Daunorubicin liposomal 44mg / Cytarabine liposomal 100mg powder for solution for infusion vials

The first 5 decades of research in acute myeloid leukemia (AML) were dominated by the cytarabine plus anthracyclines backbone, with advances in strategies including allogeneic hematopoietic stem cell transplantation, high‐dose cytarabine, supportive care measures, and targeted therapies for the subset of patients with acute promyelocytic leukemia. Since 2017, a turning point in AML research, 12 agents have received regulatory approval for AML in the United States: venetoclax (BCL2 inhibitor); gemtuzumab ozogamicin (CD33 antibody–drug conjugate); midostaurin, gilteritinib, and quizartinib (fms‐like tyrosine kinase 3 inhibitors); ivosidenib, olutasidenib, and enasidenib (isocitrate dehydrogenase 1 and 2 inhibitors); oral azacitidine (a partially absorbable formulation); CPX351 (liposomal encapsulation of cytarabine:daunorubicin at a molar ratio of 5:1); glasdegib (hedgehog inhibitor); and recently revumenib (menin inhibitor; approved November 2024). Oral decitabine‐cedazuridine, which is approved as a bioequivalent alternative to parenteral hypomethylating agents in myelodysplastic syndrome, can be used for the same purpose in AML. Menin inhibitors, CD123 antibody–drug conjugates, and other antibodies targeting CD123, CD33, and other surface markers are showing promising results. Herein, the authors review the frontline and later line therapies in AML and discuss important research directions.

Abstract licence: CC BY-NC-ND

AbstractCPX-351 was approved for the treatment of acute myeloid leukemia (AML) using now-outdated definitions of AML with myelodysplasia-related changes (AML-MRC) and therapy-related AML. We evaluated whether the overall survival (OS) benefit of CPX-351 over standard cytarabine plus anthracycline (7+3) therapy is confined to molecularly defined AML subgroups by performing DNA sequencing in 184 patients enrolled in the pivotal phase 3 randomized trial. Patients were categorized hierarchically based on gene mutations: (1) TP53-AML, (2) DDX41-AML, (3) myelodysplasia-related AML (AML-MR) defined by the World Health Organization fifth edition criteria, or (4) other-AML. TP53-AML was subclassified as single (TP53single) or multihit (TP53multi) based on the number of alleles altered via mutation, deletion, or copy neutral loss of heterozygosity. Two-year OS differed significantly across molecular subgroups: TP53-AML (7%), AML-MR (19%), other-AML (37%), and DDX41-AML (70%) (P< .001). CPX-351 improved survival in patients with AML-MR compared with 7+3 (median, 9.7 vs 6.8 months; P = .037), with no benefit in TP53-AML or other-AML. For patients undergoing transplantation, CPX-351 improved 2-year survival (76% vs 27%; P< .01), an effect primarily observed in AML-MR. Multivariable analysis confirmed the independent association with survival of both CPX-351 and hematopoietic cell transplantation in AML-MR. TP53multi demonstrated significantly worse survival than TP53single (median, 3.8 vs 7.0 months; P = .004). The OS benefit of CPX-351 observed in the trial was driven by AML-MR with no benefit of CPX-351 in TP53-AML, in which the primary prognostic factor was allelic state. This trial was registered at www.clinicaltrials.gov as #NCT01696084.

Abstract licence: CC BY-NC-ND