The combination of CUDC-907 and gilteritinib shows promising in vitro and in vivo antileukemic activity against FLT3-ITD AML.
Xinan QiaoJun MaTristan KnightYongwei SuHolly EdwardsLisa PolinJing LiJuiwanna KushnerSijana H DzinicKathryn WhiteJian WangHai LinYue WangLiping WangGuan WangJeffrey W TaubYubin GePublished in: Blood cancer journal (2021)
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.
Keyphrases
- acute myeloid leukemia
- tyrosine kinase
- allogeneic hematopoietic stem cell transplantation
- end stage renal disease
- signaling pathway
- epidermal growth factor receptor
- cell proliferation
- chronic kidney disease
- ejection fraction
- dna methylation
- oxidative stress
- newly diagnosed
- cell death
- ms ms
- poor prognosis
- gene expression
- long non coding rna
- cancer therapy
- case report
- drug delivery
- diffuse large b cell lymphoma
- patient reported outcomes
- drug administration
- patient reported