AG-221, a First-in-Class Therapy Targeting Acute Myeloid Leukemia Harboring Oncogenic Mutations.

Somatic gain-of-function mutations in isocitrate dehydrogenases () 1 and 2 are found in multiple hematologic and solid tumors, leading to accumulation of the oncometabolite ()-2-hydroxyglutarate (2HG). 2HG competitively inhibits α-ketoglutarate-dependent dioxygenases, including histone demethylases and methylcytosine dioxygenases of the TET family, causing epigenetic dysregulation and a block in cellular differentiation. studies have provided proof of concept for mutant IDH inhibition as a therapeutic approach. We report the discovery and characterization of AG-221, an orally available, selective, potent inhibitor of the mutant IDH2 enzyme. AG-221 suppressed 2HG production and induced cellular differentiation in primary human mutation-positive acute myeloid leukemia (AML) cells and in xenograft mouse models. AG-221 also provided a statistically significant survival benefit in an aggressive IDH2-mutant AML xenograft mouse model. These findings supported initiation of the ongoing clinical trials of AG-221 in patients with mutation-positive advanced hematologic malignancies. Mutations in are identified in approximately 20% of patients with AML and contribute to leukemia via a block in hematopoietic cell differentiation. We have shown that the targeted inhibitor AG-221 suppresses the mutant IDH2 enzyme in multiple preclinical models and induces differentiation of malignant blasts, supporting its clinical development. .