1
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Sun M, Yin Q, Liang Y, Chang C, Zheng J, Li J, Ji C, Qiu H, Li J, Gong Y, Luo S, Zhang Y, Chen R, Shen Z, Yue Z, Wang S, Shi Q, Yang J, Jin J, Wang J. Ivosidenib in Chinese patients with relapsed or refractory isocitrate dehydrogenase 1 mutated acute myeloid leukemia: a registry study. BLOOD SCIENCE 2024; 6:e00196. [PMID: 38911469 PMCID: PMC11191922 DOI: 10.1097/bs9.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/10/2024] [Indexed: 06/25/2024] Open
Abstract
Ivosidenib, an isocitrate dehydrogenase 1 (IDH1) inhibitor, has demonstrated clinical benefits in a pivotal study (AG120-C-001) in patients with IDH1-mutated (mIDH1) acute myeloid leukemia (AML). A registry study (CS3010-101: NCT04176393) was conducted to assess the pharmacokinetic (PK) characteristics, safety, and efficacy of ivosidenib in Chinese patients with relapsed or refractory (R/R) mIDH1 AML. Patients received ivosidenib 500 mg once daily for 28-day cycles until disease progression. Ten subjects underwent intensive PK/progressive disease (PD) assessments. All subjects had the clinical response assessed at screening, every 28 days through month 12, and then every 56 days. Between November 12, 2019, and April 2, 2021, 30 patients were enrolled; 26 (86.7%) had de novo AML and 18 (60.0%) were transfusion-dependent at baseline. Following single and repeated doses of ivosidenib, median time to maximum plasma concentration (T max) was 4.0 and 2.0 hours, respectively. The inter-individual variability of pharmacokinetic exposure was moderate to high (coefficient of variation [CV], 25%-53%). No obvious accumulation was observed after repeated doses at cycle 2 day 1. Regarding the clinical response, the CR + CRh rate was 36.7% (95% confidence interval [CI]: 19.9%-56.1%), the median duration of CR + CRh was 19.7 months (95% CI: 2.9 months-not reached [NR]), and median duration of response (DoR) was 14.3 months (95% CI: 6.4 months-NR). Consistent clinical benefits and safety of ivosidenib were consistently observed at the final data cutoff with median follow-up time 26.0 months, as compared with primary data cutoff, and the data from Chinese R/R mIDH1 AML patients were also consistent with results from pivotal study.
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Affiliation(s)
- Mingyuan Sun
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Disease, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Qingsong Yin
- Department of Hematology, Henan Cancer Hospital, Zhengzhou, China
| | - Yang Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chunkang Chang
- Department of Hematology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zheng
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Chunyan Ji
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Huiying Qiu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junmin Li
- Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuping Gong
- Department of Hematology, West China Hospital of Sichuan University, Chengdu, China
| | - Sheng Luo
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan Zhang
- CStone Pharmaceuticals (Suzhou) Co. Ltd., Suzhou, China
| | - Rumei Chen
- CStone Pharmaceuticals (Suzhou) Co. Ltd., Suzhou, China
| | - Zhenwei Shen
- CStone Pharmaceuticals (Suzhou) Co. Ltd., Suzhou, China
| | - Zenglian Yue
- CStone Pharmaceuticals (Suzhou) Co. Ltd., Suzhou, China
| | - Siyuan Wang
- CStone Pharmaceuticals (Suzhou) Co. Ltd., Suzhou, China
| | - Qingmei Shi
- CStone Pharmaceuticals (Suzhou) Co. Ltd., Suzhou, China
| | - Jason Yang
- CStone Pharmaceuticals (Suzhou) Co. Ltd., Suzhou, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Disease, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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2
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Nyquist OE, Dalgaard J, Spetalen S, Torkildsen S, Frøen H, Galteland E, Klungsøyr O, Bergrem A, Vo C, Sørbø H, Eiken B, Lerdal H, Solvang AK, Jensvoll H, Pandzic T, Baliakas P, Dybedal I. Pathogenic DDX41 variants, possible response predictors to low-dose melphalan in hypo- and normocellular MDS and AML. Br J Haematol 2024; 204:724-729. [PMID: 38016923 DOI: 10.1111/bjh.19226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Otto Emil Nyquist
- Cancer and Hematology Center, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jakob Dalgaard
- Medical Department, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | - Signe Spetalen
- Department of Pathology, and Institute of Clinical Medicine, The Medical Faculty, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Synne Torkildsen
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Hege Frøen
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Eivind Galteland
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ole Klungsøyr
- Oslo Centre of Biostatistics and Epidemiology Department for Research and Education, Division of Mental Health and Addiction Oslo University Hospital, Oslo, Norway
| | - Astrid Bergrem
- Department of Hematology, Lovisenberg Hospital, Oslo, Norway
| | - Camilla Vo
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Hjalmar Sørbø
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Birgitte Eiken
- Consultant Department of Hematology, Central Hospital Østfold Kalnes, Grålum, Norway
| | - Hedda Lerdal
- Medical Department, Sorlandet Hospital HF, Kristiansand, Norway
| | | | - Hilde Jensvoll
- Hematological Department, University Hospital of North Norway, Tromsø, Norway
| | - Tatjana Pandzic
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Clinical Genetics, Uppsala University Hospital, Uppsala, Sweden
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Clinical Genetics, Uppsala University Hospital, Uppsala, Sweden
| | - Ingunn Dybedal
- Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Clinical Research Unit, Pharmacological Department, Oslo University Hospital, Oslo, Norway
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3
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de Botton S, Montesinos P, Schuh AC, Papayannidis C, Vyas P, Wei AH, Ommen H, Semochkin S, Kim HJ, Larson RA, Koprivnikar J, Frankfurt O, Thol F, Chromik J, Byrne J, Pigneux A, Thomas X, Salamero O, Vidriales MB, Doronin V, Döhner H, Fathi AT, Laille E, Yu X, Hasan M, Martin-Regueira P, DiNardo CD. Enasidenib vs conventional care in older patients with late-stage mutant-IDH2 relapsed/refractory AML: a randomized phase 3 trial. Blood 2023; 141:156-167. [PMID: 35714312 PMCID: PMC10644040 DOI: 10.1182/blood.2021014901] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 01/22/2023] Open
Abstract
This open-label, randomized, phase 3 trial (NCT02577406) compared enasidenib, an oral IDH2 (isocitrate dehydrogenase 2) inhibitor, with conventional care regimens (CCRs) in patients aged ≥60 years with late-stage, mutant-IDH2 acute myeloid leukemia (AML) relapsed/refractory (R/R) to 2 or 3 prior AML-directed therapies. Patients were first preselected to a CCR (azacitidine, intermediate-dose cytarabine, low-dose cytarabine, or supportive care) and then randomized (1:1) to enasidenib 100 mg per day or CCR. The primary endpoint was overall survival (OS). Secondary endpoints included event-free survival (EFS), time to treatment failure (TTF), overall response rate (ORR), hematologic improvement (HI), and transfusion independence (TI). Overall, 319 patients were randomized to enasidenib (n = 158) or CCR (n = 161). The median age was 71 years, median (range) enasidenib exposure was 142 days (3 to 1270), and CCR was 36 days (1 to 1166). One enasidenib (0.6%) and 20 CCR (12%) patients received no randomized treatment, and 30% and 43%, respectively, received subsequent AML-directed therapies during follow-up. The median OS with enasidenib vs CCR was 6.5 vs 6.2 months (HR [hazard ratio], 0.86; P = .23); 1-year survival was 37.5% vs 26.1%. Enasidenib meaningfully improved EFS (median, 4.9 vs 2.6 months with CCR; HR, 0.68; P = .008), TTF (median, 4.9 vs 1.9 months; HR, 0.53; P < .001), ORR (40.5% vs 9.9%; P <.001), HI (42.4% vs 11.2%), and red blood cell (RBC)-TI (31.7% vs 9.3%). Enasidenib safety was consistent with prior reports. The primary study endpoint was not met, but OS was confounded by early dropout and subsequent AML-directed therapies. Enasidenib provided meaningful benefits in EFS, TTF, ORR, HI, and RBC-TI in this heavily pretreated older mutant-IDH2 R/R AML population.
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Affiliation(s)
| | - Pau Montesinos
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
| | - Paresh Vyas
- Oxford Biomedical Research Centre and Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Andrew H. Wei
- The Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Hans Ommen
- Aarhus University Hospital, Århus, Denmark
| | - Sergey Semochkin
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Hee-Je Kim
- Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | - Jaime Koprivnikar
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
| | - Olga Frankfurt
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Felicitas Thol
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Medizinische Hochschule Hannover, Hanover, Germany
| | - Jörg Chromik
- Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Jenny Byrne
- Nottingham University Hospitals Trust, Nottingham, United Kingdom
| | - Arnaud Pigneux
- Bordeaux Haut-Leveque University Hospital, Pessac, France
| | - Xavier Thomas
- Centre Hospitalier Universitaire de Lyon-Sud, Lyon, France
| | - Olga Salamero
- Vall d’Hebron Hospital Universitari, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maria Belen Vidriales
- University Hospital of Salamanca and Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - Vadim Doronin
- City Clinical Hospital No. 40, Moscow, Russian Federation
| | | | - Amir T. Fathi
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Xin Yu
- Bristol Myers Squibb, Princeton, NJ
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4
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Giudice V, Serio B, Ferrara I, Manzo P, Gorrese M, Pepe R, Bertolini A, D’Alto F, Verdesca F, Langella M, Filippelli A, Selleri C. Clinical efficacy of azacytidine and venetoclax and prognostic impact of Tim-3 and galectin-9 in acute myeloid leukemia and high-risk myelodysplastic syndromes: A single-center real-life experience. Front Pharmacol 2022; 13:1052060. [PMID: 36618908 PMCID: PMC9810751 DOI: 10.3389/fphar.2022.1052060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Treatment of acute myeloid leukemia (AML) and high-risk myelodysplastic syndromes (MDS) is difficult in older patients with comorbidities and high-risk disease factors. Venetoclax, the first-in-class Bcl-2 inhibitor, has proven efficacy and safety in combination with azacytidine for treatment of high-risk myeloid diseases. In this single-center real-life retrospective study, a total of 27 consecutive patients treated with azacytidine plus venetoclax were included, and clinical outcomes, hematological improvements, and biomarkers of responsiveness to therapy were compared to those observed in an historical cohort of 95 consecutive patients treated with azacytidine as single agent. Azacytidine plus venetoclax was effective and safe in older and frail AML and high-risk MDS patients, with median overall survival of 22.3 months, higher than that reported in phase III trial (14.7 months), and higher than that of historical cohort (5.94 months). Progression-free survival was higher in patients treated with the drug combination compared to those treated with azacytidine as single agent (p = 0.0065). Clinical benefits might increase when azacytidine and venetoclax are administered as upfront therapy (p = 0.0500). We showed that Tim-3 expression could be a promising therapeutic target in refractory/relapsed patients, and galectin-9 a biomarker of responsiveness to therapy. Moreover, patients treated with azacytidine and venetoclax displayed a higher overall survival regardless the presence of negative prognostic markers at diagnosis (e.g., increased WT1 copies and/or normalized blast count). These encouraging results in a real-world setting supported efficacy and safety of azacytidine plus venetoclax as upfront therapy in AML and high-risk MDS, with clinical outcomes comparable to those of clinical trials when an appropriate venetoclax management with bone marrow assessment at every first, second, fourth, and eighth cycle, and dose adjustments for toxicities are performed.
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Affiliation(s)
- Valentina Giudice
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy,Department of Medicine, University of Salerno, Baronissi, Italy,Pharmacology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Bianca Serio
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Idalucia Ferrara
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Paola Manzo
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Marisa Gorrese
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Rita Pepe
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Angela Bertolini
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy,Department of Medicine, University of Salerno, Baronissi, Italy
| | - Francesca D’Alto
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Francesco Verdesca
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Maddalena Langella
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Amelia Filippelli
- Department of Medicine, University of Salerno, Baronissi, Italy,Pharmacology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Carmine Selleri
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy,Department of Medicine, University of Salerno, Baronissi, Italy,*Correspondence: Carmine Selleri,
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5
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Prebet T, Goldberg AD, Jurcic JG, Khaled S, Dail M, Feng Y, Green C, Li C, Ma C, Medeiros BC, Yan M, Grunwald MR. A phase 1b study of atezolizumab in combination with guadecitabine for the treatment of acute myeloid leukemia. Leuk Lymphoma 2022; 63:2180-2188. [DOI: 10.1080/10428194.2022.2057484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Thomas Prebet
- Hematology, Yale University, New Haven, Connecticut, United States
| | - Aaron D. Goldberg
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Joseph G. Jurcic
- Columbia University Irving Medical Center, New York, New York, United States
| | | | - Monique Dail
- Genentech, Inc, South San Francisco, California, United States
| | - Yuning Feng
- Genentech, Inc, South San Francisco, California, United States
| | - Cherie Green
- Genentech, Inc, South San Francisco, California, United States
| | - Chunze Li
- Genentech, Inc, South San Francisco, California, United States
| | - Connie Ma
- Genentech, Inc, South San Francisco, California, United States
| | | | - Mark Yan
- Hoffmann-La Roche Ltd, Mississauga, Ontario, Canada
| | - Michael R. Grunwald
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, United States
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6
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Pratz KW, Panayiotidis P, Recher C, Wei X, Jonas BA, Montesinos P, Ivanov V, Schuh AC, DiNardo CD, Novak J, Pejsa V, Stevens D, Yeh SP, Kim I, Turgut M, Fracchiolla N, Yamamoto K, Ofran Y, Wei AH, Bui CN, Benjamin K, Kamalakar R, Potluri J, Mendes W, Devine J, Fiedler W. Venetoclax combinations delay the time to deterioration of HRQoL in unfit patients with acute myeloid leukemia. Blood Cancer J 2022; 12:71. [PMID: 35443742 PMCID: PMC9021259 DOI: 10.1038/s41408-022-00668-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 12/17/2022] Open
Abstract
Phase 3 trials Viale-A and Viale-C evaluated health-related quality of life (HRQoL) in patients with AML unfit for intensive chemotherapy who received venetoclax (VEN) + (AZA) (Viale-A) or low-dose cytarabine (LDAC) (Viale-C) or placebo (PBO) + AZA or LDAC. Patient-reported outcomes included: EORTC QLQ-C30 global health status (GHS/QoL) and physical functioning (PF), PROMIS Cancer Fatigue Short Form 7a (Fatigue), and EQ-5D-5L health status visual analog scale (HS-VAS). Time to deterioration (TTD), defined as worsening from baseline in meaningful change thresholds (MCT) of ≥10, 5, or 7 points for GHS/QoL or PF, fatigue, and HS-VAS, respectively, was assessed; differences between groups were analyzed using Kaplan-Meier and unadjusted log-rank analyses. VEN + AZA vs PBO + AZA patients had longer TTD in GHS/QoL (P = 0.066) and fatigue (P = 0.189), and significantly longer TTD in PF (P = 0.028) and HS-VAS (P < 0.001). VEN + LDAC vs PBO + LDAC patients had significantly longer TTD in GHS/QoL (P = 0.011), PF (P = 0.020), and fatigue (P = 0.004), and a trend in HS-VAS (P = 0.057). Approximately 43%, 35%, 32%, and 18% of patients treated with VEN + AZA, AZA + PBO, VEN + LDAC, or LDAC + PBO, respectively, saw improvements >MCT in GHS/QoL. Overall, VEN may positively impact HRQoL in patients with AML ineligible for intensive chemotherapy, leading to longer preservation of functioning and overall health status.
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Affiliation(s)
- Keith W Pratz
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
| | - Panayiotis Panayiotidis
- National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - Christian Recher
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université de Toulouse 3 Paul Sabatier, Toulouse, France
| | - Xudong Wei
- The Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou, China
| | - Brian A Jonas
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Pau Montesinos
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vladimir Ivanov
- Almazov National Medical Research Center, Saint Petersburg, Russian Federation
| | - Andre C Schuh
- Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Courtney D DiNardo
- Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan Novak
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vlatko Pejsa
- Department of Hematology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Don Stevens
- Norton Cancer Institute, Louisville, KY, USA
| | - Su-Peng Yeh
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Inho Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Mehmet Turgut
- Department of Internal Medicine, Division of Hematology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Nicola Fracchiolla
- Hematology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Kazuhito Yamamoto
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
| | - Yishai Ofran
- Department of Hematology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Andrew H Wei
- Australian Center for Blood Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
| | | | | | | | | | | | | | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation With Section Pneumology, Hubertus Wald University Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Hypomethylating Agents (HMAs) as Salvage Therapy in Relapsed or Refractory AML: An Italian Multicentric Retrospective Study. Biomedicines 2021; 9:biomedicines9080972. [PMID: 34440176 PMCID: PMC8394759 DOI: 10.3390/biomedicines9080972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Data on the use of azacytidine and decitabine as salvage therapy for acute myeloid leukemia are limited. We retrospectively reviewed clinical records of 100 patients treated with hypomethylating agents (HMA) as salvage therapy in nine Italian institutions. A total of 24% of patients obtained a response to HMA (CR, PR, or CRi), while 26% showed a stable disease (SD); 50% of patients experienced progressive disease. Median OS was 6.5 months. OS in patients with de novo AML was 6.1 months, while OS in patients with secondary AML (sAML) was 12.3 months (p = 0.037). Median OS after HMA in patients with SD as best response to HMA was similar to median OS in patients with response to HMA (10.6 months vs. 13 months). On multivariate analysis, OS difference between patients who obtained a response versus patients who did not was significant (p = 0.0037). OS difference in sAML was significantly better than in de novo AML (p < 0.00001). HMA showed a remarkable efficacy in terms of response rate and OS in a subgroup of patients (sAMLs), historically characterized by a poor outcome. Therefore, 5Azacitidine and decitabine may represent a good clinical option in a selected patient population with relapsed or refractory AML, unsuitable for allo-HSCT.
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8
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Lin TL, Pagano L. The important role of intensive induction chemotherapy in the treatment of acute myeloid leukemia. Expert Rev Hematol 2021; 14:303-314. [PMID: 33593202 DOI: 10.1080/17474086.2021.1886920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Intensive induction chemotherapy followed by post-remission consolidation and/or allogeneic hematopoietic transplantation has been a standard-of-care therapy for acute myeloid leukemia (AML) for decades. In recent years, a plethora of new agents have been approved for AML treatment, dramatically changing the AML treatment landscape.Areas covered: This review provides an overview of the current role of intensive chemotherapy in the changing AML treatment landscape. PubMed-indexed publications (through 2020) and abstracts presented at major national and international conferences were reviewed for inclusion.Expert opinion: While intensive chemotherapy is standard-of-care therapy for younger patients with AML, older patients were historically viewed as universally ineligible for intensive chemotherapy; however, several studies suggest many older patients benefit from intensive chemotherapy with a curative intent, and a more holistic approach to determining eligibility for intensive treatment is recommended. Intensive strategies have also been expanded to include novel chemotherapy designs and chemotherapy in combination with targeted agents for patients with certain disease characteristics, which may permit more personalized treatment decisions. Intensive chemotherapy continues to play a pivotal role for the management of many AML patients and can offer the best chance of long-term remission, especially when followed by transplantation.
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Affiliation(s)
- Tara L Lin
- Medicine, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Livio Pagano
- Hematology, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Visani G, Loscocco F, Dennis M, Zuffa E, Candoni A, Sensi A, Giannini B, Musuraca G, Mianulli AM, Clavio M, Rocchi M, Gibellini D, Navari M, Gilkes A, Piccaluga PP, Isidori A. Gene expression profile predicts response to the combination of tosedostat and low-dose cytarabine in elderly AML. Blood Adv 2020; 4:5040-5049. [PMID: 33075137 PMCID: PMC7594404 DOI: 10.1182/bloodadvances.2020002305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/08/2020] [Indexed: 11/20/2022] Open
Abstract
Tosedostat is an orally administered metalloenzyme inhibitor with antiproliferative and antiangiogenic activity against hematological and solid human cancers. Clinical activity has been demonstrated in relapsed acute myeloid leukemia (AML). Thirty-three elderly patients with AML (median age, 75 years) received 120 mg tosedostat orally once daily combined with subcutaneous low-dose cytarabine (20 mg twice per day for 10 days, up to 8 cycles), until disease progression. Induction mortality was 12%. According to an intention-to-treat analysis, the complete remission (CR) rate was 48.5%, and thus the primary end point of the study was reached (expected CR, 25%). The partial remission rate was 6.1%, with an overall response rate of 54.5%. Furthermore, 4 of 33 patients had stable disease (median: 286 days). The median progression-free survival and overall survival (OS) were 203 days and 222 days, respectively. Responding patients had a longer median OS than nonresponding patients (P = .001). A microarray analysis performed in 29 of 33 patients identified 188 genes associated with clinical response (CR vs no CR). Three of them (CD93, GORASP1, CXCL16) were validated by quantitative polymerase chain reaction, which correctly classified 83% of the patients. Specifically, CR achievement was efficiently predicted by the gene expression patterns, with an overall accuracy exceeding 90%. Finally, a negative predictive value of 100% was validated in an independent series, thus representing the first molecular predictor for clinical response to a specific combination drug treatment for AML. This trial has been registered at the European Medicines Agency and on the European Clinical Trials Database (https://www.clinicaltrialsregister.eu) as #2012-000334-19.
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Affiliation(s)
- Giuseppe Visani
- Hematology and Stem Cell Transplant Center, Azienda Ospedaliera Ospedali Riuniti Marche Nord (AORMN), Pesaro, Italy
| | - Federica Loscocco
- Hematology and Stem Cell Transplant Center, Azienda Ospedaliera Ospedali Riuniti Marche Nord (AORMN), Pesaro, Italy
| | - Mike Dennis
- Haematology and Transplant Unit, The Christie, Manchester, United Kingdom
| | | | - Anna Candoni
- Division of Hematology and Bone Marrow Transplant (BMT), Department of Experimental and Clinical Medical Sciences, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Alberto Sensi
- Genetica Medica, Centro Servizi Laboratorio Unico Area Vasta Romagna (ARV), Pievesistina di Cesena, Italy
| | - Barbara Giannini
- Genetica Medica, Centro Servizi Laboratorio Unico Area Vasta Romagna (ARV), Pievesistina di Cesena, Italy
| | - Gerardo Musuraca
- Onco-Hematology, Instituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | | | - Marino Clavio
- Clinic of Hematology, Department of Internal Medicine (DiMI), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliera Universitaria (AOU) San Martino-Italia Sistemi Tecnologici (IST), University of Genoa, Genoa, Italy
| | - Marco Rocchi
- Institute of Biomathematics, Urbino University, Urbino, Italy
| | - Davide Gibellini
- Microbiology Section, Department of Diagnostic and Public Health, Verona University, Verona, Italy
| | - Mohsen Navari
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Amanda Gilkes
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
| | - Pier Paolo Piccaluga
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
- Department of Haematology, Cardiff University, Cardiff, United Kingdom
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy; and
- Department of Pathology, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Alessandro Isidori
- Hematology and Stem Cell Transplant Center, Azienda Ospedaliera Ospedali Riuniti Marche Nord (AORMN), Pesaro, Italy
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Yu J, Jiang PYZ, Sun H, Zhang X, Jiang Z, Li Y, Song Y. Advances in targeted therapy for acute myeloid leukemia. Biomark Res 2020; 8:17. [PMID: 32477567 PMCID: PMC7238648 DOI: 10.1186/s40364-020-00196-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023] Open
Abstract
Acute myeloid leukemia (AML) is a clonal malignancy characterized by genetic heterogeneity due to recurrent gene mutations. Treatment with cytotoxic chemotherapy has been the standard of care for more than half of a century. Although much progress has been made toward improving treatment related mortality rate in the past few decades, long term overall survival has stagnated. Exciting developments of gene mutation-targeted therapeutic agents are now changing the landscape in AML treatment. New agents offer more clinical options for patients and also confer a more promising outcome. Since Midostaurin, a FLT3 inhibitor, was first approved by US FDA in 2017 as the first gene mutation-targeted therapeutic agent, an array of new gene mutation-targeted agents are now available for AML treatment. In this review, we will summarize the recent advances in gene mutation-targeted therapies for patients with AML.
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Affiliation(s)
- Jifeng Yu
- The First Affiliated Hospital of Zhengzhou University, #1 East Jianshe Road, Zhengzhou, 450052 China
- Academy of Medical and Pharmaceutical Sciences of Zhengzhou University, #1 East Jianshe Road, Zhengzhou, 450052 China
| | - Peter Y. Z. Jiang
- Department of Hematology and Oncology, The Everett Clinic and Providence Regional Cancer Partnership, 1717 13th Street, Everett, WA 98201 USA
| | - Hao Sun
- The First Affiliated Hospital of Zhengzhou University, #1 East Jianshe Road, Zhengzhou, 450052 China
| | - Xia Zhang
- The First Affiliated Hospital of Zhengzhou University, #1 East Jianshe Road, Zhengzhou, 450052 China
| | - Zhongxing Jiang
- The First Affiliated Hospital of Zhengzhou University, #1 East Jianshe Road, Zhengzhou, 450052 China
| | - Yingmei Li
- The First Affiliated Hospital of Zhengzhou University, #1 East Jianshe Road, Zhengzhou, 450052 China
| | - Yongping Song
- The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, 450008 China
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