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Clinical update: novel targets in gynecologic malignancies
1Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Abstract:
The proteasome inhibitor bortezomib has shown activity in chemotherapy-resistant tumors and is approved for treatment of multiple myeloma. The critical component of bortezomib's antitumor activity is the inhibition of nuclear factor-kappa B (NF-kappaB). Patients with ovarian cancer respond to initial platinum-based chemotherapy, such as cisplatin. However, these agents have been shown to induce tumor cell survival by inducing NF-kappaB activity. Phase I trials of bortezomib in solid tumors, including ovarian cancer, are summarized and examined to determine if the compound can overcome the impact of chemoresistance. In one trial of single-agent bortezomib in advanced malignancies, it was deemed a safe and manageable drug with potential efficacy in solid tumors. A second phase I trial explored inhibition of NF-kappaB with bortezomib to see if the drug rendered platinum agents more sensitive in ovarian cancer patients. Seven of the nine patients in the study had major responses to the combination of carboplatin and bortezomib. The two trials indicate promising results for bortezomib in patients with solid tumors and patients with recurrent ovarian cancer, but further investigation is warranted.
Insights
Bortezomib, a proteasome inhibitor, shows promise in treating chemotherapy-resistant ovarian cancer by blocking nuclear factor-kappa B (NF-kappaB). Combination therapy with carboplatin yielded significant responses in a Phase I trial.
Area of Science:
- Oncology
- Pharmacology
- Cancer Biology
Background:
- Bortezomib is a proteasome inhibitor effective against chemotherapy-resistant tumors, notably multiple myeloma.
- Nuclear factor-kappa B (NF-kappaB) activation is implicated in tumor cell survival and chemoresistance, particularly in ovarian cancer treated with platinum agents.
- Platinum-based chemotherapy (e.g., cisplatin) is a first-line treatment for ovarian cancer, but resistance can develop.
Purpose of the Study:
- To evaluate the safety and efficacy of bortezomib in solid tumors, including ovarian cancer.
- To determine if bortezomib can overcome chemoresistance by inhibiting NF-kappaB.
- To assess the potential of combining bortezomib with platinum-based chemotherapy in ovarian cancer patients.
Main Methods:
- Summary and examination of two Phase I clinical trials involving bortezomib.
- Trial 1: Single-agent bortezomib in advanced malignancies.
- Trial 2: Combination of bortezomib with carboplatin in ovarian cancer patients, focusing on NF-kappaB inhibition.
Main Results:
- Single-agent bortezomib was found to be safe and manageable in advanced solid tumors, with potential efficacy.
- In the combination trial, seven out of nine ovarian cancer patients experienced major responses to bortezomib and carboplatin.
- Bortezomib demonstrated the ability to inhibit NF-kappaB, a key factor in chemoresistance.
Conclusions:
- Bortezomib shows promising results as a single agent in solid tumors and in combination therapy for recurrent ovarian cancer.
- The inhibition of NF-kappaB by bortezomib may overcome platinum resistance in ovarian cancer.
- Further clinical investigation is warranted to confirm these findings and establish optimal treatment strategies.
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