Leukemia: Targeted Therapy for Acute Myeloid Leukemia
Cancer is one of the biggest healthcare problems facing the world today. Dramatic improvements have been realized using treatments that target the immune responses against solid tumors in patient outcomes. However, the role of immunotherapy in the management and treatment of acute leukemia is still in its formative stages. Drugs that target specific parts of the cancerous cells have been developed in the recent past. These drugs work differently from the standard chemotherapy drugs as well as have different side effects. This paper reviews Targeted Therapy for Acute Myeloid Leukemia procedures and innovation. Some of the targeted drugs used for treating people with acute myeloid leukemia include the: FLT3 Inhibitors
The leukemia cell has a mutation in the FLT3 gene in some people with AML. It was approved by the FDA in 2017. When added to conventional therapy in younger patients, it increases the overall complete response rates (Weisberg, Sattler, & Griffin, 2018). The Midostaurin drug works effectively in blocking FLT3 and other proteins on the cancer cells that help it to grow. The drug is also used together with certain chemotherapy drugs to treat newly diagnosed young adults that have FLT3 in their leukemia cell mutation. Midostaurin is an oral drug and it is taken twice a day. However, it has been associated with chest pains, respiratory infections, breath shortness, high blood sugar levels, and reduction of the production of white blood cells.
Rituximab in B-Lineage Adult Acute Lymphoblastic Leukemia
Leukemia treatment using Rituximab has significantly improved the outcome for non-Hodgkin’s lymphoma patients. Moreover, patients with B-linage acute lymphoblastic leukemia can also intake the CD20 antigen, which is targeted by rituximab. Notably, the outcomes for patients with acute lymphoblastic leukemia have improved because of treatment with more sensitive chemotherapy that is similar to the one used for pediatric ALL (Weisberg, Sattler, & Griffin, 2018). Moreover, the use of rituximab in the treatment of acute lymphoblastic leukemia showed trends of improved overall survival and more rapid clearing of rapid residual disease. Thus, there were fewer allergic reactions to asparaginase in the rituximab treatments (June, & Sadelain, 2018). Consequently, rituximab is undoubtedly a reasonable treatment approach for healthcare providers to take given the rate of improvement in survival and relapse.
Inotuzumab Ozogamicin is another effective drug that is used in the treatment of acute B cell lymphoblastic leukemia. The drug is an antibody conjugate that is directed to the CD22-positive antigen that is present on B cells in patients with mature B-ALL. It is a humanized CD22 monoclonal antibody that is connected to the cytotoxic agent calicheamicin. It is expressed in >90% of ALL patients (Kantarjian et al., 2016). The drug has shown excellent clinical activity among comprehensively pretreated refractory/relapsed B-ALL, and elderly B- ALL patients. Inotizumab Ozogamicin has significantly higher rates of complete remission compared with other standard chemotherapy.
Blinatumomab is a bispecific antibody that is combined with anti-CD3 and anti-CD9 and has demonstrated improved activity in ALL. The use of blinatumomab has resulted in significantly prolonged survival rates than chemotherapy (Weisberg, Sattler, & Griffin, 2018). The rate of remission, when compared with chemotherapy, was within 12 weeks after initiation of treatment, and they result in a higher rate of event-free survival six months earlier than chemotherapy. However, the response rate according to Golay et al., (2018), the response rates are moderate although there is a clear overall benefit compared with conventional therapy. Nevertheless, blinatumomab is still not used in curing the entire disease because it can become cumbersome in the four-week continuous infusion and it has substantial toxicities.
CAR T cells is a medication that is used to target the T cells via a Chimeric Antigen Receptor (CAR). The use of CAR T cell therapy is restricted to smaller clinical trials, primarily in patients that have advanced lymphoblastic leukemia (June, & Sadelain, 2018). However, CAR T cell therapy has been used to capture and treat children with acute lymphoblastic leukemia and some in adults with advanced lymphomas. CAR T cell therapy is engineered with the white blood cells to target cancerous cells more effectively. Once the engineering process is achieved, the T cells are then injected into the infected individual and they assault the infected body cells. Thus the role of the engineering process is to destroy the abnormal cells in the blood. However, if there were not specially engineered, the T cells would be incapable of distinguishing the normal and the abnormal cells rendering them useless or less effective. Similarly, converting them into CAR T cell is used to overcome these insufficiencies. The patient samples are collected by the lab technicians together with the patients’ blood sample to reengineer them to sprout special protruding structures known as chimeric antigen receptors (Salmikangas, Kinsella, & Chamberlain, 2018).. There are many ways of dealing with leukemia, although it depends with the infected individual because some respond negatively to some medicine while others just adapt smoothly to the various therapies provided.
References
Golay, J., Martinelli, S., Alzani, R., Cribioli, S., Albanese, C., Gotti, E., … & Introna, M. (2018). Cord blood–derived cytokine-induced killer cells combined with blinatumomab as a therapeutic strategy for CD19+ tumors. Cytotherapy, 20(8), 1077-1088. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1465324918305450
June, C. H., & Sadelain, M. (2018). Chimeric antigen receptor therapy. New England Journal of Medicine, 379(1), 64-73. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMra1706169
Kantarjian, H. M., DeAngelo, D. J., Stelljes, M., Martinelli, G., Liedtke, M., Stock, W., … & Paccagnella, M. L. (2016). Inotuzumab ozogamicin versus standard therapy for acute lymphoblastic leukemia. New England Journal of Medicine, 375(8), 740-753. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMoa1509277
Salmikangas, P., Kinsella, N., & Chamberlain, P. (2018). Chimeric Antigen Receptor T-Cells (CAR T-Cells) for Cancer Immunotherapy–Moving Target for Industry?. Pharmaceutical research, 35(8), 152. Retrieved from https://link.springer.com/article/10.1007/s11095-018-2436-z
Weisberg, E., Sattler, M., Manley, P. W., & Griffin, J. D. (2018). Spotlight on midostaurin in the treatment of FLT3-mutated acute myeloid leukemia and systemic mastocytosis: design, development, and potential place in therapy. OncoTargets and therapy, 11, 175. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749544/