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ABSTRACT: Purpose
To evaluate the safety and efficacy of the combination of the histone deacetylase inhibitor vorinostat with idarubicin and ara-C (cytarabine) in patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS).Patients and methods
Patients with previously untreated AML or higher-risk MDS age 15 to 65 years with appropriate organ function and no core-binding factor abnormality were candidates. Induction therapy was vorinostat 500 mg orally three times a day (days 1 to 3), idarubin 12 mg/m(2) intravenously (IV) daily × 3 (days 4 to 6), and cytarabine 1.5 g/m(2) IV as a continuous infusion daily for 3 or 4 days (days 4 to 7). Patients in remission could be treated with five cycles of consolidation therapy and up to 12 months of maintenance therapy with single-agent vorinostat. The study was designed to stop early if either excess toxicity or low probability of median event-free survival (EFS) of more than 28 weeks was likely.Results
After a three-patient run-in phase, 75 patients were treated. Median age was 52 years (range, 19 to 65 years), 29 patients (39%) were cytogenetically normal, and 11 (15%) had FLT-3 internal tandem duplication (ITD). No excess vorinostat-related toxicity was observed. Induction mortality was 4%. EFS was 47 weeks (range, 3 to 134 weeks), and overall survival was 82 weeks (range, 3 to 134 weeks). Overall response rate (ORR) was 85%, including 76% complete response (CR) and 9% in CR with incomplete platelet recovery. ORR was 93% in diploid patients and 100% in FLT-3 ITD patients. Levels of NRF2 and CYBB were associated with longer survival.Conclusion
The combination of vorinostat with idarubicin and cytarabine is safe and active in AML.
SUBMITTER: Garcia-Manero G
PROVIDER: S-EPMC4879705 | biostudies-literature | 2012 Jun
REPOSITORIES: biostudies-literature
Garcia-Manero Guillermo G Tambaro Francesco Paolo FP Bekele Nebiyou B NB Yang Hui H Ravandi Farhad F Jabbour Elias E Borthakur Gautam G Kadia Tapan M TM Konopleva Marina Y MY Faderl Stefan S Cortes Jorge E JE Brandt Mark M Hu Yumin Y McCue Deborah D Newsome Willie Mae WM Pierce Sherry R SR de Lima Marcos M Kantarjian Hagop M HM
Journal of clinical oncology : official journal of the American Society of Clinical Oncology 20120514 18
<h4>Purpose</h4>To evaluate the safety and efficacy of the combination of the histone deacetylase inhibitor vorinostat with idarubicin and ara-C (cytarabine) in patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS).<h4>Patients and methods</h4>Patients with previously untreated AML or higher-risk MDS age 15 to 65 years with appropriate organ function and no core-binding factor abnormality were candidates. Induction therapy was vorinostat 500 mg orally three times a day ...[more]