Efficacy and safety of midostaurin in patients with advanced systemic mastocytosis: 10-year median follow-up of a phase II trial

D. J. DeAngelo, T. I. George, A. Linder, C. Langford, C. Perkins, J. Ma, P. Westervelt, J. D. Merker, C. Berube, S. Coutre, M. Liedtke, B. Medeiros, D. Sternberg, C. Dutreix, P. A. Ruffie, Christopher Corless, T. J. Graubert, J. Gotlib

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Abstract

Patients with advanced systemic mastocytosis (SM) (e.g. aggressive SM (ASM), SM with an associated hematologic neoplasm (SMAHN) 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.

Original languageEnglish (US)
Pages (from-to)470-478
Number of pages9
JournalLeukemia
Volume32
Issue number2
DOIs
StatePublished - Feb 1 2018

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4'-N-benzoylstaurosporine
Systemic Mastocytosis
Safety
Mast-Cell Leukemia
Tryptases
Antiemetics
Survival
Hematologic Neoplasms
Mast Cells
Bone Marrow Cells

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

Cite this

DeAngelo, D. J., George, T. I., Linder, A., Langford, C., Perkins, C., Ma, J., ... Gotlib, J. (2018). Efficacy and safety of midostaurin in patients with advanced systemic mastocytosis: 10-year median follow-up of a phase II trial. Leukemia, 32(2), 470-478. https://doi.org/10.1038/leu.2017.234

Efficacy and safety of midostaurin in patients with advanced systemic mastocytosis : 10-year median follow-up of a phase II trial. / DeAngelo, D. J.; George, T. I.; Linder, A.; Langford, C.; Perkins, C.; Ma, J.; Westervelt, P.; Merker, J. D.; Berube, C.; Coutre, S.; Liedtke, M.; Medeiros, B.; Sternberg, D.; Dutreix, C.; Ruffie, P. A.; Corless, Christopher; Graubert, T. J.; Gotlib, J.

In: Leukemia, Vol. 32, No. 2, 01.02.2018, p. 470-478.

Research output: Contribution to journalArticle

DeAngelo, DJ, George, TI, Linder, A, Langford, C, Perkins, C, Ma, J, Westervelt, P, Merker, JD, Berube, C, Coutre, S, Liedtke, M, Medeiros, B, Sternberg, D, Dutreix, C, Ruffie, PA, Corless, C, Graubert, TJ & Gotlib, J 2018, 'Efficacy and safety of midostaurin in patients with advanced systemic mastocytosis: 10-year median follow-up of a phase II trial', Leukemia, vol. 32, no. 2, pp. 470-478. https://doi.org/10.1038/leu.2017.234
DeAngelo, D. J. ; George, T. I. ; Linder, A. ; Langford, C. ; Perkins, C. ; Ma, J. ; Westervelt, P. ; Merker, J. D. ; Berube, C. ; Coutre, S. ; Liedtke, M. ; Medeiros, B. ; Sternberg, D. ; Dutreix, C. ; Ruffie, P. A. ; Corless, Christopher ; Graubert, T. J. ; Gotlib, J. / Efficacy and safety of midostaurin in patients with advanced systemic mastocytosis : 10-year median follow-up of a phase II trial. In: Leukemia. 2018 ; Vol. 32, No. 2. pp. 470-478.
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abstract = "Patients with advanced systemic mastocytosis (SM) (e.g. aggressive SM (ASM), SM with an associated hematologic neoplasm (SMAHN) 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.",
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