Multiple myeloma (MM) is a cancer of bone marrow plasma cells that results in over ten thousand deaths a year in the USA. For a while it responds well to treatment with DNA alkylators, glucocorticoids, proteasome inhibitors and the IMiD class of immunomodulators (thalidomide, lenalidomide and pomalidomide). All of these drugs can have profound effects on the immune system, and may interact either positively or negatively with different immunotherapies. Using the immunocompetent Vk*MYC genetically engineered mouse model of multiple myeloma we have noted marked in vivo but little in vitro anti-MM activity of SMAC-mimetic compounds (SMC), which we found activate the innate immune system causing a type I interferon dependent anti-tumor response. We have previously shown that response in this mouse model has a 68% positive predictive value for response in patients with MM. Based on these data we have intiated a phase II clinical trial in MM, and the first patients are responding to treatment. We propose to explore the combination of standard of care agents with SMC using the Vk*MYC mouse model to determine what properties of the former are synergistic or antagonistic for the combination. In parallel we will study the samples obtained from patients enrolled in the clinical trial. Preliminary studies suggest that these drugs are suppressing monocyte/macrophage secretion of inflammatory cytokines, and activating plasmacyoid dendritic cells to secrete interferon, resulting in MM cell death in vivo. The current proposal will use congenic tumor transplant models with selective immuno depletion, genetic depletion, and selecive add-back to precisely identify the host cells mediating the anti-MM effect in vivo and the effects of the combintaion with a standard of care agent. Finally we will analyze blood and bone marrow samples from MM patients treated on a phase II clinical trial of an IAP-antagonist to determine the immunologic sequelae of in vivo drug treatment. These studies will pave the way for the rational combination of standard of care agents with a new class of immunomodularity drugs for the treatment of multiple myeloma.

Public Health Relevance

Multiple myeloma is a cancer that responds well, but eventually relapses from our current treatment approaches, that uses drugs that all have profound effects on the immune system. This proposal will study how best to use these standard of agents in combination with an entirely novel form of immunotherapy, a new drug that modulates the innate immune system resulting in marked anti-MM activity in mice, and we expect, also in humans with MM

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA190045-04
Application #
9335305
Study Section
Special Emphasis Panel (ZCA1)
Program Officer
Merritt, William D
Project Start
2014-09-17
Project End
2019-08-31
Budget Start
2017-09-01
Budget End
2019-08-31
Support Year
4
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Mayo Clinic, Arizona
Department
Type
DUNS #
153665211
City
Scottsdale
State
AZ
Country
United States
Zip Code
85259
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Chesi, Marta; Mirza, Noweeda N; Garbitt, Victoria M et al. (2016) IAP antagonists induce anti-tumor immunity in multiple myeloma. Nat Med 22:1411-1420
Bordini, Jessica; Bertilaccio, Maria Teresa Sabrina; Ponzoni, Maurilio et al. (2015) Erythroblast apoptosis and microenvironmental iron restriction trigger anemia in the VK*MYC model of multiple myeloma. Haematologica 100:834-841
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Calcinotto, Arianna; Ponzoni, Maurilio; Ria, Roberto et al. (2015) Modifications of the mouse bone marrow microenvironment favor angiogenesis and correlate with disease progression from asymptomatic to symptomatic multiple myeloma. Oncoimmunology 4:e1008850