New orally active proteasome inhibitors in multiple myeloma.
Bortezomib is the first proteasome inhibitor approved for the therapy of multiple myeloma (MM). Although Bortezomib has renovated the treatment of MM, a considerable proportion of subjects fail to respond to Bortezomib treatment and almost all patients relapse from this drug either alone or when used in combination therapies. However, the good clinical outcome of Bortezomib treatment in MM patients gave impulsion for the development of second generation proteasome inhibitors with the ambition of improving efficacy of proteasome inhibition, enhancing antitumor activity, and decreasing toxicity, as well as providing flexible dosing schedules and patient convenience. This review provides an overview of the role of oral proteasome inhibitors including Marizomib, Oprozomib, Delanzomib, chemical proteasome inhibitors, and cinnabaramides, in the therapy of MM, focusing on developments over the past five years. These emerging drugs with different mechanisms of action have exhibited promising antitumor activity in patients with relapsed/refractory MM, and they are creating chances to target multiple pathways, overcome resistance, and improve clinical outcomes, mainly for those subjects who are refractory to approved agents. Future steps in the clinical development of oral inhibitors include the optimization of the schedule and the definition of their antitumor activity in MM.
Division of Hematology University of Messina, Messina, Italy. Electronic address: alessandro.allegra@tin.it.
Alessandro
A
Allegra
Division of Hematology University of Messina, Messina, Italy.
Andrea
A
Alonci
Division of Hematology University of Messina, Messina, Italy.
Demetrio
D
Gerace
Division of Hematology University of Messina, Messina, Italy.
Sabina
S
Russo
Division of Hematology University of Messina, Messina, Italy.
Vanessa
V
Innao
Division of Hematology University of Messina, Messina, Italy.
Laura
L
Calabrò
Division of Hematology University of Messina, Messina, Italy.
Caterina
C
Musolino
D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D015394:Molecular Structure; D009101:Multiple Myeloma / Q000188:drug therapy*; D061988:Proteasome Inhibitors / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D061988:Proteasome Inhibitors
Bortezomib; Carfilzomib; Delanzomib; Ixazomib; Marizomib; Multiple myeloma; Oral administration; Proteasome inhibitor; Therapy