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2015 ; 2
(2
): e974463
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Trial Watch: Proteasomal inhibitors for anticancer therapy
#MMPMID27308423
Obrist F
; Manic G
; Kroemer G
; Vitale I
; Galluzzi L
Mol Cell Oncol
2015[Apr]; 2
(2
): e974463
PMID27308423
show ga
The so-called "ubiquitin-proteasome system" (UPS) is a multicomponent molecular
apparatus that catalyzes the covalent attachment of several copies of the small
protein ubiquitin to other proteins that are generally (but not always) destined
to proteasomal degradation. This enzymatic cascade is crucial for the maintenance
of intracellular protein homeostasis (both in physiological conditions and in the
course of adaptive stress responses), and regulates a wide array of signaling
pathways. In line with this notion, defects in the UPS have been associated with
aging as well as with several pathological conditions including cardiac,
neurodegenerative, and neoplastic disorders. As transformed cells often
experience a constant state of stress (as a result of the hyperactivation of
oncogenic signaling pathways and/or adverse microenvironmental conditions), their
survival and proliferation are highly dependent on the integrity of the UPS. This
rationale has driven an intense wave of preclinical and clinical investigation
culminating in 2003 with the approval of the proteasomal inhibitor bortezomib by
the US Food and Drug Administration for use in multiple myeloma patients. Another
proteasomal inhibitor, carfilzomib, is now licensed by international regulatory
agencies for use in multiple myeloma patients, and the approved indications for
bortezomib have been extended to mantle cell lymphoma. This said, the clinical
activity of bortezomib and carfilzomib is often limited by off-target effects,
innate/acquired resistance, and the absence of validated predictive biomarkers.
Moreover, the antineoplastic activity of proteasome inhibitors against solid
tumors is poor. In this Trial Watch we discuss the contribution of the UPS to
oncogenesis and tumor progression and summarize the design and/or results of
recent clinical studies evaluating the therapeutic profile of proteasome
inhibitors in cancer patients.