更新于：2024-04-01

NPM1

核仁磷酸蛋白

更新于：2024-04-01

基本信息

别名

B23、NPM、NPM1

+ [7]

简介

Involved in diverse cellular processes such as ribosome biogenesis, centrosome duplication, protein chaperoning, histone assembly, cell proliferation, and regulation of tumor suppressors p53/TP53 and ARF. Binds ribosome presumably to drive ribosome nuclear export. Associated with nucleolar ribonucleoprotein structures and bind single-stranded nucleic acids. Acts as a chaperonin for the core histones H3, H2B and H4. Stimulates APEX1 endonuclease activity on apurinic/apyrimidinic (AP) double-stranded DNA but inhibits APEX1 endonuclease activity on AP single-stranded RNA. May exert a control of APEX1 endonuclease activity within nucleoli devoted to repair AP on rDNA and the removal of oxidized rRNA molecules. In concert with BRCA2, regulates centrosome duplication. Regulates centriole duplication: phosphorylation by PLK2 is able to trigger centriole replication. Negatively regulates the activation of EIF2AK2/PKR and suppresses apoptosis through inhibition of EIF2AK2/PKR autophosphorylation. Antagonizes the inhibitory effect of ATF5 on cell proliferation and relieves ATF5-induced G2/M blockade (PubMed:22528486). In complex with MYC enhances the transcription of MYC target genes (PubMed:25956029). May act as chaperonin or cotransporter in the nucleolar localization of transcription termination factor TTF1 (By similarity).

关联

项与 NPM1 相关的药物

YTR-107

靶点

NPM1

作用机制

NPM1抑制剂 [+1]

在研机构

Cumberland Pharmaceuticals, Inc. [+1]

原研机构

Cumberland Pharmaceuticals, Inc.

在研适应症

非小细胞肺癌

非在研适应症-

最高研发阶段临床前

首次获批国家/地区-

首次获批日期1800-01-20

RASP-301

靶点

NPM1

作用机制

NPM1抑制剂

在研机构

Actavia Life Sciences, Inc.

原研机构

Actavia Life Sciences, Inc.

在研适应症

急性髓性白血病

非在研适应症-

最高研发阶段临床前

首次获批国家/地区-

首次获批日期1800-01-20

100 项与 NPM1 相关的临床结果

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100 项与 NPM1 相关的转化医学

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0 项与 NPM1 相关的专利（医药）

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4,038

项与 NPM1 相关的文献（医药）

2024-03-01·Hematological oncology

Clinical characteristics and prognosis of acute myeloid leukemia patients with Runt-related transcription factor 1 mutation: A single-center retrospective analysis.

Article

作者: Lin-Ya Wang ; Yao Li ; Qian Jiang ; Hao Jiang ; Yu Wang ; Lan-Ping Xu ; Xiao-Hui Zhang ; Kai-Yan Liu ; Fei-Fei Tang

This study aimed to investigate the clinical characteristics and prognosis of Runt-related transcription factor 1 (RUNX1) mutant acute myeloid leukemia (AML) patients by comparing the features of AML patients with or without RUNX1 mutation. We retrospectively analyzed 180 AML patients including 36 AML patients with mutant RUNX1(AML-RUNX1^mut ) and 144 AML patients with wild-type RUNX1(AML-RUNX1^wt ) were selected using the case-pair method(1:4). Compared to AML-RUNX1^wt , AML-RUNX1^mut showed higher frequency of ASXL1 (p < 0.001), SRSF2 (p < 0.001), BCORL1 (p < 0.001), RAS (p = 0.010) mutations, and absent NPM1 mutations (p = 0.022). The 3-year overall survival (OS) and disease-free survival (DFS) of AML-RUNX1^mut and AML-RUNX1^wt were 73.1% versus 68.0% (p = 0.64) and 80.7% versus 71.6% (p = 0.37), respectively. AML-RUNX1^mut receiving allogeneic hematopoietic cell transplantation (allo-HSCT) showed better survival than those who did not receive allo-HSCT (3-year OS, 84.3% vs. 52.7%; p = 0.006). Multivariate analysis showed that EZH2 mutation (p = 0.003), white blood cell (WBC) ≥30 × 10⁹ /L (p = 0.036) and age ≥60 years (p = 0.038) were significant independent risk factors for inferior OS of AML-RUNX1^mut ; WBC ≥30 × 10⁹ /L (p = 0.013) and DNMT3A mutation (p = 0.045) were significant independent risk factors for shorter DFS of AML-RUNX1^mut . In conclusion, AML-RUNX1^mut showed unique clinical characteristics, but the survival between AML-RUNX1^mut and AML-RUNX1^wt were comparable. EZH2 co-mutation, DNMT3A co-mutation, old age and high WBC count were associated with inferior survival of AML-RUNX1^mut . Allo-HSCT can significantly improve the prognosis of AML-RUNX1^mut .

2024-02-23·Circulation

Targeting NPM1 Epigenetically Promotes Postinfarction Cardiac Repair by Reprogramming Reparative Macrophage Metabolism.

Article

作者: Sheng Zhang ; Yunkai Zhang ; Xuewen Duan ; Bo Wang ; Zhenzhen Zhan

BACKGROUND:

Reparative macrophages play a crucial role in limiting excessive fibrosis and promoting cardiac repair after myocardial infarction (MI), highlighting the significance of enhancing their reparative phenotype for wound healing. Metabolic adaptation orchestrates the phenotypic transition of macrophages; however, the precise mechanisms governing metabolic reprogramming of cardiac reparative macrophages remain poorly understood. In this study, we investigated the role of NPM1 (nucleophosmin 1) in the metabolic and phenotypic shift of cardiac macrophages in the context of MI and explored the therapeutic effect of targeting NPM1 for ischemic tissue repair.

METHODS:

Peripheral blood mononuclear cells were obtained from healthy individuals and patients with MI to explore NPM1 expression and its correlation with prognostic indicators. Through RNA sequencing, metabolite profiling, histology, and phenotype analyses, we investigated the role of NPM1 in postinfarct cardiac repair using macrophage-specific NPM1 knockout mice. Epigenetic experiments were conducted to study the mechanisms underlying metabolic reprogramming and phenotype transition of NPM1-deficient cardiac macrophages. The therapeutic efficacy of antisense oligonucleotide and inhibitor targeting NPM1 was then assessed in wild-type mice with MI.

RESULTS:

NPM1 expression was upregulated in the peripheral blood mononuclear cells from patients with MI that closely correlated with adverse prognostic indicators of MI. Macrophage-specific NPM1 deletion reduced infarct size, promoted angiogenesis, and suppressed tissue fibrosis, in turn improving cardiac function and protecting against adverse cardiac remodeling after MI. Furthermore, NPM1 deficiency boosted the reparative function of cardiac macrophages by shifting macrophage metabolism from the inflammatory glycolytic system to oxygen-driven mitochondrial energy production., The oligomeric NPM1 mechanistically recruited histone demethylase KDM5b to the promoter of Tsc1 (TSC complex subunit 1), the mTOR (mechanistic target of rapamycin kinase) complex inhibitor, reduced histone H3K4me3 modification, and inhibited TSC1 expression, which then facilitated mTOR-related inflammatory glycolysis and antagonized the reparative function of cardiac macrophages. The in vivo administration of antisense oligonucleotide targeting NPM1 or oligomerization inhibitor NSC348884 substantially ameliorated tissue injury and enhanced cardiac recovery in mice after MI.

CONCLUSIONS:

Our findings uncover the key role of epigenetic factor NPM1 in impeding postinfarction cardiac repair by remodeling metabolism pattern and impairing the reparative function of cardiac macrophages. NPM1 may serve as a promising prognostic biomarker and a valuable therapeutic target for heart failure after MI.

2024-02-23·PLoS pathogens

Porcine circovirus type 2 infection promotes the SUMOylation of nucleophosmin-1 to facilitate the viral circular single-stranded DNA replication.

Article

作者: Qian Du ; Lei Zhu ; Jianhui Zhong ; Xueqi Wei ; Qi Zhang ; Tengfei Shi ; Cong Han ; Xinhuan Yin ; Xingqi Chen ; Dewen Tong ; Yong Huang

The mechanism of genome DNA replication in circular single-stranded DNA viruses is currently a mystery, except for the fact that it undergoes rolling-circle replication. Herein, we identified SUMOylated porcine nucleophosmin-1 (pNPM1), which is previously reported to be an interacting protein of the viral capsid protein, as a key regulator that promotes the genome DNA replication of porcine single-stranded DNA circovirus. Upon porcine circovirus type 2 (PCV2) infection, SUMO2/3 were recruited and conjugated with the K263 site of pNPM1's C-terminal domain to SUMOylate pNPM1, subsequently, the SUMOylated pNPM1 were translocated in nucleoli to promote the replication of PCV2 genome DNA. The mutation of the K263 site reduced the SUMOylation levels of pNPM1 and the nucleolar localization of pNPM1, resulting in a decrease in the level of PCV2 DNA replication. Meanwhile, the mutation of the K263 site prevented the interaction of pNPM1 with PCV2 DNA, but not the interaction of pNPM1 with PCV2 Cap. Mechanistically, PCV2 infection increased the expression levels of Ubc9, the only E2 enzyme involved in SUMOylation, through the Cap-mediated activation of ERK signaling. The upregulation of Ubc9 promoted the interaction between pNPM1 and TRIM24, a potential E3 ligase for SUMOylation, thereby facilitating the SUMOylation of pNPM1. The inhibition of ERK activation could significantly reduce the SUMOylation levels and the nucleolar localization of pNPM1, as well as the PCV2 DNA replication levels. These results provide new insights into the mechanism of circular single-stranded DNA virus replication and highlight NPM1 as a potential target for inhibiting PCV2 replication.

190

项与 NPM1 相关的新闻（医药）

2024-03-28

·药明康德

速递 | 难治性癌症ORR达63%！潜在“first-in-class”小分子药物获FDA优先审评资格

▎药明康德内容团队编辑Syndax Pharmaceuticals日前宣布，美国FDA接受其为在研疗法revumenib递交的新药申请（NDA）并授予其优先审评资格，用于治疗携带KMT2A重排（KMT2Ar）的复发/难治性急性白血病患者。Revumenib是一款潜在“first-in-class”的menin抑制剂。该NDA的提交得到了来自关键性临床试验AUGMENT-101的积极数据的支持，该试验研究了revumenib对携带KMT2Ar的急性髓系白血病（AML）和急性淋巴细胞白血病（ALL）成人和儿科患者的疗效。如先前报告，该试验在中期分析中达到了主要终点，在携带KMT2Ar的急性白血病人群中，57名可评估患者中有23%（13/57；95% CI：12.7，35.8，单边p=0.0036）达到完全缓解（CR）或带部分血液学恢复的完全缓解（CRh）。在达到CR/CRh且进行了最小残留病（MRD）评估的患者中，70%的患者MRD为阴性。此外，患者中的总缓解率（ORR）达到63%（36/57）。Revumenib是一种针对menin-KMT2A相互作用的强效、选择性小分子抑制剂。Revumenib已被FDA和欧洲委员会授予孤儿药资格，用于治疗AML患者，并被FDA授予快速通道资格，用于治疗携带KMT2A重排或NPM1突变的成人和儿科复发/难治性急性白血病患者。Revumenib还被FDA授予突破性疗法指定，用于治疗携带KMT2A重排的成人和儿科复发/难治性急性白血病患者。大家都在看作为药明康德旗下专注于细胞和基因疗法的CTDMO，药明生基致力于加速和变革基因和细胞治疗及其他高端治疗的开发、测试、生产和商业化。药明生基能够助力全球客户将更多创新疗法早日推向市场，造福病患。如您有相关业务需求，欢迎点击下方图片填写具体信息。▲如您有任何业务需求，请长按扫描上方二维码，或点击文末“阅读原文/Read more”，即可访问业务对接平台，填写业务需求信息▲欲了解更多前沿技术在生物医药产业中的应用，请长按扫描上方二维码，即可访问“药明直播间”，观看相关话题的直播讨论与精彩回放参考资料：[1] Syndax Announces FDA Priority Review of NDA for Revumenib for the Treatment of Relapsed/Refractory KMT2Ar Acute Leukemia. Retrieved March 27, 2024, from https://www.prnewswire.com/news-releases/syndax-announces-fda-priority-review-of-nda-for-revumenib-for-the-treatment-of-relapsedrefractory-kmt2ar-acute-leukemia-302100145.html免责声明：药明康德内容团队专注介绍全球生物医药健康研究进展。本文仅作信息交流之目的，文中观点不代表药明康德立场，亦不代表药明康德支持或反对文中观点。本文也不是治疗方案推荐。如需获得治疗方案指导，请前往正规医院就诊。版权说明：本文来自药明康德内容团队，欢迎个人转发至朋友圈，谢绝媒体或机构未经授权以任何形式转载至其他平台。转载授权请在「药明康德」微信公众号回复“转载”，获取转载须知。分享，点赞，在看，聚焦全球生物医药健康创新

优先审批孤儿药基因疗法细胞疗法快速通道

2024-03-28

·BioSpace

Syndax Announces Completion of Enrollment in AUGMENT-101 Pivotal Trial Cohort of Patients with Relapsed/Refractory mNPM1 Acute Myeloid Leukemia

– Topline data expected in 4Q24 could support sNDA filing in 1H25 – – Revumenib has the potential to address $2 billion mNPM1 and KMT2Ar R/R acute leukemia U.S. market opportunity – WALTHAM, Mass., March 28, 2024 /PRNewswire/ -- Syndax Pharmaceuticals Inc.(Nasdaq: SNDX), a clinical stage biopharmaceutical company developing an innovative pipeline of cancer therapies, today announced completion of enrollment in the AUGMENT-101 pivotal trial cohort of patients with relapsed/refractory (R/R) mutant nucleophosmin (mNPM1) acute myeloid leukemia (AML). Topline data is expected in the fourth quarter of 2024 and could support a supplemental New Drug Application (sNDA) filing for revumenib in R/R mNPM1 AML in the first half of 2025. "We are thrilled to announce that we are one step closer to potentially expanding the therapeutic reach of revumenib in genetically defined acute leukemias," said Neil Gallagher, M.D., Ph.D., President, Head of Research and Development at Syndax. "We look forward to reporting topline data for this pivotal cohort in the fourth quarter of this year, which will follow closely behind a potential first approval of KMT2A acute leukemia in the third quarter." Michael A. Metzger, Chief Executive Officer, added, "With revumenib and axatilimab, two first-and best-in-class drugs, expected to launch in 2024 and the potential to expand beyond first approvals and into additional indications, Syndax is well positioned to deliver on its mission to improve the lives of cancer patients and create meaningful long-term value for shareholders." Sixty-four (64) adult and up to 20 pediatric patients with mNPM1 AML have been enrolled into the pivotal portion of AUGMENT-101, a pivotal trial designed to evaluate the safety, tolerability, pharmacokinetics, and efficacy of orally administered revumenib. The primary endpoint for the trial is efficacy as measured by complete remission (CR) or a CR with partial hematological recovery (CRh) rate (CR + CRh) per protocol, with secondary endpoints including duration of response (DOR) and overall survival (OS). A new drug application (NDA) is under review by the U.S. Food and Drug Administration (FDA) for revumenib in R/R KMT2Ar acute leukemia with a Prescription Drug User Fee Act (PDUFA) action date of September 26, 2024. The NDA submission is supported by positive data from the AUGMENT-101 pivotal trial cohort of revumenib in adult and pediatric patients with KMT2Ar AML and acute lymphoblastic leukemia (ALL). About Revumenib Revumenib is a potent, selective, small molecule inhibitor of the menin-KMT2A binding interaction that is being developed for the treatment of KMT2A-rearranged, also known as mixed lineage leukemia rearranged or MLLr, acute leukemias including ALL and AML, and NPM1-mutant AML. Positive topline results from the Phase 2 AUGMENT-101 trial in R/R KMT2Ar acute leukemia showing the trial met its primary endpoint were presented at the 65th American Society of Hematology Annual Meeting and data from the Phase 1 portion of AUGMENT-101 in acute leukemia was published in Nature. Revumenib was granted Orphan Drug Designation by the FDA and European Commission for the treatment of patients with AML, and Fast Track designation by the FDA for the treatment of adult and pediatric patients with R/R acute leukemias harboring a KMT2A rearrangement or NPM1 mutation. Revumenib was granted Breakthrough Therapy Designation (BTD) by the FDA for the treatment of adult and pediatric patients with R/R acute leukemia harboring a KMT2A rearrangement. About NPM1-Mutant Acute Myeloid Leukemia NPM1-mutant AML, which is distinguished by mutations in the NPM1 gene that drive the leukemic phenotype, is the most common type of cytogenetically normal adult AML and represents approximately 30% of all adult AML cases. This subtype of AML has a five-year overall survival rate of approximately 50%. Similar to KMT2A-rearranged acute leukemia, NPM1-mutant AML is highly dependent on the expression of specific developmental genes shown to be negatively impacted by inhibitors of the menin-KMT2A interaction. NPM1-mutant AML is routinely diagnosed through currently available screening techniques. There are currently no approved therapies indicated for NPM1-mutant AML. About Syndax Syndax Pharmaceuticals is a clinical stage biopharmaceutical company developing an innovative pipeline of cancer therapies. Highlights of the Company's pipeline include revumenib, a highly selective inhibitor of the menin–KMT2A binding interaction, and axatilimab, a monoclonal antibody that blocks the colony stimulating factor 1 (CSF-1) receptor. For more information, please visit. For more information, please visit or follow the Company on X (formerly Twitter) and LinkedIn. Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as "anticipate," "believe," "could," "estimate," "expects," "intend," "may," "plan," "potential," "predict," "project," "should," "will," "would" or the negative or plural of those terms, and similar expressions (as well as other words or expressions referencing future events, conditions or circumstances) are intended to identify forward-looking statements. These forward-looking statements are based on Syndax's expectations and assumptions as of the date of this press release. Each of these forward-looking statements involves risks and uncertainties. Actual results may differ materially from these forward-looking statements. Forward-looking statements contained in this press release include, but are not limited to, statements about the progress, timing, clinical development and scope of clinical trials, the reporting of clinical data for Syndax's product candidates, and the potential use of its product candidates to treat various cancer indications and fibrotic diseases. Many factors may cause differences between current expectations and actual results, including: unexpected safety or efficacy data observed during preclinical or clinical trials; clinical trial site activation or enrollment rates that are lower than expected; changes in expected or existing competition; changes in the regulatory environment; failure of Syndax's collaborators to support or advance collaborations or product candidates; and unexpected litigation or other disputes. Other factors that may cause Syndax's actual results to differ from those expressed or implied in the forward-looking statements in this press release are discussed in Syndax's filings with the U.S. Securities and Exchange Commission, including the "Risk Factors" sections contained therein. Except as required by law, Syndax assumes no obligation to update any forward-looking statements contained herein to reflect any change in expectations, even as new information becomes available. Syndax Contact Sharon Klahre Syndax Pharmaceuticals, Inc. sklahre@syndax.com Tel 781.684.9827 SNDX-G Company Codes: NASDAQ-NMS:SNDX

孤儿药临床结果快速通道突破性疗法ASH会议

2024-03-27

·CPHI制药在线

一文了解伴FLT3突变急性髓系白血病，3款新型FLT3抑制剂带来新希望

关注并星标CPHI制药在线FLT3是急性髓系白血病（AML）中经常出现的突变基因。当AML患者的FLT3基因发生突变时，他们的疾病预后往往较差，且更容易复发。因此，及时识别FLT3基因的突变情况，并选择恰当的治疗策略，对AML患者的治疗效果具有重要意义。 Fms样酪氨酸激酶3（FLT3）在细胞信号传递路径中起着关键作用，作为一种受体酪氨酸激酶。实际上，AML中出现的最常见的基因突变，其中一个就是在FLT3。这一基因的突变在成人AML患者中约占了30%的比例。其突变形式主要有两种，即FLT3的内部串联重复序列（FLT3-ITD）和酪氨酸激酶结构域（FLT3-TKD）突变。在这些突变中，FLT3-ITD是最常见的，其在AML中的检出率达到了25% [1]。 FLT3突变急性髓系白血病（AML）患者的临床特点通常为年纪偏大、白细胞与血小板计数偏高，以及骨髓原始细胞比例偏高。尽管这些患者的缓解率较低，且治疗后容易复发，但常规化疗的复发率也相对较高，且往往伴随着其他基因突变。特别值得关注的是，一些最常见的共存基因突变包括NPM1、DNMT3A、WT1、TET2、RAS、RUNX1以及PTPN11。对于FLT3-TKD突变，其预后仍然存在争议；相比之下，FLT3-ITD突变具有较强的异质性，预后受其等位基因比率（AR）、插入位点、ITD长度、核型以及其他伴随基因突变如NPM1、DNMT3A、WT1、RUNX1的影响而有所不同。值得关注的是，与NPM1突变同时出现的FLT3-ITD AML的预后相对较好，然而，当与IDH1/2、TET2、DNMT3A、WT1突变同时出现，或者同时合并NPM1和DNMT3A突变时，FLT3-ITD AML的预后则较差。随着对FLT3突变AML发病机制的深入了解、新的检测技术的出现以及FLT3抑制剂的广泛应用，其预后已得到显著改善。因此，根据欧洲白血病网（ELN 2022）的最新指南，所有FLT3-ITD AML现已被归类为中危。 FLT3抑制剂属于酪氨酸激酶抑制剂，通过竞争激酶活性区域的ATP结合位点抑制FLT3蛋白发生磷酸化，进而抑制相关下游生长信号通路（PI3K/Akt、Ras/MAPK和STAT5等）发挥治疗作用。根据FLT3抑制剂与FLT3结合的程度，可将FLT3抑制剂分为第一代和第二代抑制剂和新型FLT3抑制剂。一代FLT3抑制剂索拉非尼索拉非尼是一种能够同时抑制RAF、VEGFR、KIT和FLT3等多个靶点的小分子药物。南方医科大学血液病研究院的刘启发教授领导的研究团队进行了一项临床研究[7]，他们评估了将索拉非尼与维奈克拉、阿扎胞苷和高三尖杉酯碱（简称VAH方案）联合使用，在患有FLT3-ITD阳性的复发/难治性急性髓系白血病（AML）患者中的治疗效果和患者的耐受程度。研究数据表明，患者接受这一治疗方案后的总缓解率高达82.4%。中位随访期为17.7个月，研究尚未观察到中位复合完全缓解（CRc）的持续时间。这些患者的总生存期（OS）平均为18.1个月，无事件生存期（EFS）平均为11.4个月。在接受治疗的患者中，出现3-4级不良事件（AE）的情况包括中性粒细胞减少症、血小板减少导致的贫血、发热性中性粒细胞减少症、肺炎和脓毒症等。其中，有2名患者因治疗相关原因不幸去世。米哚妥林欧洲药品管理局（EMA）和美国食品药品监督管理局（FDA）共同批准了米哚妥林与标准化疗相结合，作为针对FLT3突变成年急性髓系白血病（AML）患者的首选治疗策略。除此之外，对于经历过异基因造血干细胞移植（allo-HSCT）的患者，米哚妥林在维持治疗方面也表现出显著效果，它不仅能够优化患者的预后，而且其安全性也得到了充分验证[8]。这些进展为患有急性髓系白血病（AML）的患者提供了新的治疗选择和更好的康复机会。二代FLT3抑制剂吉瑞替尼（Gilteritinib） 2018年11月28日，美国食品药品监督管理局（FDA）正式批准吉瑞替尼作为治疗FLT3突变型复发或难治性急性髓系白血病（AML）成人患者的药物。随后，在2021年，吉瑞替尼获得中国批准并上市，用以治疗患有复发或难治性FLT3突变型AML的患者[9]。由中国医学科学院血液病医院王健祥教授率领的团队，联合多个国家包括中国、俄罗斯、新加坡、泰国和马来西亚等，开展了一项名为COMMODORE的III期开放、多中心临床试验，对比了吉瑞替尼与挽救性化疗（SC）在治疗FLT3突变复发难治AML患者上的疗效[10]。研究显示，吉瑞替尼组（包含116名患者）的完全缓解（CR）率达到了16.4%，这一数据超过了挽救性化疗（SC）组（包含118名患者，CR率为10.2%）。此外，吉瑞替尼组患者的1年中位总生存期（mOS）也显著长于挽救性化疗（SC）组，分别为9个月和4.7个月（P=0.001 26）。这一研究成果再次确立了吉瑞替尼在针对FLT3突变复发难治AML治疗上的显著优势。奎扎替尼（Quizartinib） 2023年7月20日，美国食品药品监督管理局（FDA）正式批准了奎扎替尼联合标准阿糖胞苷、蒽环类药物的诱导治疗与阿糖胞苷巩固治疗，以及在巩固化疗后单独使用奎扎替尼作为维持治疗，这一治疗方案针对的是新诊断的FLT3-ITD阳性急性髓系白血病（AML）成年患者。这项医疗进展意味着对白血病治疗的一个重要突破，可以为这些患者提供更好的治疗效果和生存率。 QuANTUM-First（NCT02668653）试验是一项双盲随机、安慰剂对照的研究，共纳入了539名新诊断的FLT3-ITD阳性急性髓系白血病患者。通过对奎扎替尼组与安慰剂组之间的对比分析，结果显示，奎扎替尼组在总生存期（OS）上具有显著的统计学意义改善[风险比（HR）0.78，95%置信区间（CI）0.62-0.98，两组比较p=0.0324]。这一数据进一步证明了奎扎替尼在治疗FLT3-ITD阳性急性髓系白血病患者中的疗效和安全性，为这一病症的治疗提供了新的选择。 Crenolanib Richard M. Stone教授的研究团队，隶属于美国丹娜法伯癌症研究所，进行了一项关键性的II期研究[7]，旨在评估在新发现的FLT3突变急性髓系白血病（AML）病患中结合使用Crenolanib的治疗成效。该研究涉及了44名患者（男性占22名），他们的中位数年龄是57岁（年龄范围：19-75岁）。结果显示，总体复合完全缓解（CRc）率高达73%（32/44）。特别是在经过两个周期的治疗后，总CRc率跃升至86%（38/44）。年轻患者的总体缓解率表现尤为突出，达到了90%，且其MRD阴性率高达89%。相较之下，尽管年长患者的总体缓解率为80%，但他们的MRD阴性率相对较低，为45%。此外，值得注意的是，超过70%的年轻患者在接受治疗后的三年时间里仍然存活。这项研究的结果为FLT3突变急性髓系白血病的治疗提供了新的方向，尤其是对于那些年轻的患者，Crenolanib联合治疗方案展现出了显著的效果。新型FLT3抑制剂 Tuspetinib Tuspetinib，这是一种新兴的可口服FLT3抑制剂，凭借其强大的能力，被公认为一种高效的髓系激酶抑制药物。它的作用机制在于能够抑制导致AML细胞增殖异常的多种激酶，这当中就包括了SYK、FLT3、JAK1/2、RSK1/2、突变型KIT和TAK1-TAB1激酶等。一项涉及I/II期的研究[13]对Tuspetinib单独使用（TUS）和与维奈克拉联合使用（VEN/TUS）治疗复发性或难治性AML（R/R AML）的安全性和疗效进行了评估，并确定了II期推荐剂量（RP2D）。该研究的结果表明，Tuspetinib单药治疗的安全性较高，总体完全缓解/完全缓解伴部分血液学恢复（CR/CRh）的比率为36%。对于FLT3突变型AML患者，这一比率高达50%，而对于FLT3野生型AML患者，这一比率则为25%。这些结果为Tuspetinib在AML治疗中的潜在应用提供了重要的临床依据。 EmavusertibEmavusertib作为一种创新型的FLT3抑制剂，其独特之处在于可以口服使用，为治疗提供了便利。它能够精确地针对IRAK4和FLT3进行作用，表现出令人满意且可管理的安全性。目前，TakeAim Leukemia试验正在深入研究Emavusertib在治疗复发/难治性急性髓性白血病（R/R AML）和高危骨髓增生异常综合征（HR-MDS）方面的安全性、临床疗效以及潜在的生物标志物，为未来的治疗策略提供更为坚实的科学依据。 EP0042 EP0042是一款口服型的药物，它能够有效抑制FLT3和Aurora激酶。研究表明，Aurora激酶在急性髓系白血病（AML）的发病过程中扮演着关键角色，并与FLT3抑制剂耐药性的产生密切相关。因此，EP0042通过同时针对FLT3和Aurora激酶，有望克服对选择性FLT3抑制所产生的获得性耐药性。为了探索EP0042的最佳给药方案，一项I/IIa期研究采用了标准的3+3剂量递增设计，并纳入了复发/难治性AML或骨髓增生异常综合征（MDS）的患者进行临床试验[15]。总结 FLT3抑制剂的研发成功，为那些罹患FLT3突变急性髓性白血病（AML）的患者提供了全新治疗策略。在临床应用中，目前已有一线和二线的FLT3抑制剂可供选用。不仅如此，新型的FLT3抑制剂，如Tuspetinib、Emavusertib和EP0042，也正在接受临床试验的检验，其初步成果显示出了良好的治疗潜力。随着对FLT3突变机制的深入研究以及药物研发的持续进步，我们有理由期待更多高效、精准的靶向治疗药物的出现。这些药物的问世，将为AML患者带来更加显著的治疗效果，帮助他们更好地战胜疾病。参考文献： [1] 邱林，马军. 急性髓系白血病靶向治疗研究进展[J]. 白血病·淋巴瘤， 2022,31(4):197-203. DOI：10.3760/cma.j.cn115356-20220210-00033 . [2] Yu S, Zhang Y, Yu G, Wang Y, Shao R, Du X, et al. Sorafenib plus triplet therapy with venetoclax, azacitidine and homoharringtonine for refractory/ relapsed acute myeloid leukemia with FLT3ITD: A multicenter phase 2 study. J Intern Med.2023;00:1-13. [3] 袁伟，张世忠，主鸿鹄. FLT3抑制剂治疗急性髓系白血病患者研究进展[J].浙江大学学报:医学版, 2022, 51(4):507-514. [4]https://www.fda.gov/drugs/fda-approves-gilteritinib-relapsed-or-refractory-acute-myeloid-leukemia-aml-flt3-mutation [5] Wang JX ， Jiang B ， Li J ，et al. Gilteritinib versus salvage chemotherapy for relapsed/refractory FLT3-mutated acute myeloid leukemia：a phase 3，randomized，multicenter，open-label trial in Asia[J]. Blood， 2021，138Suppl 1：695. doi: 10.1182/blood-2021-145436 .[6] https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-quizartinib-newly-diagnosed-acute-myeloid-leukemia[7] Eunice S. Wang, et al. 2022ASCO.Abstract#7007.[8] Naval Daver, et al. Tuspetinib Myeloid Kinase Inhibitor Safety and Efficacy As Monotherapy and Combined with Venetoclax in Phase 1/2 Trial of Patients with Relapsed or Refractory (R/R) Acute Myeloid Leukemia (AML). 2023 ASH. Abstract #162.[9] Eric S Winer, et al. Preliminary Safety and Efficacy of Emavusertib (CA-4948) in Acute Myeloid Leukemia Patients with FLT3 Mutation. 2023 ASH. Abstract #2924.[10] David Taussig, et al. EP0042, a Dual FLT3 and Aurora Kinase Inhibitor: Results from an Ongoing Phase I/IIa Dose-Finding/Dose Optimization Study in Patients with Relapsed/Refractory Acute Myeloid Leukemia. 2023 ASH. Abstract #4285. [6] Zhao J , Agarwal S , Ahmad H ,et al.A review of FLT3 inhibitors in acute myeloid leukemia[J].Blood reviews, 2021:100905. [7] 张钰, 邵若洋, 刘启发. FLT3突变急性髓系白血病的全程管理[J].临床血液学杂志,2023,36(5):303-308 [8] DöhnerH, WeiAH, Appelbaum FR, et al. Diagnosis ·and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN [J].Blood,2022,140(12):1345-1377. [9] WANG Z, CAI J, CHENG J, et al. FLT3 inhibitors in acute myeloid leukemia: challenges and recent developments in overcoming resistance[J]. J Med Chem, 2021, 64(6): 2878-2900. [10] 袁伟，张世忠，主鸿鹄. FLT3抑制剂治疗急性髓系白血病患者研究进展[J].浙江大学学报:医学版, 2022, 51(4):507-514. [11] TALLMAN M S, WANG E S, ALTMAN J K, et al. Acute myeloid leukemia, version 3.2019, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2019, 17(6): 721-749. [12] LEVIS M. Midostaurin approved for FLT3-mutated AML[J]. Blood, 2017, 129(26): 3403-3406. [13] SERVE H, KRUG U, WAGNER R, et al. Sorafenib in combination with intensive chemotherapy in elderly patients with acute myeloid leukemia: results from a randomized, placebo-controlled trial[J]. J Clin Oncol, 2013, 31(25): 3110-3118. [14] YILMAZ M, KANTARJIAN H M, MUFTUOGLU M, et al. Quizartinib with decitabine +/- venetoclax is highly active in patients (pts) with FLT3-ITD mutated (mut) acute myeloid leukemia (AML): clinical report and signaling cytof profiling from a phase Ⅰb/Ⅱ trial[J]. Blood, 2020, 136(Supplement 1): 19-20. [15] PERL A E, MARTINELLI G, CORTES J E, et al. Gilteritinib or chemotherapy for relapsed or refractory FLT3-mutated AML[J]. N Engl J Med, 2019, 381(18): 1728-1740. [16] WANG R, LI Y, GONG P, et al. Arsenic/trioxide and sorafenib induce synthetic lethality of FLT3-ITD acute myeloid leukemia cells[J]. Mol Cancer Ther, 2018,17(9): 1871-1880. [17] YILMAZ M, KANTARJIAN H, SHORT N J, et al. Hypomethylating agent and venetoclax with FLT3 inhibitor "triplet" therapy in older/unfit patients with FLT3 mutated AML[J]. Blood Cancer J, 2022, 12(5): 77.【智药研习社近期课程预告】来源：CPHI制药在线声明：本文仅代表作者观点，并不代表制药在线立场。本网站内容仅出于传递更多信息之目的。如需转载，请务必注明文章来源和作者。投稿邮箱：Kelly.Xiao@imsinoexpo.com▼更多制药资讯，请关注CPHI制药在线▼点击阅读原文，进入智药研习社~

临床结果