Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045.
Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045.
Am J Hematol. 2014 Sep;89(9):896-903. doi: 10.1002/ajh.23776. Epub 2014 Jun 19.
Treatment of BCR-ABL1(+) leukemia has been revolutionized with the development of tyrosine kinase inhibitors. However, patients with BCR-ABL1(+) acute lymphoblastic leukemia and subsets of patients with chronic myeloid leukemia are at high risk of relapse despite kinase inhibition therapy, necessitating novel treatment strategies. We previously reported synthetic lethality in BCR-ABL1(+) leukemia cells by blocking both calcineurin/NFAT signaling and BCR-ABL1, independent of drug efflux inhibition by cyclosporine. Here, using RNA-interference we confirm that calcineurin inhibition sensitizes BCR-ABL1(+) cells to tyrosine kinase inhibition in vitro. However, when we performed pharmacokinetic and pharmacodynamic studies of dasatinib and cyclosporine in mice, we found that co-administration of cyclosporine increases peak concentrations and the area under the curve of dasatinib, which contributes to the enhanced disease control. We also report the clinical experience of two subjects in whom we observed more hematopoietic toxicity than expected while enrolled in a Phase Ib trial designed to assess the safety and tolerability of adding cyclosporine to dasatinib in humans. Thus, the anti-leukemia benefit of co-administration of cyclosporine and dasatinib is mechanistically pleiotropic, but may not be tolerable, at least as administered in this trial. These data highlight some of the challenges associated with combining targeted agents to treat leukemia.
BCR-ABL1(+) 白血病的治疗已经随着酪氨酸激酶抑制剂的发展而发生了革命性的变化。然而,尽管接受了激酶抑制治疗,BCR-ABL1(+)急性淋巴细胞白血病和部分慢性髓性白血病患者仍存在高复发风险,需要新的治疗策略。我们之前报道了通过同时阻断钙调神经磷酸酶/NFAT 信号和 BCR-ABL1 在 BCR-ABL1(+)白血病细胞中产生合成致死性,而不依赖于环孢素的药物外排抑制。在这里,我们使用 RNA 干扰证实钙调神经磷酸酶抑制可使 BCR-ABL1(+)细胞对体外酪氨酸激酶抑制敏感。然而,当我们在小鼠中进行达沙替尼和环孢菌素的药代动力学和药效学研究时,我们发现环孢菌素的联合使用增加了达沙替尼的峰值浓度和曲线下面积,从而增强了疾病控制。我们还报告了两名受试者的临床经验,他们在参加一项旨在评估在人类中添加环孢菌素至达沙替尼的安全性和耐受性的 Ib 期试验时,观察到比预期更多的血液毒性。因此,环孢菌素和达沙替尼联合使用的抗白血病益处在机制上是多效的,但至少在本试验中可能无法耐受。这些数据突出了与联合使用靶向药物治疗白血病相关的一些挑战。