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Blood, 15 June 2007, Vol. 109, No. 12, pp. 5151-5156. Prepublished online as a Blood First Edition Paper on March 9, 2007; DOI 10.1182/blood-2006-09-046144.
CLINICAL TRIALS AND OBSERVATIONS A phase 2 study of the oral farnesyltransferase inhibitor tipifarnib in patients with refractory or relapsed acute myeloid leukemia1 From the Service d'Hématologie, Hôtel Dieu, Nantes, France; 2 H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa; 3 Service des Maladies du Sang, Hôpital du Haut Leveque, Pessac, France; 4 Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands; 5 Service des Maladies du Sang, Hôpital Edouard Herriot, Lyon, France; 6 Service d'Hématologie, Chu Purpan, Toulouse Cedex, France; 7 Hématologie, Avicenne Hôpital, Paris, France; 8 Johnson & Johnson Pharmaceutical Research & Development, Raritan, NJ; and 9 Adult Leukemia Program, Dana-Farber Cancer Institute, Boston, MA This phase 2 study evaluated the efficacy and safety of the oral farnesyltransferase inhibitor tipifarnib in adults with refractory or relapsed acute myeloid leukemia (AML). Patients (n = 252) received tipifarnib 600 mg twice a day for 21 days in 28-day cycles. Median age was 62 years; 99 (39%) patients were 65 years or older. Eleven (4%) of 252 patients achieved complete remission (CR) or complete remission with incomplete platelet recovery (CRp; 9 CR and 2 CRp). Nineteen patients (8%), including those who achieved CR/CRp, achieved a reduction in bone marrow blasts to less than 5% blasts. Bone marrow blasts were reduced more than 50% in an additional 8 patients (total = 27; 11%). Median survival was 369 days for patients who achieved CR/CRp. Myelosuppression was the most common adverse event. The most common nonhematologic toxicities were fever, nausea, and hypokalemia. Single-agent treatment with tipifarnib induced durable CR/CRp, which was associated with prolonged survival, in some patients with refractory or relapsed AML. The response rate observed in this heavily pretreated group of patients suggests the requirement to enhance the response rate either by combining tipifarnib with other active agents or determining factors that are predictive of response.
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