Vol 10, No 4 (2019)
Review paper
Published online: 2020-04-21

open access

Page views 782
Article views/downloads 545
Get Citation

Connect on Social Media

Connect on Social Media

Ponatinib for the treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia

Katarzyna Barbara Dulik1, Sebastian Giebel1
Hematologia 2019;10(4):174-178.

Abstract

Acute lymphoblastic leukemia (ALL) with the presence of the Philadelphia chromosome (Ph+) is one of the most aggressive tumors. Improvement in the prognosis of patients occurred with the introduction of tyrosine kinase inhibitors (TKI), which are currently used in combination with chemotherapy. Such treatment is associated with over 90% chance of achieving complete remission. Next generations of TKI allow achieving deeper and longer responses, which translates into event-free and overall survival. Ponatinib (3rd generation TKI) is currently registered in the treatment of patients with Ph(+) ALL after intolerance and/or resistance of first and second generation TKI or in patients with T315I mutation of BCR-ABL1 kinase. Work on assessing the efficacy and safety of ponatinib in the first line of therapy is ongoing.

Article available in PDF format

View PDF (Polish) Download PDF file

References

  1. Faderl S, Jeha S, Kantarjian HM. The biology and therapy of adult acute lymphoblastic leukemia. Cancer. 2003; 98(7): 1337–1354.
  2. Giebel S, Piątkowska-Jakubas B, Adamczyk-Cioch M, et al. Leczenie chorych na ostrą białaczkę limfoblastyczną z obecnością chromosomu Filadelfia. Hematologia. 2011; 2(1): 33–42.
  3. Ottmann OG. Management of Philadelphia chromosome-positive acute lymphoblastic leukemia. Leukemia Suppl. 2012; 1(S2): S7–S9.
  4. Chalandon Y, Thomas X, Hayette S, et al. Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL). Randomized study of reduced-intensity chemotherapy combined with imatinib in adults with Ph-positive acute lymphoblastic leukemia. Blood. 2015; 125(24): 3711–3719.
  5. Vignetti M, Fazi P, Cimino G, et al. Imatinib plus steroids induces complete remissions and prolonged survival in elderly Philadelphia chromosome-positive patients with acute lymphoblastic leukemia without additional chemotherapy: results of the Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) LAL0201-B protocol. Blood. 2007; 109(9): 3676–3678.
  6. Foà R, Vitale A, Vignetti M, et al. GIMEMA Acute Leukemia Working Party. Dasatinib as first-line treatment for adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood. 2011; 118(25): 6521–6528.
  7. Pfeifer H, Wassmann B, Pavlova A, et al. Kinase domain mutations of BCR-ABL frequently precede imatinib-based therapy and give rise to relapse in patients with de novo Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL). Blood. 2007; 110(2): 727–734.
  8. Soverini S, Bassan R, Lion T. Treatment and monitoring of Philadelphia chromosome-positive leukemia patients: recent advances and remaining challenges. J Hematol Oncol. 2019; 12(1): 39.
  9. Shamroe CL, Comeau JM. Ponatinib: a new tyrosine kinase inhibitor for the treatment of chronic myeloid leukemia and Philadelphia chromosome-positive acute lymphoblastic leukemia. Ann Pharmacother. 2013; 47(11): 1540–1546.
  10. Byrgazov K, Lucini CB, Valent P, et al. BCR-ABL1 compound mutants display differential and dose-dependent responses to ponatinib. Haematologica. 2018; 103(1): e10–e12.
  11. Pricl S, Fermeglia M, Ferrone M, et al. T315I-mutated Bcr-Abl in chronic myeloid leukemia and imatinib: insights from a computational study. Mol Cancer Ther. 2005; 4(8): 1167–1174.
  12. Tan FH, Putoczki TL, Stylli SS, et al. Ponatinib: a novel multi-tyrosine kinase inhibitor against human malignancies. Onco Targets Ther. 2019; 12: 635–645.
  13. Cortes JE, Kantarjian H, Shah NP, et al. Ponatinib in refractory Philadelphia chromosome-positive leukemias. N Engl J Med. 2012; 367(22): 2075–2088.
  14. Cortes JE, Kim DW, Pinilla-Ibarz J, et al. PACE Investigators. A phase 2 trial of ponatinib in Philadelphia chromosome-positive leukemias. N Engl J Med. 2013; 369(19): 1783–1796.
  15. Cortes JE, Kim DW, Pinilla-Ibarz J, et al. Ponatinib efficacy and safety in Philadelphia chromosome-positive leukemia: final 5-year results of the phase 2 PACE trial. Blood. 2018; 132(4): 393–404.
  16. Jabbour E, Kantarjian H, Ravandi F, et al. First report of a phase II prospective study of combination of hyper-CVAD with ponatinib in frontline therapy of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Lancet Oncol. 2015; 16(15): 1547–1555.
  17. Jabbour E, Short NJ, Ravandi F, et al. Combination of hyper-CVAD with ponatinib as first-line therapy for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia: long-term follow-up of a single-centre, phase 2 study. Lancet Haematol. 2018; 5(12): e618–e627.
  18. Sasaki K, Jabbour E, Ravandi F, et al. Hyper-CVAD + ponatinib vs. hyper-CVAD + dasatinib as frontline therapy for Ph-positive ALL: a propensity score analysis. Cancer. 2016; 122(23): 3650–3656.
  19. Martinelli G, Piciocchi A, Papayannidis C, et al. First report of the Gimema LAL1811 phase II prospective study of the combination of steroids with ponatinib as frontline therapy of elderly or unfit patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood. 2017; 130(Suppl): 99.
  20. Jabbour E, Martinelli G, Vignetti M, et al. Ponatinib vs imatinib with reduced-intensity chemotherapy in patients with newly diagnosed Philadelphia chromosome–positive (Ph+) ALL: PhALLCON study. Clinical Lymphoma Myeloma and Leukemia. 2019; 19: S194.
  21. Hoelzer D, Bassan R, Dombret H, et al. Acute lymphoblastic leukaemia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016; 27(suppl 5): v69–v82.
  22. Giebel S, Labopin M, Socié G, et al. Improving results of allogeneic hematopoietic cell transplantation for adults with acute lymphoblastic leukemia in first complete remission: an analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica. 2017; 102(1): 139–149.
  23. Soverini S, Bassan R, Lion T. Treatment and monitoring of Philadelphia chromosome-positive leukemia patients: recent advances and remaining challenges. J Hematol Oncol. 2019; 12(1): 39.
  24. Kantarjian HM, DeAngelo DJ, Stelljes M, et al. Inotuzumab ozogamicin versus standard therapy for acute lymphoblastic leukemia. N Engl J Med. 2016; 375(8): 740–753.
  25. Martinelli G, Boissel N, Chevallier P, et al. Complete hematologic and molecular response in adult patients with relapsed/refractory Philadelphia chromosome-positive B-precursor acute lymphoblastic leukemia following treatment with blinatumomab: results from a phase II, single-arm, multicenter study. J Clin Oncol. 2017; 35(16): 1795–1802.
  26. Bassan R, Bourquin JP, DeAngelo DJ, et al. New approaches to the management of adult acute lymphoblastic leukemia. J Clin Oncol. 2018 [Epub ahead of print]: JCO2017773648.



Hematology in Clinical Practice