1
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Shukla M, Abdul-Hay M, Choi JH. Molecular Features and Treatment Paradigms of Acute Myeloid Leukemia. Biomedicines 2024; 12:1768. [PMID: 39200232 PMCID: PMC11351617 DOI: 10.3390/biomedicines12081768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/26/2024] [Accepted: 07/31/2024] [Indexed: 09/02/2024] Open
Abstract
Acute myeloid leukemia (AML) is a common hematologic malignancy that is considered to be a disease of aging, and traditionally has been treated with induction chemotherapy, followed by consolidation chemotherapy and/or allogenic hematopoietic stem cell transplantation. More recently, with the use of next-generation sequencing and access to molecular information, targeted molecular approaches to the treatment of AML have been adopted. Molecular targeting is gaining prominence, as AML mostly afflicts the elderly population, who often cannot tolerate traditional chemotherapy. Understanding molecular changes at the gene level is also important for accurate disease classification, risk stratification, and prognosis, allowing for more personalized medicine. Some mutations are well studied and have an established gene-specific therapy, including FLT3 and IDH1/2, while others are being investigated in clinical trials. However, data on most known mutations in AML are still minimal and therapeutic studies are in pre-clinical stages, highlighting the importance of further research and elucidation of the pathophysiology involving these genes. In this review, we aim to highlight the key molecular alterations and chromosomal changes that characterize AML, with a focus on pathophysiology, presently available treatment approaches, and future therapeutic options.
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Affiliation(s)
| | | | - Jun H. Choi
- Department of Hematology and Medical Oncology, NYU Langone Health, Perlmutter Cancer Center, New York, NY 10016, USA; (M.S.)
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2
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Urrutia S, Takahashi K. Precision medicine in AML: overcoming resistance. Int J Hematol 2024:10.1007/s12185-024-03827-8. [PMID: 39085680 DOI: 10.1007/s12185-024-03827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/04/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
The development of molecularly targeted therapy for acute myeloid leukemia is progressing at an accelerated pace. Therapies targeting FLT3, IDH1, IDH2, and BCL2 have been approved in the last 5 years. As we exploit these biological vulnerabilities, various mechanisms of resistance arise. Emergence of competing clones with different genetic drivers and acquisition of constitutional mutations in the target renders therapies ineffective, and enzymatic isoform changes can lead to reappearance of the disease phenotype. Understanding the timing and circumstances of resistance origination will allow clinicians to develop combinatorial and sequential therapeutic approaches to deepen responses and improve survival. The objective of this review is to illustrate the biological underpinnings of each therapy and the landscape of resistance mechanisms and discuss strategies to overcome on- and off-target resistance.
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Affiliation(s)
- Samuel Urrutia
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1901 East Road, 4SCR6.2085, Houston, TX, 77030-4009, USA
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA.
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3
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Kowalczyk A, Zarychta J, Lejman M, Latoch E, Zawitkowska J. Clinical Implications of Isocitrate Dehydrogenase Mutations and Targeted Treatment of Acute Myeloid Leukemia with Mutant Isocitrate Dehydrogenase Inhibitors-Recent Advances, Challenges and Future Prospects. Int J Mol Sci 2024; 25:7916. [PMID: 39063158 PMCID: PMC11276768 DOI: 10.3390/ijms25147916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Despite the better understanding of the molecular mechanisms contributing to the pathogenesis of acute myeloid leukemia (AML) and improved patient survival in recent years, AML therapy still remains a clinical challenge. For this reason, it is important to search for new therapies that will enable the achievement of remission. Recently, the Food and Drug Administration approved three mutant IDH (mIDH) inhibitors for the treatment of AML. However, the use of mIDH inhibitors in monotherapy usually leads to the development of resistance and the subsequent recurrence of the cancer, despite the initial effectiveness of the therapy. A complete understanding of the mechanisms by which IDH mutations influence the development of leukemia, as well as the processes that enable resistance to mIDH inhibitors, may significantly improve the efficacy of this therapy through the use of an appropriate synergistic approach. The aim of this literature review is to present the role of IDH1/IDH2 mutations in the pathogenesis of AML and the results of clinical trials using mIDH1/IDH2 inhibitors in AML and to discuss the challenges related to the use of mIDH1/IDH2 inhibitors in practice and future prospects related to the potential methods of overcoming resistance to these agents.
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Affiliation(s)
- Adrian Kowalczyk
- Student Scientific Society of Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (A.K.); (J.Z.)
| | - Julia Zarychta
- Student Scientific Society of Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (A.K.); (J.Z.)
| | - Monika Lejman
- Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Eryk Latoch
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-274 Bialystok, Poland;
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland
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4
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Zhang Y, Yan H, Wei Y, Wei X. Decoding mitochondria's role in immunity and cancer therapy. Biochim Biophys Acta Rev Cancer 2024; 1879:189107. [PMID: 38734035 DOI: 10.1016/j.bbcan.2024.189107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/22/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
The functions of mitochondria, including energy production and biomolecule synthesis, have been known for a long time. Given the rising incidence of cancer, the role of mitochondria in cancer has become increasingly popular. Activated by components released by mitochondria, various pathways interact with each other to induce immune responses to protect organisms from attack. However, mitochondria play dual roles in the progression of cancer. Abnormalities in proteins, which are the elementary structures of mitochondria, are closely linked with oncogenesis. Both the aberrant accumulation of intermediates and mutations in enzymes result in the generation and progression of cancer. Therefore, targeting mitochondria to treat cancer may be a new strategy. Several drugs aimed at inhibiting mutated enzymes and accumulated intermediates have been tested clinically. Here, we discuss the current understanding of mitochondria in cancer and the interactions between mitochondrial functions, immune responses, and oncogenesis. Furthermore, we discuss mitochondria as hopeful targets for cancer therapy, providing insights into the progression of future therapeutic strategies.
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Affiliation(s)
- Yu Zhang
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041 Chengdu, Sichuan, PR China
| | - Hong Yan
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041 Chengdu, Sichuan, PR China
| | - Yuquan Wei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041 Chengdu, Sichuan, PR China.
| | - Xiawei Wei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041 Chengdu, Sichuan, PR China.
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5
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Wu J, Liu N, Chen J, Tao Q, Li Q, Li J, Chen X, Peng C. The Tricarboxylic Acid Cycle Metabolites for Cancer: Friend or Enemy. RESEARCH (WASHINGTON, D.C.) 2024; 7:0351. [PMID: 38867720 PMCID: PMC11168306 DOI: 10.34133/research.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/18/2024] [Indexed: 06/14/2024]
Abstract
The tricarboxylic acid (TCA) cycle is capable of providing sufficient energy for the physiological activities under aerobic conditions. Although tumor metabolic reprogramming places aerobic glycolysis in a dominant position, the TCA cycle remains indispensable for tumor cells as a hub for the metabolic linkage and interconversion of glucose, lipids, and certain amino acids. TCA intermediates such as citrate, α-ketoglutarate, succinate, and fumarate are altered in tumors, and they regulate the tumor metabolism, signal transduction, and immune environment to affect tumorigenesis and tumor progression. This article provides a comprehensive review of the modifications occurring in tumor cells in relation to the intermediates of the TCA cycle, which affects tumor pathogenesis and current therapeutic strategy for therapy through targeting TCA cycle in cancer cells.
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Affiliation(s)
- Jie Wu
- The Department of Dermatology, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- Furong Labratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,
Central South University, Changsha, Hunan, China
| | - Nian Liu
- The Department of Dermatology, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- Furong Labratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,
Central South University, Changsha, Hunan, China
| | - Jing Chen
- The Department of Dermatology, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- Furong Labratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,
Central South University, Changsha, Hunan, China
| | - Qian Tao
- The Department of Dermatology, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- Furong Labratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,
Central South University, Changsha, Hunan, China
| | - Qiuqiu Li
- The Department of Dermatology, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- Furong Labratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,
Central South University, Changsha, Hunan, China
| | - Jie Li
- The Department of Dermatology, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- Furong Labratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,
Central South University, Changsha, Hunan, China
| | - Xiang Chen
- The Department of Dermatology, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- Furong Labratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,
Central South University, Changsha, Hunan, China
| | - Cong Peng
- The Department of Dermatology, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- Furong Labratory, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital,
Central South University, Changsha, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital,
Central South University, Changsha, Hunan, China
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6
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Skálová A, Agaimy A, Bradova M, Poorten VV, Hanna E, Guntinas-Lichius O, Franchi A, Hellquist H, Simpson RHW, Lopéz F, Nuyts S, Chiesa-Estomba C, Ng SP, Homma A, Teng Y, Leivo I, Ferlito A. Molecularly defined sinonasal malignancies: an overview with focus on the current WHO classification and recently described provisional entities. Virchows Arch 2024; 484:885-900. [PMID: 38491228 PMCID: PMC11186917 DOI: 10.1007/s00428-024-03775-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
Classification of tumors of the head and neck has evolved in recent decades including a widespread application of molecular testing in tumors of the sinonasal tract, salivary glands, and soft tissues with a predilection for the head and neck. The availability of new molecular techniques has allowed for the definition of multiple novel tumor types unique to head and neck sites. Moreover, an expanding spectrum of immunohistochemical markers specific to genetic alterations facilitates rapid identification of diagnostic molecular abnormalities. As such, it is currently possible for head and neck pathologists to benefit from a molecularly defined tumor classification while making diagnoses that are still based largely on histopathology and immunohistochemistry. This review covers the principal molecular alterations in sinonasal malignancies, such as alterations in DEK, AFF2, NUTM1, IDH1-2, and SWI/SNF genes in particular, that are important from a practical standpoint for diagnosis, prognosis, and prediction of response to treatment.
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Affiliation(s)
- Alena Skálová
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic.
- Bioptic Laboratory, Ltd., Pilsen, Czech Republic.
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Martina Bradova
- Sikl's Department of Pathology, Faculty of Medicine in Pilsen, Charles University, E. Benese 13, 305 99, Pilsen, Czech Republic
- Bioptic Laboratory, Ltd., Pilsen, Czech Republic
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
- Department of Oncology, Section Head and Neck Oncology, Leuven Cancer Institute, KU Leuven, Louvain, Belgium
| | - Ehab Hanna
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alessandro Franchi
- Department of Translational Research, School of Medicine, University of Pisa, Pisa, Italy
| | - Henrik Hellquist
- Faculty of Medicine and Biomedical Sciences (FMCB), Biomedical Center Research Institute (ABC-RI), University of Algarve, Faro, Portugal
| | | | - Fernando Lopéz
- Department of Otolaryngology, ISPA, IUOPA, CIBERONC, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000, Louvain, Belgium
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, Donostia-San Sebastian, Guipuzkoa-Basque Country, Spain
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yong Teng
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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7
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Montesinos P, Fathi AT, de Botton S, Stein EM, Zeidan AM, Zhu Y, Prebet T, Vigil CE, Bluemmert I, Yu X, DiNardo CD. Differentiation syndrome associated with treatment with IDH2 inhibitor enasidenib: pooled analysis from clinical trials. Blood Adv 2024; 8:2509-2519. [PMID: 38507688 PMCID: PMC11131052 DOI: 10.1182/bloodadvances.2023011914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
ABSTRACT Treatment with enasidenib, a selective mutant isocitrate dehydrogenase isoform 2 (IDH2) inhibitor, has been associated with the development of differentiation syndrome (DS) in patients with acute myeloid leukemia (AML). Studies on the incidence and clinical features of DS are limited in this setting, and diagnosis is challenging because of nonspecific symptoms. This study assessed the incidence, diagnostic criteria, risk factors, and correlation with clinical response of DS based on the pooled analysis of 4 clinical trials in patients with IDH2-mutated AML treated with enasidenib as monotherapy, or in combination with azacitidine or with chemotherapy. Across the total AML population, 67 of 643 (10.4%) had ≥1 any-grade DS event, with highest incidence in patients who received enasidenib plus azacitidine and lowest incidence in patients who received enasidenib plus chemotherapy (13/74 [17.6%] and 2/93 [2.2%]). The most common symptoms of DS were dyspnea/hypoxia (80.6%) and pulmonary infiltrate (73.1%). Median time to onset of first DS event across all studies was 32 days (range, 4-129). Most patients (88.1%) received systemic steroids for treatment of DS. Evaluation of baseline risk factors for DS identified higher levels of bone marrow blasts and lactate dehydrogenase as independent factors associated with increased grade 3 to 5 DS risk. Overall, these results suggest that DS associated with IDH inhibition is manageable, given the benefits of enasidenib treatment in IDH2-mutated AML. We further characterized enasidenib-related DS in these patients and identified risk factors, which could be used for DS management in clinical practice. These trials were registered at www.ClinicalTrials.gov as # NCT01915498, NCT02577406, NCT02677922, and NCT02632708.
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Affiliation(s)
- Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amir T. Fathi
- Leukemia Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Eytan M. Stein
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amer M. Zeidan
- Section of Hematology, Department of Internal Medicine, Yale University and Yale Cancer Center, New Haven, CT
| | - Yue Zhu
- Bristol Myers Squibb, Philadelphia, PA
| | | | | | | | - Xin Yu
- Bristol Myers Squibb, Summit, NJ
| | - Courtney D. DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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8
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Forsberg M, Konopleva M. AML treatment: conventional chemotherapy and emerging novel agents. Trends Pharmacol Sci 2024; 45:430-448. [PMID: 38643058 DOI: 10.1016/j.tips.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
Acute myeloid leukemia (AML) is driven by complex mutations and cytogenetic abnormalities with profound tumoral heterogeneity, making it challenging to treat. Ten years ago, the 5-year survival rate of patients with AML was only 29% with conventional chemotherapy and stem cell transplantation. All attempts to improve conventional therapy over the previous 40 years had failed. Now, new genomic, immunological, and molecular insights have led to a renaissance in AML therapy. Improvements to standard chemotherapy and a wave of new targeted therapies have been developed. However, how best to incorporate these advances into frontline therapy and sequence them in relapse is not firmly established. In this review, we highlight current treatments of AML, targeted agents, and pioneering attempts to synthesize these developments into a rational standard of care (SoC).
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Affiliation(s)
- Mark Forsberg
- Montefiore Einstein Cancer Center, Department of Oncology, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Marina Konopleva
- Montefiore Einstein Cancer Center, Department of Oncology, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
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9
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Fruchtman H, Avigan ZM, Waksal JA, Brennan N, Mascarenhas JO. Management of isocitrate dehydrogenase 1/2 mutated acute myeloid leukemia. Leukemia 2024; 38:927-935. [PMID: 38600315 PMCID: PMC11073971 DOI: 10.1038/s41375-024-02246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
The emergence of next generation sequencing and widespread use of mutational profiling in acute myeloid leukemia (AML) has broadened our understanding of the heterogeneous molecular basis of the disease. Since genetic sequencing has become a standard practice, several driver mutations have been identified. Accordingly, novel targeted therapeutic agents have been developed and are now approved for the treatment of subsets of patients that carry mutations in FLT3, IDH1, and IDH2 [1, 2]. The emergence of these novel agents in AML offers patients a new modality of therapy, and shifts treatment paradigms toward individualized medicine. In this review, we outline the role of IDH mutations in malignant transformation, focus in on a novel group of targeted therapeutic agents directed toward IDH1- and IDH2-mutant AML, and explore their impact on prognosis in patients with AML.
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Affiliation(s)
| | - Zachary M Avigan
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julian A Waksal
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - John O Mascarenhas
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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10
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Elgamal OA, Fobare S, Vibhute S, Mehmood A, Vroom DC, Johnson ML, Stearns B, Lerma JR, Truxall J, Stahl E, Carmichael B, Orwick SJ, Mims AS, Curran E, Santhanam R, Tridandapani S, Phelps MA, Xie Z, Coss CC, Baker SD, Patrick J, Ezzell JK, Rai J, Pan J, Rai SN, Stillwell C, Wunderlich M, Abdulrahim M, Goodwin TE, Hilinski G, Bennett CE, Hertlein E, Byrd JC. Pyrimidine depletion enhances targeted and immune therapy combinations in acute myeloid leukemia. JCI Insight 2024; 9:e173646. [PMID: 38646934 PMCID: PMC11141866 DOI: 10.1172/jci.insight.173646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
Acute myeloid leukemia (AML) is a fatal disease characterized by the accumulation of undifferentiated myeloblasts, and agents that promote differentiation have been effective in this disease but are not curative. Dihydroorotate dehydrogenase inhibitors (DHODHi) have the ability to promote AML differentiation and target aberrant malignant myelopoiesis. We introduce HOSU-53, a DHODHi with significant monotherapy activity, which is further enhanced when combined with other standard-of-care therapeutics. We further discovered that DHODHi modulated surface expression of CD38 and CD47, prompting the evaluation of HOSU-53 combined with anti-CD38 and anti-CD47 therapies, where we identified a compelling curative potential in an aggressive AML model with CD47 targeting. Finally, we explored using plasma dihydroorotate (DHO) levels to monitor HOSU-53 safety and found that the level of DHO accumulation could predict HOSU-53 intolerability, suggesting the clinical use of plasma DHO to determine safe DHODHi doses. Collectively, our data support the clinical translation of HOSU-53 in AML, particularly to augment immune therapies. Potent DHODHi to date have been limited by their therapeutic index; however, we introduce pharmacodynamic monitoring to predict tolerability while preserving antitumor activity. We additionally suggest that DHODHi is effective at lower doses with select immune therapies, widening the therapeutic index.
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Affiliation(s)
- Ola A. Elgamal
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Sydney Fobare
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Sandip Vibhute
- Medicinal Chemistry Shared Resource, Comprehensive Cancer Center
| | - Abeera Mehmood
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Dennis C. Vroom
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mariah L. Johnson
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Blaise Stearns
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - James R. Lerma
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jean Truxall
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Emily Stahl
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Bridget Carmichael
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Shelley J. Orwick
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Alice S. Mims
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - Emily Curran
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ramasamy Santhanam
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | | | | | - Zhiliang Xie
- College of Pharmacy and Comprehensive Cancer Center; and
| | - Christopher C. Coss
- Drug Development Institute, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | | | - Jeffrey Patrick
- Drug Development Institute, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Janel K. Ezzell
- Drug Development Institute, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Jayesh Rai
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine
- Cancer Data Science Center, College of Medicine; and
- Biostatistics and Informatics Shared Resource, University of Cincinnati Cancer Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jianmin Pan
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine
- Cancer Data Science Center, College of Medicine; and
- Biostatistics and Informatics Shared Resource, University of Cincinnati Cancer Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Shesh N. Rai
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine
- Cancer Data Science Center, College of Medicine; and
- Biostatistics and Informatics Shared Resource, University of Cincinnati Cancer Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cody Stillwell
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mark Wunderlich
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | - Gerard Hilinski
- Drug Development Institute, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Chad E. Bennett
- Medicinal Chemistry Shared Resource, Comprehensive Cancer Center
- Drug Development Institute, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Erin Hertlein
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Hematology, Department of Internal Medicine, College of Medicine
| | - John C. Byrd
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Hematology, Department of Internal Medicine, College of Medicine
- College of Pharmacy and Comprehensive Cancer Center; and
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11
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Liu Y, Yu S, Chen Y, Hu Z, Fan L, Liang G. The clinical regimens and cell membrane camouflaged nanodrug delivery systems in hematologic malignancies treatment. Front Pharmacol 2024; 15:1376955. [PMID: 38689664 PMCID: PMC11059051 DOI: 10.3389/fphar.2024.1376955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Hematologic malignancies (HMs), also referred to as hematological or blood cancers, pose significant threats to patients as they impact the blood, bone marrow, and lymphatic system. Despite significant clinical strategies using chemotherapy, radiotherapy, stem cell transplantation, targeted molecular therapy, or immunotherapy, the five-year overall survival of patients with HMs is still low. Fortunately, recent studies demonstrate that the nanodrug delivery system holds the potential to address these challenges and foster effective anti-HMs with precise treatment. In particular, cell membrane camouflaged nanodrug offers enhanced drug targeting, reduced toxicity and side effects, and/or improved immune response to HMs. This review firstly introduces the merits and demerits of clinical strategies in HMs treatment, and then summarizes the types, advantages, and disadvantages of current nanocarriers helping drug delivery in HMs treatment. Furthermore, the types, functions, and mechanisms of cell membrane fragments that help nanodrugs specifically targeted to and accumulate in HM lesions are introduced in detail. Finally, suggestions are given about their clinical translation and future designs on the surface of nanodrugs with multiple functions to improve therapeutic efficiency for cancers.
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Affiliation(s)
- Yuanyuan Liu
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang, Henan, China
| | - Shanwu Yu
- College of Horticulture and Plant Protection, Henan University of Science and Technology, Luoyang, Henan, China
| | - Yixiang Chen
- Luoyang Vocational and Technical College, Luoyang, Henan, China
| | - Zhihong Hu
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang, Henan, China
| | - Lingling Fan
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang, Henan, China
| | - Gaofeng Liang
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang, Henan, China
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12
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Hagen JT, Montgomery MM, Aruleba RT, Chrest BR, Green TD, Kassai M, Zeczycki TN, Schmidt CA, Bhowmick D, Tan SF, Feith DJ, Chalfant CE, Loughran TP, Liles D, Minden MD, Schimmer AD, Cabot MC, Mclung JM, Fisher-Wellman KH. Mitochondria inside acute myeloid leukemia cells hydrolyze ATP to resist chemotherapy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.12.589110. [PMID: 38659944 PMCID: PMC11042215 DOI: 10.1101/2024.04.12.589110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Despite early optimism, therapeutics targeting oxidative phosphorylation (OxPhos) have faced clinical setbacks, stemming from their inability to distinguish healthy from cancerous mitochondria. Herein, we describe an actionable bioenergetic mechanism unique to cancerous mitochondria inside acute myeloid leukemia (AML) cells. Unlike healthy cells which couple respiration to the synthesis of ATP, AML mitochondria were discovered to support inner membrane polarization by consuming ATP. Because matrix ATP consumption allows cells to survive bioenergetic stress, we hypothesized that AML cells may resist cell death induced by OxPhos damaging chemotherapy by reversing the ATP synthase reaction. In support of this, targeted inhibition of BCL-2 with venetoclax abolished OxPhos flux without impacting mitochondrial membrane potential. In surviving AML cells, sustained polarization of the mitochondrial inner membrane was dependent on matrix ATP consumption. Mitochondrial ATP consumption was further enhanced in AML cells made refractory to venetoclax, consequential to downregulations in both the proton-pumping respiratory complexes, as well as the endogenous F1-ATPase inhibitor ATP5IF1. In treatment-naive AML, ATP5IF1 knockdown was sufficient to drive venetoclax resistance, while ATP5IF1 overexpression impaired F1-ATPase activity and heightened sensitivity to venetoclax. Collectively, our data identify matrix ATP consumption as a cancer-cell intrinsic bioenergetic vulnerability actionable in the context of mitochondrial damaging chemotherapy.
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Affiliation(s)
- James T Hagen
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
| | - Mclane M Montgomery
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
| | - Raphael T Aruleba
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
| | - Brett R Chrest
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
| | - Thomas D Green
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
| | - Miki Kassai
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
- Department of Biochemistry and Molecular Biology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tonya N Zeczycki
- Department of Biochemistry and Molecular Biology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Cameron A Schmidt
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
- Department of Biology, East Carolina University, Greenville, NC
| | - Debajit Bhowmick
- Flow Cytometry Core Facility, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Su-Fern Tan
- Department of Medicine, Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA
- University of Virginia Cancer Center, Charlottesville, VA
| | - David J Feith
- Department of Medicine, Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA
- University of Virginia Cancer Center, Charlottesville, VA
| | - Charles E Chalfant
- Department of Medicine, Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA
- University of Virginia Cancer Center, Charlottesville, VA
- Department of Cell Biology, University of Virginia, Charlottesville, VA
- Research Service, Richmond Veterans Administration Medical Center, Richmond, VA
| | - Thomas P Loughran
- Department of Medicine, Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA
- University of Virginia Cancer Center, Charlottesville, VA
| | - Darla Liles
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Mark D Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Aaron D Schimmer
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Myles C Cabot
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
- Department of Biochemistry and Molecular Biology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Joseph M Mclung
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Kelsey H Fisher-Wellman
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
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13
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Wysota M, Konopleva M, Mitchell S. Novel Therapeutic Targets in Acute Myeloid Leukemia (AML). Curr Oncol Rep 2024; 26:409-420. [PMID: 38502417 PMCID: PMC11021231 DOI: 10.1007/s11912-024-01503-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE OF REVIEW This review seeks to identify and describe novel genetic and protein targets and their associated therapeutics currently being used or studied in the treatment of acute myeloid leukemia (AML). RECENT FINDINGS Over the course of the last 5-6 years, several targeted therapies have been approved by the FDA, for the treatment of both newly diagnosed as well as relapsed/refractory AML. These novel therapeutics, as well as several others currently under investigation, have demonstrated activity in AML and have improved outcomes for many patients. Patient outcomes in AML have slowly improved over time, though for many patients, particularly elderly patients or those with relapsed/refractory disease, mortality remains very high. With the identification of several molecular/genetic drivers and protein targets and development of therapeutics which leverage those mechanisms to target leukemic cells, outcomes for patients with AML have improved and continue to improve significantly.
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Affiliation(s)
- Michael Wysota
- Department of Oncology, Montefiore Medical Center, 111 East 210 Street, Bronx, NY, 10467, USA.
| | - Marina Konopleva
- Montefiore Medical Center/Albert Einstein College of Medicine, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, Ullmann Building, 1300 Morris Park AvenueRoom 915, Bronx, NY, 10461, USA.
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14
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Iat A, Loschi M, Benachour S, Calleja A, Chiche E, Sudaka I, Aquaronne D, Ferrero C, Fenwarth L, Marceau A, Fournier E, Dadone‐Montaudie B, Cluzeau T. Comparison of clinical outcomes of several risk stratification tools in newly diagnosed AML patients: A real-world evidence in our current therapeutic era. Cancer Med 2024; 13:e7103. [PMID: 38506267 PMCID: PMC10952023 DOI: 10.1002/cam4.7103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/23/2024] [Accepted: 03/02/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND OF THE STUDY AML classification tools have been developed to stratify the risk at AML diagnosis. There is a need to evaluate these tools in the current therapeutic era. COHORT CHARACTERISTICS In this retrospective study, we compared five classifiers: ELN 2017, ELN 2022, ALFA classifier, Papaemmanuil et al. classifier, and Lindsley et al. classifier, in a real-life cohort of 281 patients newly diagnosed for AML in Nice University Hospital. In our cohort median age was 68 years old, sex ratio was M/F 56%/44%, performance status was lower than 2 in 73.1% of patients, AML subtype was "De novo" in 71.5%, "secondary" in 22.4%, and "therapy-related" in 6.0% of patients. Intensive chemotherapy was used in 53.0% of patients, and non-intensive chemotherapy in 40.6% of patients. Molecular analysis was available in a large majority of patients and the main mutations found were NPM1 (22.7%), DNMT3A (17.4%), TP53 (13.1%), TET2 (12.4%), and FLT3-ITD (12.4%). RESULTS In our findings, the comparison of overall survival between the three prognostic groups in the global cohort was statistically significant in all classifiers: ELN 2017 p < 0.0001, ELN 2022 p < 0.0001, ALFA classifier p < 0.0001, Papaemmanuil classifier p < 0.0001, Lindsley classifier p = 0.001. ELN 2017, ELN 2022, ALFA classifier, Papaemmanuil classifier, and Lindsley classifier were calculated respectively in 99%, 99%, 89%, 90%, and 89% of patients. CONCLUSIONS Using Akaike's information criteria (AIC) to compare all five classifiers, ELN 2022 is the best classifier into younger and older patients and for prognosis.
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Affiliation(s)
- Alexandre Iat
- Hematology departmentNice University HospitalNiceFrance
| | - Michael Loschi
- Hematology departmentNice University HospitalNiceFrance
- Mediterranean Center of Molecular Medecine, INSERMNiceFrance
- Cote d'Azur UniversityNiceFrance
| | | | - Anne Calleja
- Hematology departmentNice University HospitalNiceFrance
| | - Edmond Chiche
- Hematology departmentNice University HospitalNiceFrance
- Cote d'Azur UniversityNiceFrance
| | | | | | | | | | - Alice Marceau
- Hematology LaboratoryLille University HospitalLilleFrance
| | - Elise Fournier
- Hematology LaboratoryLille University HospitalLilleFrance
| | | | - Thomas Cluzeau
- Hematology departmentNice University HospitalNiceFrance
- Mediterranean Center of Molecular Medecine, INSERMNiceFrance
- Cote d'Azur UniversityNiceFrance
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15
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Nguyen TM, Joyce P, Ross DM, Bremmell K, Jambhrunkar M, Wong SS, Prestidge CA. Combating Acute Myeloid Leukemia via Sphingosine Kinase 1 Inhibitor-Nanomedicine Combination Therapy with Cytarabine or Venetoclax. Pharmaceutics 2024; 16:209. [PMID: 38399263 PMCID: PMC10893145 DOI: 10.3390/pharmaceutics16020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
MP-A08 is a novel sphingosine kinase 1 (SPHK1) inhibitor with activity against acute myeloid leukemia (AML). A rationally designed liposome-based encapsulation and delivery system has been shown to overcome the physicochemical challenges of MP-A08 and enable its effective delivery for improved efficacy and survival of mice engrafted with human AML in preclinical models. To establish therapies that overcome AML's heterogeneous nature, here we explored the combination of MP-A08-loaded liposomes with both the standard chemotherapy, cytarabine, and the targeted therapy, venetoclax, against human AML cell lines. Cytarabine (over the dose range of 0.1-0.5 µM) in combination with MP-A08 liposomes showed significant synergistic effects (as confirmed by the Chou-Talalay Combination Index) against the chemosensitised human AML cell lines MV4-11 and OCI-AML3. Venetoclax (over the dose range of 0.5-250 nM) in combination with MP-A08 liposomes showed significant synergistic effects against the chemosensitised human AML cell lines, particularly in venetoclax-resistant human AML cells. This strong synergistic effect is due to multiple mechanisms of action, i.e., inhibiting MCL-1 through SPHK1 inhibition, leading to ceramide accumulation, activation of protein kinase R, ATF4 upregulation, and NOXA activation, ultimately resulting in MCL-1 degradation. These combination therapies warrant further consideration and investigation in the search for a more comprehensive treatment strategy for AML.
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Affiliation(s)
- Thao M. Nguyen
- Centre for Pharmaceutical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (T.M.N.); (P.J.); (K.B.); (M.J.); (S.S.W.)
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5001, Australia;
| | - Paul Joyce
- Centre for Pharmaceutical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (T.M.N.); (P.J.); (K.B.); (M.J.); (S.S.W.)
| | - David M. Ross
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5001, Australia;
- Department of Haematology, Flinders University and Medical Centre, Adelaide, SA 5001, Australia
- Department of Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA 5001, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA 5001, Australia
| | - Kristen Bremmell
- Centre for Pharmaceutical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (T.M.N.); (P.J.); (K.B.); (M.J.); (S.S.W.)
| | - Manasi Jambhrunkar
- Centre for Pharmaceutical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (T.M.N.); (P.J.); (K.B.); (M.J.); (S.S.W.)
| | - Sook S. Wong
- Centre for Pharmaceutical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (T.M.N.); (P.J.); (K.B.); (M.J.); (S.S.W.)
| | - Clive A. Prestidge
- Centre for Pharmaceutical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (T.M.N.); (P.J.); (K.B.); (M.J.); (S.S.W.)
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16
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Eisfeld AK, Mardis ER. Acute Myeloid Leukemia Genomics: Impact on Care and Remaining Challenges. Clin Chem 2024; 70:4-12. [PMID: 38175584 DOI: 10.1093/clinchem/hvad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/03/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Ann-Kathrin Eisfeld
- Division of Hematology, The Ohio State University College of Medicine, Columbus, OH, United States
- Clara D. Bloomfield Center for Leukemia Outcomes Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Elaine R Mardis
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, United States
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17
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Becker M, Farina KA, Mascarenhas J. Acute myeloid leukemia: Current understanding and management. JAAPA 2024; 37:34-39. [PMID: 38128137 DOI: 10.1097/01.jaa.0000995680.52352.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
ABSTRACT Although relatively rare, acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. AML is associated with poor 5-year overall survival and prompt treatment is critical. Classifying AML based on World Health Organization criteria is important for determining prognosis and applying a risk-adapted treatment approach. Throughout therapy, patients require comprehensive supportive care measures with blood product transfusions, antimicrobial treatment, and frequent monitoring for chemotherapy-related complications. This article provides an overview of AML and its treatments. Clinicians in all specialties must be able to recognize the early signs of AML and ensure their patients seek appropriate expert medical care with a hematologist/oncologist.
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Affiliation(s)
- Michelle Becker
- Michelle Becker practices in the adult leukemia program at the Icahn School of Medicine at Mount Sinai in New York, N.Y. Kyle A. Farina is a clinical pharmacy manager, working on the leukemia service at Mount Sinai Hospital in New York, N.Y. John Mascarenhas is director of the adult leukemia program, leader of the Myeloproliferative Disorders Clinical Research Program in the Division of Hematology/Oncology at the Tisch Cancer Institute at Mount Sinai Hospital, and a professor of medicine at the Icahn School of Medicine at Mount Sinai. Dr. Farina discloses that he is a consultant and speaker for Bristol Myers Squibb. Dr. Mascarenhas discloses that he is a consultant for Celgene Corp., Bristol Myers Squibb Co., Incyte Inc., F. Hoffmann-La Roche AG, PharmaEssentia Corp., Geron Corp., CTI Biopharma Corp., MorphoSys AG, Abbvie Inc., Kartos Therapeutics, Novartis AG, Sierra Oncology Inc., GSK plc, Karyopharm Therapeutics Inc., Galecto Inc., Imago BioSciences Inc., and Pfizer Inc., and receives research funding from Bristol Myers Squibb, Abbvie, CTI Biopharma, Incyte, Merck & Co., Novartis, Roche, Kartos, PharmaEssentia, and Geron. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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18
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Schiller GJ, Kustanovich V. Considerations regarding maintenance therapy for acute myeloid leukemia in remission. Expert Rev Anticancer Ther 2024; 24:15-20. [PMID: 38230741 DOI: 10.1080/14737140.2024.2306164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/12/2024] [Indexed: 01/18/2024]
Abstract
INTRODUCTION For most adult patients with acute myeloid leukemia, relapse is characteristic of the disease. When allotransplant in first complete remission is administered as consolidative therapy, relapse is still common, affecting 20-40% of recipients. Maintenance of remission with low-dose treatments may hold promise in preventing relapse. AREAS COVERED Improvements in the detection of clinical and biological variants of disease allow the practitioner to identify which patients, based on disease features, may benefit from therapy directed at residual clonal elements that might contribute to relapse. Along with improvements in methods of detecting residual disease, novel agents are under investigation as a platform in order to maintain remission and may contribute to prolonged survival. In this manuscript, we review literature available through PubMed regarding the use of maintenance therapy, described as post-remission or post-transplant treatment intended to delay or prevent relapse. EXPERT OPINION Although results of randomized studies are limited, a role for maintenance therapy, particularly directed at molecular targets, in distinct settings of post-remission management is recommended. We also advise that randomized studies of immune therapy along with opportunities for further evaluation of risk-agnostic interventions be a focus of cooperative groups.
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Affiliation(s)
- Gary J Schiller
- Hematological Malignancy/Stem Cell Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vlad Kustanovich
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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19
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Murphy LA, Winters AC. Emerging and Future Targeted Therapies for Pediatric Acute Myeloid Leukemia: Targeting the Leukemia Stem Cells. Biomedicines 2023; 11:3248. [PMID: 38137469 PMCID: PMC10741170 DOI: 10.3390/biomedicines11123248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Acute myeloid leukemia (AML) is a rare subtype of acute leukemia in the pediatric and adolescent population but causes disproportionate morbidity and mortality in this age group. Standard chemotherapeutic regimens for AML have changed very little in the past 3-4 decades, but the addition of targeted agents in recent years has led to improved survival in select subsets of patients as well as a better biological understanding of the disease. Currently, one key paradigm of bench-to-bedside practice in the context of adult AML is the focus on leukemia stem cell (LSC)-targeted therapies. Here, we review current and emerging immunotherapies and other targeted agents that are in clinical use for pediatric AML through the lens of what is known (and not known) about their LSC-targeting capability. Based on a growing understanding of pediatric LSC biology, we also briefly discuss potential future agents on the horizon.
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Affiliation(s)
- Lindsey A. Murphy
- Department of Pediatrics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
| | - Amanda C. Winters
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
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20
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Blackmon AL, Hourigan CS. Test Then Erase? Current Status and Future Opportunities for Measurable Residual Disease Testing in Acute Myeloid Leukemia. Acta Haematol 2023; 147:133-146. [PMID: 38035547 PMCID: PMC10963159 DOI: 10.1159/000535463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Measurable residual disease (MRD) test positivity during and after treatment in patients with acute myeloid leukemia (AML) has been associated with higher rates of relapse and worse overall survival. Current approaches for MRD testing are not standardized leading to inconsistent results and poor prognostication of disease. Pertinent studies evaluating AML MRD testing at specific times points, with various therapeutics and testing methods are presented. SUMMARY AML is a set of diseases with different molecular and cytogenetic characteristics and is often polyclonal with evolution over time. This genetic diversity poses a great challenge for a single AML MRD testing approach. The current ELN 2021 MRD guidelines recommend MRD testing by quantitative polymerase chain reaction in those with a validated molecular target or multiparameter flow cytometry (MFC) in all other cases. The benefit of MFC is the ability to use this method across disease subsets, at the relative expense of suboptimal sensitivity and specificity. AML MRD detection may be improved with molecular methods. Genetic characterization at AML diagnosis and relapse is now standard of care for appropriate therapeutic assignment, and future initiatives will provide the evidence to support testing in remission to direct clinical interventions. KEY MESSAGES The treatment options for patients with AML have expanded for specific molecular subsets such as FLT3 and IDH1/2 mutated AML, with development of novel agents for NPM1 mutated or KMT2A rearranged AML ongoing, but also due to effective venetoclax-combinations. Evidence regarding highly sensitive molecular MRD detection methods for specific molecular subgroups, in the context of these new treatment approaches, will likely shape the future of AML care.
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Affiliation(s)
- Amanda L. Blackmon
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Christopher S. Hourigan
- Laboratory of Myeloid Malignancies, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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21
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Kim H, Jung I, Lee CH, An J, Ko M. Development of Novel Epigenetic Anti-Cancer Therapy Targeting TET Proteins. Int J Mol Sci 2023; 24:16375. [PMID: 38003566 PMCID: PMC10671484 DOI: 10.3390/ijms242216375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Epigenetic dysregulation, particularly alterations in DNA methylation and hydroxymethylation, plays a pivotal role in cancer initiation and progression. Ten-eleven translocation (TET) proteins catalyze the successive oxidation of 5-methylcytosine (5mC) to 5-hydroxymethylcytosine (5hmC) and further oxidized methylcytosines in DNA, thereby serving as central modulators of DNA methylation-demethylation dynamics. TET loss of function is causally related to neoplastic transformation across various cell types while its genetic or pharmacological activation exhibits anti-cancer effects, making TET proteins promising targets for epigenetic cancer therapy. Here, we developed a robust cell-based screening system to identify novel TET activators and evaluated their potential as anti-cancer agents. Using a carefully curated library of 4533 compounds provided by the National Cancer Institute, Bethesda, MD, USA, we identified mitoxantrone as a potent TET agonist. Through rigorous validation employing various assays, including immunohistochemistry and dot blot studies, we demonstrated that mitoxantrone significantly elevated 5hmC levels. Notably, this elevation manifested only in wild-type (WT) but not TET-deficient mouse embryonic fibroblasts, primary bone marrow-derived macrophages, and leukemia cell lines. Furthermore, mitoxantrone-induced cell death in leukemia cell lines occurred in a TET-dependent manner, indicating the critical role of TET proteins in mediating its anti-cancer effects. Our findings highlight mitoxantrone's potential to induce tumor cell death via a novel mechanism involving the restoration of TET activity, paving the way for targeted epigenetic therapies in cancer treatment.
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Affiliation(s)
- Hyejin Kim
- Department of Biological Sciences, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea; (H.K.); (I.J.)
| | - Inkyung Jung
- Department of Biological Sciences, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea; (H.K.); (I.J.)
| | - Chan Hyeong Lee
- Department of Life Sciences, Jeonbuk National University, Jeonju 54896, Republic of Korea;
| | - Jungeun An
- Department of Life Sciences, Jeonbuk National University, Jeonju 54896, Republic of Korea;
| | - Myunggon Ko
- Department of Biological Sciences, Ulsan National Institute of Science and Technology, Ulsan 44919, Republic of Korea; (H.K.); (I.J.)
- Center for Genomic Integrity, Institute for Basic Science, Ulsan 44919, Republic of Korea
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22
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Babakhanlou R, DiNardo C, Borthakur G. IDH2 mutations in acute myeloid leukemia. Leuk Lymphoma 2023; 64:1733-1741. [PMID: 37462435 DOI: 10.1080/10428194.2023.2237153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/07/2023] [Indexed: 11/07/2023]
Abstract
Advances in the treatment of acute myeloid leukemia (AML) over the last 40 years have been limited. With an improved understanding of the pathophysiology of the disease, the advent of new treatment options has enriched the armamentarium of the physician to combat the disease. Mutations of the isocitrate dehydrogenase (IDHs) genes are common in AML and occur in 20-30% of cases. These mutations lead to DNA hypermethylation, aberrant gene expression, cell proliferation, and abnormal differentiation. Targeting mutant IDH, either as monotherapy or in combination with hypomethylating agents (HMAs) or BCL-2 inhibitors, has opened new avenues of therapy for these patients.This review will outline the function of IDHs and focus on the biological effects of IDH2 mutations in AML, their prognosis and treatment options.
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Affiliation(s)
- Rodrick Babakhanlou
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Courtney DiNardo
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, United States
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23
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Zarnegar-Lumley S, Alonzo TA, Gerbing RB, Othus M, Sun Z, Ries RE, Wang J, Leonti A, Kutny MA, Ostronoff F, Radich JP, Appelbaum FR, Pogosova-Agadjanyan EL, O’Dwyer K, Tallman MS, Litzow M, Atallah E, Cooper TM, Aplenc RA, Abdel-Wahab O, Gamis AS, Luger S, Erba H, Levine R, Kolb EA, Stirewalt DL, Meshinchi S, Tarlock K. Characteristics and prognostic impact of IDH mutations in AML: a COG, SWOG, and ECOG analysis. Blood Adv 2023; 7:5941-5953. [PMID: 37267439 PMCID: PMC10562769 DOI: 10.1182/bloodadvances.2022008282] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 06/04/2023] Open
Abstract
Somatic mutations in isocitrate dehydrogenase (IDH) genes occur frequently in adult acute myeloid leukemia (AML) and less commonly in pediatric AML. The objective of this study was to describe the prevalence, mutational profile, and prognostic significance of IDH mutations in AML across age. Our cohort included 3141 patients aged between <1 month and 88 years treated on Children's Cancer Group/Children's Oncology Group (n = 1872), Southwest Oncology Group (n = 359), Eastern Cooperative Oncology Group (n = 397) trials, and in Beat AML (n = 333) and The Cancer Genome Atlas (n = 180) genomic characterization cohorts. We retrospectively analyzed patients in 4 age groups (age range, n): pediatric (0-17, 1744), adolescent/young adult (18-39, 444), intermediate-age (40-59, 640), older (≥60, 309). IDH mutations (IDHmut) were identified in 9.2% of the total cohort (n = 288; IDH1 [n = 123, 42.7%]; IDH2 [n = 165, 57.3%]) and were strongly correlated with increased age: 3.4% pediatric vs 21% older, P < .001. Outcomes were similar in IDHmut and IDH-wildtype (IDHWT) AML (event-free survival [EFS]: 35.6% vs 40.0%, P = .368; overall survival [OS]: 50.3% vs 55.4%, P = .196). IDH mutations frequently occurred with NPM1 (47.2%), DNMT3A (29.3%), and FLT3-internal tandem duplication (ITD) (22.4%) mutations. Patients with IDHmut AML with NPM1 mutation (IDHmut/NPM1mut) had significantly improved survival compared with the poor outcomes experienced by patients without (IDHmut/NPM1WT) (EFS: 55.1% vs 17.0%, P < .001; OS: 66.5% vs 35.2%, P < .001). DNTM3A or FLT3-ITD mutations in otherwise favorable IDHmut/NPM1mut AML led to inferior outcomes. Age group analysis demonstrated that IDH mutations did not abrogate the favorable prognostic impact of NPM1mut in patients aged <60 years; older patients had poor outcomes regardless of NPM1 status. These trials were registered at www.clinicaltrials.gov as #NCT00070174, #NCT00372593, #NCT01371981, #NCT00049517, and #NCT00085709.
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Affiliation(s)
- Sara Zarnegar-Lumley
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Todd A. Alonzo
- Children’s Oncology Group, Monrovia, CA
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Zhuoxin Sun
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Rhonda E. Ries
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jim Wang
- Children’s Oncology Group, Monrovia, CA
| | - Amanda Leonti
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew A. Kutny
- Division of Hematology/Oncology, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | - Fabiana Ostronoff
- Intermountain Blood and Marrow Transplant and Acute Leukemia Program, Intermountain Healthcare, Salt Lake City, UT
| | - Jerald P. Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | - Frederick R. Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | | | - Kristen O’Dwyer
- Department of Medicine, Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Martin S. Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark Litzow
- Department of Internal Medicine and Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN
| | - Ehab Atallah
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Todd M. Cooper
- Division of Hematology/Oncology, Seattle Children’s Hospital Cancer and Blood Disorders Center, University of Washington, Seattle, WA
| | - Richard A. Aplenc
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Omar Abdel-Wahab
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan S. Gamis
- Division of Hematology/Oncology/Bone Marrow Transplantation, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Selina Luger
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Harry Erba
- Division of Hematologic Malignancies and Cellular Therapies, Department of Medicine, Duke Cancer Institute, Durham, NC
| | - Ross Levine
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E. Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Derek L. Stirewalt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Departments of Oncology and Hematology, University of Washington, Seattle, WA
| | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Katherine Tarlock
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Hematology/Oncology, Seattle Children’s Hospital Cancer and Blood Disorders Center, University of Washington, Seattle, WA
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24
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Wei Q, Yao K, Yang J, Zhou Q, Liu P, Chen J, Liu H, Lai Y, Cao P. Structure-Based Drug Design of Novel Triaminotriazine Derivatives as Orally Bioavailable IDH2 R140Q Inhibitors with High Selectivity and Reduced hERG Inhibitory Activity for the Treatment of Acute Myeloid Leukemia. J Med Chem 2023; 66:12894-12910. [PMID: 37706660 DOI: 10.1021/acs.jmedchem.3c00835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Neomorphic IDH2R140Q mutation is commonly found in acute myeloid leukemia (AML), and inhibiting its activity has been validated as an effective treatment for AML. Herein, we report a series of highly potent and selective IDH2R140Q inhibitors. Among them, compound 36 was identified as the most promising inhibitor, with an IC50 value of 29 nM and more than 490-fold selectivity over wild-type IDH2. The compound significantly suppressed D2HG production (IC50 = 10 nM) and induced differentiation in TF-1/IDH2R140Q cells. Furthermore, it showed reasonable pharmacokinetic properties with high bioavailability (F = 90.3%) and an appropriate half-life (T1/2 = 6.4 h). In vivo, oral administration of compound 36 at a dose of 25 mg/kg effectively reduced D2HG levels in the tumor of TF-1/IDH2R140Q xenograft mouse model. Besides, compound 36 displayed little effect on the hERG current. These results suggest that compound 36 has the potential to be an efficacious treatment for AML.
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Affiliation(s)
- Qingyun Wei
- Jiangsu Provincial Medical Innovation Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Kun Yao
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases, Center of Drug Discovery, China Pharmaceutical University, Nanjing 210009, China
| | - Jie Yang
- Jiangsu Provincial Medical Innovation Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Qian Zhou
- Jiangsu Provincial Medical Innovation Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Pengyu Liu
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases, Center of Drug Discovery, China Pharmaceutical University, Nanjing 210009, China
| | - Jiao Chen
- Jiangsu Provincial Medical Innovation Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
| | - Haipeng Liu
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases, Center of Drug Discovery, China Pharmaceutical University, Nanjing 210009, China
| | - Yisheng Lai
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases, Center of Drug Discovery, China Pharmaceutical University, Nanjing 210009, China
| | - Peng Cao
- Jiangsu Provincial Medical Innovation Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
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25
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[Chinese guidelines for diagnosis and treatment of adult acute myeloid leukemia (not APL) (2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:705-712. [PMID: 38049312 PMCID: PMC10630568 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Indexed: 12/06/2023]
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26
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Bruzzese A, Labanca C, Martino EA, Mendicino F, Lucia E, Olivito V, Neri A, Imovilli A, Morabito F, Vigna E, Gentile M. Ivosidenib in acute myeloid leukemia. Expert Opin Pharmacother 2023; 24:2093-2100. [PMID: 37874005 DOI: 10.1080/14656566.2023.2272659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Traditional treatment strategies for acute myeloid leukemia (AML) have primarily relied on standard chemotherapy regimens for four decades. Indeed, the landscape of AML therapy has evolved substantially in recent years, mainly due to the introduction of hypomethylating agents and small molecules.Bcl2 inhibitor venetoclax, Fms-like tyrosine kinase 3 (FLT3) inhibitors such as midostaurin and gilteritinib, and isocitrate dehydrogenases 1 and 2 (IDH1 and IDH2) inhibitors ivosidenib and enasidenib, as well as hedgehog (HH) pathway inhibitor glasdegib represented a significant step forward in AML therapeutic armamentarium. Smoothened (SMO) inhibitor in combination with low-dose cytarabine marks a recent milestone. AREAS COVERED Ivosidenib, the first-in-class, selective, allosteric IDH1R132 inhibitor, showed the capability to induce in vitro differentiation of primary mIDH1 AML blasts. Clinical data highlighted its exceptional safety profile, as a standalone therapy and in combination strategy. Additionally, comprehensive studies consistently demonstrated its effectiveness, both in monotherapy and in association with chemotherapy. EXPERT OPINION The identified ivosidenib's strengths, including its remarkable safety record and ability to yield positive therapeutic outcomes, position it as an ideal partner for both classic chemotherapy and biological treatments, i.e. hypometilant agents and/or venetoclax. Further studies are warranted to explore strategies for overcoming the occurrence of ivosidenib resistance.
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Affiliation(s)
- Antonella Bruzzese
- Department of Onco-Hematology, Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Caterina Labanca
- Department of Onco-Hematology, Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Enrica Antonia Martino
- Department of Onco-Hematology, Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Francesco Mendicino
- Department of Onco-Hematology, Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Eugenio Lucia
- Department of Onco-Hematology, Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Virginia Olivito
- Department of Onco-Hematology, Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Antonino Neri
- Scientific Directorate IRCCS di Reggio Emilia, EmiliaRomagna, Reggio Emilia, Italy
| | - Annalisa Imovilli
- Department of Hematology, Azienda USL-IRCCS di Reggio Emilia, Emilia Romagna, Reggio Emilia, Italy
| | | | - Ernesto Vigna
- Department of Onco-Hematology, Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Massimo Gentile
- Department of Onco-Hematology, Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
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27
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Tangella AV, Gajre A, Kantheti VV. Isocitrate Dehydrogenase 1 Mutation and Ivosidenib in Patients With Acute Myeloid Leukemia: A Comprehensive Review. Cureus 2023; 15:e44802. [PMID: 37692182 PMCID: PMC10483130 DOI: 10.7759/cureus.44802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/12/2023] Open
Abstract
Acute myeloid leukemia (AML) arises from immature myeloid progenitors, resulting in a stem-cell-like proliferative state. This leads to excessive pools of immature cells that cannot function, which usually happens at the cost of the production of mature functional cells, leading to deleterious consequences. The management of AML has intensified as newer targeted therapies have come into existence owing to deeper genetic analysis of the disease and patients. Isocitrate dehydrogenase (IDH) is a cytosolic enzyme that is a part of the Krebs cycle and is extremely important in maintaining the homeostasis of the cell. It is produced by two different genes: IDH1 and IDH2. Ivosidenib has been associated with IDH1 inhibition and has been studied in numerous cancers. This review highlights the studies that have dealt with ivosidenib, an IDH1 inhibitor, in AML, the side effect profile, and the possible future course of the drug. After a scoping review of the available literature, we have identified that studies have consistently shown positive outcomes and that ivosidenib is a promising avenue for the management of AML. But it also has to be kept in mind that resistance to IDH inhibitors is on the rise, and the need to identify ways to circumvent this is to be addressed.
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Affiliation(s)
| | - Ashwin Gajre
- Internal Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, IND
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28
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Senapati J, Kadia TM, Ravandi F. Maintenance therapy in acute myeloid leukemia: advances and controversies. Haematologica 2023; 108:2289-2304. [PMID: 37139599 PMCID: PMC10483353 DOI: 10.3324/haematol.2022.281810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023] Open
Abstract
The last decade has seen steadfast progress in drug development in acute myeloid leukemia (AML) which has moved progressively towards genomic-based therapy. With these advances, outcomes in AML have improved but remains far from satisfactory. One approach towards preventing relapse in AML is to use maintenance therapy in patients, after attaining remission. Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective post-remission therapy that has been proven to reduce the risk of relapse. However, in patients who are ineligible for HSCT or have a high risk of relapse, other effective measures to prevent relapse are needed. There is also a need for post-HSCT maintenance to reduce relapse in high-risk subsets. Over the last 3 decades maintenance therapy in AML has evolved from the use of chemotherapeutic agents to more targeted therapies and better modulation of the immune system. Unfortunately, improvements in survival outcomes as a result of using these agents have not been consistently demonstrated in clinical trials. To derive the optimum benefit from maintenance therapy the time points of therapy initiation need to be defined and therapy must be selected precisely with respect to the AML genetics and risk stratification, prior treatment exposure, transplant eligibility, expected toxicity and the patient's clinical profile and desires. The far-reaching goal is to facilitate patients with AML in remission to achieve a normal quality of life while improving remission duration and overall survival. The QUAZAR trial was a welcome step towards a safe maintenance drug that is easy to administer and showed survival benefit but leaves many open issues for discussion. In this review we will discuss these issues, highlighting the development of AML maintenance therapies over the last 3 decades.
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Affiliation(s)
- Jayastu Senapati
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center.
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29
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Mellinghoff IK, van den Bent MJ, Blumenthal DT, Touat M, Peters KB, Clarke J, Mendez J, Yust-Katz S, Welsh L, Mason WP, Ducray F, Umemura Y, Nabors B, Holdhoff M, Hottinger AF, Arakawa Y, Sepulveda JM, Wick W, Soffietti R, Perry JR, Giglio P, de la Fuente M, Maher EA, Schoenfeld S, Zhao D, Pandya SS, Steelman L, Hassan I, Wen PY, Cloughesy TF. Vorasidenib in IDH1- or IDH2-Mutant Low-Grade Glioma. N Engl J Med 2023; 389:589-601. [PMID: 37272516 DOI: 10.1056/nejmoa2304194] [Citation(s) in RCA: 131] [Impact Index Per Article: 131.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Isocitrate dehydrogenase (IDH)-mutant grade 2 gliomas are malignant brain tumors that cause considerable disability and premature death. Vorasidenib, an oral brain-penetrant inhibitor of mutant IDH1 and IDH2 enzymes, showed preliminary activity in IDH-mutant gliomas. METHODS In a double-blind, phase 3 trial, we randomly assigned patients with residual or recurrent grade 2 IDH-mutant glioma who had undergone no previous treatment other than surgery to receive either oral vorasidenib (40 mg once daily) or matched placebo in 28-day cycles. The primary end point was imaging-based progression-free survival according to blinded assessment by an independent review committee. The key secondary end point was the time to the next anticancer intervention. Crossover to vorasidenib from placebo was permitted on confirmation of imaging-based disease progression. Safety was also assessed. RESULTS A total of 331 patients were assigned to receive vorasidenib (168 patients) or placebo (163 patients). At a median follow-up of 14.2 months, 226 patients (68.3%) were continuing to receive vorasidenib or placebo. Progression-free survival was significantly improved in the vorasidenib group as compared with the placebo group (median progression-free survival, 27.7 months vs. 11.1 months; hazard ratio for disease progression or death, 0.39; 95% confidence interval [CI], 0.27 to 0.56; P<0.001). The time to the next intervention was significantly improved in the vorasidenib group as compared with the placebo group (hazard ratio, 0.26; 95% CI, 0.15 to 0.43; P<0.001). Adverse events of grade 3 or higher occurred in 22.8% of the patients who received vorasidenib and in 13.5% of those who received placebo. An increased alanine aminotransferase level of grade 3 or higher occurred in 9.6% of the patients who received vorasidenib and in no patients who received placebo. CONCLUSIONS In patients with grade 2 IDH-mutant glioma, vorasidenib significantly improved progression-free survival and delayed the time to the next intervention. (Funded by Servier; INDIGO ClinicalTrials.gov number, NCT04164901.).
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Affiliation(s)
- Ingo K Mellinghoff
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Martin J van den Bent
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Deborah T Blumenthal
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Mehdi Touat
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Katherine B Peters
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Jennifer Clarke
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Joe Mendez
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Shlomit Yust-Katz
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Liam Welsh
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Warren P Mason
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - François Ducray
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Yoshie Umemura
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Burt Nabors
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Matthias Holdhoff
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Andreas F Hottinger
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Yoshiki Arakawa
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Juan M Sepulveda
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Wolfgang Wick
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Riccardo Soffietti
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - James R Perry
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Pierre Giglio
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Macarena de la Fuente
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Elizabeth A Maher
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Steven Schoenfeld
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Dan Zhao
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Shuchi S Pandya
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Lori Steelman
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Islam Hassan
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Patrick Y Wen
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
| | - Timothy F Cloughesy
- From Memorial Sloan Kettering Cancer Center, New York (I.K.M.); the Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, the Netherlands (M.J.B.); Tel Aviv Medical Center, Tel Aviv University, Tel Aviv (D.T.B., S.Y.-K.), and the Davidoff Cancer Center, Rabin Medical Center, Petah Tikva (S.Y.-K.) - both in Israel; Sorbonne Université, Institut du Cerveau, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Paris (M.T.), and Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Centre de Recherche en Cancérologie de Lyon, Lyon (F.D.) - both in France; Duke University Medical Center, Durham, NC (K.B.P.); the University of California, San Francisco, San Francisco (J.C.); Huntsman Cancer Institute, University of Utah, Salt Lake City (J.M.); the Royal Marsden Hospital, London (L.W.); Princess Margaret Cancer Centre (W.P.M.), and Sunnybrook Health Sciences Centre (J.R.P.), University of Toronto (W.P.M.) - both in Toronto; the University of Michigan Comprehensive Cancer Center, Ann Arbor (Y.U.); the University of Alabama at Birmingham, Birmingham (B.N.); Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore (M.H.); Lundin Family Brain Tumor Research Center, University Hospital of Lausanne, and the University of Lausanne - both in Lausanne, Switzerland (A.F.H.); Kyoto University Graduate School of Medicine, Kyoto, Japan (Y.A.); Hospital Universitario 12 de Octubre, Madrid (J.M.S.); Universitätsklinikum Heidelberg and the German Cancer Research Center - both in Heidelberg, Germany (W.W.); the University of Turin, Turin, Italy (R.S.); Ohio State University Wexner Medical Center, Columbus (P.G.); Sylvester Comprehensive Cancer Center and the Department of Neurology, University of Miami, Miami (M.F.); University of Texas Southwestern Medical Center, Dallas (E.A.M.); Servier Pharmaceuticals (S.S., D.Z., S.S.P., L.S., I.H.) and Dana-Farber Cancer Institute (P.Y.W.) - both in Boston; and the University of California, Los Angeles, Los Angeles (T.F.C.)
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Yuan H, Lu Y, Feng Y, Wang N. Epigenetic inhibitors for cancer treatment. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2023; 383:89-144. [PMID: 38359972 DOI: 10.1016/bs.ircmb.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Epigenetics is a heritable and reversible modification that occurs independent of the alteration of primary DNA sequence but remarkably affects genetic expression. Aberrant epigenetic regulators are frequently observed in cancer progression not only influencing the behavior of tumor cells but also the tumor-associated microenvironment (TME). Increasing evidence has shown their great potential as biomarkers to predict clinical outcomes and chemoresistance. Hence, targeting the deregulated epigenetic regulators would be a compelling strategy for cancer treatment. So far, current epigenetic drugs have shown promising efficacy in both preclinical trials and clinical treatment of cancer, which encourages research discoveries on the development of novel epigenetic inhibitors either from natural compounds or artificial synthesis. However, only a few have been approved by the FDA, and more effort needs to be put into the related research. This chapter will update the applications and latest progress of epigenetic inhibitors in cancer treatment and provide prospects for the future development of epigenetic drugs.
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Affiliation(s)
- Hongchao Yuan
- School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yuanjun Lu
- School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yibin Feng
- School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ning Wang
- School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
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31
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Chen X, Xing H, Xie X, Kou L, Li J, Li Y. Efficacy and safety of FDA-approved IDH inhibitors in the treatment of IDH mutated acute myeloid leukemia: a systematic review and meta-analysis. Clin Epigenetics 2023; 15:113. [PMID: 37434249 PMCID: PMC10334617 DOI: 10.1186/s13148-023-01529-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE To systematically evaluate the efficacy and safety of FDA-approved isocitrate dehydrogenase (IDH) inhibitors in the treatment of IDH-mutated acute myeloid leukemia (AML). METHODS We used R software to conduct a meta-analysis of prospective clinical trials of IDH inhibitors in the treatment of IDH-mutated AML published in PubMed, Embase, Clinical Trials, Cochrane Library and Web of Science from inception to November 15th, 2022. RESULTS A total of 1109 IDH-mutated AML patients from 10 articles (11 cohorts) were included in our meta-analysis. The CR rate, ORR rate, 2-year survival (OS) rate and 2-year event-free survival (EFS) rate of newly diagnosed IDH-mutated AML (715 patients) were 47%, 65%, 45% and 29%, respectively. The CR rate, ORR rate, 2-year OS rate, median OS and median EFS of relapsed or refractory (R/R) IDH-mutated AML (394 patients) were 21%, 40%, 15%, 8.21 months and 4.73 months, respectively. Gastrointestinal adverse events were the most frequently occurring all-grade adverse events and hematologic adverse events were the most frequently occurring ≥ grade 3 adverse events. CONCLUSION IDH inhibitor is a promising treatment for R/R AML patients with IDH mutations. For patients with newly diagnosed IDH-mutated AML, IDH inhibitors may not be optimal therapeutic agents due to low CR rates. The safety of IDH inhibitors is controllable, but physicians should always pay attention to and manage the differentiation syndrome adverse events caused by IDH inhibitors. The above conclusions need more large samples and high-quality RCTs in the future to verify.
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Affiliation(s)
- Xiu Chen
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Hongyun Xing
- Department of Hematology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaolu Xie
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Liqiu Kou
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Jun Li
- Department of Traditional Chinese Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Yaling Li
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Wang J, Tomlinson B, Lazarus HM. Update on Small Molecule Targeted Therapies for Acute Myeloid Leukemia. Curr Treat Options Oncol 2023; 24:770-801. [PMID: 37195589 DOI: 10.1007/s11864-023-01090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/18/2023]
Abstract
OPINION STATEMENT The search for effective therapies for the highly heterogenous disease acute myeloid leukemia (AML) has remained elusive. While cytotoxic therapies can induce complete remission and even, at times, long-term survival, this approach is associated with significant toxic effects to visceral organs and worsening of immune dysfunction and marrow suppression leading to death. Sophisticated molecular studies have revealed defects within the AML cell that can be exploited by utilizing small molecule agents to target these defects, often dubbed "target therapy." Several medications have already established new standards of care for many patients with AML, including FDA-approved agents that inhibitor IDH1, IDH2, FLT3, and BCL-2. Emerging small molecules hold additional to add to the armamentarium of AML treatment options including MCL-1 inhibitors, TP53 inhibitors, menin inhibitors, and E-selectin antagonists. Moreover, the increasing options also mean that future combinations of these agents need to be explored, including with cytotoxic drugs and other newer emerging strategies such as immunotherapies for AML. Recent investigations continue to show that overcoming many of the challenges of treating AML finally is on the horizon.
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Affiliation(s)
- Jiasheng Wang
- Division of Hematology, Department of Medicine, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11000 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Benjamin Tomlinson
- Division of Hematology, Department of Medicine, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11000 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Hillard M Lazarus
- Division of Hematology, Department of Medicine, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11000 Euclid Avenue, Cleveland, OH, 44106, USA
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Turkalj S, Radtke FA, Vyas P. An Overview of Targeted Therapies in Acute Myeloid Leukemia. Hemasphere 2023; 7:e914. [PMID: 37304938 PMCID: PMC10256410 DOI: 10.1097/hs9.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 06/13/2023] Open
Abstract
Acute myeloid leukemia (AML) is the most aggressive adult leukemia, characterized by clonal differentiation arrest of progenitor or precursor hematopoietic cells. Intense preclinical and clinical research has led to regulatory approval of several targeted therapeutics, administered either as single agents or as combination therapies. However, the majority of patients still face a poor prognosis and disease relapse frequently occurs due to selection of therapy-resistant clones. Hence, more effective novel therapies, most likely as innovative, rational combination therapies, are urgently needed. Chromosomal aberrations, gene mutations, and epigenetic alterations drive AML pathogenesis but concurrently provide vulnerabilities to specifically target leukemic cells. Other molecules, either aberrantly active and/or overexpressed in leukemic stem cells, may also be leveraged for therapeutic benefit. This concise review of targeted therapies for AML treatment, which are either approved or are being actively investigated in clinical trials or recent preclinical studies, provides a flavor of the direction of travel, but also highlights the current challenges in AML treatment.
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Affiliation(s)
- Sven Turkalj
- MRC Molecular Hematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, United Kingdom
- Oxford Centre for Hematology, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Felix A. Radtke
- MRC Molecular Hematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, United Kingdom
- Oxford Centre for Hematology, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Department of Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Paresh Vyas
- MRC Molecular Hematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, United Kingdom
- Oxford Centre for Hematology, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Department of Hematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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34
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Suo X, Zheng F, Wang D, Zhao L, Liu J, Li L, Zhang Z, Zhang C, Li Y, Yang S, Zhao X, Shi R, Wu Y, Jiao Z, Song J, Zhang L, Lu X, Yuan L, Gao S, Zhang J, Zhao X, Bai G, Liu K, Mi Y. Venetoclax combined with daunorubicin and cytarabine (2 + 6) as induction treatment in adults with newly diagnosed acute myeloid leukemia: a phase 2, multicenter, single-arm trial. Exp Hematol Oncol 2023; 12:45. [PMID: 37173750 PMCID: PMC10176670 DOI: 10.1186/s40164-023-00409-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Venetoclax (Ven) combined with intensive chemotherapy was proven effective in the management of acute myeloid leukemia (AML). However, the severe and prolonged myelosuppression remains a concern to worry about. To explore more appropriate combination regimens, we designed Ven combining daunorubicin and cytarabine (DA 2 + 6) regimen as induction therapy, aimed to evaluate the effectiveness and safety in adults de novo AML. METHODS A phase 2 clinical trial was performed in 10 Chinese hospitals to investigate Ven combined with daunorubicin and cytarabine (DA 2 + 6) in patients with AML. The primary endpoints were overall response rate (ORR), comprising of complete remission (CR), complete remission with incomplete blood cell count recovery (CRi), and partial response (PR). Secondary endpoints included measurable residual disease (MRD) of bone marrow assessed by flow cytometry, overall survival (OS), event-free survival (EFS), disease-free survival (DFS), and the safety of regimens. This study is a currently ongoing trial listed on the Chinese Clinical Trial Registry as ChiCTR2200061524. RESULTS Overall, 42 patients were enrolled from January 2022 to November 2022; 54.8% (23/42) were male, and the median age was 40 (range, 16-60) years. The ORR after one cycle of induction was 92.9% (95% confidence interval [CI], 91.6-94.1; 39/42) with a composite complete response rate (CR + CRi) 90.5% (95% CI, 89.3-91.6, CR 37/42, CRi 1/42). Moreover, 87.9% (29/33) of the CR patients with undetectable MRD (95% CI, 84.9-90.8). Grade 3 or worse adverse effects included neutropenia (100%), thrombocytopenia (100%), febrile neutropenia (90.5%), and one mortality. The median neutrophil and platelet recovery times were 13 (5-26) and 12 (8-26) days, respectively. Until Jan 30, 2023, the estimated 12-month OS, EFS, and DFS rates were 83.1% (95% CI, 78.8-87.4), 82.7% (95% CI, 79.4-86.1), and 92.0% (95% CI, 89.8-94.3), respectively. CONCLUSION Ven with DA (2 + 6) is a highly effective and safe induction therapy for adults with newly diagnosed AML. To the best of our knowledge, this induction therapy has the shortest myelosuppressive period but has similar efficacy to previous studies.
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Affiliation(s)
- Xiaohui Suo
- Department of Hematology, Handan Central Hospital, Handan, Hebei, China
| | - Fang Zheng
- Department of Hematology, Baiyun Hospital Affiliated to Guizhou Medical University, Guiyang, Guizhou, China
| | - Dongmei Wang
- Department of Hematology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Liyun Zhao
- Department of Hematology, People Hospital of XingTai, Xing Tai, Hebei, China
| | - Jie Liu
- Department of Hematology, Sinopharm Tongmei General Hospital, Datong, Shanxi, China
| | - Ling Li
- Department of Hematology, Inner Mongolia People's Hospital, Huhehaote, Neimenggu, China
| | - Zhihua Zhang
- Department of Hematology, The Affiliated Hospital of Chengde Medical College, Chengde, Hebei, China
| | - Congcong Zhang
- Department of Hematology, Handan Central Hospital, Handan, Hebei, China
| | - Yinling Li
- Department of Hematology, Handan Central Hospital, Handan, Hebei, China
| | - Sisi Yang
- Department of Hematology, Baiyun Hospital Affiliated to Guizhou Medical University, Guiyang, Guizhou, China
| | - Xuemei Zhao
- Department of Hematology, Baiyun Hospital Affiliated to Guizhou Medical University, Guiyang, Guizhou, China
| | - Rui Shi
- Department of Hematology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Yan Wu
- Department of Hematology, Harrison International Peace Hospital, Hengshui, Hebei, China
| | - Zongjiu Jiao
- Department of Hematology, People Hospital of XingTai, Xing Tai, Hebei, China
| | - Jiaojie Song
- Department of Hematology, People Hospital of XingTai, Xing Tai, Hebei, China
| | - Ling Zhang
- Department of Hematology, Sinopharm Tongmei General Hospital, Datong, Shanxi, China
| | - Xinxiao Lu
- Department of Hematology, Oncology Center, Tianjin People's Hospital, No. 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - Linyu Yuan
- Department of Hematology, Oncology Center, Tianjin People's Hospital, No. 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - Sifeng Gao
- Department of Hematology, The Affiliated Tai'an City Central Hospital of Qingdao University, Taian, Shandong, China
| | - Jilei Zhang
- Department of Hematology, The Affiliated Tai'an City Central Hospital of Qingdao University, Taian, Shandong, China
| | - Xingli Zhao
- Department of Hematology, Oncology Center, Tianjin People's Hospital, No. 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - Guanchen Bai
- Department of Hematology, The Affiliated Tai'an City Central Hospital of Qingdao University, Taian, Shandong, China
| | - Kaiqi Liu
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
- Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin, China.
| | - Yingchang Mi
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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Lai C, Bhansali RS, Kuo EJ, Mannis G, Lin RJ. Older Adults With Newly Diagnosed AML: Hot Topics for the Practicing Clinician. Am Soc Clin Oncol Educ Book 2023; 43:e390018. [PMID: 37155946 DOI: 10.1200/edbk_390018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, our understanding of AML pathogenesis and pathophysiology has improved significantly with mutational profiling. This has led to translational advances in therapeutic options, as there have been 10 new US Food and Drug Administration (FDA) approvals for AML therapies since 2017, half of which target specific driver mutations in FLT3, IDH1, or IDH2. These new agents have expanded the therapeutic armamentarium for AML, particularly for patients who are considered ineligible for intensive chemotherapy with anthracycline- and cytarabine-containing regimens. These new treatment options are relevant because the median age at diagnosis is 68 years, and outcomes for patients older than 60 years have historically been dismal. However, the optimal approach to incorporating novel agents into frontline regimens remains a clinical challenge, particularly with regard to sequencing of therapies, considering the role of allogeneic hematopoietic stem cell transplantation and managing toxicities.
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Affiliation(s)
- Catherine Lai
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Rahul S Bhansali
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Eric J Kuo
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Gabriel Mannis
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - Richard J Lin
- Memorial Sloan Kettering Cancer Center, New York, NY
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Aiman W, Ali MA, Basit MA, Omar Z, Suleman M, Hassan M, Jamil T, Anwar MS, Shafique Z, Dhanesar G, Faisal MS, Akerman MJ, Maroules M, Anwer F. Efficacy and tolerability of isocitrate dehydrogenase inhibitors in patients with acute myeloid leukemia: A systematic review of clinical trials. Leuk Res 2023; 129:107077. [PMID: 37100025 DOI: 10.1016/j.leukres.2023.107077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a hematological malignancy due to anomalous differentiation and proliferation of hematopoietic stem cells with myeloid blast buildup. Induction chemotherapy is considered the first line of treatment in most patients with AML. However, targeted therapy in the form of FLT-3, IDH, BCL-2, and immune checkpoint inhibitors, can be considered as the first line depending on their molecular profile, resistance to chemotherapy, comorbidities, etc. This review aims to assess the tolerability and efficacy of isocitrate dehydrogenase (IDH) inhibitors in AML. METHODS We searched Medline, WOS, Embase, and clinicaltrials.gov. PRISMA guidelines were followed in this systematic review. 3327 articles were screened, and 9 clinical trials (N = 1119) were included. RESULTS In randomized clinical trials (RCTs), objective response (OR) was reported in 63-74% of the patients with IDH inhibitors + azacitidine as compared to 19-36 % of the patients with azacitidine monotherapy in newly diagnosed (ND) medically unfit patients. Survival rates were significantly improved with the use of ivosidenib. OR was reported in 39.1-46 % of the patients who relapsed/refractory to chemotherapy. ≥Grade 3 IDH differentiation syndrome and QT prolongation were reported in 3.9-10 % and 2-10 % of the patients, respectively. CONCLUSION IDH inhibitors (ivosidenib for IDH-1 and enasidenib for IDH-2) are safe and effective in treating ND medically unfit or relapsed refractory patients with IDH mutation. However, no survival benefit was reported with enasidenib. More randomized multicenter double-blinded clinical studies are needed to confirm these results and compare them with other targeting agents.
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Affiliation(s)
- Wajeeha Aiman
- Saint Michael's Medical Center, New York College of Medicine, Newark, NJ, USA; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Muhammad Ashar Ali
- New York Medical College at St. Mary's and St. Clare's, Denville, NJ, USA; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA.
| | - Muhammad Abdul Basit
- Services Institute of Medical Sciences, Lahore, Pakistan; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Zainab Omar
- Dubai Medical College for Girls, Dubai, United Arab Emirates; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Muhammad Suleman
- Islamic International Medical College, Rawalpindi, Pakistan; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Muhammad Hassan
- Banner University Medical Center, Tucson, AZ, USA; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Taimoor Jamil
- King Edward Medical University, Lahore, Pakistan; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Muhammad Saad Anwar
- King Edward Medical University, Lahore, Pakistan; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Zubair Shafique
- Sahiwal Medical College, Sahiwal, Pakistan; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Gurneel Dhanesar
- New York Medical College at St. Mary's and St. Clare's, Denville, NJ, USA; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Muhammad Salman Faisal
- Roswell Park Cancer Institute, Buffalo, NY, USA; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Michael J Akerman
- New York Medical College at St. Mary's and St. Clare's, Denville, NJ, USA; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Michael Maroules
- New York Medical College at St. Mary's and St. Clare's, Denville, NJ, USA; Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA
| | - Faiz Anwer
- Cancer Center, Saint Mary's General Hospital, Passaic, NJ, USA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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Sasaki K, Ravandi F, Kadia TM, Borthakur G, Short NJ, Jain N, Daver NG, Jabbour EJ, Garcia-Manero G, Loghavi S, Patel KP, Montalban-Bravo G, Masarova L, DiNardo CD, Kantarjian HM. Prediction of survival with lower intensity therapy among older patients with acute myeloid leukemia. Cancer 2023; 129:1017-1029. [PMID: 36715486 DOI: 10.1002/cncr.34609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study was to develop a prognostic model for survival in older/unfit patients with newly diagnosed acute myeloid leukemia (AML) who were treated with lower-intensity chemotherapy regimens. METHODS The authors reviewed all older/unfit patients with newly diagnosed AML who received lower-intensity chemotherapy from 2000 until 2020 at their institution. A total of 1462 patients were included. They were divided (3:1 basis) into a training (n = 1088) and a validation group (n = 374). RESULTS In the training cohort of 1088 patients (median age, 72 years), the multivariate analysis identified 11 consistent independent adverse factors associated with survival: older age, therapy-related myeloid neoplasm, existence of previous myelodysplastic syndrome or myeloproliferative neoplasms, poor performance status, pulmonary comorbidity, anemia, thrombocytopenia, elevated lactate dehydrogenase, cytogenetic abnormalities, and the presence of infection at diagnosis, and therapy not containing venetoclax. The 3-year survival rates were 52%, 24%, 10%, and 1% in favorable, intermediate, poor, and very poor risk, respectively. This survival model was validated in an independent cohort. In a subset of patients in whom molecular mutation profiles were performed in more recent times, adding the mutation profiles after accounting for the effects of previous factors identified IDH2 (favorable), NPM1 (favorable), and TP53 (unfavorable) mutations as molecular prognostic factors. CONCLUSION The proposed survival model with lower-intensity chemotherapy in older/unfit patients with newly diagnosed AML may help to advise patients on their expected outcome, to propose different strategies in first complete remission, and to compare the results of different existing or future investigational therapies. PLAIN LANGUAGE SUMMARY Lower intensity therapy can be considered for older patients to avoid severe toxicities and adverse events. However, survival prediction in AML was commonly developed in patients who received intensive chemotherapy. In this study, we have proposed a survival model to guide therapeutic approach in older patients who received lower-intensity therapy.
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Affiliation(s)
- Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naval G Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elias J Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Lucia Masarova
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Kuron D, Pohlmann A, Angenendt L, Kessler T, Mesters R, Berdel WE, Stelljes M, Lenz G, Schliemann C, Mikesch JH. Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis. Ann Hematol 2023; 102:755-760. [PMID: 36749402 PMCID: PMC9998561 DOI: 10.1007/s00277-023-05111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
Intensive chemotherapy is the backbone of induction treatment in patients with acute myeloid leukemia (AML). However, AML patients with concomitant cardiac disease may not be eligible for anthracycline-based therapies. In a small cohort of patients, we have previously shown that anthracycline-free, amsacrine-based chemotherapy TAA (thioguanine, cytarabine, amsacrine) may be as effective as cytarabine/daunorubicin for induction therapy in these patients. In this systematic retrospective single-center analysis, we documented the outcome of 31 patients with significant cardiac comorbidities including coronary heart disease or cardiomyopathy receiving TAA as induction chemotherapy. Median (range) ejection fraction (EF) was 48% (30-67%) in this cohort. Patients with EF below 30% were considered unfit for intensive induction therapy. Event-free survival (EFS), overall survival (OS), and relapse-free survival (RFS) were 1.61, 5.46, and 13.6 months respectively. Poor outcome was primarily related to a high early mortality rate within the first 30 days of therapy, mainly caused by infectious complications. TAA cannot be recommended as a substitute of standard induction for AML patients with significant concomitant cardiac disease. In the era of novel agents, alternative strategies (e.g., hypomethylating agents plus venetoclax) should be considered when anthracycline-based regimens are not suitable.
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Affiliation(s)
- David Kuron
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany. .,Current Affiliation: Department of Medicine II, University Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Alexander Pohlmann
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Linus Angenendt
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Torsten Kessler
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Rolf Mesters
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Matthias Stelljes
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
| | | | - Jan-Henrik Mikesch
- Department of Medicine A, University Hospital Münster, 48149, Münster, Germany
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39
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Bhansali RS, Pratz KW, Lai C. Recent advances in targeted therapies in acute myeloid leukemia. J Hematol Oncol 2023; 16:29. [PMID: 36966300 PMCID: PMC10039574 DOI: 10.1186/s13045-023-01424-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/14/2023] [Indexed: 03/27/2023] Open
Abstract
Acute myeloid leukemia (AML) is the most common acute leukemia in adults. While survival for younger patients over the last several decades has improved nearly sixfold with the optimization of intensive induction chemotherapy and allogeneic stem cell transplantation (alloHSCT), this effect has been largely mitigated in older and less fit patients as well as those with adverse-risk disease characteristics. However, the last 10 years has been marked by major advances in the molecular profiling of AML characterized by a deeper understanding of disease pathobiology and therapeutic vulnerabilities. In this regard, the classification of AML subtypes has recently evolved from a morphologic to a molecular and genetic basis, reflected by recent updates from the World Health Organization and the new International Consensus Classification system. After years of stagnation in new drug approvals for AML, there has been a rapid expansion of the armamentarium against this disease since 2017. Low-intensity induction therapy with hypomethylating agents and venetoclax has substantially improved outcomes, including in those previously considered to have a poor prognosis. Furthermore, targeted oral therapies against driver mutations in AML have been added to the repertoire. But with an accelerated increase in treatment options, several questions arise such as how to best sequence therapy, how to combine therapies, and if there is a role for maintenance therapy in those who achieve remission and cannot undergo alloHSCT. Moreover, certain subtypes of AML, such as those with TP53 mutations, still have dismal outcomes despite these recent advances, underscoring an ongoing unmet need and opportunity for translational advances. In this review, we will discuss recent updates in the classification and risk stratification of AML, explore the literature regarding low-intensity and novel oral combination therapies, and briefly highlight investigative agents currently in early clinical development for high-risk disease subtypes.
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Affiliation(s)
- Rahul S Bhansali
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Keith W Pratz
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Catherine Lai
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, South Pavilion, 12th Floor, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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40
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Hellou T, Cohen O, Avigdor A, Amitai I, Shimoni A, Misgav M, Canaani J. The occurrence of thrombosis during intensive chemotherapy treatment for acute myeloid leukemia patients does not impact on long-term survival. Ann Hematol 2023; 102:1037-1043. [PMID: 36905445 DOI: 10.1007/s00277-023-05158-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
Venous thromboembolism (VTE) is frequently seen in acute myeloid leukemia (AML) patients and presents a significant clinical challenge. The association of VTE during intensive chemotherapy with risk models such as the Medical Research Council (MRC) cytogenetic-based assessment and the European LeukemiaNet (ELN) 2017 molecular risk model have not been rigorously evaluated. Additionally, there is a paucity of data pertaining to the long-term prognostic impact of VTE in AML patients. We performed an analysis of baseline parameters of AML patients diagnosed with VTE during intensive chemotherapy and compared them with patients without VTE. The analyzed cohort consisted of 335 newly diagnosed AML patients with a median age of 55 years. Thirty-five patients (11%) were classified as MRC favorable risk, 219 (66%) patients as intermediate risk, 58 patients (17%) as adverse risk. Per ELN 2017, 132 patients (40%) had favorable risk disease, 122 patients (36%) intermediate risk, and 80 patients (24%) had adverse risk. VTE was seen in 33 patients (9.9%), occurring mostly during induction (70%), and required catheter removal in 9 patients (28%). Baseline clinical, laboratory, molecular, and ELN 2017 parameters were not significantly different groups. However, MRC intermediate-risk group patients were significantly more likely to experience thrombosis compared to favorable risk and adverse risk patients (12.8% versus 5.7% and 1.7%, respectively; p = 0.049). Median overall survival was not significantly impacted by the diagnosis of thrombosis (3.7 years versus 2.2 years; p = 0.47). VTE is tightly associated with temporal and cytogenetic parameters in AML but does not significantly impact on long-term outcomes.
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Affiliation(s)
- Tamer Hellou
- Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, 52621, Tel-Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omri Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel
| | - Abraham Avigdor
- Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, 52621, Tel-Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irina Amitai
- Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, 52621, Tel-Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avichai Shimoni
- Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, 52621, Tel-Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mudi Misgav
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel
| | - Jonathan Canaani
- Hematology Division, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, 52621, Tel-Hashomer, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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41
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Lachowiez CA, DiNardo CD, Loghavi S. Molecularly Targeted Therapy in Acute Myeloid Leukemia: Current Treatment Landscape and Mechanisms of Response and Resistance. Cancers (Basel) 2023; 15:1617. [PMID: 36900407 PMCID: PMC10001191 DOI: 10.3390/cancers15051617] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Treatment for acute myeloid leukemia (AML) has evolved rapidly over the last decade as improved understanding of cytogenetic and molecular drivers of leukemogenesis refined survival prognostication and enabled development of targeted therapeutics. Molecularly targeted therapies are now approved for the treatment of FLT3 and IDH1/2-mutated AML and additional molecularly and cellularly targeted therapeutics are in development for defined patient subgroups. Alongside these welcome therapeutic advancements, increased understanding of leukemic biology and treatment resistance has resulted in clinical trials investigating combinations of cytotoxic, cellular, and molecularly targeted therapeutics resulting in improved response and survival outcomes in patients with AML. Herein, we comprehensively review the current landscape of IDH and FLT3 inhibitors in clinical practice for the treatment of AML, highlight known resistance mechanisms, and discuss new cellular or molecularly targeted therapies currently under investigation in ongoing early phase clinical trials.
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Affiliation(s)
- Curtis A. Lachowiez
- Department of Medicine, Division of Hematology/Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Courtney D. DiNardo
- Department of Leukemia and Hematopathology, The University of Texas, MD Anderson, Houston, TX 77030, USA
| | - Sanam Loghavi
- Department of Leukemia and Hematopathology, The University of Texas, MD Anderson, Houston, TX 77030, USA
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42
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Tiong IS, Loo S. Targeting Measurable Residual Disease (MRD) in Acute Myeloid Leukemia (AML): Moving beyond Prognostication. Int J Mol Sci 2023; 24:4790. [PMID: 36902217 PMCID: PMC10003715 DOI: 10.3390/ijms24054790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Measurable residual disease (MRD) assessment in acute myeloid leukemia (AML) has an established role in disease prognostication, particularly in guiding decisions for hematopoietic cell transplantation in first remission. Serial MRD assessment is now routinely recommended in the evaluation of treatment response and monitoring in AML by the European LeukemiaNet. The key question remains, however, if MRD in AML is clinically actionable or "does MRD merely portend fate"? With a series of new drug approvals since 2017, we now have more targeted and less toxic therapeutic options for the potential application of MRD-directed therapy. Recent approval of NPM1 MRD as a regulatory endpoint is also foreseen to drastically transform the clinical trial landscape such as biomarker-driven adaptive design. In this article, we will review (1) the emerging molecular MRD markers (such as non-DTA mutations, IDH1/2, and FLT3-ITD); (2) the impact of novel therapeutics on MRD endpoints; and (3) how MRD might be used as a predictive biomarker to guide therapy in AML beyond its prognostic role, which is the focus of two large collaborative trials: AMLM26 INTERCEPT (ACTRN12621000439842) and MyeloMATCH (NCT05564390).
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Affiliation(s)
- Ing S. Tiong
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- The Alfred Hospital, Melbourne, VIC 3004, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3004, Australia
| | - Sun Loo
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC 3052, Australia
- The Northern Hospital, Epping, VIC 3076, Australia
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43
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Shimony S, Stahl M, Stone RM. Acute myeloid leukemia: 2023 update on diagnosis, risk-stratification, and management. Am J Hematol 2023; 98:502-526. [PMID: 36594187 DOI: 10.1002/ajh.26822] [Citation(s) in RCA: 97] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 01/04/2023]
Abstract
DISEASE OVERVIEW Acute myeloid leukemia (AML) is a frequently fatal bone marrow stem cell cancer characterized by unbridled proliferation of malignant marrow stem cells with associated infection, anemia, and bleeding. An improved understanding of pathophysiology, improvements in measurement technology and at least 10 recently approved therapies have led to revamping the diagnostic, prognostic, and therapeutic landscape of AML. DIAGNOSIS One updated and one new classification system were published in 2022, both emphasizing the integration of molecular analysis into daily practice. Differences between the International Consensus Classification and major revisions from the previous 2016 WHO system provide both challenges and opportunities for care and clinical research. RISK ASSESSMENT AND MONITORING The European Leukemia Net 2022 risk classification integrates knowledge from novel molecular findings and recent trial results, as well as emphasizing dynamic risk based on serial measurable residual disease assessment. However, how to leverage our burgeoning ability to measure a small number of potentially malignant myeloid cells into therapeutic decision making is controversial. RISK ADAPTED THERAPY The diagnostic and therapeutic complexity plus the availability of newly approved agents requires a nuanced therapeutic algorithm which should integrate patient goals of care, comorbidities, and disease characteristics including the specific mutational profile of the patient's AML. The framework we suggest only represents the beginning of the discussion.
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Affiliation(s)
- Shai Shimony
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Rabin Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Maximilian Stahl
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Richard M Stone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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44
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Venugopal S, Xie Z, Zeidan AM. An overview of novel therapies in advanced clinical testing for acute myeloid leukemia. Expert Rev Hematol 2023; 16:109-119. [PMID: 36718500 DOI: 10.1080/17474086.2023.2174521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The past decade has seen a sea change in the AML landscape with vastly improved cognizance of molecular pathogenesis, clonal evolution, and importance of measurable residual disease. Since 2017, the therapeutic armamentarium of AML has considerably expanded with the approval of midostaurin, enasidenib, ivosidenib, gilteritinib, and venetoclax in combination with hypomethylating agents and others. Nevertheless, relapse and treatment refractoriness remain the insurmountable challenges in AML therapy. This has galvanized the leukemic research community leading to the discovery and development of agents that specifically target gene mutations, molecularly agnostic therapies that exploit immune environment, apoptotic pathways, leukemic cell surface antigens and so forth. AREAS COVERED This article provides an overview of the pathophysiology of AML in the context of non-cellular immune and molecularly targeted and agnostic therapies that are in clinical trial development in AML. EXPERT OPINION Ever growing understanding of the molecular pathogenesis and metabolomics in AML has allowed the researchers to identify targets directed at specific genes and metabolic pathways. As a result, AML therapy is constantly evolving and so are the escape mechanisms leading to disease relapse. Therefore, it is of paramount importance to sequentially evaluate the patient during AML treatment and intervene at the right time.
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Affiliation(s)
- Sangeetha Venugopal
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Zhuoer Xie
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, FL, USA
| | - Amer M Zeidan
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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45
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Bazinet A, Kantarjian HM. Moving toward individualized target-based therapies in acute myeloid leukemia. Ann Oncol 2023; 34:141-151. [PMID: 36423744 DOI: 10.1016/j.annonc.2022.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disease at the genetic level. The field of AML therapy is increasingly shifting away from uniform approaches based solely on intensive chemotherapy (such as '7 + 3') toward personalized therapy. The treatment of AML can now be individualized based on patient characteristics and cytogenetic/molecular disease features. In this review, we provide a comprehensive updated summary of personalized, target-directed therapy in AML. We first discuss the selection of intensive versus low-intensity treatment approaches based on the patient's age and/or comorbidities. We follow with a detailed review of specific molecularly defined AML subtypes that benefit from the addition of targeted agents. In this context, we highlight the urgent need for novel therapies in tumor protein p53 (TP53)-mutated AML. We then propose approaches to optimize AML therapy in patients without directly actionable mutations. We conclude with a discussion on the emerging role of using measurable residual disease to modify therapy based on the quality of response.
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Affiliation(s)
- A Bazinet
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA.
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46
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Jaramillo S, Schlenk RF. Update on current treatments for adult acute myeloid leukemia: to treat acute myeloid leukemia intensively or non-intensively? That is the question. Haematologica 2023; 108:342-352. [PMID: 36722404 PMCID: PMC9890037 DOI: 10.3324/haematol.2022.280802] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 02/02/2023] Open
Abstract
For several decades, the treatment for acute myeloid leukemia (AML) has been a dichotomous choice between intensive chemotherapy strategies with curative intent and non-intensive options including supportive care. Patients' age and fitness, as well as comorbidities, primarily influenced this choice. However, the therapeutic armamentarium is evolving, so that there are highly effective and increasingly specific drugs, fitting the mutational profile of a patient's leukemia. There is now a spectrum of treatment options that are less intense and can be administered in an outpatient setting and to a substantial extent are equally or even more effective than standard intensive therapy. We are, therefore, witnessing a radical change in the treatment landscape of AML. In this review, we examine the current treatment options for patients with AML, considering the molecular spectrum of the disease on the background of patient-related factors.
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Affiliation(s)
- Sonia Jaramillo
- Department of Internal Medicine V, Heidelberg University Hospital
| | - Richard F. Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital,NCT-Trial Center, National Center of Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany,F. Schlenk_Richard
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47
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Cooperrider JH, Shukla N, Nawas MT, Patel AA. The Cup Runneth Over: Treatment Strategies for Newly Diagnosed Acute Myeloid Leukemia. JCO Oncol Pract 2023; 19:74-85. [PMID: 36223559 PMCID: PMC10476749 DOI: 10.1200/op.22.00342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/14/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022] Open
Abstract
Since 2017, the number of agents for acute myeloid leukemia (AML) has rapidly expanded. Given the increased therapeutic options, better identification of high-risk subsets of AML and more refined approaches to patient fitness assessment, the decisions surrounding selection of intensive chemotherapy versus lower-intensity treatment have grown increasingly more nuanced. In this review, we present available data for both standard and investigational approaches in the initial treatment of AML using an intensive chemotherapy backbone or a lower-intensity approach. We summarize management strategies in newly diagnosed secondary AML, considerations around allogeneic stem-cell transplantation, and the role of maintenance therapy. Finally, we highlight important areas of future investigation and novel agents that may hold promise in combination with standard therapies.
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Affiliation(s)
| | - Navika Shukla
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mariam T. Nawas
- Section of Hematology-Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Anand Ashwin Patel
- Section of Hematology-Oncology, Department of Medicine, University of Chicago, Chicago, IL
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48
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Mohty R, El Hamed R, Brissot E, Bazarbachi A, Mohty M. New drugs before, during, and after hematopoietic stem cell transplantation for patients with acute myeloid leukemia. Haematologica 2023; 108:321-341. [PMID: 36722403 PMCID: PMC9890036 DOI: 10.3324/haematol.2022.280798] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/02/2022] [Indexed: 02/02/2023] Open
Abstract
The treatment of acute myeloid leukemia (AML) has evolved over the past few years with the advent of next-generation sequencing. Targeted therapies alone or in combination with low-dose or high-intensity chemotherapy have improved the outcome of patients with AML treated in the frontline and relapsed/refractory settings. Despite these advances, allogeneic stem cell transplantation (allo-HCT) remains essential as consolidation therapy following frontline treatment in intermediate-and adverse-risk and relapsed/refractory disease. However, many patients relapse, with limited treatment options, hence the need for post-transplant strategies to mitigate relapse risk. Maintenance therapy following allo-HCT was developed for this specific purpose and can exploit either a direct anti-leukemia effect and/or enhance the bona fide graft-versus-leukemia effect without increasing the risk of graft-versus-host disease. In this paper, we summarize novel therapies for AML before, during, and after allo-HCT and review ongoing studies.
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Affiliation(s)
- Razan Mohty
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | - Rama El Hamed
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Eolia Brissot
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France; INSERM, Saint-Antoine Research Center, Paris
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France; INSERM, Saint-Antoine Research Center, Paris.
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Fortin J, Chiang MF, Meydan C, Foox J, Ramachandran P, Leca J, Lemonnier F, Li WY, Gams MS, Sakamoto T, Chu M, Tobin C, Laugesen E, Robinson TM, You-Ten A, Butler DJ, Berger T, Minden MD, Levine RL, Guidos CJ, Melnick AM, Mason CE, Mak TW. Distinct and opposite effects of leukemogenic Idh and Tet2 mutations in hematopoietic stem and progenitor cells. Proc Natl Acad Sci U S A 2023; 120:e2208176120. [PMID: 36652477 PMCID: PMC9942850 DOI: 10.1073/pnas.2208176120] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mutations in IDH1, IDH2, and TET2 are recurrently observed in myeloid neoplasms. IDH1 and IDH2 encode isocitrate dehydrogenase isoforms, which normally catalyze the conversion of isocitrate to α-ketoglutarate (α-KG). Oncogenic IDH1/2 mutations confer neomorphic activity, leading to the production of D-2-hydroxyglutarate (D-2-HG), a potent inhibitor of α-KG-dependent enzymes which include the TET methylcytosine dioxygenases. Given their mutual exclusivity in myeloid neoplasms, IDH1, IDH2, and TET2 mutations may converge on a common oncogenic mechanism. Contrary to this expectation, we observed that they have distinct, and even opposite, effects on hematopoietic stem and progenitor cells in genetically engineered mice. Epigenetic and single-cell transcriptomic analyses revealed that Idh2R172K and Tet2 loss-of-function have divergent consequences on the expression and activity of key hematopoietic and leukemogenic regulators. Notably, chromatin accessibility and transcriptional deregulation in Idh2R172K cells were partially disconnected from DNA methylation alterations. These results highlight unanticipated divergent effects of IDH1/2 and TET2 mutations, providing support for the optimization of genotype-specific therapies.
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Affiliation(s)
- Jerome Fortin
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
- 2To whom correspondence may be addressed. , , or
| | - Ming-Feng Chiang
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
| | - Cem Meydan
- bDepartment of Physiology and Biophysics, Weill Cornell Medicine, New York, NY10065
- cThe HRH Prince Alwaleed Bin Talal Bin Abdulaziz Al-Saud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY10065
- dWorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY10065
| | - Jonathan Foox
- bDepartment of Physiology and Biophysics, Weill Cornell Medicine, New York, NY10065
- cThe HRH Prince Alwaleed Bin Talal Bin Abdulaziz Al-Saud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY10065
| | | | - Julie Leca
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
| | - François Lemonnier
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
- eInstitut Mondor de Recherche Biomédicale, INSERMU955, Université Paris Est Créteil, Créteil94010, France
| | - Wanda Y. Li
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
- fCentre for Oncology and Immunology, Hong Kong Science Park, Hong Kong SAR, China
| | - Miki S. Gams
- gDepartment of Immunology, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ONM5G 0A4, Canada
| | - Takashi Sakamoto
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
- hDepartment of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto606-8501, Japan
| | - Mandy Chu
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
| | - Chantal Tobin
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
| | - Eric Laugesen
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
| | - Troy M. Robinson
- iHuman Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY10065
- jLouis V. Gerstner, Jr. Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, NY10065
| | - Annick You-Ten
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
| | - Daniel J. Butler
- bDepartment of Physiology and Biophysics, Weill Cornell Medicine, New York, NY10065
| | - Thorsten Berger
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
| | - Mark D. Minden
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
| | - Ross L. Levine
- iHuman Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY10065
- kCenter for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY10065
- lCenter for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY10065
| | - Cynthia J. Guidos
- gDepartment of Immunology, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ONM5G 0A4, Canada
| | - Ari M. Melnick
- mDepartment of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY10021
| | - Christopher E. Mason
- bDepartment of Physiology and Biophysics, Weill Cornell Medicine, New York, NY10065
- cThe HRH Prince Alwaleed Bin Talal Bin Abdulaziz Al-Saud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY10065
- dWorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY10065
| | - Tak W. Mak
- aPrincess Margaret Cancer Centre, University Health Network, Toronto, ONM5G 2C1, Canada
- fCentre for Oncology and Immunology, Hong Kong Science Park, Hong Kong SAR, China
- nDepartment of Pathology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- 2To whom correspondence may be addressed. , , or
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Bouligny IM, Maher KR, Grant S. Mechanisms of myeloid leukemogenesis: Current perspectives and therapeutic objectives. Blood Rev 2023; 57:100996. [PMID: 35989139 PMCID: PMC10693933 DOI: 10.1016/j.blre.2022.100996] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/28/2023]
Abstract
Acute myeloid leukemia (AML) is a heterogeneous hematopoietic neoplasm which results in clonal proliferation of abnormally differentiated hematopoietic cells. In this review, mechanisms contributing to myeloid leukemogenesis are summarized, highlighting aberrations of epigenetics, transcription factors, signal transduction, cell cycling, and the bone marrow microenvironment. The mechanisms contributing to AML are detailed to spotlight recent findings that convey clinical impact. The applications of current and prospective therapeutic targets are accentuated in addition to reviews of treatment paradigms stratified for each characteristic molecular lesion - with a focus on exploring novel treatment approaches and combinations to improve outcomes in AML.
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Affiliation(s)
- Ian M Bouligny
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
| | - Keri R Maher
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
| | - Steven Grant
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
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