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对美国食品药品监督管理局(FDA)批准的除“7 + 3”方案之外的急性髓系白血病疗法的综述。

A review of FDA-approved acute myeloid leukemia therapies beyond '7 + 3'.

作者信息

Bazinet Alexandre, Assouline Sarit

机构信息

Department of Hematology, Jewish General Hospital, McGill University, Montreal, QC, Canada.

出版信息

Expert Rev Hematol. 2021 Feb;14(2):185-197. doi: 10.1080/17474086.2021.1875814. Epub 2021 Jan 19.

Abstract

: The standard anthracycline and cytarabine-based chemotherapy for acute myeloid leukemia (AML) has changed relatively little since the 1970s and produces unsatisfactory outcomes in many patients. In the past two decades, a better understanding of the pathophysiology and heterogeneity of this disease has led to promising new therapies, resulting in a flurry of new drug approvals.: The MEDLINE database, ClinicalTrials.gov and conference proceedings were reviewed for the most salient literature concerning FDA-approved drugs for AML beyond standard chemotherapy: gemtuzumab ozogamicin, hypomethylating agents, Fms-like tyrosine kinase 3 (FLT3) inhibitors, isocitrate dehydrogenase (IDH) inhibitors, venetoclax, liposomal cytarabine and daunorubicin (CPX-351), and hedgehog pathway inhibitors. Key evidence for their efficacy is discussed. For each drug category, indications, typical usage and responses, major toxicities, and future directions for research are highlighted.: The treatment paradigm for AML is rapidly evolving. Promising new drugs targeting driver mutations have improved outcomes in specific AML subgroups. In parallel, advances in low-intensity therapies have allowed patients unfit for standard induction chemotherapy to achieve meaningful disease control. Further work is ongoing to identify synergistic drug combinations as well as optimal treatment selection guided by individual patient and disease features.

摘要

自20世纪70年代以来,用于急性髓系白血病(AML)的以蒽环类药物和阿糖胞苷为基础的标准化疗变化相对较小,并且在许多患者中产生了不尽人意的结果。在过去二十年中,对这种疾病病理生理学和异质性的更好理解带来了有前景的新疗法,导致了一系列新药获批。

对MEDLINE数据库、ClinicalTrials.gov和会议论文集进行了审查,以获取有关FDA批准的用于AML的非标准化疗药物的最突出文献:吉妥珠单抗奥唑米星、低甲基化剂、Fms样酪氨酸激酶3(FLT3)抑制剂、异柠檬酸脱氢酶(IDH)抑制剂、维奈克拉、脂质体阿糖胞苷和柔红霉素(CPX-351)以及刺猬通路抑制剂。讨论了它们疗效的关键证据。针对每个药物类别,突出显示了适应证、典型用法和反应、主要毒性以及未来研究方向。

AML的治疗模式正在迅速演变。针对驱动基因突变的有前景的新药改善了特定AML亚组的治疗结果。与此同时,低强度疗法的进展使不适合标准化疗诱导的患者能够实现有意义的疾病控制。正在进行进一步的工作,以确定协同药物组合以及根据个体患者和疾病特征指导的最佳治疗选择。

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