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Gilteritinib or Chemotherapy for Relapsed or Refractory FLT3-Mutated AML
Alexander E Perl1, Giovanni Martinelli1, Jorge E Cortes1
1From the Abramson Cancer Center, University of Pennsylvania (A.E.P.), and Thomas Jefferson University (M.K.) - both in Philadelphia; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola (G.M.), L. and A. Seràgnoli Institute of Hematology, Bologna University Medical School, Bologna (S.P.), Ospedali Riuniti Villa Sofia-Cervello, Palermo (F.F.), and IRCCS San Raffaele Scientific Institute, Milan (F.C.) - all in Italy; University of Texas M.D. Anderson Cancer Center, Houston (J.E.C.); Universitätsklinikum Giessen und Marburg, Marburg, Germany (A.N.); Memorial Sloan Kettering Cancer Center, New York (E. Berman); Hospital Universitari i Politècnic La Fe, Valencia, and Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Instituto Carlos III, Madrid - both in Spain (P.M.); University of Maryland Greenebaum Comprehensive Cancer Center (M.R.B.) and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University (M.J.L.) - both in Baltimore; University of Chicago, Chicago (R.A.L.), and Astellas Pharma, Northbrook (C.L., N. Hasabou, X.L., E. Bahceci) - both in Illinois; University of Minnesota, Minneapolis (C.U.); University of Alabama at Birmingham, Birmingham (H.P.E., A.D.S.); Hollings Cancer Center, Medical University of South Carolina, Charleston (R.S.); University of California, San Francisco, San Francisco (R.O.); National Taiwan University, Taipei City, Taiwan (W.-C.C.); Yale University School of Medicine, New Haven, CT (N.P.); Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France (C.R.); Sendai Medical Center, National Hospital Organization, Sendai (H.Y.), and University of Fukui, Fukui (N. Hosono) - both in Japan; Seoul National University (S.-S.Y.) and Asan Medical Center, University of Ulsan College of Medicine (J.-H.L.) - both in Seoul, South Korea; Wake Forest Baptist Medical Center, Winston-Salem, NC (T.P.); and Massachusetts General Hospital, Harvard Medical School, Boston (A.T.F.).
Gilteritinib significantly improved survival and remission rates in patients with relapsed or refractory FMS-like tyrosine kinase 3-mutated acute myeloid leukemia compared to salvage chemotherapy.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Relapsed or refractory acute myeloid leukemia (AML) with FMS-like tyrosine kinase 3 (FLT3) mutations has a poor prognosis.
- Salvage chemotherapy offers limited efficacy in this patient population.
Purpose of the Study:
- To evaluate the efficacy and safety of gilteritinib compared to salvage chemotherapy in patients with relapsed or refractory FLT3-mutated AML.
Main Methods:
- A Phase 3, randomized trial comparing gilteritinib (120 mg/day) to salvage chemotherapy in adults with relapsed/refractory FLT3-mutated AML.
- Primary endpoints included overall survival and complete remission with hematologic recovery.
- Secondary endpoints included event-free survival and complete remission rates.
Main Results:
- Gilteritinib demonstrated significantly longer median overall survival (9.3 vs. 5.6 months) and higher rates of complete remission with hematologic recovery (34.0% vs. 15.3%) compared to chemotherapy.
- Event-free survival was also improved with gilteritinib (2.8 vs. 0.7 months).
- Adverse events were less frequent with gilteritinib, with febrile neutropenia, anemia, and thrombocytopenia being the most common grade 3+ events.
Conclusions:
- Gilteritinib is a superior treatment option for patients with relapsed or refractory FLT3-mutated AML, offering improved survival and remission rates.
- The safety profile of gilteritinib was favorable compared to salvage chemotherapy.
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