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New Strategy for the Treatment of CML

Virginia Commonwealth University Massey Cancer Center researchers have identified an approach to enhance the activity of a new //anti-cancer agent that has already shown impressive efficacy in the treatment of chronic myelogenous leukemia.

Chronic myelogenous leukemia, or CML, is a cancer of the bone marrow caused by a specific genetic abnormality and is one of the more common forms of leukemia. Imatinib mesylate (Gleevec) is a highly effective anti-cancer agent that has revolutionized the course of therapy for patients with CML. It works by inhibiting the activity of a mutant protein, known as Bcr/ABl, which is responsible for this disease. However, despite initial success, patients eventually become resistant to imatinib mesylate.

According to Steven Grant, M.D., Massey's associate director for translational research and co-leader of the cancer center's cancer cell biology program, and senior author of the study, resistance to imatinib mesylate has prompted the development of newer generation inhibitors, such as a compound known as dasatinib, which are not only considerably more potent than imatinib mesylate, but also are active against cells expressing many of the mutations that make them resistant to the latter agent.

Dasatinib also inhibits another important survival protein known as Src. However, Grant said that not all patients respond to dasatinib, and the risk remains that patients will develop resistance to this agent as well.

To address this problem, Grant and colleagues examined the effects of combining dasatinib with PD184352, another clinically relevant small molecule inhibitor of a critical cellular survival pathway that inactivates an important survival protein known as ERK1/2 (extracellular-signal regulating kinase1/2). The article was pre-published as a First Edition Paper in Blood, the journal of the American Society of Hematology, which appeared online Jan. 11.

By blocking this pathway, PD184352 reduces the survival and proliferation in numerous tumor types, including leukemia cells. The team found that combining extremely low concentrations of dasatinib with PD184352 resulted in a dramatic increase in apoptosis, or programmed cell death, in association with inactivation of multiple survival signaling pathways. Notably, enhanced lethality occurred in CML cells displaying various forms of imatinib mesylate resistance, said Grant.

“While the development of newer, more effective kinase inhibitors such as dasatinib for diseases such as CML is a clear priority, resistance of leukemia cells to these novel agents may also develop,” said Grant.

“Addition of a second, targeted agent that potentiates the activity of dasatinib may reduce the leukemic burden further, and thereby reduce, or possibly even prevent the emergence of drug resistance. If validated, this concept could have significant implications for the treatment of CML and possibly other hematologic malignancies,” said Grant.

This work was supported by grants from the National Institutes of Health, the Leukemia and Lymphoma Society of America and the Department of Defense.

Grant, who is also a professor of medicine and the Shirley Carter and Sture Gordon Olsson Professor of oncology, worked with a team that included: Tri K. Nguyen, Ph.D., Mohamed Rahmani, Ph.D., Hisashi Harada, Ph.D., all in the VCU Department of Medicine; and Paul Dent, Ph.D., a professor in the VCU Department of Biochemistry.

About VCU and the VCU Medical Center: Virginia Commonwealth University is the largest university in Virginia and ranks among the top 100 universities in the country in sponsored research. Located on two downtown campuses in Richmond, VCU enrolls more than 30,000 students in nearly 200 certificate and degree programs in the arts, sciences and humanities.

Sixty-three of the programs are unique in Virginia, many of them crossing the disciplines of VCU’s 15 sch ools and one college. MCV Hospitals and the health sciences schools of Virginia Commonwealth University compose the VCU Medical Center, one of the nation’s leading academic medical centers. For more, see http://www.vcu.edu.

About the VCU Massey Cancer Center: The VCU Massey Cancer Center is one of 61 National Cancer Institute-designated institutions that leads and shapes America’s cancer research efforts. Working with all kinds of cancers, the Center conducts basic, translational and clinical cancer research, provides state-of-the-art treatments and clinical trials, and promotes cancer prevention and education.

Since 1974, Massey has served as an internationally recognized center of excellence. It offers more clinical trials than any other institution in Virginia, serving patients in Richmond and in four satellite locations. Its 1,000 researchers, clinicians and staff members are dedicated to improving the quality of human life by developing and delivering effective means to prevent, control and ultimately to cure cancer. Visit Massey online at http://www.massey.vcu.edu or call 1-877-4-MASSEY.

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