The role of small molecule Flt3 receptor protein-tyrosine kinase inhibitors in the treatment of Flt3-positive acute myelogenous leukemias. (PubMed, Pharmacol Res)
The mainstay of treatment of acute myelogenous leukemias include daunorubicin or idarubicin and cytarabine. Older patients who are not candidates for such traditional therapy are usually given 5-azacitidine, decitabine, or clofarabine...Midostaurin is US FDA-approved in combination with standard cytarabine and daunorubicin for first-line induction chemotherapy and in combination with cytarabine for second-line consolidation chemotherapy in the treatment of acute myelogenous leukemias with FLT3-postive mutations...Gilteritinib and quizartinib bind to Flt3 with the inactive DFG-D structure and are classified as type II inhibitors. Furthermore, ponatinib is a multikinase inhibitor that is approved for the treatments of Philadelphia chromosome-positive acute lymphoblastic and chronic myelogenous leukemias; it is used off label for the treatment of patients with acute myelogenous leukemias. Other drugs that are in clinical trials for the treatment of this disorder include sorafenib, sunitinib, crenolanib, FF10101, and lestaurtinib. Unlike chronic myelogenous leukemias which result solely from the formation of the BCR-Abl chimeric protein kinase, acute myelogenous leukemias result from multi-factorial causes and are prone to be resistant to both cytotoxic and targeted therapies. Consequently, there is a pressing need for better understanding the etiologies of acute myelogenous leukemias and for the development of more effective therapies.