Phase II trial of cytarabine and mitoxantrone with devimistat in acute myeloid leukemia

Rebecca Anderson, Lance D. Miller, Scott Isom, Jeff W. Chou, Kristin M. Pladna, Nathaniel J. Schramm, Leslie R. Ellis, Dianna S. Howard, Rupali R. Bhave, Megan Manuel, Sarah Dralle, Susan Lyerly, Bayard L. Powell and Timothy S. Pardee ()
Additional contact information
Rebecca Anderson: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Lance D. Miller: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Scott Isom: Wake Forest Public Health Sciences
Jeff W. Chou: Wake Forest Public Health Sciences
Kristin M. Pladna: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Nathaniel J. Schramm: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Leslie R. Ellis: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Dianna S. Howard: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Rupali R. Bhave: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Megan Manuel: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Sarah Dralle: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Susan Lyerly: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Bayard L. Powell: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist
Timothy S. Pardee: Comprehensive Cancer Center of Atrium Health Wake Forest Baptist

Nature Communications, 2022, vol. 13, issue 1, 1-13

Abstract: Abstract Devimistat is a TCA cycle inhibitor. A previously completed phase I study of devimistat in combination with cytarabine and mitoxantrone in patients with relapsed or refractory AML showed promising response rates. Here we report the results of a single arm phase II study (NCT02484391). The primary outcome of feasibility of maintenance devimistat following induction and consolidation with devimistat in combination with high dose cytarabine and mitoxantrone was not met, as maintenance devimistat was only administered in 2 of 21 responders. The secondary outcomes of response (CR + CRi) and median survival were 44% (21/48) and 5.9 months respectively. There were no unexpected toxicities observed. An unplanned, post-hoc analysis of the phase I and II datasets suggests a trend of a dose response in older but not younger patients. RNA sequencing data from patient samples reveals an age-related decline in mitochondrial gene sets. Devimistat impairs ATP synthesis and we find a correlation between mitochondrial membrane potential and sensitivity to chemotherapy. Devimistat also induces mitochondrial reactive oxygen species and turnover consistent with mitophagy. We find that pharmacological or genetic inhibition of mitochondrial fission or autophagy sensitizes cells to devimistat. These findings suggest that an age related decline in mitochondrial quality and autophagy may be associated with response to devimistat however this needs to be confirmed in larger cohorts with proper trial design.

Date: 2022
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DOI: 10.1038/s41467-022-29039-4

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