Treatment with the HIV protease inhibitor Nelfinavir triggers the unfolded protein response and may overcome proteasome inhibitor resistance of multiple myeloma in combination with bortezomib: a phase I trial (SAKK 65/08).

Driessen, Christoph; Kraus, Marianne; Joerger, Markus; Rosing, Hilde; Bader, Jürgen; Hitz, Felicitas; Berset, Catherine; Xyrafas, Alexandros; Hawle, Hanne; Berthod, Gregoire; Overkleeft, Hermann S; Sessa, Cristiana; Huitema, Alwin; Pabst, Thomas; von Moos, Roger; Hess, Dagmar; Mey, Ulrich J M (2016). Treatment with the HIV protease inhibitor Nelfinavir triggers the unfolded protein response and may overcome proteasome inhibitor resistance of multiple myeloma in combination with bortezomib: a phase I trial (SAKK 65/08). Haematologica - the hematology journal, 101(3), pp. 346-355. Ferrata-Storti Foundation 10.3324/haematol.2015.135780

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Downregulation of the unfolded protein response mediates proteasome inhibitor resistance in Multiple Myeloma.The Human Immunodeficieny Virus protease inhibitor nelfinavir activates the unfolded protein response in vitro. We determined dose limiting toxicity and recommended dose for phase II of nelfinavir in combination with the proteasome inhibitor bortezomib. 12 patients with advanced hematological malignancies were treated with nelfinavir (2500 - 5000 mg/d p.o., d 1-14, 3+3 dose escalation) and bortezomib (1.3 mg/m2, d 1, 4, 8, 11; 21 day cycles). A run in phase with nelfinavir monotherapy allowed pharmakokinetic/pharmakodynamic assessment of nelfinavir in the presence or absence of concomittant bortezomib. Endpoints included dose limiting toxicity, activation of the unfolded protein response, proteasome activity, toxicity and response to trial treatment. Nelfinavir 2 x 2500 mg was the recommended phase II dose identified. Nelfinavir alone significantly upregulated expression of proteins related to the unfolded protein response in peripheral blood mononuclear cells and inhibited proteasome activity. Of 10 evaluable patients in the dose escalation cohort, 3 achieved a partial response, 4 stable disease for ≥ 2 cycles, while 3 had progressive disease as best response. In an exploratory extension cohort with 6 relapsed, bortezomib-refractory, lenalidomide-resistant myeloma patients treated at the recommended phase II dose, 3 reached a partial response, 2 a minor response and one progressive disease. The combination of nelfinavir with bortezomib is safe and shows promising signals for activity in advanced, bortezomib-refractory MM. Induction of the unfolded protein response by nelfinavir may overcome the biological features of proteasome inhibitor resistance. (Trial registration NCT01164709).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology

UniBE Contributor:

Pabst, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0390-6078

Publisher:

Ferrata-Storti Foundation

Language:

English

Submitter:

Marianne Zahn

Date Deposited:

02 Mar 2016 15:34

Last Modified:

02 Mar 2016 15:34

Publisher DOI:

10.3324/haematol.2015.135780

PubMed ID:

26659919

Uncontrolled Keywords:

Molecular Pharmacology Multiple Myeloma drug resistance proteasome

URI:

https://boris.unibe.ch/id/eprint/77190

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