Department of Leukemia, MD Anderson Cancer Center, University of Texas, Houston, TX, 77030, USA.
Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1079, New York, NY, 10029, USA.
J Hematol Oncol. 2020 Dec 2;13(1):162. doi: 10.1186/s13045-020-00995-y.
Hyperactive signaling of the Janus-Associated Kinase/Signal Transducers and Activators of Transcription (JAK/STAT) pathway is central to the pathogenesis of Philadelphia-chromosome-negative myeloproliferative neoplasms (MPN), i.e., polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) which are characterized by inherent biological and clinical heterogeneity. Patients with MPNs suffer from substantial symptom burden and curtailed longevity due to thrombohemorrhagic complications or progression to myelofibrosis or acute myeloid leukemia. Therefore, the management strategies focus on thrombosis risk mitigation in PV/ET, alleviation of symptom burden and improvement in cytopenias and red blood cell transfusion requirements, and disease course alteration in PMF. The United States Food and Drug Administration's (USFDA) approval of two JAK inhibitors (ruxolitinib, fedratinib) has transformed the therapeutic landscape of MPNs in assuaging the need for frequent therapeutic phlebotomy (PV) and reduction in spleen and symptom burden (PV and PMF). Despite improving biological understanding of these complex clonal hematopoietic stem/progenitor cell neoplasms, none of the currently available therapies appear to modify the proclivity of the disease per se, thereby remaining an urgent unmet clinical need and an ongoing area of intense clinical investigation. This review will highlight the evolving targeted therapeutic agents that are in early- and late-stage MPN clinical development.
Janus 相关激酶/信号转导子和转录激活子(JAK/STAT)通路的过度信号转导是费城染色体阴性骨髓增殖性肿瘤(MPN)发病机制的核心,即真性红细胞增多症(PV)、原发性血小板增多症(ET)和原发性骨髓纤维化(PMF),这些疾病具有固有生物学和临床异质性。由于血栓出血并发症或进展为骨髓纤维化或急性髓系白血病,MPN 患者会遭受大量症状负担和寿命缩短。因此,管理策略侧重于降低 PV/ET 的血栓风险、减轻症状负担和改善细胞减少症和红细胞输血需求,并改变 PMF 的疾病进程。美国食品和药物管理局(USFDA)批准了两种 JAK 抑制剂(ruxolitinib、fedratinib),改变了 MPN 的治疗格局,缓解了频繁治疗性放血(PV)的需求,并减少了脾脏和症状负担(PV 和 PMF)。尽管对这些复杂的克隆造血干细胞/祖细胞肿瘤的生物学理解有所提高,但目前尚无任何可用的治疗方法似乎能够改变疾病本身的倾向,因此仍然是一个迫切的未满足的临床需求和一个正在进行的临床研究热点。本文将重点介绍目前处于 MPN 临床开发早期和晚期的新兴靶向治疗药物。