Abstract
Treatment regimens for MM patients have undergone considerable modifications from the 1960s in an attempt to achieve that elusive “complete cure.” Proteasome inhibitors such as bortezomib (Bz) have recently become effective chemotherapeutic agents in the treatment of MM, used alone or in combination with other anticancer agents like alkylating agents, immunomodulators (IMiDs), topoisomerase inhibitors, corticosteroids, and histone deacetylase inhibitors (HDACis). However, wide interindividual variation in response to treatment with Bz is a major limitation in achieving consistent therapeutic effect in MM. In addition, patients who respond commonly develop resistance to proteasome inhibitors, with subsequent aggressive relapses. Drug resistance may be categorized into innate resistance with nonspecific resistance already present in Bz-refractory drug-naive patients who never respond to Bz treatment or emerging (acquired) resistance where a patient’s tumor cells “acquire” the ability to resist therapy in the course of treatment leading to eventual Bz-resistant relapse. We discuss molecular profiling approaches to characterize bortezomib resistance, including analysis of genomic variations, gene expression patterns, epigenetic patterns, and protein patterns. We conclude that robust approaches using multiple data types are of primary importance in profiling drug resistance in MM. The ultimate purpose of such an effort will be to create a pharmacogenomic profiling-guided therapeutic response score that can be cross-validated using clinical trials on MM patients undergoing Bz-based therapy or any chemotherapy, so that it can be routinely applied in clinical settings to improve selective response to available drugs, predict effective combinations, and identify secondary therapies to circumvent the challenges in the relapsed patient.
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Abbreviations
- alloSCT:
-
Allogeneic stem cell transplantation
- autoSCT:
-
Autologous stem cell transplantation
- BMSCs:
-
Bone marrow stromal cells
- Bz:
-
Bortezomib/Velcade®
- ChIP:
-
Chromatin immunoprecipitation
- CMAP:
-
Connectivity map
- COBRA:
-
Combined bisulfite restriction analysis
- CR:
-
Complete response
- CRD:
-
Complete response duration
- Cz:
-
Carfilzomib/Kyprolis®
- Dex:
-
Dexamethasone
- EMD:
-
Extramedullary disease
- ERK:
-
Extracellular signal-regulated kinase
- FDA:
-
Food and Drug Administration
- FGF:
-
Fibroblast growth factor
- GEP:
-
Gene expression profiling
- GSEA:
-
Gene set enrichment analysis
- HDACis:
-
Histone deacetylase inhibitors
- HPLC:
-
High-performance liquid chromatography
- IGF-1:
-
Insulin-like growth factor 1
- IL-6:
-
Interleukin 6
- IM:
-
Intermediate metabolizers
- IMiDs:
-
Immunomodulatory drugs
- JAK:
-
Janus kinase
- KMT:
-
Lysine methyltransferases
- LPS:
-
Lipopolysaccharide
- 5-mC:
-
5-Methylcytosine
- MDR1:
-
Multidrug resistance 1 or P-glycoprotein
- MEK:
-
RAS/RAF/MAPK kinase
- MGUS:
-
Monoclonal gammopathy of undetermined significance
- MM:
-
Multiple myeloma
- MM-BMSCs:
-
MM cells and bone marrow stromal cells
- MR:
-
Minimal response
- MSDA:
-
Multiple linear discriminant analysis
- Ms-SNuPE:
-
Methylation-sensitive single-nucleotide primer extension
- NC:
-
No change
- NGS:
-
Next-generation sequencing
- OS:
-
Overall survival
- PD:
-
Progressive disease
- PI3K:
-
Phosphatidylinositol-3 kinase
- PLD:
-
Pegylated liposomal doxorubicin
- PM:
-
Poor metabolizers
- PN:
-
Peripheral neuropathy
- PR:
-
Partial response
- PSGL-1:
-
P-selectin glycoprotein ligand-1
- SDF-1α:
-
SC-derived factor 1α
- SMM:
-
Smoldering multiple myeloma
- SNPs:
-
Single-nucleotide polymorphisms (or “snips”)
- STAT3:
-
Signal transducers and activators of transcription 3
- TNF:
-
Tumor necrosis factor
- TNT:
-
Time-to-next treatment
- TT3:
-
Total therapy 3
- UPR:
-
Unfolded protein response
- VEGF:
-
Vascular endothelial growth factor
- VRC2:
-
Velcade resensitizing compound 2
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Mitra, A.K., Stessman, H., Shaughnessy, J., Van Ness, B. (2014). Profiling Bortezomib Resistance in Multiple Myeloma: Implications in Personalized Pharmacotherapy. In: Dou, Q. (eds) Resistance to Proteasome Inhibitors in Cancer. Resistance to Targeted Anti-Cancer Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-319-06752-0_5
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