Tag: MCL

New Options for Treating Patients with Ibrutinib Resistant Mantle Cell Lymphoma

Earlier today the prestigious journal Cancer Discovery published the results of our program’s latest work in mantle cell lymphoma. Although previous clinical trials have demonstrated the effectiveness of ibrutinib in treating patients with mantle cell lymphoma, researchers also noted that some patient’s lymphoma developed ibrutinib resistance during treatment. Our findings revealed some insight into why this resistance occurs and offers several potential treatment strategies for patients who develop ibrutinib resistance. Based on their findings,

“…the researchers devised two treatment strategies that they tested in lymphoma cell lines. Both involve serial use of two anti-cancer drugs — the first to weaken or “prime” the cancer cells, and the second to deliver an added impact. Both use the experimental agent palbociclib (which selectively inhibits two cell-cycle promoting proteins, CDK4 and CDK6) to slow down the cancer’s growth and sensitize cells to the killing power of a second drug.”

As the study’s lead researcher, Dr. Selina Chen-Kiang commented,

“While for many patients ibrutinib represents a valuable treatment option, it has limitations, and we have been able to demonstrate how novel therapy combinations that target the cancer’s resistance pathways might possibly work better.”

These results build on years of laboratory and clinical work at WCMC, and they highlight the need for further research such as our ongoing trial with ibrutinib plus palbociclib

If you have any questions please contact us and look to our clinical trials page for our ongoing trials.

For additional information see the press release from the American Association for Cancer Research.

ASCO 2014: Selected Abstracts of Interest

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By Peter Martin, MD

The 50th annual meeting of the American Society of Clinical Oncology took place from May 30-June 3 in Chicago. Over 100 abstracts containing exciting new data were presented. Below is a brief summary of a few abstracts that I found interesting.

 

KPT-330 (selinexor) appears to be safe and active in patients with heavily pretreated non-Hodgkin lymphoma

Selective inhibitors of nuclear export (SINE) are a new class of cancer drugs that function by suppressing export of proteins and RNA from the cell nucleus into the cell cytoplasm. The accumulation of these molecules in the nucleus results in a multitude of changes that ultimately promote the death of cancer cells, while largely sparing normal cells. Selinexor is a first in class, oral SINE that has been under investigation in multiple hematologic malignancies and solid tumors. Dr. Martin Gutierrez of the John Theurer Cancer Center, presented results from a phase I study of selinexor in patients with heavily pretreated non-Hodgkin lymphoma. This study’s primary objective was to identify an appropriate dose of selinexor for future studies, to evaluate possible side effects, and to evaluate the activity of the drug. At the time of the abstract, 32 patients had received KPT-330 at multiple dose levels over a 28-day cycle. Selinexor was generally well tolerated (side-effects included nausea, loss of appetite, and fatigue) and could be administered over prolonged periods. Importantly, selinexor demonstrated signs of activity in aggressive B-cell and T-cell lymphomas that had otherwise responded poorly to prior therapies. This study is ongoing and is open at WCMC and future trials are planned in DLBCL and patients with CLL and Richter’s transformation.

Bortezomib plus rituximab is well tolerated therapeutic regime that approximates prior long term survival rates for indolent non-Hodgkin lymphoma patients with a high tumor burden

Dr. Andrew M. Evens of Tufts Medical Center, presented results from a phase II trial of bortezomib plus rituximab as a first-line therapy for patients with high tumor burden indolent non-Hodgkin lymphoma. A total of 42 patients with histologies that included follicular lymphoma, marginal zone lymphoma, small lymphocytic lymphoma, and Waldenstrom’s Macroglobulinemia were enrolled. Therapy was well tolerated with few significant side effects, and an overall response rate of 70% (including a complete remission rate of 40%) was observed. Forty-four percent of patients continued to benefit at 4 years, a rate comparable to prior series with rituximab plus cytotoxic chemotherapy. These results suggest that proteasome inhibitors, like bortezomib, have clear activity in follicular lymphoma, a fact that has likely been under appreciated in the past. Nonetheless, whether bortezomib offers any clear benefit over standard chemotherapy remains unclear. Novel proteasome inhibitors that appear to be better tolerated than bortezomib are under evaluation, including this study with oral ixazomib at WCMC.

Bortezomib appears to improve outcomes in patients receiving front-line treatment for mantle cell lymphoma

Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) remains one of the most common therapies for patients with newly diagnosed mantle cell lymphoma (MCL). In 2006, bortezomib was approved by the FDA for treatment of patients with relapsed MCL. We previously demonstrated that bortezomib could be added to R-CHOP with promising effects . Based on these and other data, investigators in Europe initiated a phase III trial to compare R-CHOP to rituximab, cyclophosphamide, doxorubicin, bortezomib, prednisone (VR-CAP) in patients with previously untreated MCL not eligible for more aggressive therapy. Dr. Franco Cavalli from the Oncology Institute of Southern Switzerland presented the results from this study. A total of 487 patients with treatment naïve, stage II-IV MCL were randomized to receive six to eight cycles R-CHOP or VR-CAP. Patients randomized to treatment with bortezomib achieved significantly longer remission duration with no significant change in side effects. This concept is currently under evaluation in North America in the E1411 trial open at WCMC.

ABT-199 monotherapy shows promise in range of relapsed or refractory non-Hodgkin lymphoma subtypes

ABT-199 is a novel, orally bioavailable, small molecule Bcl-2 inhibitor that has shown promise in the treatment of non-Hodgkin lymphoma (NHL) patients. Dr. Matthew Davids of the Dana-Farber Cancer Institute presented results from a phase I study evaluating the safety and pharmacokinetics profile of ABT-199 in patients with relapsed/refractory NHL. ABT-199 displayed anti-tumor activity across a range of NHL subtypes, most notable in MCL and WM, and at higher doses in DLBCL and FL. Dose escalation is continuing in the phase I study, while subsequent phase II studies are already ongoing in selected histologies.

Palbociclib Displays Promising Results

Palbociclib (PD 0332991) is generating significant excitement according to an April 6th online article from the New York Times. The article cites the results of a recently reported phase II trial in which women with metastatic breast cancer were randomized to receive letrozole plus palbociclib or letrozole alone. Women receiving the combination had their risk of progression cut in half compared to the group that received letrozole alone. These results come roughly one year after the FDA granted Breakthrough Therapy designation to palbociclib, which may help speed up the drug approval process.

Palbociclib is a highly specific oral drug that binds to and inhibits a specific subtype of enzymes called cyclin-dependent kinases (CDK). The same enzymes are critical to the development and progression of mantle cell lymphoma (MCL). Investigators at Weill Cornell Medical College have been leading the evaluation of palbociclib in MCL. Within the next month, we will open a phase I trial evaluating the combination of palbociclib plus ibrutinib in patients with previously treated MCL. For additional information regarding the upcoming trial or other trials in lymphoma, call Amelyn Rodriguez, RN at (212) 746-1362 or e-mail Amelyn at amr2017@med.cornell.edu.