Benjamin K Tomlinson1, Molly M Gallogly1, Donna M Kane1, Leland Metheny1, Hillard M Lazarus1, Basem M William1, Michael D Craig2, Mark J Levis3, Brenda W Cooper4. 1. Division of Hematology and Oncology, Department of Medicine, Seidman Cancer Center, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH. 2. Department of Medicine, Section of Hematology/Oncology, West Virginia University Cancer Institute, Morgantown, WV. 3. Department of Oncology and Medicine, Division of Hematologic Malignancies, Johns Hopkins, Baltimore, MD. 4. Division of Hematology and Oncology, Department of Medicine, Seidman Cancer Center, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH. Electronic address: brenda.cooper@uhhospitals.org.
Abstract
BACKGROUND: Midostaurin, a multikinase inhibitor, is approved for treatment of FLT3-mutant acute myeloid leukemia (AML). A phase I study established that midostaurin 75 mg orally twice daily for 14 days with standard dose azacitidine was safe and tolerable in elderly patients with AML. Herein, we report the phase II expansion cohort of previously untreated elderly or unfit patients with AML. PATIENTS AND METHODS: Primary objectives were to further describe the toxicity profile and determine the response rate in untreated patients with AML. Patients received midostaurin 75 mg orally twice daily on days 8 to 21 in combination with intravenous azacitidine at 75 mg/m2 on days 1 to 7. Plasma inhibitory activity assay for FLT3 was performed pretreatment and on day 8 and day 15 of each cycle. RESULTS: Twenty-six patients (median age, 74 years; range, 59-85 years) with FLT3 wild-type AML were accrued. Patients received a median of 2 cycles of therapy (range, 1-10 cycles). Seven (29%) of 24 evaluable patients achieved a clinical response (4 complete response; 1 complete response with incomplete count recovery; and 2 partial response). The median overall survival was 244 days (95% confidence interval, 203-467 days). Hematologic, infectious, and gastrointestinal toxicities were comparable to similar studies. Peripheral blood FLT3 wild-type phosphorylation declined to 8% to 55% of pretreatment by day 15 of cycle 1 (7 patients) and declined with subsequent cycles (< 10% baseline) in 2 patients who were analyzed after cycle 3. CONCLUSION: Multiple cycles of azacitidine and midostaurin were not well-tolerated, but persistent inhibition of FLT3 wild-type phosphorylation suggest intermittent dosing of midostaurin should be considered in future low-intensity regimens for FLT3-mutant AML.
BACKGROUND:Midostaurin, a multikinase inhibitor, is approved for treatment of FLT3-mutant acute myeloid leukemia (AML). A phase I study established that midostaurin 75 mg orally twice daily for 14 days with standard dose azacitidine was safe and tolerable in elderly patients with AML. Herein, we report the phase II expansion cohort of previously untreated elderly or unfit patients with AML. PATIENTS AND METHODS: Primary objectives were to further describe the toxicity profile and determine the response rate in untreated patients with AML. Patients received midostaurin 75 mg orally twice daily on days 8 to 21 in combination with intravenous azacitidine at 75 mg/m2 on days 1 to 7. Plasma inhibitory activity assay for FLT3 was performed pretreatment and on day 8 and day 15 of each cycle. RESULTS: Twenty-six patients (median age, 74 years; range, 59-85 years) with FLT3 wild-type AML were accrued. Patients received a median of 2 cycles of therapy (range, 1-10 cycles). Seven (29%) of 24 evaluable patients achieved a clinical response (4 complete response; 1 complete response with incomplete count recovery; and 2 partial response). The median overall survival was 244 days (95% confidence interval, 203-467 days). Hematologic, infectious, and gastrointestinal toxicities were comparable to similar studies. Peripheral blood FLT3 wild-type phosphorylation declined to 8% to 55% of pretreatment by day 15 of cycle 1 (7 patients) and declined with subsequent cycles (< 10% baseline) in 2 patients who were analyzed after cycle 3. CONCLUSION: Multiple cycles of azacitidine and midostaurin were not well-tolerated, but persistent inhibition of FLT3 wild-type phosphorylation suggest intermittent dosing of midostaurin should be considered in future low-intensity regimens for FLT3-mutant AML.
Keywords:
Acute myeloid leukemia; Efficacy and toxicity of low intensity treatment; FLT3 phosphorylation; Front line therapy; Sequential azacitidine and midostaurin
Authors: Diana Passaro; Manuel Garcia-Albornoz; Giovanni Diana; Probir Chakravarty; Linda Ariza-McNaughton; Antoniana Batsivari; Clara Borràs-Eroles; Ander Abarrategi; Alexander Waclawiczek; Luigi Ombrato; Ilaria Malanchi; John Gribben; Dominique Bonnet Journal: Cell Rep Date: 2021-05-11 Impact factor: 9.423