1
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Franco S, Geng X, Korostyshevskiy V, Karp JE, Lai C. Systematic review and meta-analysis: Prognostic impact of time from diagnosis to treatment in patients with acute myeloid leukemia. Cancer 2023; 129:2975-2985. [PMID: 37254580 DOI: 10.1002/cncr.34894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/11/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) has been considered an oncologic emergency that requires initiation of chemotherapy immediately after diagnosis. With the introduction of novel targeted therapies, there is a potential benefit associated with delaying definitive treatment for identification of actionable therapeutic targets. Unfortunately, cytogenetic/molecular testing can take >7 days to return, and there is not a consensus regarding the prognostic impact of time from diagnosis to treatment (TDT) in AML. METHODS A literature review and meta-analysis of studies done to date that evaluate TDT was conducted. Studies that reported baseline characteristics, TDT, and outcomes for patients with AML were selected. Outcomes included overall survival (OS), complete remission (CR), and mortality. Studies that measured CR rates within each TDT range and data to calculate odds ratios were included in the meta-analysis. The remaining outcomes were synthesized descriptively for literature review. RESULTS Thirteen studies were identified, which comprised a total of 14,946 patients. Median TDT values were between 1 and 8 days. Several studies found a significant association between prolonged TDT and older age and lower proliferation burden. Four of 11 studies did not detect a significant relationship between TDT and OS. No studies found a significant association between TDT and early death. Six of eight studies did not find a significant association between TDT and CR rate. The meta-analysis found a significant association between prolonged TDT and decreased achievement of CR (p < .05). CONCLUSIONS Results were highly variable but suggest it may be feasible to pursue cytogenetic/molecular testing in patients who are clinically stable, particularly in those aged 60 years and older.
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Affiliation(s)
- Stephanie Franco
- Department of Internal Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Xue Geng
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Valeriy Korostyshevskiy
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Judith E Karp
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Hochman MJ, Othus M, Hasserjian RP, Ambinder A, Brunner A, Percival MEM, Hourigan CS, Swords R, DeZern AE, Estey EH, Karp JE. Prognostic impact of secondary versus de novo ontogeny in acute myeloid leukemia is accounted for by the European LeukemiaNet 2022 risk classification. Leukemia 2023; 37:1915-1918. [PMID: 37524919 PMCID: PMC10457181 DOI: 10.1038/s41375-023-01985-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
Secondary AML (sAML), defined by either history of antecedent hematologic disease (AHD) or prior genotoxic therapy (tAML), is classically regarded as having worse prognosis than de novo disease (dnAML). Clinicians may infer a new AML diagnosis is secondary based on a history of antecedent blood count (ABC) abnormalities in the absence of known prior AHD, but whether abnormal ABCs are associated with worse outcomes is unclear. Secondary-type mutations have recently been incorporated into the European LeukemiaNet (ELN) 2022 guidelines as adverse-risk features, raising the question of whether clinical descriptors of ontogeny (i.e., de novo or secondary) are prognostically significant when accounting for genetic risk by ELN 2022. In a large multicenter cohort of patients (n = 734), we found that abnormal ABCs are not independently prognostic after adjusting for genetic characteristics in dnAML patients. Furthermore, history of AHD and tAML do not confer increased risk of death compared to dnAML on multivariate analysis, suggesting the prognostic impact of ontogeny is accounted for by disease genetics as stratified by ELN 2022 risk and TP53 mutation status. These findings emphasize the importance that disease genetics should play in risk stratification and clinical trial eligibility in AML.
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Affiliation(s)
- Michael J Hochman
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Alex Ambinder
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew Brunner
- Leukemia Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Mary-Elizabeth M Percival
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christopher S Hourigan
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ronan Swords
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Amy E DeZern
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Elihu H Estey
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Judith E Karp
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
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3
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Frankel PH, Groshen S, Beumer JH, Cleveland L, Kim ES, Karp JE. Ethics and Clinical Research: Improving Transparency and Informed Consent in Phase I Oncology Trials. J Clin Oncol 2023; 41:2155-2158. [PMID: 36724409 PMCID: PMC10448934 DOI: 10.1200/jco.22.01736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/15/2022] [Accepted: 11/18/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Paul H. Frankel
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA
| | - Susan Groshen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Jan H. Beumer
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | - Judith E. Karp
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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4
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Cook MR, Karp JE, Lai C. The spectrum of genetic mutations in myelodysplastic syndrome: Should we update prognostication? EJHaem 2022; 3:301-313. [PMID: 35846202 PMCID: PMC9176033 DOI: 10.1002/jha2.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 06/12/2023]
Abstract
The natural history of patients with myelodysplastic syndrome (MDS) is dependent upon the presence and magnitude of diverse genetic and molecular aberrations. The International Prognostic Scoring System (IPSS) and revised IPSS (IPSS-R) are the most widely used classification and prognostic systems; however, somatic mutations are not currently incorporated into these systems, despite evidence of their independent impact on prognosis. Our manuscript reviews prognostic information for TP53, EZH2, DNMT3A, ASXL1, RUNX1, SRSF2, CBL, IDH 1/2, TET2, BCOR, ETV6, GATA2, U2AF1, ZRSR2, RAS, STAG2, and SF3B1. Mutations in TP53, EZH2, ASXL1, DNMT3A, RUNX1, SRSF2, and CBL have extensive evidence for their negative impact on survival, whereas SF3B1 is the lone mutation carrying a favorable prognosis. We use the existing literature to propose the incorporation of somatic mutations into the IPSS-R. More data are needed to define the broad spectrum of other genetic lesions, as well as the impact of variant allele frequencies, class of mutation, and impact of multiple interactive genomic lesions. We postulate that the incorporation of these data into MDS prognostication systems will not only enhance our therapeutic decision making but lead to targeted treatment in an attempt to improve outcomes in this formidable disease.
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Affiliation(s)
- Michael R. Cook
- Division of Hematology and OncologyLombardi Comprehensive Cancer CenterGeorgetown University HospitalWashingtonDistrict of ColumbiaUSA
| | - Judith E. Karp
- Divison of Hematology and OncologyThe Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University HospitalBaltimoreMarylandUSA
| | - Catherine Lai
- Division of Hematology and OncologyLombardi Comprehensive Cancer CenterGeorgetown University HospitalWashingtonDistrict of ColumbiaUSA
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5
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Carraway HE, Sawalha Y, Gojo I, Lee MJ, Lee S, Tomita Y, Yuno A, Greer J, Smith BD, Pratz KW, Levis MJ, Gore SD, Ghosh N, Dezern A, Blackford AL, Baer MR, Gore L, Piekarz R, Trepel JB, Karp JE. Phase 1 study of the histone deacetylase inhibitor entinostat plus clofarabine for poor-risk Philadelphia chromosome-negative (newly diagnosed older adults or adults with relapsed refractory disease) acute lymphoblastic leukemia or biphenotypic leukemia. Leuk Res 2021; 110:106707. [PMID: 34563945 DOI: 10.1016/j.leukres.2021.106707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 08/22/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite advances in immunotherapies, the prognosis for adults with Philadelphia chromosome-negative, newly diagnosed (ND) or relapsed/refractory (R/R) acute lymphoblastic leukemia/acute biphenotypic leukemia (ALL/ABL) remains poor. The benzamide derivative entinostat inhibits histone deacetylase and induces histone hyperacetylation. The purine nucleoside analogue clofarabine is FDA-approved for R/R ALL in children 1-21 years of age. Low doses of clofarabine have been reported to induce DNA hypomethylation. We conducted a phase 1 study of low dose clofarabine with escalating doses of entinostat in adults with ND or R/R ALL/ABL. EXPERIMENTAL DESIGN Adults ≥60 years with ND ALL/ABL or ≥21 years with R/R ALL/ABL received repeated cycles every 3 weeks of entinostat (4 mg, 6 mg or 8 mg orally days 1 and 8) and clofarabine (10 mg/m2/day IV for 5 days, days 3-7) (Arm A). Adults aged 40-59 years with ND ALL/ABL or age ≥21 years in first relapse received entinostat and clofarabine prior to traditional chemotherapy on day 11 (Arm B). Changes in DNA damage, global protein lysine acetylation, myeloid-derived suppressor cells and monocytes were measured in PBMCs before and during therapy. RESULTS Twenty-eight patients were treated at three entinostat dose levels with the maximum administered dose being entinostat 8 mg. The regimen was well tolerated with infectious and metabolic derangements more common in the older population versus the younger cohort. There was no severe hyperglycemia and no peripheral neuropathy in this small study. There were 2 deaths (1 sepsis, 1 intracranial bleed). Overall response rate was 32 %; it was 50 % for ND ALL/ABL. Entinostat increased global protein acetylation and inhibited immunosuppressive monocyte subpopulations, while clofarabine induced DNA damage in all cell subsets examined. CONCLUSION Entinostat plus clofarabine appears to be tolerable and active in older adults with ND ALL/ABL, but less active in R/R patients. Further evaluation of this regimen in ND ALL/ABL appears warranted.
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Affiliation(s)
- Hetty E Carraway
- Hematology Oncology Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Yazeed Sawalha
- Arthur G. James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Ivana Gojo
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, United States
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, United States
| | - Sunmin Lee
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, United States
| | - Yusuke Tomita
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, United States
| | - Akira Yuno
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, United States
| | - Jackie Greer
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, United States
| | - B Douglas Smith
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, United States
| | - Keith W Pratz
- The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, United States
| | - Steven D Gore
- Cancer Therapy Evaluation Program (CTEP), National Cancer Institute, NIH, Bethesda, MD, United States
| | - Nilanjan Ghosh
- Atrium Health, Carolinas HealthCare System, Charlotte, NC, United States
| | - Amy Dezern
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, United States
| | - Amanda L Blackford
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, United States
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, United States
| | - Lia Gore
- University of Colorado Cancer Center, Aurora, CO, United States
| | - Richard Piekarz
- Cancer Therapy Evaluation Program (CTEP), National Cancer Institute, NIH, Bethesda, MD, United States
| | - Jane B Trepel
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, United States
| | - Judith E Karp
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, MD, United States
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6
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Doucette K, Percival ME, Williams L, Kandahari A, Taylor A, Wang S, Ahn J, Karp JE, Lai C. Hypoalbuminemia as a prognostic biomarker for higher mortality and treatment complications in acute myeloid leukemia. Hematol Oncol 2021; 39:697-706. [PMID: 34499366 DOI: 10.1002/hon.2925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/05/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022]
Abstract
Older age and poor performance status lead to worse outcomes in acute myeloid leukemia (AML) patients. Hypoalbuminemia is a negative predictor of morbidity and mortality in several malignancies. We evaluated the relationship between baseline serum albumin levels on treatment-related complications, as well as short-term mortality and overall survival (OS) in 756 newly diagnosed AML patients. We conducted a retrospective multicenter study to examine treatment-related complications and OS according to pretreatment serum albumin levels: normal albumin ≥3.5 g/dl, marked hypoalbuminemia <2.5 g/dl, and hypoalbuminemia 2.5-3.4 g/dl. In an adjusted multivariate analysis, a lower baseline albumin was independently associated with a higher number of grade ≥3 complications when adjusting for age, secondary AML, sex and intensive treatment. When comparing normal to markedly low albumin levels, the estimated mean number of complications increases by a factor of 1.35. Patients who had a normal baseline albumin had a 30 day-mortality rate of 4.8%, which was significantly lower compared with patients with hypoalbuminemia (16.5%) and marked hypoalbuminemia (33.9%; p < 0.01). Similarly, 60-day mortality rate was significantly higher in the hypoalbuminemia group (24.0%) and marked hypoalbuminemia group (45%) compared with normal albumin group (8.3%; p < 0.01). Patients with lower baseline albumin levels have increased treatment-related morbidity and mortality, suggesting that pre-treatment serum albumin is an important independent prognostic marker.
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Affiliation(s)
- Kimberley Doucette
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Mary-Elizabeth Percival
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lacey Williams
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Adrese Kandahari
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allison Taylor
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Shuqi Wang
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Jaeil Ahn
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith E Karp
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Catherine Lai
- Division of Hematology/Oncology, Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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7
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Williams L, Doucette K, Karp JE, Lai C. Genetics of donor cell leukemia in acute myelogenous leukemia and myelodysplastic syndrome. Bone Marrow Transplant 2021; 56:1535-1549. [PMID: 33686252 DOI: 10.1038/s41409-021-01214-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 01/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is an important therapeutic modality for patients with acute myelogenous leukemia (AML) with poor risk features. Nonetheless, roughly 30% of such patients have leukemia recurrence and up to 2% of these are donor-derived leukemias, in which malignancy develops in the donor's transplanted cells, despite extremely low rates of leukemia in the donors themselves. Notably, over 20% of these malignancies carry chromosome 7 abnormalities nearly all of which are monosomies. Recent advances in whole exome and genome sequencing have allowed for detection of candidate genes that likely contribute to the development of AML in donor cells (donor leukemia, DCL). These genes include CEBPA, GATA2, JAK2, RUNX1, DDX41, EZH2, IDH1/2, DNMT3A, ASXL1, XPD, XRCC3, and CHEK1. The potential roles of variants in these genes are evaluated based on familial clustering of MDS/AML and corresponding animal studies demonstrating their leukemogenic nature. This review describes the spectrum of genetic aberrations detected in DCL cases in the literature with regard to the character of the individual cases, existing family cohorts that carry individual genes, and functional studies that support etiologic roles in AML development. DCL presents a unique opportunity to examine genetic variants in the donors and recipients with regards to progression to malignancy.
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Affiliation(s)
- Lacey Williams
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Kimberley Doucette
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith E Karp
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine Lai
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
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8
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Ding H, Vincelette ND, McGehee CD, Kohorst MA, Koh BD, Venkatachalam A, Meng XW, Schneider PA, Flatten KS, Peterson KL, Correia C, Lee SH, Patnaik M, Webster JA, Ghiaur G, Smith BD, Karp JE, Pratz KW, Li H, Karnitz LM, Kaufmann SH. CDK2-Mediated Upregulation of TNFα as a Mechanism of Selective Cytotoxicity in Acute Leukemia. Cancer Res 2021; 81:2666-2678. [PMID: 33414171 DOI: 10.1158/0008-5472.can-20-1504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/21/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
Although inhibitors of the kinases CHK1, ATR, and WEE1 are undergoing clinical testing, it remains unclear how these three classes of agents kill susceptible cells and whether they utilize the same cytotoxic mechanism. Here we observed that CHK1 inhibition induces apoptosis in a subset of acute leukemia cell lines in vitro, including TP53-null acute myeloid leukemia (AML) and BCR/ABL-positive acute lymphoid leukemia (ALL), and inhibits leukemic colony formation in clinical AML samples ex vivo. In further studies, downregulation or inhibition of CHK1 triggered signaling in sensitive human acute leukemia cell lines that involved CDK2 activation followed by AP1-dependent TNF transactivation, TNFα production, and engagement of a TNFR1- and BID-dependent apoptotic pathway. AML lines that were intrinsically resistant to CHK1 inhibition exhibited high CHK1 expression and were sensitized by CHK1 downregulation. Signaling through this same CDK2-AP1-TNF cytotoxic pathway was also initiated by ATR or WEE1 inhibitors in vitro and during CHK1 inhibitor treatment of AML xenografts in vivo. Collectively, these observations not only identify new contributors to the antileukemic cell action of CHK1, ATR, and WEE1 inhibitors, but also delineate a previously undescribed pathway leading from aberrant CDK2 activation to death ligand-induced killing that can potentially be exploited for acute leukemia treatment. SIGNIFICANCE: This study demonstrates that replication checkpoint inhibitors can kill AML cells through a pathway involving AP1-mediated TNF gene activation and subsequent TP53-independent, TNFα-induced apoptosis, which can potentially be exploited clinically.
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Affiliation(s)
- Husheng Ding
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota. .,Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Nicole D Vincelette
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Cordelia D McGehee
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Mira A Kohorst
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Brian D Koh
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Annapoorna Venkatachalam
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - X Wei Meng
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | | | - Karen S Flatten
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Peterson
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Cristina Correia
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Sun-Hee Lee
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Mrinal Patnaik
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Gabriel Ghiaur
- Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - B Douglas Smith
- Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Judith E Karp
- Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Keith W Pratz
- Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Hu Li
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Larry M Karnitz
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Scott H Kaufmann
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota. .,Division of Oncology Research, Mayo Clinic, Rochester, Minnesota.,Division of Hematology, Mayo Clinic, Rochester, Minnesota
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9
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Litzow MR, Wang XV, Carroll MP, Karp JE, Ketterling RP, Zhang Y, Kaufmann SH, Lazarus HM, Luger SM, Paietta EM, Pratz KW, Tun HW, Altman JK, Broun ER, Rybka WB, Rowe JM, Tallman MS. A randomized trial of three novel regimens for recurrent acute myeloid leukemia demonstrates the continuing challenge of treating this difficult disease. Am J Hematol 2019; 94:111-117. [PMID: 30370956 DOI: 10.1002/ajh.25333] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/21/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022]
Abstract
To improve the outcome of relapsed/refractory acute myeloid leukemia (AML), a randomized phase II trial of three novel regimens was conducted. Ninety patients were enrolled and were in first relapse or were refractory to induction/re-induction chemotherapy. They were randomized to the following regimens: carboplatin-topotecan (CT), each by continuous infusion for 5 days; alvocidib (formerly flavopiridol), cytarabine, and mitoxantrone (FLAM) in a timed sequential regimen; or sirolimus combined with mitoxantrone, etoposide, and cytarabine (S-MEC). The primary objective was attainment of a complete remission (CR). A Simon two-stage design was used for each of the three arms. The median age of the patients in the FLAM arm was older at 62 years compared with 55 years for the CT arm and the S-MEC arm. The overall response was 14% in the CT arm (5/35, 90% CI 7%-35%), 28% in the FLAM arm (10/36, 90% CI, 16%-43%), and 16% in the S-MEC arm (3/19, 90% CI, 4%-36%). There were nine treatment-related deaths, seven of which occurred in the FLAM arm with four of these in elderly patients. We conclude that the FLAM regimen had an encouraging response rate and should be considered for further clinical development but should be used with caution in elderly patients.
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Affiliation(s)
- Mark R. Litzow
- Departments of Hematology; Mayo Clinic; Rochester Minnesota
| | - Xin V. Wang
- Biostatistics and Computational Biology; Dana Farber Cancer Institute; Boston Massachusetts
| | - Martin P. Carroll
- Oncology; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Judith E. Karp
- Hematology/Medical Oncology; Johns Hopkins University; Baltimore Maryland
| | - Rhett P. Ketterling
- Departments of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Yanming Zhang
- Departments of Pathology; Memorial Sloan Kettering Cancer Center; New York New York
| | | | - Hillard M. Lazarus
- Seidman Cancer Center; University Hospitals Cleveland Medical Center, Case Western Reserve University; Cleveland Ohio
| | - Selina M. Luger
- Oncology; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Elisabeth M. Paietta
- Oncology; Albert Einstein College of Medicine, Montefiore Medical Center; Bronx New York
| | - Keith W. Pratz
- Hematology/Medical Oncology; Johns Hopkins University; Baltimore Maryland
| | - Han Win Tun
- Hematology/Oncology; Mayo Clinic; Jacksonville Florida
| | - Jessica K. Altman
- Hematology/Medical Oncology; Northwestern University School of Medicine; Chicago Illinois
| | - Edward R. Broun
- Hematology/Oncology; Oncology Hematology Care, Inc, Jewish Hospital; Cincinnati Ohio
| | - Witold B. Rybka
- Medicine and Pathology; Penn State Hershey Cancer Institute; Hershey Pennsylvania
| | - Jacob M. Rowe
- Department of Hematology; Shaare Zedek Medical Center; Jerusalem Israel
| | - Martin S. Tallman
- Hematology/Oncology; Memorial Sloan Kettering Cancer Center; New York New York
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10
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Singh R, Mehrotra S, Gopalakrishnan M, Gojo I, Karp JE, Greer JM, Chen A, Piekarz R, Kiesel BF, Gobburu J, Rudek MA, Beumer JH. Population pharmacokinetics and exposure-response assessment of veliparib co-administered with temozolomide in patients with myeloid leukemias. Cancer Chemother Pharmacol 2018; 83:319-328. [PMID: 30456480 DOI: 10.1007/s00280-018-3731-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Veliparib is an oral inhibitor of poly(ADP-ribose) polymerase enzyme. Combination of veliparib and temozolomide was well-tolerated and demonstrated clinical activity in older patients with relapsed or refractory acute myeloid leukemia (AML) or AML arising from pre-existing myeloid malignancies. We aimed to perform quantitative assessments of pharmacokinetics, efficacy, and safety of veliparib in this patient population to inform future trial design. METHODS Population pharmacokinetic analysis was performed using Phoenix® NLME with pharmacokinetic data obtained from 37 subjects after oral administration of veliparib in a Phase I study with and without temozolomide. Effect of covariates (age, sex, BMI, creatinine clearance (CLCR), and co-administration of temozolomide) on the pharmacokinetics of veliparib were evaluated, as well as impact of veliparib exposure on mucositis (dose-limiting toxicity), objective response rate (ORR), and overall survival. RESULTS A two-compartment model with first-order elimination and a first-order absorption with lag-time adequately described veliparib pharmacokinetics. CLCR and body weight were clinically significant covariates for veliparib disposition. The proportion of subjects with all grade mucositis increased with veliparib exposure (AUC). However, no trend in ORR and overall survival was observed with increasing exposure. CONCLUSIONS Veliparib with temozolomide presents a promising combination for older patients with myeloid leukemias. An exposure-safety relationship was established for this combination. Further clinical investigations aimed at elucidating the veliparib exposure-efficacy/safety relationship and optimizing dosing recommendations for maximizing benefit-risk in patients with advanced myeloid malignancies should study veliparib doses ranging up to 120 mg in combination with temozolomide.
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Affiliation(s)
- Renu Singh
- Center for Translational Medicine, University of Maryland, Baltimore, MD, USA
| | - Shailly Mehrotra
- Center for Translational Medicine, University of Maryland, Baltimore, MD, USA
| | | | - Ivana Gojo
- The Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Judith E Karp
- The Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Jacqueline M Greer
- The Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Alice Chen
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Richard Piekarz
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | | | - Jogarao Gobburu
- Center for Translational Medicine, University of Maryland, Baltimore, MD, USA
| | - Michelle A Rudek
- The Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Jan H Beumer
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
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11
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Knaus HA, Berglund S, Hackl H, Blackford AL, Zeidner JF, Montiel-Esparza R, Mukhopadhyay R, Vanura K, Blazar BR, Karp JE, Luznik L, Gojo I. Signatures of CD8+ T cell dysfunction in AML patients and their reversibility with response to chemotherapy. JCI Insight 2018; 3:120974. [PMID: 30385732 DOI: 10.1172/jci.insight.120974] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/19/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Our understanding of phenotypic and functional signatures of CD8+ T cell dysfunction in acute myeloid leukemia (AML) is limited. Deciphering these deranged T cell functional states and how they are impacted by induction chemotherapy is essential for incorporation of novel immune-based strategies to restore and maintain antileukemia immunity. METHODS We utilized high-dimensional immunophenotyping, gene expression, and functional studies to characterize peripheral blood and bone marrow CD8+ T cells in 72 AML patients at diagnosis and after induction chemotherapy. RESULTS Our data suggest that multiple aspects of deranged T cell function are operative in AML at diagnosis, with exhaustion and senescence being the dominant processes. Following treatment, the phenotypic and transcriptional profile of CD8+ T cells diverged between responders and nonresponders. Response to therapy correlated with upregulation of costimulatory, and downregulation of apoptotic and inhibitory, T cell signaling pathways, indicative of restoration of T cell function. In functional studies, AML blasts directly altered CD8+ T cell viability, expansion, co-signaling and senescence marker expression. This CD8+ T cell dysfunction was in part reversible upon PD-1 blockade or OX40 costimulation in vitro. CONCLUSION Our findings highlight the uniqueness of AML in sculpting CD8+ T cell responses and the plasticity of their signatures upon chemotherapy response, providing a compelling rationale for integration of novel immunotherapies to augment antileukemia immunity. FUNDING This work was supported by the Leukemia & Lymphoma Society grant no. 6449-13; NIH grants UM1-CA186691 and R01-HL110907-01; the American Society for Blood and Marrow Transplantation New Investigator Award/Gabrielle's Angel Foundation; the Vienna Fund for Innovative Cancer Research; and by fellowships from the Wenner-Gren Foundation and the Swedish Society for Medical Research.
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Affiliation(s)
- Hanna A Knaus
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sofia Berglund
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hubert Hackl
- Division of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua F Zeidner
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Raúl Montiel-Esparza
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rupkatha Mukhopadhyay
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katrina Vanura
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Judith E Karp
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leo Luznik
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ivana Gojo
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
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12
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Knaus HA, Berglund S, Hackl H, Blackford AL, Zeidner JF, Montiel-Esparza R, Mukhopadhyay R, Vanura K, Blazar BR, Karp JE, Luznik L, Gojo I. Signatures of CD8+ T cell dysfunction in AML patients and their reversibility with response to chemotherapy. JCI Insight 2018. [PMID: 30385732 DOI: 10.1172/jci.insight.120974:e120974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Our understanding of phenotypic and functional signatures of CD8+ T cell dysfunction in acute myeloid leukemia (AML) is limited. Deciphering these deranged T cell functional states and how they are impacted by induction chemotherapy is essential for incorporation of novel immune-based strategies to restore and maintain antileukemia immunity. METHODS We utilized high-dimensional immunophenotyping, gene expression, and functional studies to characterize peripheral blood and bone marrow CD8+ T cells in 72 AML patients at diagnosis and after induction chemotherapy. RESULTS Our data suggest that multiple aspects of deranged T cell function are operative in AML at diagnosis, with exhaustion and senescence being the dominant processes. Following treatment, the phenotypic and transcriptional profile of CD8+ T cells diverged between responders and nonresponders. Response to therapy correlated with upregulation of costimulatory, and downregulation of apoptotic and inhibitory, T cell signaling pathways, indicative of restoration of T cell function. In functional studies, AML blasts directly altered CD8+ T cell viability, expansion, co-signaling and senescence marker expression. This CD8+ T cell dysfunction was in part reversible upon PD-1 blockade or OX40 costimulation in vitro. CONCLUSION Our findings highlight the uniqueness of AML in sculpting CD8+ T cell responses and the plasticity of their signatures upon chemotherapy response, providing a compelling rationale for integration of novel immunotherapies to augment antileukemia immunity. FUNDING This work was supported by the Leukemia & Lymphoma Society grant no. 6449-13; NIH grants UM1-CA186691 and R01-HL110907-01; the American Society for Blood and Marrow Transplantation New Investigator Award/Gabrielle's Angel Foundation; the Vienna Fund for Innovative Cancer Research; and by fellowships from the Wenner-Gren Foundation and the Swedish Society for Medical Research.
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Affiliation(s)
- Hanna A Knaus
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sofia Berglund
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hubert Hackl
- Division of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua F Zeidner
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Raúl Montiel-Esparza
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rupkatha Mukhopadhyay
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katrina Vanura
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Judith E Karp
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leo Luznik
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ivana Gojo
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
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13
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Zeidner JF, Foster MC, Blackford AL, Litzow MR, Morris LE, Strickland SA, Lancet JE, Bose P, Levy MY, Tibes R, Gojo I, Gocke CD, Rosner GL, Little RF, Wright JJ, Doyle LA, Smith BD, Karp JE. Final results of a randomized multicenter phase II study of alvocidib, cytarabine, and mitoxantrone versus cytarabine and daunorubicin (7 + 3) in newly diagnosed high-risk acute myeloid leukemia (AML). Leuk Res 2018; 72:92-95. [PMID: 30118897 DOI: 10.1016/j.leukres.2018.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/17/2018] [Accepted: 08/07/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Joshua F Zeidner
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States.
| | - Matthew C Foster
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States
| | - Amanda L Blackford
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | | | - Lawrence E Morris
- The Blood and Marrow Transplant Program at Northside Hospital, Bone Marrow Transplant Group of Georgia, Atlanta, GA, United States
| | | | - Jeffrey E Lancet
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Prithviraj Bose
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, United States; University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - M Yair Levy
- Texas Oncology, Baylor Charles A. Simmons Cancer Center, Dallas, TX, United States
| | - Raoul Tibes
- Mayo Clinic, Scottsdale, AZ, United States; New York University School of Medicine, Laura & Isaac Perlmutter Cancer Center, New York, NY, United States
| | - Ivana Gojo
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; University of Maryland Medical Center, Stewart Greenebaum Cancer Center, Baltimore, MD, United States
| | - Christopher D Gocke
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Gary L Rosner
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | | | - John J Wright
- National Cancer Institute, Rockville, MD, United States
| | | | - B Douglas Smith
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Judith E Karp
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
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14
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Ding J, Karp JE, Emadi A. Elevated lactate dehydrogenase (LDH) can be a marker of immune suppression in cancer: Interplay between hematologic and solid neoplastic clones and their microenvironments. Cancer Biomark 2018; 19:353-363. [PMID: 28582845 DOI: 10.3233/cbm-160336] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Metabolism of neoplastic cells is shifted toward high glucose uptake and enhanced lactate production. Lactate dehydrogenase (LDH), which is comprised of two major subunits, LDH-A and LDH-B, reversibly catalyzes the conversion of pyruvate to lactate or lactate to pyruvate. LDH-A has a higher affinity for pyruvate and is a key enzyme in the glycolytic pathway. Elevated LDH is a negative prognostic biomarker not only because it is a key enzyme involved in cancer metabolism, but also because it allows neoplastic cells to suppress and evade the immune system by altering the tumor microenvironment. LDH-A alters the tumor microenvironment via increased production of lactate. This leads to enhancement of immune-suppressive cells, such as myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages (TAMs), and dendritic cells (DCs); and inhibition of cytolytic cells, such as natural killer (NK) cells and cytotoxic T-lymphocytes (CTLs). By promoting immune-suppression in the tumor microenvironment, LDH-A is able to promote resistance to chemo/radio/targeted therapy. Here we discuss the evidence that LDH is both a metabolic and an immune surveillance prognostic biomarker and its elevation is harbinger of negative outcome in both solid and hematologic neoplasms.
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Affiliation(s)
- Jennifer Ding
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Judith E Karp
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, MD, USA
| | - Ashkan Emadi
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
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15
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Mehrotra S, Gopalakrishnan M, Gobburu J, Ji J, Greer JM, Piekarz R, Karp JE, Pratz KW, Rudek MA. Exposure-Response of Veliparib to Inform Phase II Trial Design in Refractory or Relapsed Patients with Hematological Malignancies. Clin Cancer Res 2017; 23:6421-6429. [PMID: 28751440 PMCID: PMC5837045 DOI: 10.1158/1078-0432.ccr-17-0143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/04/2017] [Accepted: 07/18/2017] [Indexed: 11/16/2022]
Abstract
Purpose: A phase I trial of veliparib in combination with topotecan plus carboplatin (T+C) demonstrated a 33% objective response rate in patients with hematological malignancies. The objective is to perform exposure-response analysis to inform the phase II trial design.Experimental Design: Pharmacokinetic, efficacy, and safety data from 95 patients, who were administered 10 to 100 mg b.i.d. doses of veliparib for either 8, 14, or 21 days with T+C, were utilized for exposure-efficacy (objective response and overall survival) and exposure-safety (≥grade 3 mucositis) analysis. Multivariate cox proportional hazards and logistic regression analyses were conducted. The covariates evaluated were disease status, duration of treatment, and number of prior therapies.Results: The odds of having objective response were 1.08-fold with 1,000 ng/hr/mL increase in AUC, 1.8-fold with >8 days treatment, 2.8-fold in patients with myeloproliferative neoplasms (MPN), and 0.5-fold with ≥2 prior therapies. Based on analysis of overall survival, hazard of death decreased by 1.5% for 1,000 ng/hr/mL increase in AUC, 39% with >8 days treatment, 44% in patients with MPN, while increased by 19% with ≥2 prior therapies. The odds of having ≥grade 3 mucositis increased by 29% with 1,000 ng.h/mL increase in AUC.Conclusions: Despite shallow exposure-efficacy relationship, doses lower than 80 mg do not exceed veliparib single agent preclinical IC50 Shallow exposure-mucositis relationship also supports the 80-mg dose. Based on benefit/risk assessment, veliparib at a dose of 80 mg b.i.d. for at least 14 days in combination with T+C is recommended to be studied in MPN patients. Clin Cancer Res; 23(21); 6421-9. ©2017 AACR.
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Affiliation(s)
- Shailly Mehrotra
- Center for Translational Medicine, University of Maryland, Baltimore, Maryland
| | | | - Jogarao Gobburu
- Center for Translational Medicine, University of Maryland, Baltimore, Maryland
| | - Jiuping Ji
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Jacqueline M Greer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Richard Piekarz
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Judith E Karp
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Keith W Pratz
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Michelle A Rudek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, Maryland
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16
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Norsworthy KJ, DeZern AE, Tsai HL, Hand WA, Varadhan R, Gore SD, Gojo I, Pratz K, Carraway HE, Showel M, McDevitt MA, Gladstone D, Ghiaur G, Prince G, Seung AH, Benani D, Levis MJ, Karp JE, Smith BD. Timed sequential therapy for acute myelogenous leukemia: Results of a retrospective study of 301 patients and review of the literature. Leuk Res 2017; 61:25-32. [PMID: 28869816 DOI: 10.1016/j.leukres.2017.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/09/2017] [Accepted: 08/20/2017] [Indexed: 11/16/2022]
Abstract
Timed sequential therapy (TST) aims to improve outcomes in acute myelogenous leukemia (AML) by harnessing drug-induced cell cycle kinetics of AML, where a second drug is timed to coincide with peak leukemia proliferation induced by the first drugs. We analyzed outcomes in 301 newly diagnosed AML patients treated from 2004-2013 with cytarabine, anthracycline, and etoposide TST induction. Median age was 52 (range 20-74) and complete remission rate 68%. With median follow-up 5.8 years, 5-year DFS and overall survival (OS) were 37% (95% CI 31-45%) and 32% (95% CI 27-38%), respectively. In multivariate analysis, older age, unfavorable cytogenetics, and WBC≥50×109/L resulted in worse OS. Among patients not undergoing blood and marrow transplant, a propensity score analysis, which reduces imbalance in baseline characteristics, showed consolidation with TST compared with 1 or more cycles high-dose cytarabine trended toward lower DFS and post-remission survival with hazard ratio (HR) 1.9 (95% CI 0.9-4.0), and 1.6 (95% CI 0.7-3.6), respectively. Our results demonstrate the efficacy and feasibility of TST induction for newly diagnosed patients with AML, with results comparable to that seen in clinical trials with other TST therapies and 7+3.
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Affiliation(s)
- Kelly J Norsworthy
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Amy E DeZern
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Hua-Ling Tsai
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Wesley A Hand
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Ravi Varadhan
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Steven D Gore
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; Yale Cancer Center, New Haven, CT, United States
| | - Ivana Gojo
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Keith Pratz
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Hetty E Carraway
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, United States
| | - Margaret Showel
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Michael A McDevitt
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; Global Medicines Development, AstraZeneca, Gaithersburg, MD, United States
| | - Douglas Gladstone
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Gabriel Ghiaur
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Gabrielle Prince
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Amy H Seung
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States; AssistRx, Orlando, FL, United States
| | - Dina Benani
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Mark J Levis
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Judith E Karp
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - B Douglas Smith
- Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States.
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17
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Mehrotra S, Gopalakrishnan M, Gobburu J, Greer JM, Piekarz R, Karp JE, Pratz K, Rudek MA. Population pharmacokinetics and site of action exposures of veliparib with topotecan plus carboplatin in patients with haematological malignancies. Br J Clin Pharmacol 2017; 83:1688-1700. [PMID: 28156017 DOI: 10.1111/bcp.13253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/18/2017] [Accepted: 01/30/2017] [Indexed: 11/28/2022] Open
Abstract
AIMS Veliparib is a potent inhibitor of poly(ADP-ribose) polymerase (PARP) enzyme. The objectives of the analysis were to evaluate the effect of baseline covariates and co-administration of topotecan plus carboplatin (T + C) on pharmacokinetics of veliparib in patients with refractory acute leukaemia, and compare veliparib concentration in various biological matrices. METHODS A population pharmacokinetic model was developed and effect of age, body size indices, sex, creatinine clearance (CrCL) and co-administration of T + C on the pharmacokinetics of veliparib were evaluated. The final model was qualified using bootstrap and quantitative predictive check. Linear regression was conducted to correlate concentrations of veliparib in various biological matrices. RESULTS A two compartment model with first-order absorption with Tlag described veliparib pharmacokinetics. The apparent clearance (CL/F) and volume (Vc /F) were 16.5 l h-1 and 122.7 l, respectively. The concomitant administration of T + C was not found to affect veliparib CL/F. CrCL and lean body mass (LBM) were significant covariates on CL/F and Vc/F, respectively. While a strong positive relationship was observed between veliparib concentrations in plasma and bone marrow supernatant, no correlation was observed between plasma and peripheral blood or bone marrow blasts. CONCLUSIONS Consistent with veliparib's physiochemical properties and its elimination mechanism, LBM and CrCL were found to affect pharmacokinetics of veliparib while concomitant administration of T + C did not affect veliparib's CL/F. Plasma concentrations were found to be a reasonable surrogate for veliparib concentrations in peripheral blood and bone marrow supernatant but not blasts. The current model will be utilized to conduct exposure-response analysis to support dosing recommendations.
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Affiliation(s)
- Shailly Mehrotra
- Center for Translational Medicine, University of Maryland, Baltimore, Maryland
| | | | - Jogarao Gobburu
- Center for Translational Medicine, University of Maryland, Baltimore, Maryland
| | - Jacqueline M Greer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Richard Piekarz
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Judith E Karp
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Keith Pratz
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Michelle A Rudek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland.,Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, Maryland
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18
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Knorr KL, Finn LE, Smith BD, Hess AD, Foran JM, Karp JE, Kaufmann SH. Assessment of Drug Sensitivity in Hematopoietic Stem and Progenitor Cells from Acute Myelogenous Leukemia and Myelodysplastic Syndrome Ex Vivo. Stem Cells Transl Med 2017; 6:840-850. [PMID: 28297583 PMCID: PMC5442784 DOI: 10.5966/sctm.2016-0034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 09/19/2016] [Indexed: 01/24/2023] Open
Abstract
Current understanding suggests that malignant stem and progenitor cells must be reduced or eliminated for prolonged remissions in myeloid neoplasms such as acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS). Multicolor flow cytometry has been widely used to distinguish stem and myeloid progenitor cells from other populations in normal and malignant bone marrow. In this study, we present a method for assessing drug sensitivity in MDS and AML patient hematopoietic stem and myeloid progenitor cell populations ex vivo using the investigational Nedd8‐activating enzyme inhibitor MLN4924 and standard‐of‐care agent cytarabine as examples. Utilizing a multicolor flow cytometry antibody panel for identification of hematopoietic stem cells, multipotent progenitors, common myeloid progenitors, granulocyte‐monocyte progenitors, and megakaryocyte‐erythroid progenitors present in mononuclear cell fractions isolated from bone marrow aspirates, we compare stem and progenitor cell counts after treatment for 24 hours with drug versus diluent. We demonstrate that MLN4924 exerts a cytotoxic effect on MDS and AML stem and progenitor cell populations, whereas cytarabine has more limited effects. Further application of this method for evaluating drug effects on these populations ex vivo and in vivo may inform rational design and selection of therapies in the clinical setting. Stem Cells Translational Medicine2017;6:840–850
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Affiliation(s)
- Katherine L.B. Knorr
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura E. Finn
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - B. Douglas Smith
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Allan D. Hess
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James M. Foran
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Judith E. Karp
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott H. Kaufmann
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hematological Malignancies, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
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LaCerte C, Ivaturi V, Gobburu J, Greer JM, Doyle LA, Wright JJ, Karp JE, Rudek MA. Exposure-Response Analysis of Alvocidib (Flavopiridol) Treatment by Bolus or Hybrid Administration in Newly Diagnosed or Relapsed/Refractory Acute Leukemia Patients. Clin Cancer Res 2017; 23:3592-3600. [PMID: 28174232 DOI: 10.1158/1078-0432.ccr-16-2629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/01/2016] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
Purpose: To elucidate any differences in the exposure-response of alvocidib (flavopiridol) given by 1-hour bolus or a hybrid schedule (30-minute bolus followed by a 4-hour infusion) using a flavopiridol/cytosine arabinoside/mitoxantrone sequential protocol (FLAM) in patients with acute leukemia. The hybrid schedule was devised to be pharmacologically superior in chronic leukemia based on unbound exposure.Experimental Design: Data from 129 patients in three FLAM studies were used for pharmacokinetic/pharmacodynamic modeling. Newly diagnosed (62%) or relapsed/refractory (38%) patients were treated by bolus (43%) or hybrid schedule (57%). Total and unbound flavopiridol concentrations were fit using nonlinear mixed-effect population pharmacokinetic methodologies. Exposure-response relationships using unbound flavopiridol AUC were explored using recursive partitioning.Results: Flavopiridol pharmacokinetic parameters were estimated using a two-compartment model. No pharmacokinetic covariates were identified. Flavopiridol fraction unbound was 10.9% and not different between schedules. Partitioning found no association between dosing schedule and clinical response. Clinical response was associated with AUC ≥ 780 h*ng/mL for newly diagnosed patients and AUC ≥ 1,690 h*ng/mL for relapsed/refractory patients. Higher exposures were not associated with increases in severe adverse events (≥ grade 3).Conclusions: Pharmacokinetic modeling showed no difference in flavopiridol plasma protein binding for bolus versus hybrid dosing. Further trials in newly diagnosed patients with acute leukemia should utilize the bolus FLAM regimen at the MTD of 50 mg/m2/day. Trials in relapsed/refractory patients should use the hybrid dosing schedule at the MTD (30/60 mg/m2/day) to achieve the higher exposures required for maximal efficacy in this population. Clin Cancer Res; 23(14); 3592-600. ©2017 AACR.
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Affiliation(s)
- Carl LaCerte
- Center for Translational Medicine, University of Maryland, Baltimore, Maryland
| | - Vijay Ivaturi
- Center for Translational Medicine, University of Maryland, Baltimore, Maryland.
| | - Joga Gobburu
- Center for Translational Medicine, University of Maryland, Baltimore, Maryland
| | - Jacqueline M Greer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - L Austin Doyle
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - John J Wright
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Judith E Karp
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Michelle A Rudek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland. .,Department of Oncology, Johns Hopkins University, Baltimore, Maryland.,Department of Medicine, Division of Clinical Pharmacology, Johns Hopkins University, Baltimore, Maryland
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Gojo I, Beumer JH, Pratz KW, McDevitt MA, Baer MR, Blackford AL, Smith BD, Gore SD, Carraway HE, Showel MM, Levis MJ, Dezern AE, Gladstone DE, Ji JJ, Wang L, Kinders RJ, Pouquet M, Ali-Walbi I, Rudek MA, Poh W, Herman JG, Karnitz LM, Kaufmann SH, Chen A, Karp JE. A Phase 1 Study of the PARP Inhibitor Veliparib in Combination with Temozolomide in Acute Myeloid Leukemia. Clin Cancer Res 2017; 23:697-706. [PMID: 27503200 PMCID: PMC5290001 DOI: 10.1158/1078-0432.ccr-16-0984] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/23/2016] [Accepted: 07/17/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE In preclinical studies, the PARP inhibitor veliparib enhanced the antileukemic action of temozolomide through potentiation of DNA damage. Accordingly, we conducted a phase 1 study of temozolomide with escalating doses of veliparib in patients with relapsed, refractory acute myeloid leukemia (AML) or AML arising from aggressive myeloid malignancies. EXPERIMENTAL DESIGN Patients received veliparib [20-200 mg once a day on day 1 and twice daily on days 4-12 in cycle 1 (days 1-8 in cycle ≥2)] and temozolomide [150-200 mg/m2 daily on days 3-9 in cycle 1 (days 1-5 in cycle ≥2)] every 28 to 56 days. Veliparib pharmacokinetics and pharmacodynamics [ability to inhibit poly(ADP-ribose) polymer (PAR) formation and induce H2AX phosphorylation] were assessed. Pretreatment levels of MGMT and PARP1 protein, methylation of the MGMT promoter, and integrity of the Fanconi anemia pathway were also examined. RESULTS Forty-eight patients were treated at seven dose levels. Dose-limiting toxicities were oral mucositis and esophagitis lasting >7 days. The MTD was veliparib 150 mg twice daily with temozolomide 200 mg/m2 daily. The complete response (CR) rate was 17% (8/48 patients). Veliparib exposure as well as inhibition of PAR polymer formation increased dose proportionately. A veliparib-induced increase in H2AX phosphorylation in CD34+ cells was observed in responders. Three of 4 patients with MGMT promoter methylation achieved CR. CONCLUSIONS Veliparib plus temozolomide is well tolerated, with activity in advanced AML. Further evaluation of this regimen and of treatment-induced phosphorylation of H2AX and MGMT methylation as potential response predictors appears warranted. Clin Cancer Res; 23(3); 697-706. ©2016 AACR.
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Affiliation(s)
- Ivana Gojo
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland.
| | - Jan H Beumer
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Keith W Pratz
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael A McDevitt
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Maria R Baer
- Department of Medicine, University of Maryland Greenebaum Cancer Center, Baltimore, Maryland
| | - Amanda L Blackford
- Department of Statistics, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - B Douglas Smith
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven D Gore
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Hetty E Carraway
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Margaret M Showel
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Mark J Levis
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Amy E Dezern
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Douglas E Gladstone
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Jiuping Jay Ji
- Laboratory of Human Toxicology and Pharmacology, Applied/Developmental Research Support Directorate, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland
| | - Lihua Wang
- Laboratory of Human Toxicology and Pharmacology, Applied/Developmental Research Support Directorate, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland
| | - Robert J Kinders
- Laboratory of Human Toxicology and Pharmacology, Applied/Developmental Research Support Directorate, SAIC-Frederick, Inc., NCI-Frederick, Frederick, Maryland
| | - Marie Pouquet
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ismail Ali-Walbi
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle A Rudek
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Weijie Poh
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - James G Herman
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Larry M Karnitz
- Division of Oncology Research and Department of Molecular Pharmacology, Mayo Clinic, Rochester, Minnesota
| | - Scott H Kaufmann
- Division of Oncology Research and Department of Molecular Pharmacology, Mayo Clinic, Rochester, Minnesota
| | - Alice Chen
- Cancer Therapy Evaluation Program, NCI, Rockville, Maryland
| | - Judith E Karp
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
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Lundqvist A, van Hoef V, Zhang X, Wennerberg E, Lorent J, Witt K, Sanz LM, Liang S, Murray S, Larsson O, Kiessling R, Mao Y, Sidhom JW, Bessell CA, Havel J, Schneck J, Chan TA, Sachsenmeier E, Woods D, Berglund A, Ramakrishnan R, Sodre A, Weber J, Zappasodi R, Li Y, Qi J, Wong P, Sirard C, Postow M, Newman W, Koon H, Velcheti V, Callahan MK, Wolchok JD, Merghoub T, Lum LG, Choi M, Thakur A, Deol A, Dyson G, Shields A, Haymaker C, Uemura M, Murthy R, James M, Wang D, Brevard J, Monaghan C, Swann S, Geib J, Cornfeld M, Chunduru S, Agrawal S, Yee C, Wargo J, Patel SP, Amaria R, Tawbi H, Glitza I, Woodman S, Hwu WJ, Davies MA, Hwu P, Overwijk WW, Bernatchez C, Diab A, Massarelli E, Segal NH, Ribrag V, Melero I, Gangadhar TC, Urba W, Schadendorf D, Ferris RL, Houot R, Morschhauser F, Logan T, Luke JJ, Sharfman W, Barlesi F, Ott PA, Mansi L, Kummar S, Salles G, Carpio C, Meier R, Krishnan S, McDonald D, Maurer M, Gu X, Neely J, Suryawanshi S, Levy R, Khushalani N, Wu J, Zhang J, Basher F, Rubinstein M, Bucsek M, Qiao G, Hembrough T, Spacek J, Vocka M, Zavadova E, Skalova H, Dundr P, Petruzelka L, Francis N, Tilman RT, Hartmann A, MacDonald C, Netikova I, Ballesteros-Merino C, Stump J, Tufman A, Berger F, Neuberger M, Hatz R, Lindner M, Sanborn RE, Handy J, Hylander B, Fox B, Bifulco C, Huber RM, Winter H, Reu S, Sun C, Xiao W, Tian Z, Arora K, Desai N, Repasky E, Kulkarni A, Rajurkar M, Rivera M, Deshpande V, Ting D, Tsai K, Nosrati A, Goldinger S, Hamid O, Algazi A, Chatterjee S, Tumeh P, Hwang J, Liu J, Chen L, Dummer R, Rosenblum M, Daud A, Tsao TS, Ashworth-Sharpe J, Johnson D, Daenthanasanmak A, Bhaumik S, Bieniarz C, Couto J, Farrell M, Ghaffari M, Habensus I, Hubbard A, Jones T, Kelly B, Kosmeder J, Chakraborty P, Lee C, Marner E, Meridew J, Polaske N, Racolta A, Uribe D, Zhang H, Zhang J, Zhang W, Zhu Y, Toth K, Morrison L, Pestic-Dragovich L, Tang L, Tsujikawa T, Borkar RN, Azimi V, Kumar S, Thibault G, Mori M, El Rassi E, Meek M, Clayburgh DR, Kulesz-Martin MF, Flint PW, Coussens LM, Villabona L, Masucci GV, Geiss G, Birditt B, Mei Q, Huang A, Garrett-Mayer E, White AM, Eagan MA, Ignacio E, Elliott N, Dunaway D, Dennis L, Warren S, Beechem J, Dunaway D, Jung J, Nishimura M, Merritt C, Sprague I, Webster P, Liang Y, Warren S, Beechem J, Wenthe J, Enblad G, Karlsson H, Essand M, Paulos C, Savoldo B, Dotti G, Höglund M, Brenner MK, Hagberg H, Loskog A, Bernett MJ, Moore GL, Hedvat M, Bonzon C, Beeson C, Chu S, Rashid R, Avery KN, Muchhal U, Desjarlais J, Hedvat M, Bernett MJ, Moore GL, Bonzon C, Rashid R, Yu X, Chu S, Avery KN, Muchhal U, Desjarlais J, Kraman M, Kmiecik K, Allen N, Faroudi M, Zimarino C, Wydro M, Mehrotra S, Doody J, Srinivasa SP, Govindappa N, Reddy P, Dubey A, Periyasamy S, Adekandi M, Dey C, Joy M, van Loo PF, Zhao F, Veninga H, Shamsili S, Throsby M, Dolstra H, Bakker L, Alva A, Gschwendt J, Loriot Y, Bellmunt J, Feng D, Evans K, Poehlein C, Powles T, Antonarakis ES, Drake CG, Wu H, Poehlein C, De Bono J, Bannerji R, Byrd J, Gregory G, Xiao C, Opat S, Shortt J, Yee AJ, Raje N, Thompson S, Balakumaran A, Kumar S, Rini BI, Choueiri TK, Mariani M, Holtzhausen A, Albiges L, Haanen JB, Atkins MB, Larkin J, Schmidinger M, Magazzù D, di Pietro A, Motzer RJ, Borch TH, Andersen R, Hanks BA, Kongsted P, Pedersen M, Nielsen M, Met Ö, Donia M, Svane IM, Boudadi K, Wang H, Vasselli J, Baughman JE, Scharping N, Wigginton J, Abdallah R, Ross A, Drake CG, Antonarakis ES, Canter RJ, Park J, Wang Z, Grossenbacher S, Luna JI, Menk AV, Withers S, Culp W, Chen M, Monjazeb A, Kent MS, Murphy WJ, Chandran S, Somerville R, Wunderlich J, Danforth D, Moreci R, Yang J, Sherry R, Klebanoff C, Goff S, Paria B, Sabesan A, Srivastava A, Rosenberg SA, Kammula U, Curti B, Whetstone R, Richards J, Faries M, Andtbacka RHI, Grose M, Shafren D, Diaz LA, Le DT, Yoshino T, André T, Bendell J, Dadey R, Koshiji M, Zhang Y, Kang SP, Lam B, Jäger D, Bauer TM, Wang JS, Lee JK, Manji GA, Kudchadkar R, Watkins S, Kauh JS, Tang S, Laing N, Falchook G, Garon EB, Halmos B, Rina H, Leighl N, Lee SS, Walsh W, Ferris R, Dragnev K, Piperdi B, Rodriguez LPA, Shinwari N, Wei Z, Gustafson MP, Maas ML, Deeds M, Armstrong A, Bornschlegl S, Delgoffe GM, Peterson T, Steinmetz S, Gastineau DA, Parney IF, Dietz AB, Herzog T, Backes FJ, Copeland L, Del Pilar Estevez Diz M, Hare TW, Peled J, Huh W, Kim BG, Moore KM, Oaknin A, Small W, Tewari KS, Monk BJ, Kamat AM, Bellmunt J, Choueiri TK, Devlin S, Nam K, De Santis M, Dreicer R, Hahn NM, Perini R, Siefker-Radtke A, Sonpavde G, de Wit R, Witjes JA, Keefe S, Staffas A, Bajorin D, Kline J, Armand P, Kuruvilla J, Moskowitz C, Hamadani M, Ribrag V, Zinzani PL, Chlosta S, Thompson S, Lumish M, Balakumaran A, Bartlett N, Kyi C, Sabado R, Saenger Y, William L, Donovan MJ, Sacris E, Mandeli J, Salazar AM, Rodriguez KP, Friedlander P, Bhardwaj N, Powderly J, Brody J, Nemunaitis J, Emens L, Luke JJ, Patnaik A, McCaffery I, Miller R, Ahr K, Laport G, Coveler AL, Smith DC, Grilley-Olson JE, Gajewski TF, Goel S, Gardai SJ, Law CL, Means G, Manley T, Perales M, Curti B, Marrone KA, Rosner G, Anagnostou V, Riemer J, Wakefield J, Zanhow C, Baylin S, Gitlitz B, Brahmer J, Giralt S, McDermott DF, Signoretti S, Li W, Schloss C, Michot JM, Armand P, Ding W, Ribrag V, Christian B, Balakumaran A, Taur Y, Marinello P, Chlosta S, Zhang Y, Shipp M, Zinzani PL, Najjar YG, Lin, Butterfield LH, Tarhini AA, Davar D, Pamer E, Zarour H, Rush E, Sander C, Kirkwood JM, Fu S, Bauer T, Molineaux C, Bennett MK, Orford KW, Papadopoulos KP, van den Brink MRM, Padda SK, Shah SA, Colevas AD, Narayanan S, Fisher GA, Supan D, Wakelee HA, Aoki R, Pegram MD, Villalobos VM, Jenq R, Liu J, Takimoto CH, Chao M, Volkmer JP, Majeti R, Weissman IL, Sikic BI, Page D, Yu W, Conlin A, Annels N, Ruzich J, Lewis S, Acheson A, Kemmer K, Perlewitz K, Moxon NM, Mellinger S, Bifulco C, Martel M, Koguchi Y, Pandha H, Fox B, Urba W, McArthur H, Pedersen M, Westergaard MCW, Borch TH, Nielsen M, Kongsted P, Juhler-Nøttrup T, Donia M, Simpson G, Svane IM, Desai J, Markman B, Sandhu S, Gan H, Friedlander ML, Tran B, Meniawy T, Lundy J, Colyer D, Mostafid H, Ameratunga M, Norris C, Yang J, Li K, Wang L, Luo L, Qin Z, Mu S, Tan X, Song J, Harrington K, Millward M, Katz MHG, Bauer TW, Varadhachary GR, Acquavella N, Merchant N, Petroni G, Slingluff CL, Rahma OE, Rini BI, Melcher A, Powles T, Chen M, Song Y, Puhlmann M, Atkins MB, Sathyanaryanan S, Hirsch HA, Shu J, Deshpande A, Khattri A, Grose M, Reeves J, Zi T, Brisson R, Harvey C, Michaelson J, Law D, Seiwert T, Shah J, Mateos MV, Matsumoto M, Davies B, Blacklock H, Rocafiguera AO, Goldschmidt H, Iida S, Yehuda DB, Ocio E, Rodríguez-Otero P, Jagannath S, Lonial S, Kher U, Au G, Marinello P, San-Miguel J, Shah J, Lonial S, de Oliveira MR, Yimer H, Mateos MV, Rifkin R, Schjesvold F, Ocio E, Karpathy R, Rodríguez-Otero P, San-Miguel J, Ghori R, Marinello P, Jagannath S, Spreafico A, Lee V, Ngan RKC, To KF, Ahn MJ, Shafren D, Ng QS, Hong RL, Lin JC, Swaby RF, Gause C, 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Westergaard MCW, Bianchi V, Legut M, Attaf M, Dolton G, Szomolay B, Ott S, Lyngaa R, Hadrup SR, Sewell AK, Svane IM, Fan A, Kumai T, Celis E, Frank I, Stramer A, Blaskovich MA, Wardell S, Fardis M, Bender J, Lotze MT, Goff SL, Zacharakis N, Assadipour Y, Prickett TD, Gartner JJ, Somerville R, Black M, Xu H, Chinnasamy H, Kriley I, Lu L, Wunderlich J, Robbins PF, Rosenberg S, Feldman SA, Trebska-McGowan K, Kriley I, Malekzadeh P, Payabyab E, Sherry R, Rosenberg S, Goff SL, Gokuldass A, Blaskovich MA, Kopits C, Rabinovich B, Lotze MT, Green DS, Kamenyeva O, Zoon KC, Annunziata CM, Hammill J, Helsen C, Aarts C, Bramson J, Harada Y, Yonemitsu Y, Helsen C, Hammill J, Mwawasi K, Denisova G, Bramson J, Giri R, Jin B, Campbell T, Draper LM, Stevanovic S, Yu Z, Weissbrich B, Restifo NP, Trimble CL, Rosenberg S, Hinrichs CS, Tsang K, Fantini M, Hodge JW, Fujii R, Fernando I, Jochems C, Heery C, Gulley J, Soon-Shiong P, Schlom J, Jing W, Gershan J, Blitzer G, Weber J, McOlash L, Johnson BD, Kiany S, Gangxiong H, Kleinerman ES, Klichinsky M, Ruella M, Shestova O, Kenderian S, Kim M, Scholler J, June CH, Gill S, Moogk D, Zhong S, Yu Z, Liadi I, Rittase W, Fang V, Dougherty J, Perez-Garcia A, Osman I, Zhu C, Varadarajan N, Restifo NP, Frey A, Krogsgaard M, Landi D, Fousek K, Mukherjee M, Shree A, Joseph S, Bielamowicz K, Byrd T, Ahmed N, Hegde M, Lee S, Byrd D, Thompson J, Bhatia S, Tykodi S, Delismon J, Chu L, Abdul-Alim S, Ohanian A, DeVito AM, Riddell S, Margolin K, Magalhaes I, Mattsson J, Uhlin M, Nemoto S, Villarroel PP, Nakagawa R, Mule JJ, Mailloux AW, Mata M, Nguyen P, Gerken C, DeRenzo C, Spencer DM, Gottschalk S, Mathieu M, Pelletier S, Stagg J, Turcotte S, Minutolo N, Sharma P, Tsourkas A, Powell DJ, Mockel-Tenbrinck N, Mauer D, Drechsel K, Barth C, Freese K, Kolrep U, Schult S, Assenmacher M, Kaiser A, Mullinax J, Hall M, Le J, Kodumudi K, Royster E, Richards A, Gonzalez R, Sarnaik A, Pilon-Thomas S, Nielsen M, Krarup-Hansen A, Hovgaard D, Petersen MM, Loya AC, Junker N, Svane IM, Rivas C, Parihar R, Gottschalk S, Rooney CM, Qin H, Nguyen S, Su P, Burk C, Duncan B, Kim BH, Kohler ME, Fry T, Rao AA, Teyssier N, Pfeil J, Sgourakis N, Salama S, Haussler D, Richman SA, Nunez-Cruz S, Gershenson Z, Mourelatos Z, Barrett D, Grupp S, Milone M, Rodriguez-Garcia A, Robinson MK, Adams GP, Powell DJ, Santos J, Havunen R, Siurala M, Cervera-Carrascón V, Parviainen S, Antilla M, Hemminki A, Sethuraman J, Santiago L, Chen JQ, Dai Z, Wardell S, Bender J, Lotze MT, Sha H, Su S, Ding N, Liu B, Stevanovic S, Pasetto A, Helman SR, Gartner JJ, Prickett TD, Robbins PF, Rosenberg SA, Hinrichs CS, Bhatia S, Burgess M, Zhang H, Lee T, Klingemann H, Soon-Shiong P, Nghiem P, Kirkwood JM, Rossi JM, Sherman M, Xue A, Shen YW, Navale L, Rosenberg SA, Kochenderfer JN, Bot A, Veerapathran A, Gokuldass A, Stramer A, Sethuraman J, Blaskovich MA, Wiener D, Frank I, Santiago L, Rabinovich B, Fardis M, Bender J, Lotze MT, Waller EK, Li JM, Petersen C, Blazar BR, Li J, Giver CR, Wang Z, Grossenbacher SK, Sturgill I, Canter RJ, Murphy WJ, Zhang C, Burger MC, Jennewein L, Waldmann A, Mittelbronn M, Tonn T, Steinbach JP, Wels WS, Williams JB, Zha Y, Gajewski TF, Williams LC, Krenciute G, Kalra M, Louis C, Gottschalk S, Xin G, Schauder D, Jiang A, Joshi N, Cui W, Zeng X, Menk AV, Scharping N, Delgoffe GM, Zhao Z, Hamieh M, Eyquem J, Gunset G, Bander N, Sadelain M, Askmyr D, Abolhalaj M, Lundberg K, Greiff L, Lindstedt M, Angell HK, Kim KM, Kim ST, Kim S, Sharpe AD, Ogden J, Davenport A, Hodgson DR, Barrett C, Lee J, Kilgour E, Hanson J, Caspell R, Karulin A, Lehmann P, Ansari T, Schiller A, Sundararaman S, Lehmann P, Hanson J, Roen D, Karulin A, Lehmann P, Ayers M, Levitan D, Arreaza G, Liu F, Mogg R, Bang YJ, O’Neil B, Cristescu R, Friedlander P, Wassman K, Kyi C, Oh W, Bhardwaj N, Bornschlegl S, Gustafson MP, Gastineau DA, Parney IF, Dietz AB, Carvajal-Hausdorf D, Mani N, Velcheti V, Schalper K, Rimm D, Chang S, Levy R, Kurland J, Krishnan S, Ahlers CM, Jure-Kunkel M, Cohen L, Maecker H, Kohrt H, Chen S, Crabill G, Pritchard T, McMiller T, Pardoll D, Pan F, Topalian S, Danaher P, Warren S, Dennis L, White AM, D’Amico L, Geller M, Disis ML, Beechem J, Odunsi K, Fling S, Derakhshandeh R, Webb TJ, Dubois S, Conlon K, Bryant B, Hsu J, Beltran N, Müller J, Waldmann T, Duhen R, Duhen T, Thompson L, Montler R, Weinberg A, Kates M, Early B, Yusko E, Schreiber TH, Bivalacqua TJ, Ayers M, Lunceford J, Nebozhyn M, Murphy E, Loboda A, Kaufman DR, Albright A, Cheng J, Kang SP, Shankaran V, Piha-Paul SA, Yearley J, Seiwert T, Ribas A, McClanahan TK, Cristescu R, Mogg R, Ayers M, Albright A, Murphy E, Yearley J, Sher X, Liu XQ, Nebozhyn M, Lunceford J, Joe A, Cheng J, Plimack E, Ott PA, McClanahan TK, Loboda A, Kaufman DR, Forrest-Hay A, Guyre CA, Narumiya K, Delcommenne M, Hirsch HA, Deshpande A, Reeves J, Shu J, Zi T, Michaelson J, Law D, Trehu E, Sathyanaryanan S, Hodkinson BP, Hutnick NA, Schaffer ME, Gormley M, Hulett T, Jensen S, Ballesteros-Merino C, Dubay C, Afentoulis M, Reddy A, David L, Fox B, Jayant K, Agrawal S, Agrawal R, Jeyakumar G, Kim S, Kim H, Silski C, Suisham S, Heath E, Vaishampayan U, Vandeven N, Viller NN, O’Connor A, Chen H, Bossen B, Sievers E, Uger R, Nghiem P, Johnson L, Kao HF, Hsiao CF, Lai SC, Wang CW, Ko JY, Lou PJ, Lee TJ, Liu TW, Hong RL, Kearney SJ, Black JC, Landis BJ, Koegler S, Hirsch B, Gianani R, Kim J, He MX, Zhang B, Su N, Luo Y, Ma XJ, Park E, Kim DW, Copploa D, Kothari N, doo Chang Y, Kim R, Kim N, Lye M, Wan E, Kim N, Lye M, Wan E, Kim N, Lye M, Wan E, Knaus HA, Berglund S, Hackl H, Karp JE, Gojo I, Luznik L, Hong HS, Koch SD, Scheel B, Gnad-Vogt U, Kallen KJ, Wiegand V, Backert L, Kohlbacher O, Hoerr I, Fotin-Mleczek M, Billingsley JM, Koguchi Y, Conrad V, Miller W, Gonzalez I, Poplonski T, Meeuwsen T, Howells-Ferreira A, Rattray R, Campbell M, Bifulco C, Dubay C, Bahjat K, Curti B, Urba W, Vetsika EK, Kallergi G, Aggouraki D, Lyristi Z, Katsarlinos P, Koinis F, Georgoulias V, Kotsakis A, Martin NT, Aeffner F, Kearney SJ, Black JC, Cerkovnik L, Pratte L, Kim R, Hirsch B, Krueger J, Gianani R, Martínez-Usatorre A, Jandus C, Donda A, Carretero-Iglesia L, Speiser DE, Zehn D, Rufer N, Romero P, Panda A, Mehnert J, Hirshfield KM, Riedlinger G, Damare S, Saunders T, Sokol L, Stein M, Poplin E, Rodriguez-Rodriguez L, Silk A, Chan N, Frankel M, Kane M, Malhotra J, Aisner J, Kaufman HL, Ali S, Ross J, White E, Bhanot G, Ganesan S, Monette A, Bergeron D, Amor AB, Meunier L, Caron C, Morou A, Kaufmann D, Liberman M, Jurisica I, Mes-Masson AM, Hamzaoui K, Lapointe R, Mongan A, Ku YC, Tom W, Sun Y, Pankov A, Looney T, Au-Young J, Hyland F, Conroy J, Morrison C, Glenn S, Burgher B, Ji H, Gardner M, Mongan A, Omilian AR, Conroy J, Bshara W, Angela O, Burgher B, Ji H, Glenn S, Morrison C, Mongan A, Obeid JM, Erdag G, Smolkin ME, Deacon DH, Patterson JW, Chen L, Bullock TN, Slingluff CL, Obeid JM, Erdag G, Deacon DH, Slingluff CL, Bullock TN, Loffredo JT, Vuyyuru R, Beyer S, Spires VM, Fox M, Ehrmann JM, Taylor KA, Korman AJ, Graziano RF, Page D, Sanchez K, Ballesteros-Merino C, Martel M, Bifulco C, Urba W, Fox B, Patel SP, De Macedo MP, Qin Y, Reuben A, Spencer C, Guindani M, Bassett R, Wargo J, Racolta A, Kelly B, Jones T, Polaske N, Theiss N, Robida M, Meridew J, Habensus I, Zhang L, Pestic-Dragovich L, Tang L, Sullivan RJ, Logan T, Khushalani N, Margolin K, Koon H, Olencki T, Hutson T, Curti B, Roder J, Blackmon S, Roder H, Stewart J, Amin A, Ernstoff MS, Clark JI, Atkins MB, Kaufman HL, Sosman J, Weber J, McDermott DF, Weber J, Kluger H, Halaban R, Snzol M, Roder H, Roder J, Asmellash S, Steingrimsson A, Blackmon S, Sullivan RJ, Wang C, Roman K, Clement A, Downing S, Hoyt C, Harder N, Schmidt G, Schoenmeyer R, Brieu N, Yigitsoy M, Madonna G, Botti G, Grimaldi A, Ascierto PA, Huss R, Athelogou M, Hessel H, Harder N, Buchner A, Schmidt G, Stief C, Huss R, Binnig G, Kirchner T, Sellappan S, Thyparambil S, Schwartz S, Cecchi F, Nguyen A, Vaske C. 31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016): part one. J Immunother Cancer 2016. [PMCID: PMC5123387 DOI: 10.1186/s40425-016-0172-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pratz KW, Rudek MA, Gojo I, Litzow MR, McDevitt MA, Ji J, Karnitz LM, Herman JG, Kinders RJ, Smith BD, Gore SD, Carraway HE, Showel MM, Gladstone DE, Levis MJ, Tsai HL, Rosner G, Chen A, Kaufmann SH, Karp JE. A Phase I Study of Topotecan, Carboplatin and the PARP Inhibitor Veliparib in Acute Leukemias, Aggressive Myeloproliferative Neoplasms, and Chronic Myelomonocytic Leukemia. Clin Cancer Res 2016; 23:899-907. [PMID: 27551000 DOI: 10.1158/1078-0432.ccr-16-1274] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/11/2016] [Accepted: 08/03/2016] [Indexed: 12/21/2022]
Abstract
Purpose: The PARP inhibitor veliparib delays DNA repair and potentiates cytotoxicity of multiple classes of chemotherapy drugs, including topoisomerase I inhibitors and platinating agents. This study evaluated veliparib incorporation into leukemia induction therapy using a previously described topotecan/carboplatin backbone.Experimental Design: Employing a 3+3 trial design, we administered escalating doses of veliparib combined with topotecan + carboplatin in relapsed or refractory acute leukemias, aggressive myeloproliferative neoplasms (MPN), and chronic myelomonocytic leukemia (CMML).Results: A total of 99 patients received veliparib 10-100 mg orally twice daily on days 1-8, 1-14, or 1-21 along with continuous infusion topotecan 1.0-1.2 mg/m2/d + carboplatin 120-150 mg/m2/d on days 3-7. The MTD was veliparib 80 mg twice daily for up to 21 days with topotecan 1.2 mg/m2/d + carboplatin 150 mg/m2/d. Mucositis was dose limiting and correlated with high veliparib concentrations. The response rate was 33% overall (33/99: 14 CR, 11 CRi, 8 PR) but was 64% (14/22) for patients with antecedent or associated aggressive MPNs or CMML. Leukemias with baseline DNA repair defects, as evidenced by impaired DNA damage-induced FANCD2 monoubiquitination, had improved survival [HR = 0.56 (95% confidence interval, 0.27-0.92)]. A single 80-mg dose of veliparib, as well as veliparib in combination with topotecan + carboplatin, induced DNA damage as manifested by histone H2AX phosphorylation in CD34+ leukemia cells, with greater phosphorylation in cells from responders.Conclusions: The veliparib/topotecan/carboplatin combination warrants further investigation, particularly in patients with aggressive MPNs, CMML, and MPN- or CMML-related acute leukemias. Clin Cancer Res; 23(4); 899-907. ©2016 AACR.
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Affiliation(s)
- Keith W Pratz
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland.
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Ivana Gojo
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | | | - Michael A McDevitt
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Jiuping Ji
- National Clinical Target Validation Laboratory, Frederick National Laboratory for Cancer Research, Bethesda, Maryland
| | | | - James G Herman
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Robert J Kinders
- Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - B Douglas Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Steven D Gore
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Hetty E Carraway
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Margaret M Showel
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Douglas E Gladstone
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Mark J Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Hua-Ling Tsai
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Gary Rosner
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Alice Chen
- IDB/CTEP/NCI, National Cancer Institute, Rockville, Maryland
| | | | - Judith E Karp
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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Affiliation(s)
| | - Meghali Goswami
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Minoo Battiwalla
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Austin J Barrett
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sheenu Sheela
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Judith E Karp
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Catherine Lai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Pratz KW, Koh BD, Patel AG, Flatten KS, Poh W, Herman JG, Dilley R, Harrell MI, Smith BD, Karp JE, Swisher EM, McDevitt MA, Kaufmann SH. Poly (ADP-Ribose) Polymerase Inhibitor Hypersensitivity in Aggressive Myeloproliferative Neoplasms. Clin Cancer Res 2016; 22:3894-902. [PMID: 26979391 DOI: 10.1158/1078-0432.ccr-15-2351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/29/2016] [Indexed: 01/31/2023]
Abstract
PURPOSE DNA repair defects have been previously reported in myeloproliferative neoplasms (MPN). Inhibitors of PARP have shown activity in solid tumors with defects in homologous recombination (HR). This study was performed to assess MPN sensitivity to PARP inhibitors ex vivo EXPERIMENTAL DESIGN HR pathway integrity in circulating myeloid cells was evaluated by assessing the formation of RAD51 foci after treatment with ionizing radiation or PARP inhibitors. Sensitivity of MPN erythroid and myeloid progenitors to PARP inhibitors was evaluated using colony formation assays. RESULTS Six of 14 MPN primary samples had reduced formation of RAD51 foci after exposure to ionizing radiation, suggesting impaired HR. This phenotype was not associated with a specific MPN subtype, JAK2 mutation status, or karyotype. MPN samples showed increased sensitivity to the PARP inhibitors veliparib and olaparib compared with normal myeloid progenitors. This hypersensitivity, which was most pronounced in samples deficient in DNA damage-induced RAD51 foci, was observed predominantly in samples from patients with diagnoses of chronic myelogenous leukemia, chronic myelomonocytic leukemia, or unspecified myelodysplastic/MPN overlap syndromes. CONCLUSIONS Like other neoplasms with HR defects, MPNs exhibit PARP inhibitor hypersensitivity compared with normal marrow. These results suggest that further preclinical and possibly clinical study of PARP inhibitors in MPNs is warranted. Clin Cancer Res; 22(15); 3894-902. ©2016 AACR.
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Affiliation(s)
- Keith W Pratz
- Department of Oncology and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland.
| | - Brian D Koh
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Anand G Patel
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | | | - Weijie Poh
- Department of Oncology and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - James G Herman
- Division of Hematology/Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Robert Dilley
- Department of Oncology and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - Maria I Harrell
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - B Douglas Smith
- Department of Oncology and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - Judith E Karp
- Department of Oncology and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth M Swisher
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Michael A McDevitt
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Scott H Kaufmann
- Department of Oncology, Mayo Clinic, Rochester, Minnesota. Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
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Dai H, Ding H, Meng XW, Peterson KL, Schneider PA, Karp JE, Kaufmann SH. Constitutive BAK activation as a determinant of drug sensitivity in malignant lymphohematopoietic cells. Genes Dev 2016; 29:2140-52. [PMID: 26494789 PMCID: PMC4617978 DOI: 10.1101/gad.267997.115] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mitochondrial outer membrane permeabilization (MOMP), a key step in the intrinsic apoptotic pathway, is incompletely understood. Current models emphasize the role of BH3-only BCL2 family members in BAX and BAK activation. Here we demonstrate concentration-dependent BAK autoactivation under cell-free conditions and provide evidence that this autoactivation plays a key role in regulating the intrinsic apoptotic pathway in intact cells. In particular, we show that up to 80% of BAK (but not BAX) in lymphohematopoietic cell lines is oligomerized and bound to anti-apoptotic BCL2 family members in the absence of exogenous death stimuli. The extent of this constitutive BAK oligomerization is diminished by BAK knockdown and unaffected by BIM or PUMA down-regulation. Further analysis indicates that sensitivity of cells to BH3 mimetics reflects the identity of the anti-apoptotic proteins to which BAK is constitutively bound, with extensive BCLXL•BAK complexes predicting navitoclax sensitivity, and extensive MCL1•BAK complexes predicting A1210477 sensitivity. Moreover, high BAK expression correlates with sensitivity of clinical acute myelogenous leukemia to chemotherapy, whereas low BAK levels correlate with resistance and relapse. Collectively, these results inform current understanding of MOMP and provide new insight into the ability of BH3 mimetics to induce apoptosis without directly activating BAX or BAK.
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Affiliation(s)
- Haiming Dai
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota 55905, USA; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905, USA; Center for Medical Physics and Technology, Hefei Institutes of Physical Science, Chinese Academy of Science, Hefei 230031, China
| | - Husheng Ding
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - X Wei Meng
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota 55905, USA; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Kevin L Peterson
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Paula A Schneider
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Judith E Karp
- Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland 21287, USA
| | - Scott H Kaufmann
- Division of Oncology Research, Mayo Clinic, Rochester, Minnesota 55905, USA; Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905, USA
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Karp JE, Wolff AC. Cancer susceptibility genes and their potential implication regarding systemic therapy for early-stage breast cancer. Cancer 2016; 122:178-80. [PMID: 26642256 DOI: 10.1002/cncr.29613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/11/2015] [Accepted: 07/13/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Judith E Karp
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Antonio C Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
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Zeidner JF, Karp JE, Blackford AL, Foster MC, Dees EC, Smith G, Ivy SP, Harris P. Phase I Clinical Trials in Acute Myeloid Leukemia: 23-Year Experience From Cancer Therapy Evaluation Program of the National Cancer Institute. J Natl Cancer Inst 2015; 108:djv335. [PMID: 26553781 DOI: 10.1093/jnci/djv335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/13/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Therapy for acute myeloid leukemia (AML) has largely remained unchanged, and outcomes are unsatisfactory. We sought to analyze outcomes of AML patients enrolled in phase I studies to determine whether overall response rates (ORR) and mortality rates have changed over time. METHODS A retrospective analysis was performed on 711 adult AML patients enrolling in 45 phase I clinical trials supported by the Cancer Therapy Evaluation Program of the National Cancer Institute from 1986 to 2009. Changes in ORR and mortality rates for patients enrolled in 1986 to 1990, 1991 to 1995, 1996 to 2000, 2001 to 2005, and 2006 to 2009 were estimated with multivariable logistic regression models. All statistical tests were two-sided. RESULTS There was a statistically significant increase in AML patients enrolling in phase I clinical trials over time (1986 to 1990: n = 61; 2006 to 2009: n = 256; P = .03). The ORR for the entire cohort was 15.4% (1986 to 1990: 8.9%, 1991 to 1995: 21.1%; 1996 to 2000: 7.0%; 2001 to 2005: 10.0%; 2006 to 2009: 22.6%), and it statistically significantly improved over time (P < .001). There was a statistically significant improvement in ORRs with novel agents in combination vs single agents (ORR = 22.8% vs 4.7%, respectively, odds ratio = 5.95, 95% confidence interval = 3.22 to 11.9, P < .001). The 60-day mortality rate for the entire cohort was 22.6%, but it statistically significantly improved over time (P = .009). CONCLUSIONS There has been an encouraging increase in AML patients enrolling in phase I clinical studies over time. The improvement in ORRs appears to be partly because of the increase in combination trials and the inclusion of previously untreated poor-risk AML. Continued enrollment of AML patients in early phase clinical trials is vital for drug development and improvement in therapeutic outcomes.
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Affiliation(s)
- Joshua F Zeidner
- Affiliations of authors: University of North Carolina, Lineberger Comprehensive Cancer Center , Chapel Hill, NC (JFZ, MCF, ECD); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD (JEK, ALB); Cancer Therapy Evaluation Program , National Cancer Institute , Rockville, MD (GS, SPI, PH)
| | - Judith E Karp
- Affiliations of authors: University of North Carolina, Lineberger Comprehensive Cancer Center , Chapel Hill, NC (JFZ, MCF, ECD); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD (JEK, ALB); Cancer Therapy Evaluation Program , National Cancer Institute , Rockville, MD (GS, SPI, PH)
| | - Amanda L Blackford
- Affiliations of authors: University of North Carolina, Lineberger Comprehensive Cancer Center , Chapel Hill, NC (JFZ, MCF, ECD); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD (JEK, ALB); Cancer Therapy Evaluation Program , National Cancer Institute , Rockville, MD (GS, SPI, PH)
| | - Matthew C Foster
- Affiliations of authors: University of North Carolina, Lineberger Comprehensive Cancer Center , Chapel Hill, NC (JFZ, MCF, ECD); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD (JEK, ALB); Cancer Therapy Evaluation Program , National Cancer Institute , Rockville, MD (GS, SPI, PH)
| | - E Claire Dees
- Affiliations of authors: University of North Carolina, Lineberger Comprehensive Cancer Center , Chapel Hill, NC (JFZ, MCF, ECD); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD (JEK, ALB); Cancer Therapy Evaluation Program , National Cancer Institute , Rockville, MD (GS, SPI, PH)
| | - Gary Smith
- Affiliations of authors: University of North Carolina, Lineberger Comprehensive Cancer Center , Chapel Hill, NC (JFZ, MCF, ECD); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD (JEK, ALB); Cancer Therapy Evaluation Program , National Cancer Institute , Rockville, MD (GS, SPI, PH)
| | - S Percy Ivy
- Affiliations of authors: University of North Carolina, Lineberger Comprehensive Cancer Center , Chapel Hill, NC (JFZ, MCF, ECD); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD (JEK, ALB); Cancer Therapy Evaluation Program , National Cancer Institute , Rockville, MD (GS, SPI, PH)
| | - Pamela Harris
- Affiliations of authors: University of North Carolina, Lineberger Comprehensive Cancer Center , Chapel Hill, NC (JFZ, MCF, ECD); Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore, MD (JEK, ALB); Cancer Therapy Evaluation Program , National Cancer Institute , Rockville, MD (GS, SPI, PH)
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Abstract
The goal of precision medicine is to personalize therapy based on individual patient variation, to correctly select the right treatment, for the right patient, at the right time. Acute myeloid leukemia (AML) is a heterogeneous collection of myeloid malignancies with diverse genetic etiology and the potential for intra-patient clonal evolution over time. We discuss here how the precision medicine paradigm might be applied to the care of AML patients by focusing on the potential roles of targeting therapy by patient-specific somatic mutations and aberrant pathways, ex-vivo drug sensitivity and resistance testing, high sensitivity measurements of residual disease burden and biology along with potential clinical trial and regulatory constraints.
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Affiliation(s)
- Catherine Lai
- a Myeloid Malignancies Section, Hematology Branch, National Heart , Lung and Blood Institute, National Institutes of Health , Bethesda , MD , USA
| | - Judith E Karp
- a Myeloid Malignancies Section, Hematology Branch, National Heart , Lung and Blood Institute, National Institutes of Health , Bethesda , MD , USA.,b Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Christopher S Hourigan
- a Myeloid Malignancies Section, Hematology Branch, National Heart , Lung and Blood Institute, National Institutes of Health , Bethesda , MD , USA
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29
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Kremer KN, Dudakovic A, Hess AD, Smith BD, Karp JE, Kaufmann SH, Westendorf JJ, van Wijnen AJ, Hedin KE. Histone Deacetylase Inhibitors Target the Leukemic Microenvironment by Enhancing a Nherf1-Protein Phosphatase 1α-TAZ Signaling Pathway in Osteoblasts. J Biol Chem 2015; 290:29478-92. [PMID: 26491017 DOI: 10.1074/jbc.m115.668160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Indexed: 01/20/2023] Open
Abstract
Disrupting the protective signals provided by the bone marrow microenvironment will be critical for more effective combination drug therapies for acute myeloid leukemia (AML). Cells of the osteoblast lineage that reside in the endosteal niche have been implicated in promoting survival of AML cells. Here, we investigated how to prevent this protective interaction. We previously showed that SDF-1, a chemokine abundant in the bone marrow, induces apoptosis of AML cells, unless the leukemic cells receive protective signals provided by differentiating osteoblasts (8, 10). We now identify a novel signaling pathway in differentiating osteoblasts that can be manipulated to disrupt the osteoblast-mediated protection of AML cells. Treating differentiating osteoblasts with histone deacetylase inhibitors (HDACi) abrogated their ability to protect co-cultured AML cells from SDF-1-induced apoptosis. HDACi prominently up-regulated expression of the Nherf1 scaffold protein, which played a major role in preventing osteoblast-mediated protection of AML cells. Protein phosphatase-1α (PP1α) was identified as a novel Nherf1 interacting protein that acts as the downstream mediator of this response by promoting nuclear localization of the TAZ transcriptional modulator. Moreover, independent activation of either PP1α or TAZ was sufficient to prevent osteoblast-mediated protection of AML cells even in the absence of HDACi. Together, these results indicate that HDACi target the AML microenvironment by enhancing activation of the Nherf1-PP1α-TAZ pathway in osteoblasts. Selective drug targeting of this osteoblast signaling pathway may improve treatments of AML by rendering leukemic cells in the bone marrow more susceptible to apoptosis.
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Affiliation(s)
| | | | - Allan D Hess
- the Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland 21287
| | - B Douglas Smith
- the Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland 21287
| | - Judith E Karp
- the Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland 21287
| | - Scott H Kaufmann
- Oncology and Molecular Pharmacology & Experimental Therapeutics and
| | - Jennifer J Westendorf
- Orthopedic Surgery, the Center of Regenerative Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905 and
| | - Andre J van Wijnen
- Orthopedic Surgery, the Center of Regenerative Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905 and
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30
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Zeidner JF, Karp JE. Clinical activity of alvocidib (flavopiridol) in acute myeloid leukemia. Leuk Res 2015; 39:1312-8. [PMID: 26521988 DOI: 10.1016/j.leukres.2015.10.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/01/2015] [Accepted: 10/14/2015] [Indexed: 10/25/2022]
Abstract
There have been minimal therapeutic advancements in acute myeloid leukemia (AML) over the past 4 decades and outcomes remain unsatisfactory. Alvocidib (formerly flavopiridol) is a multi-serine threonine cyclin-dependent kinase inhibitor with demonstrable in vitro and clinical activity in AML when combined in a timed sequential chemotherapy regimen, FLAM (alvocidib followed by cytarabine continuous infusion and mitoxantrone). FLAM has been evaluated in sequential phase 1 and phase 2 studies in 149 and 256 relapsed/refractory and newly diagnosed non-favorable risk AML patients, respectively, with encouraging findings in both patient populations warranting further investigation. This review highlights the mechanism of action of alvocidib, pre-clinical studies of alvocidib in AML, and the clinical trials evaluating alvocidib alone and in combination with cytotoxic agents (FLAM) in AML.
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Affiliation(s)
- Joshua F Zeidner
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States.
| | - Judith E Karp
- Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
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31
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Vincelette ND, Karnitz LM, Karp JE, Smith DB, Hess AD, Mayer LD, Kaufmann SH. Abstract 3479: CPX-351 (cytarabine:daunorubicin liposome for injection) anti-leukemia activity is potentiated by Chk1 inhibition. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-3479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Cytarabine and an anthracycline, the mainstay of AML therapy, affords a five-year survival below 30%. Accordingly, there is a continuing need for improved AML therapies. CPX-351 encapsulates within liposomes a fixed 5:1 molar ratio of cytarabine and daunorubicin that is synergistic (in vitro) and markedly improved in anti-leukemic activity (in vivo). Promising evidence of improved remission and survival rates with CPX-351 compared to standard of care treatments has also been observed clinically and a pivotal Phase 3 trial is currently ongoing. Because Chk1 inhibition has been shown to enhance the actions of both cytarabine and anthracyclines, there has been interest in assessing the effect of CPX-351 when combined with Chk1 inhibitors. Here we describe the evaluation of CPX-351 alone and in combination with the Chk1 inhibitors MK-8776 and LY2603618 in AML cell lines and in clinical AML samples ex vivo. Methods: Effects of CPX-351 on Chk1 phosphorylation and cell cycle distribution in the human AML lines U937 and HL-60 were analyzed by immunoblotting and flow cytometry. Effects of Chk1 inhibitors on CPX-351-induced apoptosis were assessed by flow cytometry after propidium iodide staining (DNA cleavage), Hoechst staining (nuclear fragmentation) and colony formation in soft agar (long-term survival). Effects CPX-351 ± MK-8776 on clinical AML samples were assayed using clonogenic assays. Results: Treatment of U937 cells with CPX-351 resulted in phosphorylation of Chk1 on Ser317 and Ser296 (sites of ATR-mediated phosphorylation and autophosphorylation, respectively) as well as S phase slowing consistent with Chk1 activation. Co-treatment of AML cell lines with Chk1 inhibitors + CPX-351 resulted in increased apoptotic morphological changes and DNA fragmentation as well as diminished clonogenic survival compared to CPX-351 alone. The CPX-351/MK-8776 combination displayed enhanced antiproliferative effects against some clinical AML isolates ex vivo compared to CPX-351 alone, with additional assays ongoing. Conclusions: Collectively, these results show that Chk1 inhibition enhances the cytotoxicity of CPX-351 in AML cell lines and some clinical AML samples, offering the possibility that CPX-351 may be well suited for combining with such molecularly targeted agents.
Citation Format: Nicole D. Vincelette, Larry M. Karnitz, Judith E. Karp, Douglas B. Smith, Allan D. Hess, Lawrence D. Mayer, Scott H. Kaufmann. CPX-351 (cytarabine:daunorubicin liposome for injection) anti-leukemia activity is potentiated by Chk1 inhibition. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3479. doi:10.1158/1538-7445.AM2015-3479
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Affiliation(s)
| | | | - Judith E. Karp
- 2Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Allan D. Hess
- 2Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, MD
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32
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Knorr KLB, Schneider PA, Meng XW, Dai H, Smith BD, Hess AD, Karp JE, Kaufmann SH. MLN4924 induces Noxa upregulation in acute myelogenous leukemia and synergizes with Bcl-2 inhibitors. Cell Death Differ 2015; 22:2133-42. [PMID: 26045051 DOI: 10.1038/cdd.2015.74] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 12/31/2022] Open
Abstract
MLN4924 (pevonedistat), an inhibitor of the Nedd8 activating enzyme (NAE), has exhibited promising clinical activity in acute myelogenous leukemia (AML). Here we demonstrate that MLN4924 induces apoptosis in AML cell lines and clinical samples via a mechanism distinct from those observed in other malignancies. Inactivation of E3 cullin ring ligases (CRLs) through NAE inhibition causes accumulation of the CRL substrate c-Myc, which transactivates the PMAIP1 gene encoding Noxa, leading to increased Noxa protein, Bax and Bak activation, and subsequent apoptotic changes. Importantly, c-Myc knockdown diminishes Noxa induction; and Noxa siRNA diminishes MLN4924-induced killing. Because Noxa also neutralizes Mcl-1, an anti-apoptotic Bcl-2 paralog often upregulated in resistant AML, further experiments have examined the effect of combining MLN4924 with BH3 mimetics that target other anti-apoptotic proteins. In combination with ABT-199 or ABT-263 (navitoclax), MLN4924 exerts a synergistic cytotoxic effect. Collectively, these results provide new insight into MLN4924-induced engagement of the apoptotic machinery that could help guide further exploration of MLN4924 for AML.
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Affiliation(s)
- K L B Knorr
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN, USA
| | - P A Schneider
- Division of Oncology Research, Mayo Clinic, Rochester, MN, USA
| | - X W Meng
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN, USA.,Division of Oncology Research, Mayo Clinic, Rochester, MN, USA
| | - H Dai
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN, USA.,Division of Oncology Research, Mayo Clinic, Rochester, MN, USA
| | - B D Smith
- Division of Hematological Malignancies, Sidney Kimmel Cancer Center, Johns Hopkins, Baltimore, MD, USA
| | - A D Hess
- Division of Hematological Malignancies, Sidney Kimmel Cancer Center, Johns Hopkins, Baltimore, MD, USA
| | - J E Karp
- Division of Hematological Malignancies, Sidney Kimmel Cancer Center, Johns Hopkins, Baltimore, MD, USA
| | - S H Kaufmann
- Department of Molecular Pharmacology and Experimental Therapeutics, Rochester, MN, USA.,Division of Oncology Research, Mayo Clinic, Rochester, MN, USA
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33
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Zeidner JF, Foster MC, Blackford AL, Litzow MR, Morris LE, Strickland SA, Lancet JE, Bose P, Levy MY, Tibes R, Gojo I, Gocke CD, Rosner GL, Little RF, Wright JJ, Doyle LA, Smith BD, Karp JE. Randomized multicenter phase II study of flavopiridol (alvocidib), cytarabine, and mitoxantrone (FLAM) versus cytarabine/daunorubicin (7+3) in newly diagnosed acute myeloid leukemia. Haematologica 2015; 100:1172-9. [PMID: 26022709 DOI: 10.3324/haematol.2015.125849] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/21/2015] [Indexed: 11/09/2022] Open
Abstract
Serial studies have demonstrated that induction therapy with FLAM [flavopiridol (alvocidib) 50 mg/m(2) days 1-3, cytarabine 667 mg/m(2)/day continuous infusion days 6-8, and mitoxantrone (FLAM) 40 mg/m(2) day 9] yields complete remission rates of nearly 70% in newly diagnosed poor-risk acute myeloid leukemia. Between May 2011-July 2013, 165 newly diagnosed acute myeloid leukemia patients (age 18-70 years) with intermediate/adverse-risk cytogenetics were randomized 2:1 to receive FLAM or 7+3 (cytarabine 100 mg/m(2)/day continuous infusion days 1-7 and daunorubicin 90 mg/m(2) days 1-3), across 10 institutions. Some patients on 7+3 with residual leukemia on day 14 received 5+2 (cytarabine 100 mg/m(2)/day continuous infusion days 1-5 and daunorubicin 45 mg/m(2) days 1-2), whereas patients on FLAM were not re-treated based on day 14 bone marrow findings. The primary objective was to compare complete remission rates between one cycle of FLAM and one cycle of 7+3. Secondary end points included safety, overall survival and event-free survival. FLAM led to higher complete remission rates than 7+3 alone (70% vs. 46%; P=0.003) without an increase in toxicity, and this improvement persisted after 7+3+/-5+2 (70% vs. 57%; P=0.08). There were no significant differences in overall survival and event-free survival in both arms but post-induction strategies were not standardized. These results substantiate the efficacy of FLAM induction in newly diagnosed AML. A phase III study is currently in development. This study is registered with clinicaltrials.gov identifier: 01349972.
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Affiliation(s)
- Joshua F Zeidner
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Matthew C Foster
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Amanda L Blackford
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Lawrence E Morris
- The Blood and Marrow Transplant Program at Northside Hospital, Bone Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | | | - Jeffrey E Lancet
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Prithviraj Bose
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
| | - M Yair Levy
- Texas Oncology, Baylor Charles A. Simmons Cancer Center, Dallas, TX, USA
| | | | - Ivana Gojo
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA University of Maryland Medical Center, Stewart Greenebaum Cancer Center, Baltimore, MD, USA
| | - Christopher D Gocke
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Gary L Rosner
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | | | | | - B Douglas Smith
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Judith E Karp
- The Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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34
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Gerber JM, Zeidner JF, Morse S, Blackford A, Perkins B, Yanagisawa B, Zhang H, Morsberger L, Karp JE, Ning Y, Gocke CD, Rosner GL, Smith BD, Jones RJ. Correlation of acute myeloid leukemia (AML) stem cell phenotype with cytogenetic/molecular features and prognosis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.7000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Joshua F. Zeidner
- UNC Chapel Hill Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | - Amanda Blackford
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Brandy Perkins
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Hao Zhang
- Johns Hopkins University, Baltimore, MD
| | | | - Judith E. Karp
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Yi Ning
- Johns Hopkins University, Baltimore, MD
| | - Christopher D Gocke
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - B. Douglas Smith
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Richard J. Jones
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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35
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Ramos NR, Mo CC, Karp JE, Hourigan CS. Current Approaches in the Treatment of Relapsed and Refractory Acute Myeloid Leukemia. J Clin Med 2015; 4:665-95. [PMID: 25932335 PMCID: PMC4412468 DOI: 10.3390/jcm4040665] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/20/2015] [Indexed: 01/07/2023] Open
Abstract
The limited sensitivity of the historical treatment response criteria for acute myeloid leukemia (AML) has resulted in a different paradigm for treatment compared with most other cancers presenting with widely disseminated disease. Initial cytotoxic induction chemotherapy is often able to reduce tumor burden to a level sufficient to meet the current criteria for "complete" remission. Nevertheless, most AML patients ultimately die from their disease, most commonly as clinically evident relapsed AML. Despite a variety of available salvage therapy options, prognosis in patients with relapsed or refractory AML is generally poor. In this review, we outline the commonly utilized salvage cytotoxic therapy interventions and then highlight novel investigational efforts currently in clinical trials using both pathway-targeted agents and immunotherapy based approaches. We conclude that there is no current standard of care for adult relapsed or refractory AML other than offering referral to an appropriate clinical trial.
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Affiliation(s)
- Nestor R. Ramos
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1583, USA; E-Mail:
- Department of Hematology-Oncology, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; E-Mail:
| | - Clifton C. Mo
- Department of Hematology-Oncology, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA; E-Mail:
| | - Judith E. Karp
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; E-Mail:
| | - Christopher S. Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1583, USA; E-Mail:
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36
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Wolff AC, Blackford AL, Visvanathan K, Rugo HS, Moy B, Goldstein LJ, Stockerl-Goldstein K, Neumayer L, Langbaum TS, Theriault RL, Hughes ME, Weeks JC, Karp JE. Risk of marrow neoplasms after adjuvant breast cancer therapy: the national comprehensive cancer network experience. J Clin Oncol 2014; 33:340-8. [PMID: 25534386 DOI: 10.1200/jco.2013.54.6119] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Outcomes for early-stage breast cancer have improved. First-generation adjuvant chemotherapy trials reported a 0.27% 8-year cumulative incidence of myelodysplastic syndrome/acute myelogenous leukemia. Incomplete ascertainment and follow-up may have underestimated subsequent risk of treatment-associated marrow neoplasm (MN). PATIENTS AND METHODS We examined the MN frequency in 20,063 patients with stage I to III breast cancer treated at US academic centers between 1998 and 2007. Time-to-event analyses were censored at first date of new cancer event, last contact date, or death and considered competing risks. Cumulative incidence, hazard ratios (HRs), and comparisons with Surveillance, Epidemiology, and End Results estimates were obtained. Marrow cytogenetics data were reviewed. RESULTS Fifty patients developed MN (myeloid, n = 42; lymphoid, n = 8) after breast cancer (median follow-up, 5.1 years). Patients who developed MN had similar breast cancer stage distribution, race, and chemotherapy exposure but were older compared with patients who did not develop MN (median age, 59.1 v 53.9 years, respectively; P = .03). Two thirds of patients had complex MN cytogenetics. Risk of MN was significantly increased after surgery plus chemotherapy (HR, 6.8; 95% CI, 1.3 to 36.1) or after all modalities (surgery, chemotherapy, and radiation; HR, 7.6; 95% CI, 1.6 to 35.8), compared with no treatment with chemotherapy. MN rates per 1,000 person-years were 0.16 (surgery), 0.43 (plus radiation), 0.46 (plus chemotherapy), and 0.54 (all three modalities). Cumulative incidence of MN doubled between years 5 and 10 (0.24% to 0.48%); 9% of patients were alive at 10 years. CONCLUSION In this large early-stage breast cancer cohort, MN risk after radiation and/or adjuvant chemotherapy was low but higher than previously described. Risk continued to increase beyond 5 years. Individual risk of MN must be balanced against the absolute survival benefit of adjuvant chemotherapy.
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Affiliation(s)
- Antonio C Wolff
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Amanda L Blackford
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kala Visvanathan
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hope S Rugo
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beverly Moy
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lori J Goldstein
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Keith Stockerl-Goldstein
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leigh Neumayer
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Terry S Langbaum
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard L Theriault
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa E Hughes
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane C Weeks
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Judith E Karp
- Antonio C. Wolff, Amanda L. Blackford, Kala Visvanathan, Terry S. Langbaum, and Judith E. Karp, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Hope S. Rugo, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA; Beverly Moy, Massachusetts General Hospital Cancer Center; Melissa E. Hughes and Jane C. Weeks, Dana-Farber Cancer Institute, Boston, MA; Lori J. Goldstein, Fox Chase Cancer Center, Philadelphia, PA; Keith Stockerl-Goldstein, Siteman Cancer Center at Washington University School of Medicine, St Louis, MO; Leigh Neumayer, Huntsman Cancer Center at University of Utah School of Medicine, Salt Lake City, UT; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
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Lancet JE, Roboz GJ, Cripe LD, Michelson GC, Fox JA, Leavitt RD, Chen T, Hawtin R, Craig AR, Ravandi F, Maris MB, Stuart RK, Karp JE. A phase 1b/2 study of vosaroxin in combination with cytarabine in patients with relapsed or refractory acute myeloid leukemia. Haematologica 2014; 100:231-7. [PMID: 25381131 DOI: 10.3324/haematol.2014.114769] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Vosaroxin is a first-in-class anticancer quinolone derivative that intercalates DNA and inhibits topoisomerase II. This study assessed the safety and tolerability of vosaroxin plus cytarabine in patients with relapsed/refractory acute myeloid leukemia. Escalating vosaroxin doses (10-minute infusion; 10-90 mg/m(2); days 1, 4) were given in combination with cytarabine on one of two schedules: schedule A (24-hour continuous intravenous infusion, 400 mg/m(2)/day, days 1-5) or schedule B (2-hour intravenous infusion, 1 g/m(2)/day, days 1-5). Following dose escalation, enrollment was expanded at the maximum tolerated dose. Of 110 patients enrolled, 108 received treatment. The maximum tolerated dose of vosaroxin was 80 mg/m(2) for schedule A (dose-limiting toxicities: grade 3 bowel obstruction and stomatitis) and was not reached for schedule B (recommended phase 2 dose: 90 mg/m(2)). In the efficacy population (all patients in first relapse or with primary refractory disease treated with vosaroxin 80-90 mg/m(2); n=69), the complete remission rate was 25% and the complete remission/complete remission with incomplete blood count recovery rate was 28%. The 30-day all-cause mortality rate was 2.5% among all patients treated at a dose of 80-90 mg/m(2). Based upon these results, a phase 3 trial of vosaroxin plus cytarabine was initiated in patients with relapsed/refractory acute myeloid leukemia. (Clinicaltrials.gov identifier: NCT00541866).
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Affiliation(s)
| | - Gail J Roboz
- Cornell University/New York Presbyterian Hospital, New York, NY
| | | | | | - Judith A Fox
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA
| | | | - Tianling Chen
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA
| | | | - Adam R Craig
- Sunesis Pharmaceuticals, Inc., South San Francisco, CA
| | | | - Michael B Maris
- Rocky Mountain Blood and Marrow Transplant Center, Denver, CO
| | | | - Judith E Karp
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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Abstract
Recent advances in molecular technology have unraveled the complexity of leukemogenesis and provided the opportunity to design more personalized and pathophysiology-targeted therapeutic strategies. Despite the use of intensive chemotherapy, relapse remains the most common cause for therapeutic failure in acute myelogenous leukemia (AML). The interactions between leukemia stem cells (LSC) and marrow microenvironment appear to be critical in promoting therapeutic resistance through progressive acquisition of genetic and epigenetic changes within leukemia cells and immune evasion, resulting in leukemia cell survival. With advances in genomic-sequencing efforts, epigenetic and phenotypic characterization, personalized therapeutic strategies aimed at critical leukemia survival mechanisms may be feasible in the near future. Here, we review select novel approaches to therapy of AML such as targeting LSC, altering leukemia/marrow microenvironment interactions, inhibiting DNA repair or cell-cycle checkpoints, and augmenting immune-based antileukemia activity.
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Affiliation(s)
- Ivana Gojo
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Judith E Karp
- Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
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Sammons SL, Pratz KW, Smith BD, Karp JE, Emadi A. Sorafenib is tolerable and improves clinical outcomes in patients with FLT3-ITD acute myeloid leukemia prior to stem cell transplant and after relapse post-transplant. Am J Hematol 2014; 89:936-8. [PMID: 24898801 DOI: 10.1002/ajh.23782] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 05/30/2014] [Accepted: 06/03/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Sarah L. Sammons
- Department of Internal Medicine; Division of Hematology Oncology; University of Maryland School of Medicine, Marlene and Stewart Greenebaum Cancer Center, Leukemia and Hematologic Malignancies; Baltimore Maryland
| | - Keith W. Pratz
- Department of Internal Medicine; Division of Hematology Oncology; University of Maryland School of Medicine, Marlene and Stewart Greenebaum Cancer Center, Leukemia and Hematologic Malignancies; Baltimore Maryland
| | - B. Douglas Smith
- Division of Hematologic Malignancies; Department of Oncology; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University; Baltimore Maryland
| | - Judith E. Karp
- Division of Hematologic Malignancies; Department of Oncology; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University; Baltimore Maryland
| | - Ashkan Emadi
- Division of Hematologic Malignancies; Department of Oncology; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University; Baltimore Maryland
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40
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Abstract
Patient-specific ex vivo drug sensitivity and resistance screening can identify rational drug candidates for the testing of personalized targeted therapy. An iterative approach of genomic and drug susceptibility characterization at sequential time points during clinical trials of targeted therapy in acute myeloid leukemia may be useful both for characterizing mechanisms of resistance and clonal evolution and also for identification of novel therapeutic targets and drug combinations.
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Affiliation(s)
- Christopher S Hourigan
- 1Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, and 2The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
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41
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Meng XW, Koh BD, Zhang JS, Flatten KS, Schneider PA, Billadeau DD, Hess AD, Smith BD, Karp JE, Kaufmann SH. Poly(ADP-ribose) polymerase inhibitors sensitize cancer cells to death receptor-mediated apoptosis by enhancing death receptor expression. J Biol Chem 2014; 289:20543-58. [PMID: 24895135 PMCID: PMC4110268 DOI: 10.1074/jbc.m114.549220] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/30/2014] [Indexed: 12/21/2022] Open
Abstract
Recombinant human tumor necrosis factor-α-related apoptosis inducing ligand (TRAIL), agonistic monoclonal antibodies to TRAIL receptors, and small molecule TRAIL receptor agonists are in various stages of preclinical and early phase clinical testing as potential anticancer drugs. Accordingly, there is substantial interest in understanding factors that affect sensitivity to these agents. In the present study we observed that the poly(ADP-ribose) polymerase (PARP) inhibitors olaparib and veliparib sensitize the myeloid leukemia cell lines ML-1 and K562, the ovarian cancer line PEO1, non-small cell lung cancer line A549, and a majority of clinical AML isolates, but not normal marrow, to TRAIL. Further analysis demonstrated that PARP inhibitor treatment results in activation of the FAS and TNFRSF10B (death receptor 5 (DR5)) promoters, increased Fas and DR5 mRNA, and elevated cell surface expression of these receptors in sensitized cells. Chromatin immunoprecipitation demonstrated enhanced binding of the transcription factor Sp1 to the TNFRSF10B promoter in the presence of PARP inhibitor. Knockdown of PARP1 or PARP2 (but not PARP3 and PARP4) not only increased expression of Fas and DR5 at the mRNA and protein level, but also recapitulated the sensitizing effects of the PARP inhibition. Conversely, Sp1 knockdown diminished the PARP inhibitor effects. In view of the fact that TRAIL is part of the armamentarium of natural killer cells, these observations identify a new facet of PARP inhibitor action while simultaneously providing the mechanistic underpinnings of a novel therapeutic combination that warrants further investigation.
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Affiliation(s)
- X. Wei Meng
- From the Division of Oncology Research and
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905 and
| | | | | | | | | | | | - Allan D. Hess
- the Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, Maryland 21205
| | - B. Douglas Smith
- the Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, Maryland 21205
| | - Judith E. Karp
- the Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, Maryland 21205
| | - Scott H. Kaufmann
- From the Division of Oncology Research and
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905 and
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42
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Kremer KN, Dudakovic A, McGee-Lawrence ME, Philips RL, Hess AD, Smith BD, van Wijnen AJ, Karp JE, Kaufmann SH, Westendorf JJ, Hedin KE. Osteoblasts protect AML cells from SDF-1-induced apoptosis. J Cell Biochem 2014; 115:1128-1137. [PMID: 24851270 PMCID: PMC4161028 DOI: 10.1002/jcb.24755] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The bone marrow provides a protective environment for acute myeloid leukemia (AML) cells that often allows leukemic stem cells to survive standard chemotherapeutic regimens. Targeting these leukemic stem cells within the bone marrow is critical for preventing relapse. We recently demonstrated that SDF-1, a chemokine abundant in the bone marrow, induces apoptosis in AML cell lines and in patient samples expressing high levels of its receptor, CXCR4. Here we show that a subset of osteoblast lineage cells within the bone marrow can protect AML cells from undergoing apoptosis in response to the SDF-1 naturally present in that location. In co-culture systems, osteoblasts at various stages of differentiation protected AML cell lines and patient isolates from SDF-1-induced apoptosis. The differentiation of the osteoblast cell lines, MC3T3 and W-20-17, mediated this protection via a cell contact-independent mechanism. In contrast, bone marrow-derived mesenchymal cells, the precursors of osteoblasts, induced apoptosis in AML cells via a CXCR4-dependent mechanism and failed to protect AML cells from exogenously added SDF-1. These results indicate that osteoblasts in the process of differentiation potently inhibit the SDF-1-driven apoptotic pathway of CXCR4-expressing AML cells residing in the bone marrow. Drugs targeting this protective mechanism could potentially provide a new approach to treating AML by enhancing the SDF-1-induced apoptosis of AML cells residing within the bone marrow microenvironment.
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Affiliation(s)
- Kimberly N. Kremer
- Department of Immunology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Meghan E. McGee-Lawrence
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Rachael L. Philips
- Department of Immunology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Allan D. Hess
- Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland 21287
| | - B. Douglas Smith
- Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland 21287
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
- Center of Regenerative Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Judith E. Karp
- Sidney Kimmel Cancer Center at Johns Hopkins, Baltimore, Maryland 21287
| | - Scott H. Kaufmann
- Department of Oncology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Jennifer J. Westendorf
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
- Center of Regenerative Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Karen E. Hedin
- Department of Immunology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
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Zeidner JF, Foster MC, Blackford A, Litzow MR, Morris L, Strickland SA, Lancet JE, Bose P, Levy MY, Tibes R, Gojo I, Gocke CD, Rosner GL, Greer J, Cain JM, Little RF, Wright JJ, Doyle LA, Smith BD, Karp JE. Randomized multicenter phase II trial of timed-sequential therapy with flavopiridol (alvocidib), cytarabine, and mitoxantrone (FLAM) versus “7+3” for adults with newly diagnosed acute myeloid leukemia (AML). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joshua F. Zeidner
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Amanda Blackford
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | | | | | | | - M. Yair Levy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX
| | | | - Ivana Gojo
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Christopher D Gocke
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Gary L. Rosner
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Jacqueline Greer
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Joan M Cain
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | | | - B Douglas Smith
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Judith E. Karp
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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44
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Campian JL, Ye X, Gladstone DE, Ambady P, Borrello I, Golightly M, Karen E. King KEK, Holdhoff M, Karp JE, Grossman SA. Feasibility of lymphocyte harvesting and reinfusion in patients with newly diagnosed high-grade gliomas. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Xiaobu Ye
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | - Ivan Borrello
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Matthias Holdhoff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Judith E. Karp
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Stuart A. Grossman
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
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45
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Affiliation(s)
- Ashkan Emadi
- Leukemia & Hematologic Malignancies, Marlene & Stewart Greenebaum Cancer Center, University of Maryland School of Medicine , Baltimore, MD , USA
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46
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Zeidner JF, Karp JE, Blackford AL, Smith BD, Gojo I, Gore SD, Levis MJ, Carraway HE, Greer JM, Ivy SP, Pratz KW, McDevitt MA. A phase II trial of sequential ribonucleotide reductase inhibition in aggressive myeloproliferative neoplasms. Haematologica 2013; 99:672-8. [PMID: 24362550 DOI: 10.3324/haematol.2013.097246] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Myeloproliferative neoplasms are a varied group of disorders that can have prolonged chronic phases, but eventually accelerate and can transform into a secondary acute myeloid leukemia that is ultimately fatal. Triapine is a novel inhibitor of the M2 subunit of ribonucleotide reductase. Sequential inhibition of ribonucleotide reductase with triapine and an M1 ribonucleotide reductase inhibitor (fludarabine) was noted to be safe, and led to a 29% complete plus partial response rate in myeloproliferative neoplasms. This article reports the findings of a phase II trial of triapine (105 mg/m(2)/day) followed by fludarabine (30 mg/m(2)/day) daily for 5 consecutive days in 37 patients with accelerated myeloproliferative neoplasms and secondary acute myeloid leukemia. The overall response rate was 49% (18/37), with a complete remission rate of 24% (9/37). Overall response rates and complete remissions were seen in all disease subsets, including secondary acute myeloid leukemia, in which the overall response rate and complete remission rate were 48% and 33%, respectively. All patients with known JAK2 V617F mutations (6/6) responded. The median overall survival of the entire cohort was 6.9 months, with a median overall survival of both overall responders and complete responders of 10.6 months. These data further demonstrate the promise of sequential inhibition of ribonucleotide reductase in patients with accelerated myeloproliferative neoplasms and secondary acute myeloid leukemia. This study was registered with clinicaltrials.gov (NCT00381550).
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47
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Chaudhuri L, Vincelette ND, Koh BD, Naylor RM, Flatten KS, Peterson KL, McNally A, Gojo I, Karp JE, Mesa RA, Sproat LO, Bogenberger JM, Kaufmann SH, Tibes R. CHK1 and WEE1 inhibition combine synergistically to enhance therapeutic efficacy in acute myeloid leukemia ex vivo. Haematologica 2013; 99:688-96. [PMID: 24179152 DOI: 10.3324/haematol.2013.093187] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Novel combinations targeting new molecular vulnerabilities are needed to improve the outcome of patients with acute myeloid leukemia. We recently identified WEE1 kinase as a novel target in leukemias. To identify genes that are synthetically lethal with WEE1 inhibition, we performed a short interfering RNA screen directed against cell cycle and DNA repair genes during concurrent treatment with the WEE1 inhibitor MK1775. CHK1 and ATR, genes encoding two replication checkpoint kinases, were among the genes whose silencing enhanced the effects of WEE1 inhibition most, whereas CDK2 short interfering RNA antagonized MK1775 effects. Building on this observation, we examined the impact of combining MK1775 with selective small molecule inhibitors of CHK1, ATR and cyclin-dependent kinases. The CHK1 inhibitor MK8776 sensitized acute myeloid leukemia cell lines and primary leukemia specimens to MK1775 ex vivo, whereas smaller effects were observed with the MK1775/MK8776 combination in normal myeloid progenitors. The ATR inhibitor VE-821 likewise enhanced the antiproliferative effects of MK1775, whereas the cyclin-dependent kinase inhibitor roscovitine antagonized MK1775. Further studies showed that MK8776 enhanced MK1775-mediated activation of the ATR/CHK1 pathway in acute leukemia cell lines and ex vivo. These results indicate that combined cell cycle checkpoint interference with MK1775/MK8776 warrants further investigation as a potential treatment for acute myeloid leukemia.
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48
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Ding H, McDonald JS, Yun S, Schneider PA, Peterson KL, Flatten KS, Loegering DA, Oberg AL, Riska SM, Huang S, Sinicrope FA, Adjei AA, Karp JE, Meng XW, Kaufmann SH. Farnesyltransferase inhibitor tipifarnib inhibits Rheb prenylation and stabilizes Bax in acute myelogenous leukemia cells. Haematologica 2013; 99:60-9. [PMID: 23996484 DOI: 10.3324/haematol.2013.087734] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although farnesyltransferase inhibitors have shown promising activity in relapsed lymphoma and sporadic activity in acute myelogenous leukemia, their mechanism of cytotoxicity is incompletely understood, making development of predictive biomarkers difficult. In the present study, we examined the action of tipifarnib in human acute myelogenous leukemia cell lines and clinical samples. In contrast to the Ras/MEK/ERK pathway-mediated Bim upregulation that is responsible for tipifarnib-induced killing of malignant lymphoid cells, inhibition of Rheb-induced mTOR signaling followed by dose-dependent upregulation of Bax and Puma occurred in acute myelogenous leukemia cell lines undergoing tipifarnib-induced apoptosis. Similar Bax and Puma upregulation occurred in serial bone marrow samples harvested from a subset of acute myelogenous leukemia patients during tipifarnib treatment. Expression of FTI-resistant Rheb M184L, like knockdown of Bax or Puma, diminished tipifarnib-induced killing. Further analysis demonstrated that increased Bax and Puma levels reflect protein stabilization rather than increased gene expression. In U937 cells selected for tipifarnib resistance, neither inhibition of signaling downstream of Rheb nor Bax and Puma stabilization occurred. Collectively, these results not only identify a pathway downstream from Rheb that contributes to tipifarnib cytotoxicity in human acute myelogenous leukemia cells, but also demonstrate that FTI-induced killing of lymphoid versus myeloid cells reflects distinct biochemical mechanisms downstream of different farnesylated substrates. (ClinicalTrials.gov identifier NCT00602771).
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49
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Abstract
Technological advances in the laboratory have led to substantial improvements in clinical decision making through the introduction of pretreatment prognostic risk stratification factors in acute myeloid leukaemia (AML). Unfortunately, similar progress has not been made in treatment response criteria, with the definition of 'complete remission' in AML largely unchanged for over half a century. Several clinical trials have demonstrated that high-sensitivity measurements of residual disease burden during or after treatment can be performed, that results are predictive for clinical outcome and can be used to improve outcomes by guiding additional therapeutic intervention to patients in clinical complete remission, but at increased relapse risk. We review these recent trials, the characteristics and challenges of the modalities currently used to detect minimal residual disease (MRD), and outline opportunities to both refine detection and improve clinical use of MRD measurements. MRD measurement is already the standard of care in other myeloid malignancies, such as chronic myelogenous leukaemia and acute promyelocytic leukaemia (APL). It is our belief that response criteria for non-APL AML should be updated to include assessment for molecular complete remission and recommendations for post-consolidation surveillance should include regular monitoring for molecular relapse as standard of care.
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Affiliation(s)
- Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, 10 Centre Drive, Bethesda, MD 20892-1583, USA.
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50
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Kremer KN, Peterson KL, Schneider PA, Meng XW, Dai H, Hess AD, Smith BD, Rodriguez-Ramirez C, Karp JE, Kaufmann SH, Hedin KE. CXCR4 chemokine receptor signaling induces apoptosis in acute myeloid leukemia cells via regulation of the Bcl-2 family members Bcl-XL, Noxa, and Bak. J Biol Chem 2013; 288:22899-914. [PMID: 23798675 DOI: 10.1074/jbc.m113.449926] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The CXCR4 chemokine receptor promotes survival of many different cell types. Here, we describe a previously unsuspected role for CXCR4 as a potent inducer of apoptosis in acute myeloid leukemia (AML) cell lines and a subset of clinical AML samples. We show that SDF-1, the sole ligand for CXCR4, induces the expected migration and ERK activation in the KG1a AML cell line transiently overexpressing CXCR4, but ERK activation did not lead to survival. Instead, SDF-1 treatment led via a CXCR4-dependent mechanism to apoptosis, as evidenced by increased annexin V staining, condensation of chromatin, and cleavage of both procaspase-3 and PARP. This SDF-1-induced death pathway was partially inhibited by hypoxia, which is often found in the bone marrow of AML patients. SDF-1-induced apoptosis was inhibited by dominant negative procaspase-9 but not by inhibition of caspase-8 activation, implicating the intrinsic apoptotic pathway. Further analysis showed that this pathway was activated by multiple mechanisms, including up-regulation of Bak at the level of mRNA and protein, stabilization of the Bak activator Noxa, and down-regulation of antiapoptotic Bcl-XL. Furthermore, adjusting expression levels of Bak, Bcl-XL, or Noxa individually altered the level of apoptosis in AML cells, suggesting that the combined modulation of these family members by SDF-1 coordinates their interplay to produce apoptosis. Thus, rather than mediating survival, SDF-1 may be a means to induce apoptosis of CXCR4-expressing AML cells directly in the SDF-1-rich bone marrow microenvironment if the survival cues of the bone marrow are disrupted.
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Affiliation(s)
- Kimberly N Kremer
- Department of Immunology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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