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Blood, 1 March 2008, Vol. 111, No. 5, pp. 2589-2596.
Prepublished online as a Blood First Edition Paper on December 26, 2007; DOI 10.1182/blood-2007-09-112730.


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Submitted September 24, 2007
Accepted December 16, 2007

A two-gene classifier for predicting response to the farnesyltransferase inhibitor tipifarnib in acute myeloid leukemia

Mitch Raponi*, Jeffrey E Lancet, Hongtao Fan, Lesley Dossey, Grace Lee, Ivana Gojo, Eric J Feldman, Jason Gotlib, Lawrence E Morris, Peter L Greenberg, John J Wright, Jean-Luc Harousseau, Bob Lowenberg, Richard M Stone, Peter De Porre, Yixin Wang, and Judith E Karp

Molecular Diagnostics, Veridex, L.L.C. a Johnson and Johnson company, La Jolla, CA, United States
H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, United States
Clinical Pharmacology, Centocor R&D, Inc., Malvern, PA, United States
Greenebaum Cancer Center, University of Maryland, Baltimore, MD, United States
Weill Medical College, Cornell University, New York, NY, United States
Stanford Cancer Center, Stanford, CA, United States
Blood and Bone Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, United States
Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
Service d'Hematologie Clinique, CHRU Hotel Dieu, Nantes, France
Department of Hematology, Erasmus University Medical Center, Rotterdam, Netherlands
Adult Leukemia Program, Dana-Farber Cancer Institute, Boston, MA, United States
Oncology Development, Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Beerse, Belgium
The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States

* Corresponding author; email: mraponi1{at}ocdus.jnj.com.

Currently there is no method available to predict response to farnesyltransferase inhibitors (FTI). We analyzed gene expression profiles from the bone marrow of patients from a phase 2 study of the FTI tipifarnib, in older adults with previously untreated acute myeloid leukemia (AML). The RASGRP1:APTX gene expression ratio was found to predict response to tipifarnib with the greatest accuracy using a leave-one-out cross validation (LOOCV; 96%). RASGRP1 is a guanine nucleotide exchange factor that activates RAS, while APTX (aprataxin) is involved in DNA excision repair. The utility of this classifier for predicting response to tipifarnib was validated in an independent set of 58 samples from relapsed or refractory AML, with a negative predictive value (NPV) and positive predictive value (PPV) of 92% and 28%, respectively (odds ratio of 4.4). The classifier also predicted for improved overall survival (154 vs 56 days, p = 0.0001), which was independent of other co-variates including a previously described prognostic gene expression classifier. Therefore, these data indicate that a two-gene expression assay may have utility in categorizing a population of AML patients who are more likely to respond to tipifarnib.


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