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Synergistic Drug Combinations Prevent Resistance in ALK+ Anaplastic Large Cell Lymphoma

by Manfroni, Chiara , Ceccon, Monica , Mastini, Cristina , Zappa, Marina , Redaelli, Sara , Massimino, Luca , Mauri, Mario , Crespiatico, Ilaria , Piazza, Rocco , Mologni, Luca , Garbin, Anna , Lovisa, Federica , Fontana, Diletta , Villa, Matteo , Arosio, Giulia , Magistroni, Vera , Gambacorti-Passerini, Carlo , Sharma, Geeta G. , Mussolin, Lara

in 5-aza-2'-deoxycytidine / Anaplastic large-cell lymphoma / Antibodies / Apoptosis / Cell culture / Cell cycle / Cell growth / Chemotherapy / Chromosome rearrangements / Drug delivery / Drug resistance / Drugs / Epigenetics / Flow cytometry / Fusion protein / Gene amplification / Gene expression / Growth inhibition / Lymphoma / Mutation / Non-Hodgkin's lymphoma / Protein-tyrosine kinase / Remission / Thermal cycling / Tumor cell lines / Tumors

2021

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2021

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2021

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Journal Article

Synergistic Drug Combinations Prevent Resistance in ALK+ Anaplastic Large Cell Lymphoma

Manfroni, Chiara,

Ceccon, Monica,

Mastini, Cristina,

Zappa, Marina,

Redaelli, Sara,

Massimino, Luca,

Mauri, Mario,

Crespiatico, Ilaria,

Piazza, Rocco,

Mologni, Luca,

Garbin, Anna,

Lovisa, Federica,

Fontana, Diletta,

Villa, Matteo,

Arosio, Giulia,

Magistroni, Vera,

Gambacorti-Passerini, Carlo,

Sharma, Geeta G.,

Mussolin, Lara

2021

Overview

Anaplastic lymphoma kinase-positive (ALK+) anaplastic large-cell lymphoma (ALCL) is a subtype of non-Hodgkin lymphoma characterized by expression of the oncogenic NPM/ALK fusion protein. When resistant or relapsed to front-line chemotherapy, ALK+ ALCL prognosis is very poor. In these patients, the ALK inhibitor crizotinib achieves high response rates, however 30–40% of them develop further resistance to crizotinib monotherapy, indicating that new therapeutic approaches are needed in this population. We here investigated the efficacy of upfront rational drug combinations to prevent the rise of resistant ALCL, in vitro and in vivo. Different combinations of crizotinib with CHOP chemotherapy, decitabine and trametinib, or with second-generation ALK inhibitors, were investigated. We found that in most cases combined treatments completely suppressed the emergence of resistant cells and were more effective than single drugs in the long-term control of lymphoma cells expansion, by inducing deeper inhibition of oncogenic signaling and higher rates of apoptosis. Combinations showed strong synergism in different ALK-dependent cell lines and better tumor growth inhibition in mice. We propose that drug combinations that include an ALK inhibitor should be considered for first-line treatments in ALK+ ALCL.

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Publisher

MDPI AG,MDPI

Subject

5-aza-2'-deoxycytidine

/ Anaplastic large-cell lymphoma