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Published on: January 24, 2020
Cyclin-dependent kinase inhibitor therapy for hematologic malignancies
Prithviraj Bose1, Gary L Simmons, Steven Grant
1Virginia Commonwealth University, Internal Medicine, 1101 E Marshall St, Sanger Hall, Richmond, VA 23298, USA.
Introduction:
Cyclin-dependent kinases (CDKs) regulate cell cycle progression. Certain CDKs (e.g., CDK7, CDK9) also control cellular transcription. Consequently, CDKs represent attractive targets for anticancer drug development, as their aberrant expression is common in diverse malignancies, and CDK inhibition can trigger apoptosis. CDK inhibition may be particularly successful in hematologic malignancies, which are more sensitive to inhibition of cell cycling and apoptosis induction.
Areas Covered:
A number of CDK inhibitors, ranging from pan-CDK inhibitors such as flavopiridol (alvocidib) to highly selective inhibitors of specific CDKs (e.g., CDK4/6), such as PD0332991, that are currently in various phases of development, are profiled in this review. Flavopiridol induces cell cycle arrest, and globally represses transcription via CDK9 inhibition. The latter may represent its major mechanism of action via down-regulation of multiple short-lived proteins. In early phase trials, flavopiridol has shown encouraging efficacy across a wide spectrum of hematologic malignancies. Early results with dinaciclib and PD0332991 also appear promising.
Expert Opinion:
In general, the antitumor efficacy of CDK inhibitor monotherapy is modest, and rational combinations are being explored, including those involving other targeted agents. While selective CDK4/6 inhibition might be effective against certain malignancies, broad-spectrum CDK inhibition will likely be required for most cancers.
Insights
Cyclin-dependent kinase (CDK) inhibitors show promise for treating blood cancers by halting cell growth and triggering cell death. Combinations of CDK inhibitors with other targeted therapies are being explored for improved anticancer efficacy.
Area of Science:
- Oncology
- Molecular Biology
- Pharmacology
Background:
- Cyclin-dependent kinases (CDKs) regulate cell cycle and transcription.
- Aberrant CDK expression is common in malignancies, making them key anticancer targets.
- Hematologic malignancies are particularly sensitive to CDK inhibition-induced apoptosis.
Purpose of the Study:
- To review the development and efficacy of CDK inhibitors for cancer treatment.
- To highlight the role of CDK7 and CDK9 in cell cycle regulation and transcription.
- To explore the potential of CDK inhibitors in hematologic malignancies.
Main Methods:
- Profiling of various CDK inhibitors, including pan-CDK inhibitors (e.g., flavopiridol) and selective inhibitors (e.g., PD0332991).
- Review of early-phase clinical trial data for flavopiridol, dinaciclib, and PD0332991.
- Analysis of CDK inhibitor mechanisms, including cell cycle arrest and transcriptional repression.
Main Results:
- Flavopiridol induces cell cycle arrest and global transcription repression via CDK9 inhibition.
- Early trials show encouraging efficacy of flavopiridol in hematologic malignancies.
- Promising early results observed with dinaciclib and PD0332991.
Conclusions:
- CDK inhibitor monotherapy exhibits modest antitumor efficacy.
- Rational combinations of CDK inhibitors with other targeted agents are under investigation.
- Broad-spectrum CDK inhibition may be necessary for treating most cancers, while selective CDK4/6 inhibitors show potential for specific malignancies.
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