Emerging Targeted Therapy for Specific Genomic Abnormalities in Acute Myeloid Leukemia

• Published in: International journal of molecular sciences 2022-02, Vol.23 (4), p.2362
• Main Authors: Chi, Sung-Gi, Minami, Yosuke
• Format: Article
• Language: English
• Subjects: Abnormalities; Acute myeloid leukemia; Antineoplastic Agents - therapeutic use; BCL-2; Bcl-2 protein; Chemotherapy; Cytochrome; Cytotoxic agents; Cytotoxicity; Dehydrogenases; FLT3; Fusion protein; Genes; Humans; IDH1; IDH2; Inhibitors; Kinases; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - genetics; Leukemogenesis; Lymphoma; Medical prognosis; menin; Molecular Targeted Therapy; Mutation; p53 Protein; Patients; Proteins; Review; Stabilizers (agents); Syk protein; Therapeutic targets; Transplants & implants
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms23042362

We describe recent updates of existing molecular-targeting agents and emerging novel gene-specific strategies. FLT3 and IDH inhibitors are being tested in combination with conventional chemotherapy for both medically fit patients and patients who are ineligible for intensive therapy. FLT3 inhibitors combined with non-cytotoxic agents, such as BCL-2 inhibitors, have potential therapeutic applicability. The menin-MLL complex pathway is an emerging therapeutic target. The pathway accounts for the leukemogenesis in AML with -rearrangement, mutation, and fusion genes. Potent menin-MLL inhibitors have demonstrated promising anti-leukemic effects in preclinical studies. The downstream signaling molecule SYK represents an additional target. However, the mutation continues to remain a challenge. While the p53 stabilizer APR-246 in combination with azacitidine failed to show superiority compared to azacitidine monotherapy in a phase 3 trial, next-generation p53 stabilizers are now under development. Among a number of non-canonical approaches to -mutated AML, the anti-CD47 antibody magrolimab in combination with azacitidine showed promising results in a phase 1b trial. Further, the efficacy was somewhat better in patients with the mutation. Although clinical evidence has not been accumulated sufficiently, targeting activating mutations and RAS pathway-related molecules can be a future therapeutic strategy.