ELEVATE-TN Study. New data of acalabrutinib in first-line treatment of chronic lymphocytic leukemia. Resolution

Over the past decade, we have seen a significant change in modern approaches in the first-line treatment of chronic lymphocytic leukemia (CLL). The CLL-10 study data established the FCR regimen as the treatment of choice for younger patients with limited comorbidities, while for patients older than 65 years, the BR regimen is more often considered as less toxic one. According to published data, 46% of patients with newly diagnosed CLL have comorbidities. Moreover, high-risk patients with del(17p) and/or TP53 mutation do not have response on immunochemotherapy (ICT) most often. Thus, about 1/2 of the patients cannot be treated or will not respond to standard ICT regimens. Targeted therapy with Brutons tyrosine kinase (BTK) inhibitors is an important option of the first-line treatment of patients with CLL. Acalabrutinib is a highly selective second-generation BTK inhibitor that does not inhibit EGFR, ITK or TEC targets. Acalabrutinib in combination with obinutuzumab or as monotherapy can be considered as a highly effective and safe option of the first line of CLL therapy. Based on the hight selectivity of the agent, acalabrutinib can be considered as the preferable option for patients who are not eligible for ICT, including patients with commodities, such as cardiovascular diseases or risk factors for their development

Microenvironmental IL1 1 β promotes metastatic colonisation of breast cancer cells in the bone via activation of Wnt-dependent cancer stem cell activity

Dissemination of tumour cells to the bone marrow is an early event in breast cancer, however cells may lie dormant for many years before bone metastases develop. Treatment for bone metastases is not curative, therefore new adjuvant therapies which prevent the colonisation of disseminated cells into metastatic lesions are required. There is evidence that cancer stem cells (CSCs) within breast tumours are capable of metastasis, but the mechanism by which these colonise bone is unknown. Here, we establish that bone marrow-derived IL1β stimulates breast cancer cell colonisation in the bone by inducing intracellular NFkB and CREB signalling in breast cancer cells, leading to autocrine Wnt signalling and CSC colony formation. Importantly, we show that inhibition of this pathway prevents both CSC colony formation in the bone environment, and bone metastasis. These findings establish that targeting IL1β-NFKB/CREB-Wnt signalling should be considered for adjuvant therapy to prevent breast cancer bone metastasis

Mutation status of refractory to imatinib patients with chronic myeloid leukemia

Mutation status of 36 chronic myeloid leukemia (CML) patients in chronic phase with primary and secondary imatinib resistance was analyzed. BCR-ABL mutations identified by direct DNA sequencing. BCR-ABL kinase domain mutations were detected in 30.5 % (11 of 36) of those patients. Most of identified mutations were missense mutations: Q252H, M244V, G250E, Y253F/H, E255K/V, T315I, M351T, F359V, F359C, F486S. Patients with BCR-ABL mutations have significantly lower 4-year event-free survival compared with CML patients without mutations (18 % vs. 53 %; р = 0.003). The results can be used as reference information in deciding on therapy in imatinib resistant CML patients with clinically relevant BCR-ABL mutations

Mutation status of refractory to imatinib patients with chronic myeloid leukemia

Mutation status of 36 chronic myeloid leukemia (CML) patients in chronic phase with primary and secondary imatinib resistance was analyzed. BCR-ABL mutations identified by direct DNA sequencing. BCR-ABL kinase domain mutations were detected in 30.5 % (11 of 36) of those patients. Most of identified mutations were missense mutations: Q252H, M244V, G250E, Y253F/H, E255K/V, T315I, M351T, F359V, F359C, F486S. Patients with BCR-ABL mutations have significantly lower 4-year event-free survival compared with CML patients without mutations (18 % vs. 53 %; р = 0.003). The results can be used as reference information in deciding on therapy in imatinib resistant CML patients with clinically relevant BCR-ABL mutations.</p

Non-redundant properties of IL-1alpha and IL-1beta during acute colon inflammation in mice

Item does not contain fulltextOBJECTIVE: The differential role of the IL-1 agonists, IL-1alpha, which is mainly cell-associated versus IL-1beta, which is mostly secreted, was studied in colon inflammation. DESIGN: Dextran sodium sulfate (DSS) colitis was induced in mice globally deficient in either IL-1alpha or IL-1beta, and in wild-type mice, or in mice with conditional deletion of IL-1alpha in intestinal epithelial cells (IECs). Bone marrow transplantation experiments were performed to assess the role of IL-1alpha or IL-1beta of myeloid versus colon non-hematopoietic cells in inflammation and repair in acute colitis. RESULTS: IL-1alpha released from damaged IECs acts as an alarmin by initiating and propagating colon inflammation, as IL-1alpha deficient mice exhibited mild disease symptoms with improved recovery. IL-1beta is involved in repair of IECs and reconstitution of the epithelial barrier during the resolution of colitis; its deficiency correlates with disease exacerbation. Neutralisation of IL-1alpha in control mice during acute colitis led to alleviation of clinical and histological manifestations, whereas treatment with rIL-1Ra or anti-IL-1beta antibodies was not effective. Repair after colitis correlated with accumulation of CD8 and regulatory T cells in damaged crypts. CONCLUSIONS: The role of IL-1alpha and IL-1beta differs in DSS-induced colitis in that IL-1alpha, mainly of colon epithelial cells is inflammatory, whereas IL-1beta, mainly of myeloid cell origin, promotes healing and repair. Given the dissimilar functions of each IL-1 agonistic molecule, an IL-1 receptor blockade would not be as therapeutically effective as specific neutralising of IL-1alpha, which leaves IL-1beta function intact

Management of chronic lymphocytic leukemia (CLL) in the elderly: a position paper from an international Society of Geriatric Oncology (SIOG) Task Force

Chronic lymphocytic leukemia (CLL) mainly affects older people: the median age at diagnosis is> 70 years. Elderly patients with CLL are heterogeneous with regard both to the biology of their disease and aging. Following the diagnosis of CLL in an elderly individual, careful risk assessment is essential when treatment options are evaluated. This includes not only clinical staging and evaluation of disease-specific prognostic biomarkers such as 17p deletion and TP53 mutation, but also of comorbidities, physical capacity, nutritional status, cognitive capacity, ability to perform activities of daily living and social support. Comorbidity scoring and geriatric assessment tools are helpful in achieving such multidimensional evaluation in a systematic manner. The introduction of new drugs including novel monoclonal antibodies and kinase inhibitors offers enhanced opportunities for the treatment of elderly patients with CLL. This position paper of a Task Force of the International Society of Geriatric Oncology (SIOG) reviews currently available evidence relevant to such patients. All types of elderly patient (i. e. chronological age> 65-70 years) are considered, from robust (fit) to vulnerable (unfit) to the terminally ill. Among the topics covered are the following: (i) the relationship between chronological age, prognosis and survival, (ii) assessment of biological aging, (iii) biological age as a determinant of treatment feasibility and tolerance and (iv) tailoring of both first and further-line treatment to the circumstances of the individual patient