Molecular Targeted Therapy in Myelodysplastic Syndromes: New Options for Tailored Treatments
Abstract
:Simple Summary
Abstract
1. Introduction
2. Therapeutic Strategies
2.1. Hypomethylating Agents
2.2. New Generation HMA
2.3. Targeted Treatments
2.3.1. Venetoclax
2.3.2. IDH INHIBITORS
2.3.3. FLT3 Inhibitors
2.3.4. Splicing Inhibitors
2.3.5. Histone Modifiers
2.3.6. Drugs Targeting p53 Pathway
2.4. Immunomodulatory Treatments
2.4.1. Lenalidomide
2.4.2. Immune Checkpoint Inhibitors
2.4.3. Anti-TGF β
2.5. Other Targeted Therapies
3. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Pathway/Functions | Gene Name |
---|---|
DNA methylation | TET2, DNMT3A, IDH1, IDH2 |
Histone modification | ASXL1, KMT2, EZH2, SUZ12, JARID2, KDM6A, PHF6, EED, EP300 |
RNA splicing | SF3B1, SRSF2, U2AF1, U2AF2, ZRSR2, SF1, PRPF8, LUC7L2, DDX41 |
Cohesin complex | STAG2, RAD21, SMC3, SMC1A |
Transcription factors | RUNX1, ETV6, GATA2, CUX1 IRF1, CEBPA, BCOR |
Signal transduction | PTPN11, NF1, NRAS, KRAS, JAK2, MPL, KIT, FLT3, JAK2, CALR, CSF3R, CBL |
p53 pathway | TP53, PPM1D |
DNA repair | ATM, FANCA-L, BRCA2, RAD51 |
Others | NPM1, SETBP1, WT1 |
Agent | Mechanism of Action | NCT | Patient Population | Study Design | Start Date | Status and Outcomes | Reference |
---|---|---|---|---|---|---|---|
Guadecitabine | New generation DNMT inhibitor, resistant to cytidine deaminase | NCT02907359 (ASTRAL-3 trial) | MDS, CMML after treatment failure | Multicenter, randomized, open label; Guadecitabine vs. treatment of choice (low-dose cytarabine, BSC, intensive chemotherapy) | September 2016 | Ongoing study | |
ASTX727 | New generation DNMT inhibitor, combination of DEC and cedazuridine | NCT03306264 (ASCERTAIN trial) | Treatment naive and R/R HR-MDS, CMML, or AML | Multicenter, randomized, open label; ASTX727 vs. IV DEC | October 2017 | Ongoing study | |
CC-486 | New generation DNMT inhibitor, oral AZA | NCT01566695 | LR-MDS with transfusion-dependent Anemia and Thrombocytopenia | Multicenter, randomized, double-blind CC-486 + BSC vs. placebo + BSC | April 2012 | Ongoing study | |
NCT04173533 | AML or HR-MDS in CR following allogeneic HSCT | Multicenter, randomized, double-blind CC-486 vs. placebo for maintenance after allo-HSCT | November 2019 | Ongoing study | |||
Venetoclax | Bcl-2 inhibitor | NCT04628026 | Newly diagnosed AML and MDS-EB2 | Multicenter, randomized, double-blind, Venetoclax + chemotherapy vs. placebo +chemotherapy | November 2020 | Ongoing study | |
NCT04401748 | Newly diagnosed HR-MDS | Multicenter, randomized, double-Blind, Venetoclax + AZA vs. Placebo + AZA | May 2020 | Ongoing study | |||
Ivosidenib or Enasidenib | IDH1/2 inhibitors | NCT03839771 | Newly diagnosed AML and MDS-EB2 with IDH1/2 mutations | Multicenter, double-blind, randomized, Ivosidenib or Enasidenib + chemotherapy vs. Placebo + cheotherapy | February 2019 | Ongoing study | |
Midostaurin or Gilteritinib | FLT3 inhibitor | NCT04027309 | Newly diagnosed AML and MDS-EB2 with FLT3 mutations | Multicenter, open-label, randomized Midostaurin + chemotherapy vs. Gilteritinib + chemotherapy (followed by maintenance for 1 year according to the treatment arm) | July 2019 | Ongoing study | |
APR-246 | p53 stabilizer | NCT03745716 | Newly diagnosed MDS with TP53 mutation | multicenter, randomized, APR-246 + AZA or AZA alone | November 2018 | Ongoing study | |
Lenalidomide | complex (immunomodulation and cell cicle arrest) | NCT01243476 | LR and Int-1 IPSS MDS with 5q- and anemia without the need of transfusion | Multicenter, randomized, double-blind Lenalidomide vs. Placebo | November 2010 | Ongoing study | |
NCT01029262 (MDS-005 trial) | LR and Int-1 IPSS, transfusion dependent MDS without 5q- | Multicenter, randomized, double-blind Lenalidomide vs. Placebo | December 2009 | Teminated, Primary endpoint met: TI in 27% (Lenalidomide) vs. 2.5% (Placebo), p < 0.01 | Santini et al. JCO 2016 [117] | ||
NCT00843882 | LR and Int-1 IPSS MDS | Multicenter, randomized, Lenalidomide vs. Lenalidomide + Epoietin alpha (Procrit) | December 2009 | Terminated study (results not published yet) | |||
MBG453 | Anti-TIM3 | NCT04266301 (STIMULUS-MDS2 trial) | Treatment-naïve intermediate, high or very HR IPSS-R MDS and CMML-2 | Multicenter, randomized, double-blind MBG453 + AZA vs. Placebo + AZA | February 2020 | Ongoing study | |
Magrolimab | Anti-CD47 | NCT04313881 (ENHANCE trial) | Treatment-naïve intermediate, high or very high-risk IPSS-R MDS | Multicenter, randomized, double-blind Magrolimab + AZA vs. Placebo + AZA | March 2020 | Ongoing study | |
Luspatercept | Anti-TGFbeta | NCT02631070 | Very low, low and Intermediate-1 IPSS-R MDS in patients with transfusion dependent anemia | Multicenter, randomized, double-blind Luspatercept vs. placebo | December 2015 | Terminated, Primary endpoint met; TI in 38% (Luspatercept) vs. 13% (Placebo), p < 0.001 | Fenaux et al. NEJM 2020 [141] |
NCT03682536 (COMMAND trial) | Very low, low and Intermediate-1 IPSS-R MDS ESA Naïve patients with transfusion dependent anemia | Multicenter, randomized, open label Luspatercept vs. Epoietin alpha | September 2018 | Ongoing study | |||
Rigosertib | Multikinase inhibitor | NCT01241500 (ONTIME trial) | MDS-EB1/2 after HMA failure | Multicenter, randomized, open label Rigosertib vs. BSC | December 2010 | Terminated. (Preliminary analysis: Failure in meeting the primary endpoint. Median OS rigosertib 8.2 months vs. 5.9 months with BSC (HR 0.87, 95% CI 0.67–1.14; p = 0.33). | Garcia-Manero et al. Lancet Onc. 2016 [147] |
NCT02562443 (INSPIRE trial) | very HR IPSS-R MDS after HMA failure | Multicenter, randomized, open label; Rigosertib vs. BSC | September 2015 | Ongoing study | |||
Pevonedistat | NAE inhibitor | NCT03268954 (PANTHER trial) | Newly diagnosed HR-MDS, CMML, or pauciblastic AML | Multicenter, randomized, open-label; Pevonedistat + AZA vs. AZA alone | August 2017 | Ongoing study | |
Imetelstat | Telomerase inhibitor | NCT02598661 | Low and Intermediate-1 IPSS-R MDS ESA resistant/refractory patients | Mutlicenter phase 2/3 composed study (phase2: Open label signle arm; phase 3: Double-blind, randomized, Imetelstat vs. placebo) | November 2015 | Phase 2 published/Phase 3 ongoing | Steensma et al., JCO 2021 [158] |
Roxadustat (FG4592) | HIF inhibitor | NCT03263091 | Primary MDS (Very Low, Low or Intermediate IPSS-R with <5% blasts) | Multicenter, randomized double-blind; Roxadustat vs. placebo | August 2017 | Ongoing study |
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Pagliuca, S.; Gurnari, C.; Visconte, V. Molecular Targeted Therapy in Myelodysplastic Syndromes: New Options for Tailored Treatments. Cancers 2021, 13, 784. https://doi.org/10.3390/cancers13040784
Pagliuca S, Gurnari C, Visconte V. Molecular Targeted Therapy in Myelodysplastic Syndromes: New Options for Tailored Treatments. Cancers. 2021; 13(4):784. https://doi.org/10.3390/cancers13040784
Chicago/Turabian StylePagliuca, Simona, Carmelo Gurnari, and Valeria Visconte. 2021. "Molecular Targeted Therapy in Myelodysplastic Syndromes: New Options for Tailored Treatments" Cancers 13, no. 4: 784. https://doi.org/10.3390/cancers13040784