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Ref Type Journal Article
PMID (33563661)
Authors Pikman Y, Tasian SK, Sulis ML, Stevenson K, Blonquist TM, Apsel Winger B, Cooper TM, Pauly M, Maloney KW, Burke MJ, Brown PA, Gossai N, McNeer JL, Shukla NN, Cole PD, Kahn JM, Chen J, Barth MJ, Magee JA, Gennarini L, Adhav AA, Clinton CM, Ocasio-Martinez N, Gotti G, Li Y, Lin S, Imamovic A, Tognon CE, Patel T, Faust HL, Contreras CF, Cremer A, Cortopassi WA, Garrido Ruiz D, Jacobson MP, Dharia NV, Su A, Robichaud AL, Saur Conway A, Tarlock K, Stieglitz E, Place AE, Puissant A, Hunger SP, Kim AS, Lindeman NI, Gore L, Janeway KA, Silverman LB, Tyner JW, Harris MH, Loh ML, Stegmaier K
Title Matched Targeted Therapy for Pediatric Patients with Relapsed, Refractory or High-risk Leukemias: A Report from the LEAP Consortium.
Journal Cancer discovery
Vol
Issue
Date 2021 Feb 09
URL
Abstract Text Despite a remarkable increase in the genomic profiling of cancer, integration of genomic discoveries into clinical care has lagged behind. We report the feasibility of rapid identification of targetable mutations in 153 pediatric patients with relapsed/refractory or high-risk leukemias enrolled on a prospective clinical trial conducted by the LEAP Consortium. Eighteen percent of patients had a high confidence, Tier 1 or 2, recommendation. We describe clinical responses in the 14% of patients with relapsed/refractory leukemia who received the matched targeted therapy. Further, in order to inform future targeted therapy for patients, we validated variants of uncertain significance (VUS), performed ex vivo drug sensitivity testing in patient leukemia samples, and identified new combinations of targeted therapies in cell lines and patient-derived xenograft models. These data and our collaborative approach should inform the design of future precision medicine trials.

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Molecular Profile Treatment Approach
Gene Name Source Synonyms Protein Domains Gene Description Gene Role
Therapy Name Drugs Efficacy Evidence Clinical Trials
Drug Name Trade Name Synonyms Drug Classes Drug Description
Gene Variant Impact Protein Effect Variant Description Associated with drug Resistance
FLT3 A680V missense gain of function FLT3 A680V lies within the N-terminal kinase domain of the Flt3 protein (PMID: 15976757). A680V results in autophosphorylation of Flt3 (ASH, 2015, abstract no. 87) and leads to IL-3 independent growth in culture (PMID: 33563661).
Molecular Profile Indication/Tumor Type Response Type Therapy Name Approval Status Evidence Type Efficacy Evidence References
NRAS Q61R mixed phenotype acute leukemia no benefit Trametinib Case Reports/Case Series Actionable In a clinical study, Mekinist (trametinib) treatment was well tolerated and led to an initial decrease of peripheral blasts in a pediatric patient with mixed phenotype acute leukemia harboring NRAS Q61R who had previously undergone a stem cell transplant, but patient experienced progressive disease after 2 months, and died soon after (PMID: 33563661; NCT02670525). 33563661
KMT2A - MLLT3 NRAS G12D leukemia predicted - sensitive PD-0325901 Preclinical - Cell culture Actionable In a preclinical study, expression of NRAS G12D in murine leukemia cells harboring KMT2A-MLLT3 resulted in increased sensitivity to treatment with PD-0325901 in culture (PMID: 33563661). 33563661
FLT3 I836del acute myeloid leukemia predicted - sensitive Cytarabine + Mitoxantrone + Sorafenib Case Reports/Case Series Actionable In a clinical study, combination treatment with Cytosar-U (cytarabine), Novantrone (mitoxantrone), and Nexavar (sorafenib) treatment in an acute myeloid leukemia patient harboring FLT3 I836del led to remission with negative minimal residual disease (PMID: 33563661; NCT02670525). 33563661
FLT3 A680V hematologic cancer sensitive Gilteritinib Preclinical - Cell culture Actionable In a preclinical study, transformed cells expressing FLT3 A680V were sensitive to treatment with Xospata (gilteritinib) in culture, demonstrating decreased cell viability and decreased Flt3 phosphorylation (PMID: 33563661). 33563661
NRAS G13D B-cell acute lymphoblastic leukemia no benefit Everolimus Case Reports/Case Series Actionable In a clinical study, a pediatric patient with relapsed B-cell acute lymphoblastic leukemia harboring NRAS G13D, who also harbored SETD2 L1778fs* and an IKZF1 deletion, was treated with Afinitor (everolimus) in combination with chemotherapy and experienced persistent disease, and the patient died 6 months later (PMID: 33563661; NCT02670525). 33563661
FLT3 F594_W603dup acute myeloid leukemia predicted - sensitive Gilteritinib Case Reports/Case Series Actionable In a clinical study, Xospata (gilteritinib) treatment led to decreased disease burden (<10%) in an acute myeloid leukemia patient harboring FLT3 F594_W603dup (PMID: 33563661; NCT02670525). 33563661
FLT3 I836del acute myeloid leukemia predicted - sensitive Azacitidine + Sorafenib + Venetoclax Case Reports/Case Series Actionable In a clinical study, combination treatment with Vidaza (azacitidine), Nexavar (sorafenib) and Venclexta (venetoclax) resulted in continued remission from Cytosar-U (cytarabine), Novantrone (mitoxantrone), and Nexavar (sorafenib) treatment in an acute myeloid leukemia patient harboring FLT3 I836del (PMID: 33563661; NCT02670525). 33563661
KMT2A - MLLT3 NRAS G12D leukemia sensitive Trametinib Preclinical - Cell culture Actionable In a preclinical study, expression of NRAS G12D in murine leukemia cells harboring KMT2A-MLLT3 resulted in increased sensitivity to treatment with Mekinist (trametinib) in culture (PMID: 33563661). 33563661