Treatment of B-cell malignancies with the PI3K inhibitor (PI3Ki) idelalisib often results in high toxicity and resistance, with limited treatment alternatives for relapsed/refractory patients since idelalisib is recommended as a later or last line therapy. To investigate resistance mechanisms and identify alternative treatments, we studied functional phenotypes of idelalisib-resistant B-cell malignancy models. The idelalisib-resistant KARPAS1718 model remained sensitive to Bcl-2 inhibitors (Bcl-2i), whereas the resistant VL51 model showed reduced sensitivity compared to parental cells. Sensitivity correlated with phosphorylation and expression of the Bcl-2 family members Bcl-2 and Bim. Target addiction scoring revealed high dependence on the proteasome, and proteasome inhibitors (PI) were effective across models and in primary chronic lymphocytic leukemia (CLL) cells, independently of their PI3Ki- or Bcl-2i-sensitivities. PI treatment consistently upregulated Bim and Mcl-1, while Bcl-2 increased in KARPAS1718 and CLL cells. Bcl-2i plus PI combinations led to an additive effect in these models. A multi-refractory CLL patient in the IMPRESS-Norway trial (NCT04817956) treated with Bcl-2i plus PI showed initial clinical improvement but relapsed within four months. Treatment induced Bim and Mcl-1 upregulation and reduced cytotoxic CD8(+) T-cell and CD56(dim) NK-cell populations. Our findings suggest that PIs may overcome resistance to targeted therapies, and warrant further studies to optimize clinical responses.
Proteasome inhibition overcomes resistance to targeted therapies in B-cell malignancy models and in an index patient.
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作者:Hermansen Johanne U, Athanasiadis Paschalis, Yin Yanping, Rise Anne-Sofie F, Arribas Alberto J, Cascione Luciano, Russnes Hege G, Helland à slaug, Mato Anthony R, Bertoni Francesco, Tjønnfjord Geir E, Aittokallio Tero, SkÃ¥nland Sigrid S
期刊: | Cell Death & Disease | 影响因子: | 9.600 |
时间: | 2025 | 起止号: | 2025 Jul 23; 16(1):555 |
doi: | 10.1038/s41419-025-07884-7 |
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