- |||||||||| Iclusig (ponatinib) / Takeda, Otsuka, Incyte
Preclinical Pharmacokinetic and Pharmacodynamic Evaluation of Dasatinib and Ponatinib in Lck-Activated T-Cell Acute Lymphoblastic Leukemia (ENMCC - Hall D) - Nov 4, 2022 - Abstract #ASH2022ASH_5789; Although it is unclear whether this mutation would occur in T-ALL patients undergoing dasatinib treatment, our findings point to the need for evaluating multiple LCK inhibitors as a treatment option. In conclusion, we comprehensively characterized pharmacokinetic and pharmacodynamic profile of dasatinib and ponatinib in preclinical models of T-ALL, and our exposure-response modeling established human dosage levels for future trials of LCK inhibitor for this cancer.
- |||||||||| Scemblix (asciminib) / Novartis
Real-World Experience of Asciminib: Factors Associated with Response (ENMCC - Hall D) - Nov 4, 2022 - Abstract #ASH2022ASH_4409; While the presence of T315I mutations does not appear to significantly impact on the response to asciminib, the presence of non-T315I mutations is associated with a lower rate of MMR. Importantly the standard dosing regimen in patients with T315I mutations is fivefold higher but whether this explains the discrepant responses to T315I and non-T315I mutations requires further investigation.
- |||||||||| Bosulif (bosutinib) / Pfizer, Iclusig (ponatinib) / Takeda, Otsuka, Incyte, Tasigna (nilotinib) / Novartis, Inhibikase
Trends in Frontline Treatment and Overall Survival in the Era of Targeted Tyrosine Kinase Inhibitor Therapy for Chronic Myeloid Leukemia (ENMCC - Hall D) - Nov 4, 2022 - Abstract #ASH2022ASH_4394; Though survival has improved for all pts, pts from traditionally underserved populations, including those who are underinsured or from low-income or low-education areas, have reduced survival. Continued advances in treatment and efforts to improve access to care for underserved populations is vital in the goal to achieve equitable survival outcomes in CML.
- |||||||||| Iclusig (ponatinib) / Takeda, Otsuka, Incyte, Blincyto (blinatumomab) / Astellas, Amgen
A Phase II Study of the Sequential Combination of Low-Intensity Chemotherapy (mini-hyper-CVD) and Ponatinib Followed By Blinatumomab and Ponatinib in Patients with Philadelphia Chromosome-Positive (Ph+) Acute Lymphoblastic Leukemia (ALL) (ENMCC - Hall D) - Nov 4, 2022 - Abstract #ASH2022ASH_4158; Pts received mini-hyper-CVD alternating with methotrexate and cytarabine on cycles 1-4, followed by blinatumomab and ponatinib on cycles 5-8...Pts with CD20+ disease received rituximab on cycles 1-4...Following consolidation, pts received maintenance therapy with 15 cycles of ponatinib plus vincristine/prednisone (maintenance cycles 1-3, 5-7, 9-11, and 13-15) alternating with ponatinib plus blinatumomab (maintenance cycles 4, 8, and 12) followed by ponatinib monotherapy daily for at least 5 years...One pt discontinued ponatinib and switched to dasatinib due to pulmonary embolism that occurred in cycle 2...The 30- and 60-day mortality rates were 0%. Conclusion Sequential combination of low-intensity chemotherapy and ponatinib followed by blinatumomab and ponatinib is highly effective and well tolerated in Ph+ ALL.
- |||||||||| Iclusig (ponatinib) / Takeda, Otsuka, Incyte
Chronic Myeloid Leukemia Diagnosed during Pregnancy: How to Manage? Description of 86 Cases from ELN International Registry (ENMCC - 388-390) - Nov 4, 2022 - Abstract #ASH2022ASH_3657; Twenty (31%) pts received imatinib (IM) at late pregnancy: Me start was 18 w (range 16-34)...Seven (11%) pts received hydroxycarbamide (HC) as monotherapy or in combination with IFN or IM...However, 3 pts unfortunately died 19, 24 and 119 mo after pregnancy completion, the reasons were not thought to be related to management in pregnancy: non-compliance, progression/resistance (1 case with T315/F359 mutation in the time of pre-ponatinib availability) and death after bone marrow transplantation...IM is probably safe in 2nd- 3rd trim considering its limited placental crossing. The use of HC is more questionable, as it has no advantages over IM and passes freely to the placenta: its use may be acceptable if there is a need for the urgent cytoreduction and leucapheresis is not available.
- |||||||||| Iclusig (ponatinib) / Takeda, Otsuka, Incyte
Three-Year Update from the Optic Trial: A Dose-Optimization Study of 3 Starting Doses of Ponatinib (ENMCC - 388-390) - Nov 4, 2022 - Abstract #ASH2022ASH_3656; P2 Results from the 3-year follow-up of the Phase 2 OPTIC study provide the robust long-term efficacy and manageable safety profile of ponatinib in a highly resistant CP-CML population. Consistent with results from the primary analysis, a ponatinib starting dose of 45 mg/d with reduction to 15 mg/d upon attainment of =1% BCR::ABL1IS provided the optimal benefit:risk ratio.
- |||||||||| Iclusig (ponatinib) / Takeda, Otsuka, Incyte, Blincyto (blinatumomab) / Astellas, Amgen, Besponsa (inotuzumab ozogamicin) / Pfizer, UCB
Consolidation with Allogeneic Hematopoietic Cell Transplant Improved Survival Outcomes of Adults with Relapsed / Refractory Acute Lymphoblastic Leukemia Following Response to Memory-Enriched CD19CAR T Cells (ENMCC - Hall D) - Nov 4, 2022 - Abstract #ASH2022ASH_2886; P1 The median number of prior lines of therapy was 3 (range, 1-9); 29 (63%) pts had prior alloHCT, and 29 (63%) and 15 (33%) pts failed blinatumomab and inotuzumab before enrollment, respectively...Of the 19 pts who responded to CAR T cells and did not have alloHCT consolidation, 11 relapsed with a median time of 3.4 months (range, 2.1-10.3) post CAR T cell infusion, 3 pts died in remission, and 5 pts remained alive and in remission at last contact or date of censoring, with a median follow up of 9.7 months (range, 3.3-51.8) including 1 pt who was censored at day 99 post infusion upon initiating ponatinib maintenance... Outcomes of alloHCT consolidation in adults with high-risk r/r ALL after achieving remission with Tn/mem CD19CAR T cells were promising, including for pts receiving their second alloHCT, and transplant led to improved survival outcomes.
- |||||||||| Nailike (olverembatinib) / Ascentage Pharma
The First Report of Third-Generation TKI Olverembatinib in Adult Ph/BCR-ABL1-Positive Acute Lymphoblastic Leukemia with T315I Mutation and Relapsed Disease (ENMCC - Hall D) - Nov 4, 2022 - Abstract #ASH2022ASH_2254; Methods In this exploratory study, adult Ph/BCR-ABL1+ ALL pts with T315I mutation or disease progression were treated with olverembatinib monotherapy (40 mg, every 2 days) or in combination with VP based low intensive chemotherapy (Vincristine/Prednisone) in our institution...Meanwhile, the olverembatinib-based therapy was well-tolerated, and the main adverse events of the third-generation TKIs, such as cytopenia, elevated transaminases, hypertension, and cardiovascular events, were less frequent than those reported relating to ponatinib...Conclusion This work suggests that Olverembatinib is a very promising 3rd-generation TKI. It is effective and safe in Chinese adult Ph/BCR-ABL1+ ALL with extremely poor prognosis, especially in T315I mutated or relapsed pts.
- |||||||||| Jakafi (ruxolitinib) / Novartis, Incyte, Iclusig (ponatinib) / Takeda, Otsuka, Incyte, Blincyto (blinatumomab) / Astellas, Amgen
Outcomes of Patients with B-ALL with Concomitant BCR::ABL1 and CRLF2 Rearrangements (ENMCC - Hall D) - Nov 4, 2022 - Abstract #ASH2022ASH_2211; Patients who harbor concomitant Ph+ and CRLF2-R represent a rare but high-risk subgroup of B-ALL. High rate of relapse was noted despite treatment with chemotherapy + TKI +/- ruxolitinib; several patients cleared the Ph+ clone, but CRLF2-R clone persisted suggesting novel interventions against CRLF2-R B-ALL are warranted.
- |||||||||| ELVN-001 / Enliven Therap
Elvn-001, a Next Generation ATP-Competitive ABL1 Tyrosine Kinase Inhibitor for the Treatment of Chronic Myeloid Leukemia (ENMCC - Hall D) - Nov 4, 2022 - Abstract #ASH2022ASH_2169; Of the six small-molecule ABL1 tyrosine kinase inhibitors (TKIs) that have received FDA-approval for the treatment of BCR-ABL1-driven Chronic Myeloid Leukemia (CML), five (Imatinib, Nilotinib, Dasatinib, Ponatinib, Bosutinib) target the ATP-binding site in the kinase domain...Consistent with previously reported findings for ponatinib, while ELVN-001 showed little to no activity against cells expressing a subset of T315I-inclusive BCR-ABL1 compound mutants, the addition of Asciminib resulted in varying degrees of re-sensitizing these mutants to ELVN-001...These anti-tumor activities also compared favorably to currently approved therapies when evaluated head-to-head in these studies. Together, these findings support ELVN-001 as an extremely selective, novel ATP-competitive inhibitor of ABL1 kinase with superior pharmacokinetic and tolerability properties compared to currently approved TKIs and which retains activity against T315I and other key on-target resistance mutations, warranting its further investigation in patients with TKI-resistant/intolerant CML.
- |||||||||| Bosulif (bosutinib) / Pfizer, Iclusig (ponatinib) / Takeda, Otsuka, Incyte, Tasigna (nilotinib) / Novartis, Inhibikase
Outcome of Third-Line Tyrosine Kinase Inhibitors in Patients with Chronic Myeloid Leukemia in Chronic Phase: A Propensity Score Analysis (ENMCC - 265-268) - Nov 4, 2022 - Abstract #ASH2022ASH_1755; Prior to third-line TKI therapy, 313 patients (88%) received imatinib; 156 patients (44%), dasatinib; 161 patients (45%), nilotinib; 35 patients (10%), bosutinib. Third-line ponatinib therapy is optimal selection for patients with CML-CP who failed prior 2 TKI therapies in the absence of T315I mutation.
- |||||||||| Review, Journal: Pathogenesis and management of accelerated and blast phases of chronic myeloid leukemia. (Pubmed Central) - Oct 31, 2022
Regimens including venetoclax in myeloid BP or inotuzumab ozogamicin or blinatumomab in lymphoid BP might lead to deeper and longer responses, facilitating potentially curative allo-SCT for patients with CML-BP once CP is achieved. Newer agents and novel combination therapies are further expanding the therapeutic arsenal in advanced phase CML.
- |||||||||| Iclusig (ponatinib) / Takeda, Otsuka
Enrollment change, Trial termination: Retrospective Evaluation of CML Patients in the National Compassionate Program (clinicaltrials.gov) - Oct 26, 2022 P=N/A, N=38, Terminated, Early inhibition of glucose consumption may provide complementary information to other biomarkers in determining whether a drug will effectively limit tumor growth. N=80 --> 38 | Recruiting --> Terminated; lack of interest
- |||||||||| Review, Journal, Adverse events: Adverse events and dose modifications of tyrosine kinase inhibitors in chronic myelogenous leukemia. (Pubmed Central) - Oct 25, 2022
In addition to imatinib, second- and third-generation tyrosine kinase inhibitors (TKIs) and a novel allosteric inhibitor, asciminib, are now available...Given the high efficacy of TKI therapy, dose modifications of TKI therapy reduce the risk of toxicities and improves quality of life during therapy. In this review article, we summarize the characteristics and adverse event profile of each TKI and dose modifications in patients with CML-CP and discuss future perspectives in the treatment of CML-CP.
- |||||||||| Bosulif (bosutinib) / Pfizer, Iclusig (ponatinib) / Takeda, Otsuka, Incyte, Tasigna (nilotinib) / Novartis, Inhibikase
Retrospective data, Journal: Allogeneic hematopoietic cell transplantation in patients with CML chronic phase in the era of third generation tyrosine kinase inhibitors: a retrospective study by the Chronic Malignancies Working Party of the EBMT. (Pubmed Central) - Oct 22, 2022 No difference in OS, PFS, RI or NRM was evident related to the number of TKI prior to allo-HCT or to the type of TKI (p=ns). Significant factors influencing OS and PFS were >CP1 vs CP1 and Karnofsky performance (KPS) score >?80 vs ?80, highlighting CP1 patients undergoing allo-HCT have improved survival compared to >CP1 and the importance of careful allo-HCT candidate selection.
- |||||||||| Scemblix (asciminib) / Novartis
Review, Journal: Asciminib for chronic myeloid leukaemia: Next questions. (Pubmed Central) - Oct 22, 2022 In this review, we discuss the available data on asciminib while exploring a number of clinical trials in progress. Finally, we provide our opinion based on the current data about where asciminib is most likely to be the optimal choice, which will hopefully assist clinicians with therapy selection.
- |||||||||| Iclusig (ponatinib) / Takeda, Otsuka, Incyte, chlorogenic acid / Jiuzhang Biotech
Journal: Discovery of anti-stroke active substances in Guhong injection based on multi-phenotypic screening of zebrafish. (Pubmed Central) - Oct 22, 2022 Molecular docking suggested strong affinities between baicalein and F7, and between active substances (baicalein, chlorogenic acid, gallic acid, and rutin) and NF-κB p65. In summary, our findings established a novel drug discovery method based on multi-phenotypic screening of zebrafish, provided endogenous evidences of GHI in preventing thrombus formation and promoting behavioral recovery after cerebral ischemia, and identified baicalein, rutin, chlorogenic acid, and gallic acid as active compounds in the management of ischemic stroke.
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