1. Efficacy and safety of midostaurin in patients with advanced systemic mastocytosis: 10-year median follow-up of a phase II trial
- Author
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Cheryl Langford, J. Ma, Bruno C. Medeiros, Michaela Liedtke, Steven Coutre, Jason D. Merker, Andrea Linder, Catherine Dutreix, Cecelia Perkins, Tracy I. George, Caroline Berube, Daniel J. DeAngelo, Peter Westervelt, D.W. Sternberg, P. A. Ruffie, Christopher L. Corless, T. J. Graubert, and Jason Gotlib
- Subjects
Adult ,Male ,0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Anemia ,Leukemia, Mast-Cell ,Gastroenterology ,Asymptomatic ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Mastocytosis, Systemic ,Median follow-up ,Internal medicine ,medicine ,Humans ,Midostaurin ,Systemic mastocytosis ,Protein Kinase Inhibitors ,Aged ,business.industry ,Hematology ,Middle Aged ,Staurosporine ,medicine.disease ,Mast cell leukemia ,Surgery ,Leukemia ,030104 developmental biology ,Oncology ,chemistry ,Tolerability ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Patients with advanced systemic mastocytosis (SM) (e.g. aggressive SM (ASM), SM with an associated hematologic neoplasm (SM-AHN) and mast cell leukemia (MCL)) have limited treatment options and exhibit reduced survival. Midostaurin is an oral multikinase inhibitor that inhibits D816V-mutated KIT, a primary driver of SM pathogenesis. We conducted a phase II trial of midostaurin 100 mg twice daily, administered as 28-day cycles, in 26 patients (ASM, n=3; SM-AHN, n= 17; MCL, n=6) with at least one sign of organ damage. During the first 12 cycles, the overall response rate was 69% (major/partial response: 50/19%) with clinical benefit in all advanced SM variants. With ongoing therapy, 2 patients achieved a complete remission of their SM. Midostaurin produced a ⩾50% reduction in bone marrow mast cell burden and serum tryptase level in 68% and 46% of patients, respectively. Median overall survival for the entire cohort was 40 months, and 18.5 months for MCL patients. Low-grade gastrointestinal side effects were common and manageable with antiemetics. The most frequent grade 3/4 nonhematologic and hematologic toxicities were asymptomatic hyperlipasemia (15%) and anemia (12%). With median follow-up of 10 years, no unexpected toxicities emerged. These data establish the durable activity and tolerability of midostaurin in advanced SM.
- Published
- 2017
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