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维奈托克与 FLT3 抑制联合具有协同作用,可有效靶向 FLT3-ITD+ 急性髓系白血病模型中的白血病细胞。

Venetoclax combines synergistically with FLT3 inhibition to effectively target leukemic cells in FLT3-ITD+ acute myeloid leukemia models.

机构信息

Department of Translational Oncology, Genentech, Inc., South San Francisco, CA, USA.

Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.

出版信息

Haematologica. 2021 Apr 1;106(4):1034-1046. doi: 10.3324/haematol.2019.244020.

Abstract

FLT3 internal tandem duplication (FLT3-ITD) mutations account for ~25% of adult acute myeloid leukemia cases and are associated with poor prognosis. Venetoclax, a selective BCL-2 inhibitor, has limited monotherapy activity in relapsed/refractory acute myeloid leukemia with no responses observed in a small subset of FLT3-ITD+ patients. Further, FLT3-ITD mutations emerged at relapse following venetoclax monotherapy and combination therapy suggesting a potential mechanism of resistance. Therefore, we investigated the convergence of FLT3-ITD signaling on the BCL-2 family proteins and determined combination activity of venetoclax and FLT3-ITD inhibition in preclinical models. In vivo, venetoclax combined with quizartinib, a potent FLT3 inhibitor, showed greater anti-tumor efficacy and prolonged survival compared to monotherapies. In a patient-derived FLT3-ITD+ xenograft model, cotreatment with venetoclax and quizartinib at clinically relevant doses had greater anti-tumor activity in the tumor microenvironment compared to quizartinib or venetoclax alone. Use of selective BCL-2 family inhibitors further identified a role for BCL-2, BCL-XL and MCL-1 in mediating survival in FLT3-ITD+ cells in vivo and highlighted the need to target all three proteins for greatest anti-tumor activity. Assessment of these combinations in vitro revealed synergistic combination activity for quizartinib and venetoclax but not for quizartinib combined with BCL-XL or MCL-1 inhibition. FLT3-ITD inhibition was shown to indirectly target both BCL-XL and MCL-1 through modulation of protein expression, thereby priming cells toward BCL-2 dependence for survival. These data demonstrate that FLT3-ITD inhibition combined with venetoclax has impressive anti-tumor activity in FLT3-ITD+ acute myeloid leukemia preclinical models and provides strong mechanistic rational for clinical studies.

摘要

FLT3 内部串联重复(FLT3-ITD)突变占成人急性髓系白血病病例的约 25%,与预后不良相关。维奈托克(一种选择性 BCL-2 抑制剂)在复发/难治性急性髓系白血病中的单药活性有限,在一小部分 FLT3-ITD+患者中观察到无反应。此外,FLT3-ITD 突变在维奈托克单药治疗和联合治疗后复发时出现,表明存在潜在的耐药机制。因此,我们研究了 FLT3-ITD 信号在 BCL-2 家族蛋白上的汇聚,并确定了维奈托克和 FLT3-ITD 抑制在临床前模型中的联合活性。在体内,维奈托克与强效 FLT3 抑制剂 quizartinib 联合使用,与单药治疗相比,具有更强的抗肿瘤疗效和更长的生存时间。在源自患者的 FLT3-ITD+异种移植模型中,与单独使用 quizartinib 或维奈托克相比,维奈托克和 quizartinib 的联合治疗在肿瘤微环境中具有更强的抗肿瘤活性,在临床相关剂量下使用选择性 BCL-2 家族抑制剂进一步确定了 BCL-2、BCL-XL 和 MCL-1 在介导 FLT3-ITD+细胞体内存活中的作用,并强调需要针对这三种蛋白进行最大程度的抗肿瘤活性。这些组合在体外的评估显示,quizartinib 和维奈托克具有协同组合活性,但 quizartinib 与 BCL-XL 或 MCL-1 抑制联合使用则没有。FLT3-ITD 抑制通过调节蛋白表达间接靶向 BCL-XL 和 MCL-1,从而使细胞向 BCL-2 依赖性存活方向发展。这些数据表明,FLT3-ITD 抑制联合维奈托克在 FLT3-ITD+急性髓系白血病临床前模型中具有显著的抗肿瘤活性,并为临床研究提供了强有力的机制合理性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a417/8017817/e753e0322982/1061034.fig1.jpg

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