A phase II study of omacetaxine mepesuccinate for patients with higher-risk myelodysplastic syndrome and chronic myelomonocytic leukemia after failure of hypomethylating agents.

Abstract

The outcome of patients with myelodysplastic syndromes (MDSs) after failure of hypomethylating agents (HMAs) failure is poor with a median overall survival (OS) of only 4-6 months. Omacetaxine mepesuccinate (OM) is safe and effective in myeloid malignancies but has not been studied in MDS with HMA failure. We conducted a phase II study of OM in patients with MDS or chronic myelomonocytic leukemia (CMML) who had previously failed or been intolerant to HMAs. Patients received OM at a dose of 1.25 mg/m2 subcutaneously every 12 hours for 3 consecutive days on a 4- to 7-week schedule. The primary endpoints were the overall response rate (ORR) and OS. A total of 42 patients were enrolled with a median age of 76 years. The ORR was 33%. Patients with diploid cytogenetics were more likely to respond to OM than were those with cytogenetic abnormalities (58% vs 23%, respectively; P = .03). Overall, the median OS was 7.5 months and 1-year OS rate was 25%. Patients with diploid cytogenetics had superior OS to those with cytogenetic abnormalities (median OS 14.8 vs 6.8 months, respectively; P = .01). Two patients had ongoing response to OM of 2 years or longer (both MDS with diploid cytogenetics and RUNX1 mutation). The most common grade ≥ 3 adverse events were infections in 11 patients (26%), febrile neutropenia in 4 (10%), and hemorrhage in 3 (7%). Overall, OM was safe and active in patients with MDS or CMML who experienced HMA failure. These results support the further development of OM in this setting.

• Authors: Nicholas J Short, Elias Jabbour, Kiran Naqvi, Ami Patel, Jing Ning, Koji Sasaki, Graciela M Nogueras-Gonzalez, Prithviraj Bose, Steven M Kornblau, Koichi Takahashi, Michael Andreeff, Gabriela Sanchez-Petitto, Zeev Estrov, Courtney D Dinardo, Guillermo Montalban-Bravo, Marina Konopleva, Yesid Alvarado, Kapil N Bhalla, Warren Fiskus, Maria Khouri, Rubiul Islam, Hagop Kantarjian, Guillermo Garcia-Manero
• Journal: American journal of hematology (Am J Hematol) Vol. 94 Issue 1 Pg. 74-79 (01 2019) ISSN: 1096-8652 [Electronic] United States
• PMID: 30328139 (Publication Type: Clinical Trial, Phase II, Journal Article)
• Copyright: © 2018 Wiley Periodicals, Inc.

Chemical References

• Antineoplastic Agents
• Homoharringtonine

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Agents (adverse effects, therapeutic use)
• Chromosome Aberrations
• DNA Mutational Analysis
• Disease-Free Survival
• Drug Administration Schedule
• Drug Resistance, Neoplasm
• Drug Substitution
• Fatigue (chemically induced)
• Febrile Neutropenia (chemically induced)
• Female
• Gastrointestinal Diseases (chemically induced)
• Hemorrhage (chemically induced)
• Homoharringtonine (adverse effects, therapeutic use)
• Humans
• Kaplan-Meier Estimate
• Leukemia, Myelomonocytic, Chronic (drug therapy, genetics)
• Male
• Middle Aged
• Myelodysplastic Syndromes (drug therapy, genetics)