夸替替尼:一种强效、选择性的 FLT3 抑制剂,用于治疗 FLT3-ITD 阳性 AML 患者。

Quizartinib: a potent and selective FLT3 inhibitor for the treatment of patients with FLT3-ITD-positive AML.

机构信息

Georgia Cancer Center at Augusta University, 1410 Laney Walker Blvd., CN2222, Augusta, GA, 30912, USA.

出版信息

J Hematol Oncol. 2024 Nov 13;17(1):111. doi: 10.1186/s13045-024-01617-7.

Abstract

Mutations in FMS-related receptor tyrosine kinase 3 (FLT3) are among the most common alterations in acute myeloid leukemia (AML), present in ≈30% of newly diagnosed AML cases. Internal tandem duplications (ITD) in FLT3 (FLT3-ITD) occur in ≈25% of newly diagnosed AML cases and are associated with unfavorable outcomes. Quizartinib (formerly AC220) is a novel, second-generation, highly potent, and selective type II FLT3 inhibitor. Quizartinib is approved in Japan as monotherapy for the treatment of adult patients with FLT3-ITD-positive relapsed/refractory (R/R) AML. Quizartinib is also approved in the United States, Japan, Europe, and United Kingdom in combination with chemotherapy during induction and consolidation, and as maintenance monotherapy (but, in the United States, not after allogeneic hematopoietic cell transplantation [allo-HCT]), for the treatment of adult patients with newly diagnosed FLT3-ITD-positive AML. In this review, we summarize preclinical studies that established quizartinib as a potent and selective type II FLT3 inhibitor as well as early and pivotal phase 3 clinical studies (QuANTUM-R and QuANTUM-First) that led to the approvals of quizartinib. We also summarize mechanisms of resistance to quizartinib along with its safety profile. Furthermore, we review the ongoing post hoc analyses of the QuANTUM-First data elucidating the impact of allo-HCT, the presence of measurable residual disease, and number and length of ITD on the clinical outcomes of quizartinib. We also describe the impact of quizartinib on patient-reported outcomes. Finally, we highlight some of the ongoing studies that test quizartinib in patients with FLT3-ITD-positive AML, patients with FLT3-ITD-negative AML, in both the first-line and R/R settings, in patients fit or unfit for intensive chemotherapy, including studies for quizartinib-based combination with other compounds such as decitabine and venetoclax. Future research should aim to further optimize the clinical value of quizartinib and explore its use in additional clinical settings, which could be achieved by testing quizartinib with other drugs, better characterization of the mechanisms of resistance, identification of the role of quizartinib as a maintenance therapy after allo-HCT, and investigating quizartinib in patients with FLT3-ITD-negative AML.

摘要

FMS 相关受体酪氨酸激酶 3(FLT3)中的突变是急性髓系白血病(AML)中最常见的改变之一,约 30%的新诊断 AML 病例存在这种突变。FLT3 中的内部串联重复(ITD)(FLT3-ITD)约占新诊断 AML 病例的 25%,与不良预后相关。Quizartinib(前身为 AC220)是一种新型、第二代、高效、选择性的 II 型 FLT3 抑制剂。Quizartinib 在日本被批准用于治疗 FLT3-ITD 阳性复发/难治性(R/R)AML 的成人患者的单药治疗。在美国、日本、欧洲和英国,quizartinib 也被批准与化疗联合用于诱导和巩固治疗,并作为维持单药治疗(但在美国,不用于异基因造血细胞移植 [allo-HCT] 后),用于治疗新诊断的 FLT3-ITD 阳性 AML 的成人患者。在这篇综述中,我们总结了确立 quizartinib 作为一种强效、选择性的 II 型 FLT3 抑制剂的临床前研究,以及导致 quizartinib 获批的早期关键的 3 期临床试验(QuANTUM-R 和 QuANTUM-First)。我们还总结了对 quizartinib 的耐药机制及其安全性概况。此外,我们还回顾了 QuANTUM-First 数据的事后分析,这些分析阐明了 allo-HCT、可测量残留疾病的存在、ITD 的数量和长度对 quizartinib 临床结局的影响。我们还描述了 quizartinib 对患者报告结果的影响。最后,我们强调了一些正在进行的研究,这些研究在 FLT3-ITD 阳性 AML 患者、FLT3-ITD 阴性 AML 患者、一线和 R/R 环境中、适合或不适合强化化疗的患者中测试了 quizartinib,包括基于 quizartinib 的联合治疗与其他化合物(如地西他滨和 venetoclax)的研究。未来的研究应旨在进一步优化 quizartinib 的临床价值,并探索其在其他临床环境中的应用,这可以通过测试 quizartinib 与其他药物、更好地阐明耐药机制、确定 allo-HCT 后作为维持治疗的 quizartinib 的作用以及在 FLT3-ITD 阴性 AML 患者中研究 quizartinib 来实现。

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