The things They Said Around Clindamycin PFI-1 Is definitely Dead Wrong

ell carcinomaand have demonstrated activity against lymphoma cells bothin vitro and in vivo. Everolimus was evaluatedin a singleagent phase II PFI-1 study in patients with relapsedaggressive NHL in whom normal therapy failed. Significantresponses were noted; grade 3 or 4 events includedanemia, neutropenia, and thrombocytopenia. In an additional singleagent phase II study, everolimusshowed moderate activity in patients with RR MCL; grade3 or 4 anemia and thrombocytopenia were reported in 11%of patients. A phase II study from the combination ofeverolimus and rituximab in RR DLBCL has just beencompleted. Preliminary final results from a phaseII study in MCL patients refractory to bortezomib reportedpromising singleagent activity and excellent tolerability.A Japanese phase I study in patients with RR NHL has alsoshown preliminary evidence of activity of everolimus in NHL.
Phase III studies exploring the novel combinations ofeverolimus and panobinostator bortezomibare ongoing.A phase III study of RR MCL comparing PFI-1 temsirolimuswith physician’s choice demonstrated an ORR of 22% and2%, respectively. A phase II study of temsirolimus plusrituximab made a 59% ORR; one of the most common grade3 or 4 adverse event in rituximabsensitive andrefractorypatients was thrombocytopenia.Temsirolimus also shows some activity in DLBCL with anORR of 28%, a CR of 12%, and a median PFS of 2.6 months.The PI3K p110isoform is preferentially Clindamycin expressed incells of hematologic origin and in a variety of malignant cells. CAL101 is actually a potent p110inhibitor and has shownacceptable safety and promising pharmacodynamic and clinicalactivity in a variety of hematologic malignancies, as asingle agentand in combination with rituximabor bendamustine.
SF1126 is actually a dual PI3KmTOR inhibitor and is currentlyin phase I development in Bcell malignancies. Othernovel approaches under investigation in preclinical trialsinclude combining mTOR inhibitors with rapamycinresistantT cells, targeting the PI3KAktsurvivin pathwaywith the protease inhibitor, ritonavir, dual mTORC1mTORC2 inhibition, and use of immunosuppressiveagentsto downregulate NSCLC cyclin D1and pAkt.5.4. DACsHDACIs. A number of groups of HDACIshave been developed, and they all show activity in lymphoma,mostly cutaneous. HDACIs have been shownto promote apoptosis and to decrease angiogenesis. Vorinostat,registered for RR cutaneous Tcell lymphoma,functions synergistically with other drugs, but its role in thetreatment of DLBCL just isn't clear yet.
Several phaseI studies of vorinostatcombination regimens in relapsedlymphoma are either ongoing or have been completedrecently. Clindamycin These studies have incorporated RICEICE,pegylated liposomal doxorubicin, and conatumumab. Preclinical evidence supporting the clinical developmentof vorinostat plus the novel Aurora kinase inhibitor,MK5108, has also been presented. A recent safety andtolerability analysis of prior phase I and II trials of vorinostatbasedtherapy in CTCL, other hematologic malignancies,and solid tumors, highlighted fatigueand nauseaas one of the most common drugassociated adverse events,with fatigueand thrombocytopeniathe mostcommon grade 3 or 4 adverse events.Valproic acid functions as a HDACI, although data on itsactivity are limited.
A recent phase II trial in refractorylymphoma made 414 responses. An earlier phase I study with decitabine showed doselimitingmyelosuppression and infectious complicationswhich precluded dose escalation to PFI-1 aminimum powerful dose.Panobinostat is an oral panDACI that has shown activityin a variety of cancers. Responses have been documented in aphase II study in relapsed HLand in combination witheverolimus in a phase III study in RR HL and NHL. Itis also becoming investigated in DLBCL, where preclinical activityhas been observed in combination with decitabine.The HDACI, belinostat, has broad preclinical activity. Interim final results from a phase I study in patients withlymphoid malignancies supplied evidence of tumor shrinkage,and a phase II, Southwest Oncology Groupstudy in patients with RR aggressive Bcell NHL is ongoing.
PCI24781 is actually a broadspectrum HDACI, which hasshown activity in lymphoma cell lines and models. Ithas also demonstrated safety and initial clinical benefit in aphase I study in RR lymphoma.Entinostatis an oral, class I isoformselectiveHDACI. Several responses have been observedin an ongoing phase II study in RR NHL, and synergisticpreclinical Clindamycin activity has been reported in combination withbortezomib.Preclinical activity has also been observed with panobinostatand the oral heatshockprotein90inhibitor, SNX2112.5.5. Cell Death. The intrinsic celldeathpathway is triggered at the mitochondria by a rangeof signals, with all the most important regulators residing inthe Bcl2 family. The Bcl2 antisense nucleotide, oblimersen,was evaluated in a phase II study in combinationwith rituximab in patients with recurrent Bcell NHL. AnORR of 42% was found and most toxicity was low in gradeand was reversible.ABT263is currently becoming investigated inclinical trials of lymphoma, a