Single-agent laromustine, a novel alkylating agent, has significant activity in older patients with previously untreated poor-risk acute myeloid leukemia.

Abstract

PURPOSE An international phase II study of laromustine (VNP40101M), a sulfonylhydrazine alkylating agent, was conducted in patients age 60 years or older with previously untreated poor-risk acute myeloid leukemia (AML). PATIENTS AND METHODS Laromustine 600 mg/m(2) was administered as a single 60-minute intravenous infusion. Patients were age 70 years or older or 60 years or older with at least one additional risk factor-unfavorable AML karyotype, Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2, and/or cardiac, pulmonary, or hepatic comorbidities. Results Eighty-five patients (median age, 72 years; range, 60 to 87 years) were treated. Poor-risk features included age 70 years or older, 78%; adverse karyotype, 47%; PS of 2, 41%; pulmonary disease, 77%; cardiac disease, 73%; and hepatic disease, 3%. Ninety-six percent of patients had at least two risk factors, and 39% had at least four risk factors. The overall response rate (ORR) was 32%, with 20 patients (23%) achieving complete response (CR) and seven (8%) achieving CR with incomplete platelet recovery (CRp). ORR was 20% in patients with adverse cytogenetics; 32% in those age 70 years or older; 32% in those with PS of 2; 32% in patients with baseline pulmonary dysfunction; 34% in patients with baseline cardiac dysfunction; and 27% in 33 patients with at least four risk factors. Twelve (14%) patients died within 30 days of receiving laromustine therapy. Median overall survival was 3.2 months, with a 1-year survival of 21%; the median duration of survival for those who achieved CR/CRp was 12.4 months, with a 1-year survival of 52%. CONCLUSION Laromustine has significant single-agent activity in elderly patients with poor-risk AML. Adverse events are predominantly myelosuppressive or respiratory. Response rates are consistent across a spectrum of poor-risk features.

• Authors: Gary J Schiller, Susan M O'Brien, Arnaud Pigneux, Daniel J Deangelo, Norbert Vey, Jonathan Kell, Scott Solomon, Robert K Stuart, Verena Karsten, Ann L Cahill, Maher X Albitar, Francis J Giles
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 5 Pg. 815-21 (Feb 10 2010) ISSN: 1527-7755 [Electronic] United States
• PMID: 20026800 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study)

Chemical References

• Antineoplastic Agents, Alkylating
• Hydrazines
• Sulfonamides
• laromustine

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Antineoplastic Agents, Alkylating (administration & dosage, adverse effects, therapeutic use)
• Comorbidity
• Europe (epidemiology)
• Female
• Gene Expression Regulation, Leukemic
• Heart Diseases (mortality)
• Humans
• Hydrazines (administration & dosage, adverse effects, therapeutic use)
• Infusions, Intravenous
• Kaplan-Meier Estimate
• Karyotyping
• Leukemia, Myeloid, Acute (drug therapy, genetics, mortality)
• Liver Diseases (mortality)
• Lung Diseases (mortality)
• Male
• Middle Aged
• Prospective Studies
• Risk Assessment
• Risk Factors
• Sulfonamides (administration & dosage, adverse effects, therapeutic use)
• Treatment Outcome
• United States (epidemiology)