Therapeutic drug monitoring of imatinib - how far are we in the leukemia setting?

INTRODUCTION: Tyrosine kinase inhibitors (TKIs) have revolutionized survival rates of chronic myeloid leukemia (CML) and Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) and replaced hematopoietic stem cell transplantation (hSCT) as the key treatment option for these patients. More recently, the so-called Philadelphia chromosome-like (Ph-like) ALL has similarly benefitted from TKIs. However, many patients shift from the first generation TKI, imatinib, due to treatment-related toxicities or lack of treatment efficacy. A more personalized approach to TKI treatment could counteract these challenges and potentially be more cost-effective. Therapeutic drug monitoring (TDM) has led to higher response rates and less treatment-related toxicity in adult CML but is rarely used in ALL or in childhood CML. AREAS COVERED: This review summarizes different antileukemic treatment indications for TKIs with focus on imatinib and its pharmacokinetic/-dynamic properties as well as opportunities and pitfalls of TDM for imatinib treatment in relation to pharmacogenetics and co-medication for pediatric and adult Ph+/Ph-like leukemias. EXPERT OPINION: TDM of imatinib adds value to standard monitoring of ABL-class leukemia by uncovering non-adherence and potentially mitigating adverse effects. Clinically implementable pharmacokinetic/-dynamic models adjusted for relevant pharmacogenetics could improve individual dosing. Prospective trials of TDM-based treatments, including both children and adults, are needed.

Tumor necrosis factor α inhibition overcomes immunosuppressive M2b macrophage-induced bevacizumab resistance in triple-negative breast cancer.

Bevacizumab in neoadjuvant therapy provides a new hope of improved survival for patients with triple-negative breast cancer (TNBC) by targeting vascular endothelial growth factor in combination with chemotherapy, but curative effect is limited by bevacizumab's continuous use while mechanisms remain incompletely understood. More and more researches reported that tumor-associated macrophages mediate resistance to chemotherapy and radiotherapy in various tumors. Here we developed a TNBC model resistant to bevacizumab under bevacizumab continuous administration. It was found that proportion of a specific subset of tumor-associated macrophages characterized as M2b (CD11b+ CD86high IL10high) increased and responsible for acquired resistance to bevacizumab. Then, we showed that RAW264.7 macrophages could be polarized to M2b subtype on simultaneous exposure to bevacizumab and TLR4 ligands as occurs in the context of continuous bevacizumab treatment. Concordantly, in TLR4-deleted C57BL/10ScNJNju (TLR4lps-del) mut/mut mice with bevacizumab treatment model, it was verified that the M2b macrophage could be induced by Fc gamma receptor-TLR4 cross-talk. In MDA-MB-231-resistant tumor-bearing mice, the content of TNFα in serum kept going up consistent with CCL1, a chemokine of M2b macrophage. In vitro neutralizing tumor necrosis factor α (TNFα) could inhibit the tumor progression caused by M2b culture medium and tumor IDO1 expression. Therefore, we thought that TNFα is a key tumor-promoting effector molecule secreted by M2b macrophage. Accordingly, the curative effect of bevacizumab was proved to be significantly improved by neutralizing TNFα with anti-TNFα nanobody. This study is expected to provide theoretical and clinical evidence elucidating the drug resistance in patients receiving bevacizumab.

Temporally Dependent Rate-Distortion Optimization for Low-Delay Hierarchical Video Coding.

Low-delay hierarchical coding structure (LD-HCS), as one of the most important components in the latest High Efficiency Video Coding (HEVC) standard, greatly improves coding performance. It groups consecutive P/B frames into different layers and encodes them with different quantization parameters (QPs) and reference mechanisms in such a way that temporal dependency among frames can be exploited. However, due to varying characteristics of video contents, temporal dependency among coding units differs significantly from each other in the same or different layers, while a fixed LD-HCS scheme cannot take full advantage of the dependency, leading to a substantial loss in coding performance. This paper addresses the temporally dependent rate distortion optimization (RDO) problem by attempting to exploit varying temporal dependency of different units. First, the temporal relationship of different frames under the LD-HCS is examined, and hierarchical temporal propagation chains are constructed to represent the temporal dependency among coding units in different frames. Then, a hierarchical temporally dependent RDO scheme is developed specifically for the LD-HCS based on a source distortion propagation model. Experimental results show that our proposed scheme can achieve 2.5% and 2.3% BD-rate gain in average compared with the HEVC codec under the same configuration of P and B frames, respectively, with a negligible increase in encoding time. Furthermore, coupled with QP adaption, our proposed method can achieve higher coding gains, e.g., with multi-QP optimization, about 5.4% and 5.0% BD-rate saving in average over the HEVC codec under the same setting of P and B frames, respectively.