National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China.
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
Blood Cancer J. 2021 Jun 7;11(6):111. doi: 10.1038/s41408-021-00502-7.
About 25% of patients with acute myeloid leukemia (AML) harbor FMS-like tyrosine kinase 3 (FLT3) internal tandem duplication (ITD) mutations and their prognosis remains poor. Gilteritinib is a FLT3 inhibitor approved by the US FDA for use in adult FLT3-mutated relapsed or refractory AML patients. Monotherapy, while efficacious, shows short-lived responses, highlighting the need for combination therapies. Here we show that gilteritinib and CUDC-907, a dual inhibitor of PI3K and histone deacetylases, synergistically induce apoptosis in FLT3-ITD AML cell lines and primary patient samples and have striking in vivo efficacy. Upregulation of FLT3 and activation of ERK are mechanisms of resistance to gilteritinib, while activation of JAK2/STAT5 is a mechanism of resistance to CUDC-907. Gilteritinib and CUDC-907 reciprocally overcome these mechanisms of resistance. In addition, the combined treatment results in cooperative downregulation of cellular metabolites and persisting antileukemic effects. CUDC-907 plus gilteritinib shows synergistic antileukemic activity against FLT3-ITD AML in vitro and in vivo, demonstrating strong translational therapeutic potential.
约 25%的急性髓系白血病(AML)患者存在 FMS 样酪氨酸激酶 3(FLT3)内部串联重复(ITD)突变,其预后仍然较差。吉特替尼是一种被美国食品药品监督管理局(FDA)批准用于治疗成人 FLT3 突变的复发或难治性 AML 患者的 FLT3 抑制剂。尽管单药治疗有效,但反应短暂,这凸显了联合治疗的必要性。在这里,我们证明吉特替尼和 CUDC-907(一种 PI3K 和组蛋白去乙酰化酶的双重抑制剂)协同诱导 FLT3-ITD AML 细胞系和原发性患者样本凋亡,并具有显著的体内疗效。FLT3 的上调和 ERK 的激活是对吉特替尼产生耐药性的机制,而 JAK2/STAT5 的激活是对 CUDC-907 产生耐药性的机制。吉特替尼和 CUDC-907 相互克服这些耐药机制。此外,联合治疗导致细胞代谢物的协同下调和持续的抗白血病作用。CUDC-907 加吉特替尼在体外和体内对 FLT3-ITD AML 具有协同的抗白血病活性,显示出强大的转化治疗潜力。