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Projekt Druckansicht

Transkriptionsgekoppelte DNA Schadensantwort in der CLL Therapie

Fachliche Zuordnung Hämatologie, Onkologie
Förderung Förderung von 2013 bis 2021
Projektkennung Deutsche Forschungsgemeinschaft (DFG) - Projektnummer 226262100
 

Zusammenfassung der Projektergebnisse

Cancer is strongly associated with age. This is particularly the case for chronic lymphocytic leukemia (CLL), which is the most common age-associated leukemia. Many cancer types are highly proliferative and therefore sensitive to chemotherapies that inflict DNA damage that blocks replication. Such therapies, however, are less effective in CLL. Instead, cells that are not undergoing rapid cell divisions might be more sensitive to DNA lesions that instead of replication interfere with transcription, as cell constantly rely on mRNA synthesis regardless of cell cycle stage. Indeed, we observed that CLL cells responded highly sensitively to DNA damage types that block transcription. Transcription-blocking DNA lesions are removed by a specific repair mechanism called transcription-coupled nucleotide excision repair (TC-NER) that is induced when the RNA polymerase stalls at such a lesion. We systematically assessed treatments that inflict such damage types. Interestingly, we showed that cells are eliminated when experiencing high levels of transcription-blocking lesions but without using tumor suppressor mechanisms that are frequently defective in cancer cells. Therefore, our treatment indeed was highly effective in hard-to-manage CLL subsets. We have expanded our repertoire of chemotherapeutic options that in contrast to conventional therapy could effectively eliminate therapy resistant CLL cells. Moreover, we showed synergistic effectiveness with conventional CLL therapies. Therefore, our project opened new therapeutic avenues for CLL and particularly refractile CLL cases. We have successfully validated our approach in distinct pre-clinical CLL models and have provided new options for clinical development. Clinical trials around these principles and drugs (i.e. trabectedin) will follow. There were no major unanticipated aspects or roadblocks that could not be overcome. Admittedly, we had hoped to implement trabectedin in an early-phase clinical trial in r/r CLL patients, but the therapeutic landscape in this disease is currently biased by a strong propagation of CD20 antibodies, BTK inhibitors, and BCL2 antagonists. Real world data, however, clearly show that these strategies do not confer longterm remissions in a substantial fraction of patients. We are optimistic that the “community” and the “industry” will be resensitized towards repurposed mechanism-driven drugs like trabectedin, for which convincing pre-clinical data exist.

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