PT  - JOURNAL ARTICLE
AU  - Koch, Raphael
AU  - Christie, Amanda L.
AU  - Crombie, Jennifer L.
AU  - Palmer, Adam C.
AU  - Plana, Deborah
AU  - Shigemori, Kay
AU  - Morrow, Sara N.
AU  - Van Scoyk, Alexandria
AU  - Wu, Wenchao
AU  - Brem, Elizabeth A.
AU  - Secrist, J. Paul
AU  - Drew, Lisa
AU  - Schuller, Alwin G.
AU  - Cidado, Justin
AU  - Letai, Anthony
AU  - Weinstock, David M.
TI  - Biomarker-driven strategy for MCL1 inhibition in T-cell lymphomas
AID  - 10.1182/blood-2018-07-865527
DP  - 2019 Feb 07
TA  - Blood
PG  - 566--575
VI  - 133
IP  - 6
4099  - http://www.bloodjournal.org/content/133/6/566.short
4100  - http://www.bloodjournal.org/content/133/6/566.full
SO  - Blood2019 Feb 07; 133
AB  - We outline a biomarker-driven treatment strategy for targeting MCL1 in TCL.AZD5991 shows promising activity as both a single agent and in combination with CHOP-based therapy.There is a Blood Commentary on this article in this issue.There is a pressing need for more effective therapies to treat patients with T-cell lymphomas (TCLs), including first-line approaches that increase the response rate to cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) chemotherapy. We characterized the mitochondrial apoptosis pathway in cell lines and patient-derived xenograft (PDX) models of TCL and assessed the in vitro efficacy of BH3 mimetics, including the BCL2 inhibitor venetoclax, the BCL2/BCL-xL inhibitor navitoclax, and the novel MCL1 inhibitor AZD5991. The abundance of antiapoptotic BCL2 family members based on immunoblotting or RNA transcript levels correlated poorly with the activity of BH3 mimetics. In contrast, the functional approach BH3 profiling reliably predicted sensitivity to BH3 mimetics in vitro and in vivo. We used BH3 profiling to select TCL PDX that were dependent on MCL1. Mice xenografted with these PDX and treated with AZD5991 had markedly improved survival. The combination of AZD5991 and CHOP achieved synergy based on survival improvement beyond a mathematical “sum of benefits” model. Thus, MCL1 inhibition is a promising strategy as both a single agent and in combination with chemotherapy for patients with TCL and functional dependence on MCL1.