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Gilteritinib: First Global Approval

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Abstract

Gilteritinib (Xospata®) is an orally available small molecule receptor tyrosine kinase inhibitor developed by Astellas Pharma in collaboration with Kotobuki Pharmaceutical for the treatment of acute myeloid leukaemia (AML) harbouring FMS-like tyrosine kinase 3 (FLT3) mutations. Gilteritinib inhibits FLT3 (STK1 or FLK2), AXL (UFO or JTK11) and anaplastic lymphoma kinase (ALK or CD246). Gilteritinib inhibits FLT3 signalling in cells expressing FLT3 internal tandem duplication (ITD), tyrosine kinase domain mutation FLT3-D835Y and the double mutant FLT3-ITD-D835Y, thereby inducing apoptosis. Gilteritinib also binds to and inhibits the wild-type and mutated forms of ALK, resulting in reduced tumour cell proliferation in cancer cell types that overexpress the mutation. Gilteritinib is approved in Japan for the treatment of relapsed or refractory AML with FLT3 mutation. Recently, it was also approved in the USA for the treatment of adult patients who have relapsed or refractory AML with a FLT3 mutation, as detected by an FDA-approved test. Clinical development of gilteritinib is underway in several countries worldwide. Development for non-small cell lung cancer and solid tumours has been discontinued.

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References

  1. Siveen KS, Uddin S, Mohammad RM. Targeting acute myeloid leukemia stem cell signaling by natural products. Mol Cancer. 2017;16(1):13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Fathi AT, Chen Y-B. The role of FLT3 inhibitors in the treatment of FLT3-mutated acute myeloid leukemia. Eur J Haematol. 2017;98(4):330–6.

    Article  PubMed  Google Scholar 

  3. Stein EM. Molecularly targeted therapies for acute myeloid leukemia. Hematol Am Soc Hematol Educ Program. 2015;2015:579–83.

    Article  Google Scholar 

  4. Hassanein M, Almahayni MH, Ahmed SO, et al. FLT3 inhibitors for treating acute myeloid leukemia. Clin Lymphoma Myeloma Leuk. 2016;16(10):543–9.

    Article  PubMed  Google Scholar 

  5. Larrosa-Garcia M, Baer MR. FLT3 inhibitors in acute myeloid leukemia: current status and future directions. Mol Cancer Ther. 2017;16(6):991–1001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Astellas Pharma. Astellas announces approval in Japan for XOSPATA® 40 mg tablets for the treatment of FLT3mut + relapsed or refractory AML [media release]. 21 Sep 2018. https://www.astellas.com/en/news/14271.

  7. Astellas Pharma. XOSPATA tablets 40 mg: Japanese prescribing information. 2018. http://www.pmda.go.jp/PmdaSearch/iyakuDetail/ResultDataSetPDF/800126_4291053F1021_1_01. Accessed 2018.

  8. Invivoscribe Technologies. Invivoscribe® receives approval in Japan for its LeukoStrat® CDx FLT3 Mutation Assay to assess acute myeloid leukemia (AML) patients eligible for treatment with Xospata® (gilteritinibfumarate) [media release]. 27 Sep 2018. https://globenewswire.com/news-release/2018/09/27/1577006/0/en/Invivoscribe-Receives-Approval-in-Japan-for-its-LeukoStrat-CDx-FLT3-Mutation-Assay-to-Assess-Acute-Myeloid-Leukemia-AML-Patients-Eligible-for-Treatment-with-Xospata-gilteritinib-fu.html.

  9. US FDA. FDA approves treatment for adult patients who have relapsed or refractory acute myeloid leukemia (AML) with a certain genetic mutation [media release]. 28 Nov 2018. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm627072.htm.

  10. Astellas Pharma. XOSPATA® (gilteritinib): US Prescribing Information. 2018. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/211349s000lbl.pdf. Accessed 24 Dec 2018.

  11. Astellas Pharma. Astellas announces preliminary phase 1/2 safety, tolerability and efficacy data for ASP2215 in patients with relapsed or refractory acute myeloid leukemia (AML) [media release]. 30 May 2015. https://newsroom.astellas.us/2015-05-30-Astellas-Announces-Preliminary-Phase-1-2-Safety-Tolerability-And-Efficacy-Data-For-ASP2215-In-Patients-With-Relapsed-Or-Refractory-Acute-Myeloid-Leukemia-AML.

  12. Lee LY, Hernandez D, Rajkhowa T, et al. Preclinical studies of gilteritinib, a next-generation FLT3 inhibitor. Blood. 2017;129(2):257–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Mori M, Kaneko N, Ueno Y, et al. Gilteritinib, a FLT3/AXL inhibitor, shows antileukemic activity in mouse models of FLT3 mutated acute myeloid leukemia. Invest New Drugs. 2017;35(5):556–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Perl AE, Altman JK, Cortes J, et al. Selective inhibition of FLT3 by gilteritinib in relapsed or refractory acute myeloid leukaemia: a multicentre, first-in-human, open-label, phase 1-2 study. Lancet Oncol. 2017;18(8):1061–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ueno Y, Kaneko N, Saito R, et al. ASP2215, a novel FLT3/AXL inhibitor: preclinical evaluation in combination with cytarabine and anthracycline in acute myeloid leukemia (AML) [abstract no. 7071]. J Clin Oncol. 2014;32(15 Suppl).

  16. Ueno Y, Mori M, Kamiyama Y, et al. Gilteritinib (ASP2215), a novel FLT3/AXL inhibitor: preclinical evaluation in combination with azacitidine in acute myeloid leukemia. Blood. 2016;128(22):2830.

    Google Scholar 

  17. Knight T, Qiao X, Edwards H, et al. Novel therapy for FLT3-ITD acute myeloid leukemia utilizing the combination of CUDC-907 and gilteritinib [abstract no. 1427]. Blood. 2018;132(Suppl 1).

  18. Cloe A, Larson RA, Cheng JX. FLT3 inhibitors for the treatment of acute myeloid leukemia: an evaluation of efficacy of target inhibition and relationship to disease progression [abstract no. 4940]. Blood Conf. 2015;126(23).

  19. McMahon CM, Canaani J, Rea B, et al. Mechanisms of acquired resistance to gilteritinib therapy in relapsed and refractory FLT3-mutated acute myeloid leukemia [abstract no. 295]. Blood. 2017;130(Suppl 1).

  20. McMahon CM, Ferng TT, Canaani J, et al. RAS mutations are the dominant mechanism of secondary resistance to gilteritinib therapy for relapsed/refractory FLT3-mutated AML [abstract no. S817]. In: 23rd congress of the European haematology association. 2018.

  21. Gorcea CM, Burthem J, Tholouli E. ASP2215 in the treatment of relapsed/refractory acute myeloid leukemia with FLT3 mutation: background and design of the ADMIRAL trial. Future Oncol. 2018;14(20):1995–2004.

    Article  CAS  PubMed  Google Scholar 

  22. US National Institutes of Health. ClinicalTrials.gov (NCT02421939). 2019. https://clinicaltrials.gov/ct2/show/NCT02421939. Accessed 22 Jan 2019.

  23. Jessica A, Perl A, Cortes J, et al. Deep molecular response to gilteritinib improves survival in FLT3 mutation-positive relapsed/refractory acute myeloid leukemia [abstract no. S110]. Haematologica. 2017;102(Suppl 2):6.

  24. Levis MJ, Perl AE, Altman JK, et al. A next-generation sequencing-based assay for minimal residual disease assessment in AML patients with FLT3-ITD mutations. Blood Adv. 2018;2(8):825–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Levis MJ, Perl AE, Altman JK, et al. Impact of minimal residual disease and achievement of complete remission/complete remission with partial hematologic recovery (CR/CRh) on overall survival following treatment with gilteritinib in patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) with FLT3 mutations [abstract no. 1458]. Blood. 2018;(132).

  26. Canaani J, Rea B, Sargent R, et al. Differentiation response to gilteritinib (ASP2215) in relapsed/refractory FLT3 mutated acute myeloid leukemia patients is associated with co-mutations in NPM1 and DNMT3A [abstract no. P188]. Haematologica. 2016;101(Suppl 1):42.

  27. Usuki K, Sakura T, Kobayashi Y, et al. Clinical profile of gilteritinib in Japanese patients with relapsed/refractory acute myeloid leukemia: an open-label phase 1 study. Cancer Sci. 2018;109(10):3235–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Cortes JE, Altman J, Ritchie EK, et al. A phase II/III, multicenter, open-label, 3-arm study of gilteritinib, gilteritinib plus azacitidine, or azacitidine alone in the treatment of newly diagnosed FLT3 mutation-positive acute myeloid leukemia (AML) patients ineligible for intensive induction chemotherapy [abstract no. TPS7068]. J Clin Oncol Conf. 2017;35(15 Suppl.).

  29. Esteve J, Schots R, Del Castillo TB, et al. Multicenter, open-label, 3-arm study of gilteritinib, gilteritinib plus azacitidine, or azacitidine in newly diagnosed FLT3 mutated (FLT3 mut+) acute myeloid leukemia (AML) patienyts ineligible for intensive induction chemotherapy: findings from the safety cohort [abstract no. 2736]. Blood. 2018;132.

  30. Pratz K, Cherry M, Altman JK, et al. Preliminary results from a phase 1 study of gilteritinib in combination with induction and consolidation chemotherapy in subjects with newly diagnosed acute myeloid leukemia (AML) [abstract no. 722]. Blood. 2017;130(Suppl 1).

  31. Pratz KW, Cherry M, Altman JK, et al. Updated results from a phase I study of gilteritinib in combination with induction and consolidation chemotherapy in subjects with newly diagnosed acute myeloid leukemia (AML) [abstract no. 564]. Blood. 2018;132.

  32. Invivoscribe Technologies. Invivoscribe Technologies announces companion diagnostic agreement [media release]. 28 Apr 2015. http://www.marketwired.com/press-release/invivoscribe-technologies-announces-companion-diagnostic-agreement-2013950.htm.

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Correspondence to Sohita Dhillon.

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The preparation of this review was not supported by any external funding.

Conflict of interest

During the peer review process the manufacturer of the agent under review was offered an opportunity to comment on the article. Changes resulting from any comments received were made by the authors on the basis of scientific completeness and accuracy. Sohita Dhillon is a salaried employee of Adis/Springer, is responsible for the article content and declares no relevant conflicts of interest.

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This profile has been extracted and modified from the AdisInsight database. AdisInsight tracks drug development worldwide through the entire development process, from discovery, through pre-clinical and clinical studies to market launch and beyond.

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Dhillon, S. Gilteritinib: First Global Approval. Drugs 79, 331–339 (2019). https://doi.org/10.1007/s40265-019-1062-3

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