title: Modulation of clinical drug resistance in a B cell lymphoma patient by the protein kinase inhibitor 7-hydroxystaurosporine: presentation of a novel therapeutic paradigm.
abstract: Emerging evidence suggests that apoptosis is an important mechanism of tumor cell death from antineoplastic therapy. 7-hydroxystaurosporine (UCN-01) is a novel protein kinase inhibitor that increases chemotherapy-induced apoptosis in vitro and is in early phases of clinical development. In this report, we present a 68-year-old patient with chemotherapy-resistant lymphoma treated with UCN-01 and chemotherapy. He had a stage IV plasmacytoid lymphoma that failed to enter remission with high-dose EPOCH II (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) chemotherapy. Due to disease progression and transformation to large cell lymphoma in the liver and bone marrow, he received UCN-01. Four weeks later, he received "standard-dose" EPOCH because of progression, developed severe neutropenia for 9 days, and expired from Candida sepsis on day 23. At autopsy, there was no histological evidence of residual lymphoma, although PCR for immunoglobulin gene rearrangement analysis revealed a faint clonal band in two of six nodes but none in the liver. Significantly, no B cells were detected by immunohistochemistry in lymph nodes, and a polyclonal ladder pattern associated with the presence of normal B cells was not seen in the immunoglobulin gene rearrangement PCR assay. Profound peripheral lymphopenia (50 cells/microliter) was also observed. Pharmacokinetics showed UCN-01 salivary concentrations, a surrogate for free drug concentrations, to be within an effective range in vitro (45 nmol/L) as a modulator of DNA-damaging agent cytotoxicity. In vitro, UCN-01 is synergistic with multiple cytotoxic agents and increases fludarabine-induced apoptosis in a human breast cell line. These results suggest that UCN-01 sensitized the lymphoma to the cytotoxic effects of EPOCH, possibly by modulating the "threshold" for apoptosis, and may illustrate a new paradigm for reversal of drug resistance.
authors.affiliation: Medicine Branch, National Cancer Institute, Bethesda, Maryland 20892, USA.
authors.forename: W H
authors.initials: WH
authors.lastname: Wilson
authors.forename: L
authors.initials: L
authors.lastname: Sorbara
authors.forename: W D
authors.initials: WD
authors.lastname: Figg
authors.forename: E K
authors.initials: EK
authors.lastname: Mont
authors.forename: E
authors.initials: E
authors.lastname: Sausville
authors.forename: K E
authors.initials: KE
authors.lastname: Warren
authors.forename: F M
authors.initials: FM
authors.lastname: Balis
authors.forename: K
authors.initials: K
authors.lastname: Bauer
authors.forename: M
authors.initials: M
authors.lastname: Raffeld
authors.forename: A M
authors.initials: AM
authors.lastname: Senderowicz
authors.forename: A
authors.initials: A
authors.lastname: Monks
mesh_terms: D000368:Aged; D000470:Alkaloids / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D011493:Protein Kinase C / Q000037:antagonists & inhibitors*; D019311:Staurosporine / Q000031:analogs & derivatives; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology; D014018:Tissue Distribution
chemical_list: D000470:Alkaloids; D000970:Antineoplastic Agents; C054852:7-hydroxystaurosporine; D011493:Protein Kinase C; D019311:Staurosporine