gandhi Damaj
- c University Hospital, University of Basse-Normandie , Caen , France
| | - Martin Dreyling
- d Medical Clinic, University Hospital of Munich , Munich , Germany
| | - Brad Kahl
- e University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Eva Kimby
- f Center for Hematology, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Michinori Ogura
- g Department of Hematology , Tokai Central Hospital , Gifu , Japan
| | - Eckhart Weidmann
- h Department of Oncology and Hematology , Krankenhaus Nordwest , Frankfurt , Germany
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Chung CG, Poligone B. Other Chemotherapeutic Agents in Cutaneous T-Cell Lymphoma. Dermatol Clin 2015; 33:787-805. [DOI: 10.1016/j.det.2015.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cejalvo MJ, de la Rubia J. Clinical treatment of newly diagnosed multiple myeloma. Expert Rev Hematol 2015; 8:595-611. [DOI: 10.1586/17474086.2015.1078236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Broijl A, Sonneveld P. An update in treatment options for multiple myeloma in nontransplant eligible patients. Expert Opin Pharmacother 2015; 16:1945-57. [PMID: 26245702 DOI: 10.1517/14656566.2015.1075507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Despite the fact that multiple myeloma (MM) is still an incurable disease, the outcome of patients who are eligible and ineligible for high-dose therapy has dramatically improved with the introduction of novel agents, that is proteasome inhibitors (PIs) and immunomodulatory agents (IMiDs). However, this improvement is often not seen in elderly patients (above 75 years). AREAS COVERED This review will focus on the impact of known prognostic factors in elderly MM patients, and risk factors to identify frail elderly patients. Furthermore, data on known and novel PIs and IMiDs, as well as data on other promising novel treatment strategies, chosen based on current practice and anticipated timely approval, will be discussed. Novel treatment strategies include the use of monoclonal antibodies, such as elotuzumab, daratumumab, SAR650984 and more targeted therapies, such as histone deacetylase inhibitors, kinesin spindle protein inhibitors, and selective inhibitors of nuclear export. EXPERT OPINION Besides efficacy of treatment, toxicity and quality of life play an important role in treatment choice. Treatment and treatment dosing for the frail elderly as well as risk factors to identify the frail elderly require further consideration, as these patients frequently do not benefit from these novel agents due to early discontinuation of treatment due to toxicity.
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Affiliation(s)
- Annemiek Broijl
- Erasmus MC Cancer Institute (EMC), Department of Hematology , P.O. Box 2040, 3000 CA, Rotterdam , The Netherlands
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Mateos MV, Oriol A, Rosiñol L, de Arriba F, Puig N, Martín J, Martínez-López J, Echeveste MA, Sarrá J, Ocio E, Ramírez G, Martínez R, Palomera L, Payer A, Iglesias R, de la Rubia J, Alegre A, Chinea AI, Bladé J, Lahuerta JJ, San Miguel JF. Bendamustine, bortezomib and prednisone for the treatment of patients with newly diagnosed multiple myeloma: results of a prospective phase 2 Spanish/PETHEMA trial. Haematologica 2015; 100:1096-102. [PMID: 25911554 PMCID: PMC5004426 DOI: 10.3324/haematol.2015.124818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/22/2015] [Indexed: 11/09/2022] Open
Abstract
Bendamustine is a bifunctional alkylating agent with proven activity in myeloma. In this study 60 newly diagnosed myeloma patients were given bendamustine plus bortezomib and prednisone in a regimen consisting of one cycle of bortezomib twice weekly for 6 weeks (1.3 mg/m(2) on days 1, 4, 8, 11, 22, 25, 29, and 32), plus bendamustine (90 mg/m(2) on days 1 and 4) and prednisone. The following cycles included bortezomib once weekly. Patients who were transplant candidates proceeded to stem cell collection after four cycles and the transplant was performed after six cycles. Patients who were not candidates for transplantation received up to nine cycles. Forty-two patients were transplant candidates and after six cycles, 50% achieved at least a very good partial response, with 24% having complete responses; 35 proceeded to a transplant, and the complete response rate was 54%. Seventeen patients continued up to nine cycles, and 57% achieved at least a very good partial response, including 26% with complete responses. The 2-year progression-free survival and overall survival rates were 62% and 86%, respectively. The safety profile was manageable, but stem cell mobilization was compromised in 35% of patients. In summary, this combination is effective in untreated patients, with an acceptable toxicity profile, but given the introduction of second-generation novel agents and monoclonal antibodies, the combination will probably be better reserved for relapsing patients, in whom stem cell collection is not needed, while cost-effective combinations with non-cross-resistant drugs continue to represent a medical need. This trial was registered with ClinicalTrials.gov, number NCT01376401.
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Affiliation(s)
| | | | - Laura Rosiñol
- Hospital Clinic i Provincial, Institut d'Investigasions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona
| | | | - Noemí Puig
- University Hospital of Salamanca/IBSAL, Salamanca
| | | | | | | | - Josep Sarrá
- Hospital Universitario Joan XXIII de Tarragona, Institut Català d'Oncologia (ICO)
| | - Enrique Ocio
- University Hospital of Salamanca/IBSAL, Salamanca
| | | | | | | | - Angel Payer
- Hospital Universitario Central de Asturias, Oviedo
| | | | - Javier de la Rubia
- Hospital Dr Peset and Universidad Católica de Valencia "San Vicente Mártir"
| | | | | | - Joan Bladé
- Hospital Clinic i Provincial, Institut d'Investigasions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona
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Huber S, Huettner JP, Hacker K, Bernhardt G, König J, Buschauer A. Esters of Bendamustine Are by Far More Potent Cytotoxic Agents than the Parent Compound against Human Sarcoma and Carcinoma Cells. PLoS One 2015. [PMID: 26196503 PMCID: PMC4721923 DOI: 10.1371/journal.pone.0133743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The alkylating agent bendamustine is approved for the treatment of hematopoietic malignancies such as non-Hodgkin lymphoma, chronic lymphocytic leukemia and multiple myeloma. As preliminary data on recently disclosed bendamustine esters suggested increased cytotoxicity, we investigated representative derivatives in more detail. Especially basic esters, which are positively charged under physiological conditions, were in the crystal violet and the MTT assay up to approximately 100 times more effective than bendamustine, paralleled by a higher fraction of early apoptotic cancer cells and increased expression of p53. Analytical studies performed with bendamustine and representative esters revealed pronounced cellular accumulation of the derivatives compared to the parent compound. In particular, the pyrrolidinoethyl ester showed a high enrichment in tumor cells and inhibition of OCT1- and OCT3-mediated transport processes, suggesting organic cation transporters to be involved. However, this hypothesis was not supported by the differential expression of OCT1 (SLC22A1) and OCT3 (SLC22A3), comparing a panel of human cancer cells. Bendamustine esters proved to be considerably more potent cytotoxic agents than the parent compound against a broad panel of human cancer cell types, including hematologic and solid malignancies (e.g. malignant melanoma, colorectal carcinoma and lung cancer), which are resistant to bendamustine. Interestingly, spontaneously immortalized human keratinocytes, as a model of “normal” cells, were by far less sensitive than tumor cells against the most potent bendamustine esters.
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Affiliation(s)
- Stefan Huber
- Pharmaceutical and Medicinal Chemistry II, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Johannes Philip Huettner
- Pharmacology and Toxicology, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Kristina Hacker
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Günther Bernhardt
- Pharmaceutical and Medicinal Chemistry II, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Jörg König
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Armin Buschauer
- Pharmaceutical and Medicinal Chemistry II, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
- * E-mail:
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