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Blood, 15 February 2007, Vol. 109, No. 4, pp. 1387-1394.
Prepublished online as a Blood First Edition Paper on November 2, 2006; DOI 10.1182/blood-2006-04-014357.


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Submitted April 25, 2006
Accepted September 26, 2006

A phase II study of the farnesyltransferase inhibitor tipifarnib in poor-risk and elderly patients with previously untreated acute myelogenous leukemia

Jeffrey E Lancet*, Ivana Gojo, Jason Gotlib, Eric J. Feldman, Jaqueline Greer, Jane L. Liesveld, Laura M Bruzek, Lawrence Morris, Youn Park, Alex A Adjei, Scott H. Kaufmann, Elizabeth Garrett-Mayer, Peter L. Greenberg, John J Wright, and Judith E. Karp

H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL
Greenebaum Cancer Center, University of Maryland, Baltimore, MD
Division of Hematology, Stanford University Cancer Center, Stanford, CA
Weill Medical Center, Cornell University, New York, NY
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
Mayo Clinic, Rochester, MN
Blood & Marrow Transplant Group of Georgia, Atlanta, GA
Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ
IDB/CTEP, National Cancer Institute, Bethesda, MD

* Corresponding author; email: lancetje{at}moffitt.usf.edu.

Outcomes for older adults with acute myelogenous leukemia (AML) are poor due to both disease and host-related factors. In this phase 2 study, we tested the oral farnesyltransferase inhibitor tipifarnib in 158 older adults with previously untreated, poor-risk AML. The median age was 74 years, and a majority of patients had antecedent myelodysplastic syndrome. Complete remission was achieved in 22 patients (14%); partial remission or hematologic improvement occurred in 15 patients, for an overall response rate of 23%. The median duration of CR was 7.3 months and the median survival of complete responders was 18 months. Adverse karyotype, age ≥75, and poor performance status correlated negatively with survival. Early death in the absence of progressive disease was rare, and drug-related non-hematologic serious adverse events were observed in 74 patients (47%). Inhibition of farnesylation of the surrogate protein HDJ-2 occurred in the large majority of marrow samples tested. Baseline levels of phosphorylated mitogen-activated protein kinase and AKT did not correlate with clinical response. Tipifarnib is active and well tolerated in older adults with poor-risk AML, and may impart a survival advantage in those patients who experience a clinical response.


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