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Hou CX, Chen Y, Liu SH, Jiang YZ, Huang DP, Chen SN. Effective treatment with Gilteritinib-based regimens for FLT3-mutant extramedullary relapse in acute promyelocytic leukemia. Hematology 2024; 29:2293496. [PMID: 38095349 DOI: 10.1080/16078454.2023.2293496] [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: 06/30/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Extramedullary relapse (EMR) is rare in acute promyelocytic leukemia (APL) and, there is a lack of information on its management. Current practices for EMR in APL are always to adopt strategies from other subtypes of Acute lymphoblastic leukemia (ALL) and Acute myeloid leukemia (AML). Gilteritinib, a highly selective FLT3 inhibitor, has demonstrated a remarkable effect on EMR in FLT3-mutant AML. Therefore, it is worthwhile exploring if FLT3 mutation can be a therapeutic target and assessing the efficacy of Gilteritinib on FLT3-mutant EMR in APL. METHODS We described three cases of FLT3-mutant EMR in APL, comprising two isolated EMR cases and one systemic relapse. The patients underwent treatment with Gilteritinib-based regimens based on FLT3 mutation. RESULTS All three patients achieved complete regression of EMR, and no signs of tumor lysis syndrome during Gilteritinib-based therapy, only patient 1 showed mild granulocytopenia. They all maintained molecular complete remission (mCR) during the follow-up period. CONCLUSIONS The Gilteritinib-based regimen shows a high and sustained therapeutic effect with minimal adverse effects, and provides a valuable experience for further evaluation in EMR APL patients.
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Affiliation(s)
- Chun-Xiao Hou
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, People's Republic of China
| | - Yu Chen
- Department of Hematology, the Second Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Shan-Hao Liu
- Department of Hematology, the First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Yi-Zhi Jiang
- Department of Hematology, the First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Dong-Ping Huang
- Department of Hematology, the First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Su-Ning Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, People's Republic of China
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2
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Bruzzese A, Vigna E, Martino EA, Labanca C, Mendicino F, Lucia E, Olivito V, Stanzione G, Zimbo A, Lugli E, Neri A, Morabito F, Gentile M. The potential of triplet combination therapies for patients with FLT3-ITD -mutated acute myeloid leukemia. Expert Rev Hematol 2024; 17:241-253. [PMID: 38748404 DOI: 10.1080/17474086.2024.2356258] [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: 01/28/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) encompasses a heterogeneous group of aggressive myeloid malignancies, where FMS-like tyrosine kinase 3 (FLT3) mutations are prevalent, accounting for approximately 25-30% of adult patients. The presence of this mutation is related to a dismal prognosis and high relapse rates. In the lasts years many FLT3 inhibitors have been developed. AREAS COVERED This review provides a comprehensive overview of FLT3mut AML, summarizing the state of art of current treatment and available data about combination strategies including an FLT3 inhibitor. EXPERT OPINION In addition, the review discusses the emergence of drug resistance and the need for a nuanced approaches in treating patients who are ineligible for or resistant to intensive chemotherapy. Specifically, it explores the historical context of FLT3 inhibitors (FLT3Is) and their impact on treatment outcomes, emphasizing the pivotal role of midostaurin, as well as gilteritinib and quizartinib, and providing detailed insights into ongoing trials exploring the safety and efficacy of novel triplet combinations involving FLT3Is in different AML settings.
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Affiliation(s)
| | - Ernesto Vigna
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | | | | | - Eugenio Lucia
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | - Gaia Stanzione
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Division of Hematology, Azienda Policlinico-S. Marco, University of Catania, Catania, Italy
| | - Annamaria Zimbo
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- UOC Laboratorio Analisi Cliniche, Biomolecolari e Genetica, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Elisabetta Lugli
- Ematologia Azienda USL-IRCSS Reggio Emilia, Emilia-Romagna, Italy
| | - Antonino Neri
- Scientific Directorate IRCCS of Reggio Emilia, Emilia-Romagna, Reggio Emilia, Italy
| | | | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
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3
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Kugler E, Cohen I, Amitai I, Ram R, Frisch A, Nachmias B, Canaani J, Moshe Y, Krayem B, Aumann S, Henig I, Vainstein V, Shargian L, Ganzel C, Yeshurun M, Levi I, Raanani P, Akria L, Ofran Y, Shimony S, Wolach O. Gilteritinib with or without venetoclax for relapsed/refractory FLT3-mutated acute myeloid leukaemia. Br J Haematol 2024. [PMID: 38782575 DOI: 10.1111/bjh.19548] [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: 03/27/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
Patients with FLT3-mutated acute myeloid leukaemia (AML) that relapse or are refractory (R/R) to intensive induction have poor outcomes. Gilteritinib has recently become standard-of-care for patients with R/R FLT3-mutated AML. We investigated whether adding venetoclax to gilteritinib (gilt-ven) improves outcomes as compared with gilteritinib monotherapy. We included patients treated with gilteritinib (n = 19) and gilt-ven (n = 17) for R/R AML after intensive chemotherapy. Gilteritinib and gilt-ven groups did not differ in terms of mCRc rates (53% and 65%, p = 0.51) and realization of allogeneic haematopoietic stem-cell transplantation (HSCT, 47% and 35%, p = 0.5). Overall survival (OS) was comparable between groups, although a trend towards better OS was seen with gilt-ven (12-month OS 58.8% [95% CI 39.5%-87.6%]) versus gilteritinib (42.1% [95% CI 24.9%-71.3%] for gilteritinib). Early salvage with gilt-ven versus any other gilteritinib-based approach was associated with the best outcome (p = 0.031). Combination therapy was associated with increased haematological toxicity. In summary, gilt-ven did not improve remissions or HSCT-realization rates in patients with R/R FLT3-mutated AML as compared with gilteritinib and was associated with increased haematological toxicity. Although OS did not differ, a trend towards better survival was suggested with gilt-ven and a survival benefit was shown for gilt-ven approach when sequenced early for salvage.
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Affiliation(s)
- Eitan Kugler
- Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Inbar Cohen
- Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Irina Amitai
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Haematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ron Ram
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Institute of Haematology, Tel-Aviv Sourasky Medical Center (TLVMC), Tel-Aviv, Israel
| | - Avraham Frisch
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Boaz Nachmias
- Department of Haematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan Canaani
- Weill Medical College of Cornell University, New York, New York, USA
| | - Yakir Moshe
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Institute of Haematology, Tel-Aviv Sourasky Medical Center (TLVMC), Tel-Aviv, Israel
| | - Baher Krayem
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Shlomzion Aumann
- Department of Haematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Israel Henig
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Vladimir Vainstein
- Department of Haematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liat Shargian
- Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Chezi Ganzel
- Department of Haematology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Moshe Yeshurun
- Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Itay Levi
- Haematology Institute, Soroka Medical Center, Beer-Sheba, Israel
| | - Pia Raanani
- Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Luiza Akria
- Department of Haematology, Galilee Medical Center, Naharyia, Azrieli Faculty of Medicine Bar Ilan University, Sefad, Israel
| | - Yishai Ofran
- Department of Haematology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Shai Shimony
- Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ofir Wolach
- Institute of Haematology, Davidoff Cancer Center, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Zhao Y, Zhang X, Ding X, Wang Y, Li Z, Zhao R, Cheng HE, Sun Y. Efficacy and safety of FLT3 inhibitors in monotherapy of hematological and solid malignancies: a systemic analysis of clinical trials. Front Pharmacol 2024; 15:1294668. [PMID: 38828446 PMCID: PMC11140126 DOI: 10.3389/fphar.2024.1294668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction: FLT3 mutations are closely associated with the occurrence of hematological and solid malignancies, especially with acute myeloid leukemia. Currently, several FLT3 inhibitors are in clinical trials, and some have been applied in clinic. However, the safety, efficacy and pharmacodynamics of these FLT3 inhibitors have not been systemically analyzed before. Methods: We searched and reviewed clinical trial reports on the monotherapy of 13 FLT3 inhibitors, including sorafenib, lestaurtinib, midostaurin, gilteritinib, quizartinib, sunitinib, crenolanib, tandutinib, cabozantinib, pexidartinib, pacritinib, famitinib, and TAK-659 in patients with hematological and solid malignancies before May 31, 2023. Results: Our results showed the most common adverse events (AEs) were gastrointestinal adverse reactions, including diarrhea, hand-foot syndrome and nausea, while the most common hematological AEs were febrile neutropenia, anemia, and thrombocytopenia. Based on the published data, the mean overall survival (OS) and the mean progression-free survival (PFS) were 9.639 and 5.905 months, respectively. The incidence of overall response rate (ORR), complete remission (CR), partial response (PR), and stable disease (SD) for all these FLT3 inhibitors was 29.0%, 8.7%, 16.0%, and 42.3%, respectively. The ORRs of FLT3 inhibitors in hematologic malignancies and solid tumors were 40.8% and 18.8%, respectively, indicating FLT3 inhibitors were more effective for hematologic malignancies than for solid tumors. In addition, time to maximum plasma concentration (Tmax) in these FLT3 inhibitors ranged from 0.7-12.0 hours, but the elimination half-life (T1/2) range was highly variable, from 6.8 to 151.8 h. Discussion: FLT3 inhibitors monotherapy has shown significant anti-tumor effect in clinic, and the effectiveness may be further improved through combination medication.
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Affiliation(s)
| | | | | | | | | | | | - Hai-En Cheng
- School of Medical Laboratory, Shandong Second Medical University, Weifang, China
| | - Yanli Sun
- School of Medical Laboratory, Shandong Second Medical University, Weifang, China
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Urbino I, Secreto C, Apolito V, Olivi M, Arrigo G, Boscaro E, Catania FM, D'Ardia S, Frairia C, Giai V, Freilone R, Bruno B, Lanzarone G, Giaccone L, Busca A, Dellacasa CM, Ferrero D, Audisio E, Cerrano M. Sorafenib in combination with intensive chemotherapy for relapsed or refractory FLT3-ITD positive acute myeloid leukemia: A two centers experience. Leuk Res 2024; 136:107421. [PMID: 38042648 DOI: 10.1016/j.leukres.2023.107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Irene Urbino
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Carolina Secreto
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Vincenzo Apolito
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Matteo Olivi
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Giulia Arrigo
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Eleonora Boscaro
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Federica Maria Catania
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Stefano D'Ardia
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Chiara Frairia
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Valentina Giai
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Roberto Freilone
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Giuseppe Lanzarone
- Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Luisa Giaccone
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Alessandro Busca
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Chiara Maria Dellacasa
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Ernesta Audisio
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Marco Cerrano
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy.
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Choi YJ, Park J, Choi H, Oh SJ, Park JH, Park M, Kim JW, Kim YG, Kim YC, Kim MJ, Kang KW. PLM-101 is a novel and potent FLT3/RET inhibitor with less adverse effects in the treatment of acute myeloid leukemia. Biomed Pharmacother 2023; 165:115066. [PMID: 37392657 DOI: 10.1016/j.biopha.2023.115066] [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: 04/24/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023] Open
Abstract
Acute myeloid leukemia (AML) is a prevalent form of leukemia in adults. As its survival rate is low, there is an urgent need for new therapeutic options. In AML, FMS-like tyrosine kinase 3 (FLT3) mutations are common and have negative outcomes. However, current FLT3-targeting agents, Midostaurin and Gilteritinib, face two significant issues, specifically the emergence of acquired resistance and drug-related adverse events leading to treatment failure. Rearranged during transfection (RET), meanwhile, is a proto-oncogene linked to various types of cancer, but its role in AML has been limited. A previous study showed that activation of RET kinase enhances FLT3 protein stability, leading to the promotion of AML cell proliferation. However, no drugs are currently available that target both FLT3 and RET. This study introduces PLM-101, a new therapeutic option derived from the traditional Chinese medicine indigo naturalis with potent in vitro and in vivo anti-leukemic activities. PLM-101 potently inhibits FLT3 kinase and induces its autophagic degradation via RET inhibition, providing a superior mechanism to that of FLT3 single-targeting agents. Single- and repeated-dose toxicity tests conducted in the present study showed no significant drug-related adverse effects. This study is the first to present a new FLT3/RET dual-targeting inhibitor, PLM-101, that shows potent anti-leukemic activity and fewer adverse effects. PLM-101, therefore, should be considered for use as a potential therapeutic agent for AML.
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Affiliation(s)
- Yong June Choi
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Jaewoo Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyoyi Choi
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Su-Jin Oh
- R&D Center, PeLeMed, Co. Ltd., Seoul 06100, Republic of Korea
| | - Jin-Hee Park
- R&D Center, PeLeMed, Co. Ltd., Seoul 06100, Republic of Korea
| | - Miso Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Ji Won Kim
- Jeju Research Institute of Pharmaceutical Sciences, College of Pharmacy, Jeju National University, Jeju 63243, Republic of Korea
| | - Yoon-Gyoon Kim
- College of Pharmacy, Dankook University, Cheonan 31116, Republic of Korea
| | - Yong-Chul Kim
- R&D Center, PeLeMed, Co. Ltd., Seoul 06100, Republic of Korea; School of Life Sciences, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea
| | - Myung Jin Kim
- R&D Center, PeLeMed, Co. Ltd., Seoul 06100, Republic of Korea.
| | - Keon Wook Kang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea.
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Molica M, Perrone S, Rossi M. Gilteritinib: The Story of a Proceeding Success into Hard-to-Treat FLT3-Mutated AML Patients. J Clin Med 2023; 12:jcm12113647. [PMID: 37297842 DOI: 10.3390/jcm12113647] [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: 04/26/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
The traditionally dismal outcome of acute myeloid leukemia (AML) patients carrying the FMS-related tyrosine kinase 3 (FLT3) mutations has been mitigated by the recent introduction of tyrosine kinase inhibitors (TKI) into clinics, such as midostaurin and gilteritinib. The present work summarizes the clinical data that led to the use of gilteritinib in clinical practice. Gilteritinib is a second-generation TKI with deeper single-agent activity than first-generation drugs against both FLT3-ITD and TKD mutations in human studies. Moreover, the phase I/II dose-escalation, dose-expansion Chrysalis trial showed an acceptable safety profile of gilteritinib (diarrhea, elevated aspartate aminotransferase, febrile neutropenia, anemia, thrombocytopenia, sepsis, and pneumonia) and a 49% overall response rate (ORR) in 191 FLT3-mutated relapsed/refractory (R/R) AML patients. In 2019, the pivotal ADMIRAL trial showed that the median overall survival was significantly longer in patients treated with gilteritinib than among those receiving chemotherapy (9.3 vs. 5.6 months, respectively) and the ORR to gilteritinib was 67.6%, outperforming the 25.8% for chemotherapy arm and leading to the license for its clinical use by the US Food and Drug Administration. Since then, several real-world experiences have confirmed the positive results in the R/R AML setting. Finally, gilteritinib-based combinations currently under investigation, with several compounds (venetoclax, azacitidine, conventional chemotherapy, etc.) and some practical tips (maintenance after allogeneic transplantation, interaction with antifungal drugs, extramedullary disease, and onset of resistance), will be analyzed in detail in this review.
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Affiliation(s)
- Matteo Molica
- Department of Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, 88100 Catanzaro, Italy
| | - Salvatore Perrone
- Department of Hematology, Polo Universitario Pontino, S.M. Goretti Hospital, 04100 Latina, Italy
| | - Marco Rossi
- Department of Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, 88100 Catanzaro, Italy
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