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Type: Journal article
Title: Dual epigenetic targeting with panobinostat and azacitidine in acute myeloid leukemia and high-risk myelodysplastic syndrome
Author: Tan, P.
Wei, A.
Mithraprabhu, S.
Cummings, N.
Liu, H.
Perugini, M.
Reed, K.
Avery, S.
Patil, S.
Walker, P.
Mollee, P.
Grigg, A.
D'Andrea, R.
Dear, A.
Spencer, A.
Citation: Blood Cancer Journal, 2014; 4(1):e170-1-e170-8
Publisher: Nature
Issue Date: 2014
ISSN: 2044-5385
Statement of
P Tan, AWei, S Mithraprabhu, N Cummings, HB Liu, M Perugini, K Reed, S Avery, S Patil, P Walker, P Mollee, A Grigg, R D, Andrea, A Dear, and A Spencer
Abstract: Therapeutic options are limited for elderly patients with acute myeloid leukemia (AML). A phase Ib/II study was undertaken to evaluate the maximum-tolerated dose (MTD) and preliminary efficacy of the pan-histone deacetylase inhibitor panobinostat (LBH589) in combination with azacitidine in patients with AML or high-risk myelodysplastic syndrome (MDS) naïve to intensive chemotherapy. Thirty-nine patients (AML=29, MDS=10) received azacitidine 75 mg/m(2) subcutaneously (days 1-5) and oral panobinostat (starting on day 5, thrice weekly for seven doses) in 28-day cycles until toxicity or disease progression. Dose-limiting toxicities during the phase Ib stage were observed in 0/4 patients receiving 10 mg panobinostat, in 1/7 patients (fatigue) receiving 20 mg, in 1/6 patients (fatigue) receiving 30 mg and in 4/5 patients (fatigue, syncope, hyponatremia and somnolence) receiving 40 mg. In phase II, an additional 17 patients received panobinostat at a MTD of 30 mg. The overall response rate (ORR=CR+CRi+PR) in patients with AML was 31% (9/29) and that in patients with MDS was 50% (5/10). After a median follow-up of 13 months, the median overall survival was 8 and 16 months in patients with AML and MDS, respectively. Increased histone H3 and H4 acetylation was a useful early biomarker of clinical response. Combining panobinostat with azacitidine was tolerable and clinically active in high-risk MDS/AML patients, warranting further exploration.
Keywords: acute myeloid leukemia; myelodysplastic syndrome; epigenetic therapy; histone deacetylase inhibitor; azacitidine
Description: Presented in part at the 53rd Annual Meeting of the American Society of Hematology, San Diego, CA, December 10–13, 2011, and the 17th Congress of the European Haematology Association, Amsterdam, June 14–17, 2012.
Rights: This work is licensed under a Creative Commons Attribution 3.0 Unported License. To view a copy of this license, visit
DOI: 10.1038/bcj.2013.68
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