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Preclinical Study Identifies Potential Drug Combination for Mantle Cell Lymphoma and Chronic Lymphocytic Leukemia

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Key Points

  • The percentage of mantle cell lymphoma or chronic lymphocytic leukemia cells undergoing apoptosis was sixfold higher in samples exposed to ibrutinib and ABT-199 than with samples exposed to either drug alone.
  • Further analysis showed that the combination of ibrutinib and ABT-199 worked synergistically to cause apoptosis in leukemic cells from five of nine patients with CLL.

Combining the molecular targeted drug ibrutinib (Imbruvica) with the investigational anticancer agent ABT-199 may improve outcomes for patients with mantle cell lymphoma and chronic lymphocytic leukemia (CLL), according to preclinical data presented at the American Association for Cancer Research (AACR) special conference Hematologic Malignancies: Translating Discoveries to Novel Therapies, held September 20 to 23 in Philadelphia.

“Ibrutinib was recently approved by the [U.S. Food and Drug Administration] for the treatment of both mantle cell lymphoma and chronic lymphocytic leukemia,” said Michael J. Weber, PhD, Professor of Microbiology, Immunology, and Cancer Biology at the University of Virginia School of Medicine in Charlottesville. “Unfortunately, about one-third of patients have disease that is resistant to ibrutinib, and even for those who have disease that responds, in very few cases is it a complete response. This problem of treatment resistance is one of the biggest challenges in cancer treatment at the moment.

“We took an empirical but systematic approach to identify combinations of drugs that might improve the ability of ibrutinib to kill cancer cells,” continued Dr. Weber. “The combination of ibrutinib and ABT-199 was by far the most effective in our assays, and we are in the very earliest stages of planning a clinical trial to test this combination in the clinic.”

Study Details

In previously reported studies, Dr. Weber and colleagues found that ibrutinib and ABT-199 synergized to induce apoptosis in mantle cell lymphoma cell lines. In this study, they assessed the effects of exposure to the combination on blood samples from 16 patients who had mantle cell lymphoma or CLL cells detectable in the blood. The percentage of cells undergoing apoptosis was sixfold higher in samples exposed to the combination compared with samples exposed to either drug alone: 23% of cells exposed to the combination underwent apoptosis compared with 3.8% and 3% of cells exposed to ibrutinib and ABT-199, respectively.

Further analysis showed that the combination of ibrutinib and ABT-199 worked synergistically to cause apoptosis in leukemic cells from five of nine patients with CLL. According to Dr. Weber, the variable response to this combination points to the importance of understanding how these combinations work, so that we can match the treatments with the most appropriate patients.

“Ibrutinib and ABT-199 target different pathways involved in promoting cancer cell survival and growth,” said Dr. Weber. “This is very intriguing because in most instances where cancer cells are resistant to a particular molecularly targeted drug, we find that cancer cells adapt and find new ways to reactivate the pathway being targeted by the drug and that combinations of drugs targeting this pathway in different ways can improve outcomes. Here, we found that targeting a pathway outside the primary pathway was effective.”

This study was funded by the University of Virginia Cancer Center. Dr. Weber declared no conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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