Ex vivo venetoclax sensitivity testing predicts treatment response in acute myeloid leukemia
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The BCL-2 inhibitor venetoclax has revolutionized the treatment of acute myeloid leukemia (AML) in patients not benefiting from intensive chemotherapy. Nevertheless, treatment failure remains a challenge, and predictive markers are needed, particularly for relapsed or refractory AML. Ex vivo drug sensitivity testing may correlate with outcomes, but its prospective predictive value remains unexplored. Here we report the results of the first stage of the prospective phase II VenEx trial evaluating the utility and predictiveness of venetoclax sensitivity testing using different cell culture conditions and cell viability assays in patients receiving venetoclax-azacitidine. Participants with de novo AML ineligible for intensive chemotherapy, relapsed or refractory AML, or secondary AML were included. The primary endpoint was the treatment response in participants showing ex vivo sensitivity and the key secondary endpoints were the correlation of sensitivity with responses and survival. Venetoclax sensitivity testing was successful in 38/39 participants. Experimental conditions significantly influenced the predictive accuracy. Blast-specific venetoclax sensitivity measured in conditioned medium most accurately correlated with treatment outcomes; 88% of sensitive participants achieved a treatment response. The median survival was significantly longer for participants who were ex vivo-sensitive to venetoclax (14.6 months for venetoclax-sensitive patients vs. 3.5 for venetoclax-insensitive patients, P<0.001). This analysis illustrates the feasibility of integrating drug-response profiling into clinical practice and demonstrates excellent predictivity.
|Status||Udgivet - 2023|
This study received funding from the Finnish Medical Foundation, Cancer Foundation Finland, Helsinki University Hospital Comprehensive Cancer Center, Helsinki University, iCAN – Digital Precision Medicine and FiCAN South. HK and MK are supported by the Foundation for the Finnish Cancer Institute. SKy received support from the Finnish Medical Foundation.
This study received funding from the Finnish Medical Foun-
HK reports research funding from AbbVie and personal fees from Faron outside the submitted work. APart reports personal fees from AbbVie, Astra Zeneca, Janssen-Cilag, No-vartis, Sanofi, and Takeda outside the submitted work. KP reports personal fees from AbbVie, Astellas Pharma, BMS/Celgene, Incyte, Novartis, and Pfizer and research funding from AbbVie, BMS/Celgene, Incyte, Novartis, and Pfizer outside the submitted work. CAH reports research funding from Novartis, Orion Pharma, BMS/Celgene, Onco-peptides, and Kronos Bio Inc. and personal fees from On-copeptides outside the submitted work. PE reports personal fees from Novartis, Pfizer, Amgen, and Sanofi outside the submitted work. MP reports personal fees from Pfizer, No-vartis, and AbbVie outside the submitted work. JR reports personal fees from Astellas Pharma, AbbVie, Bristol-Myers Squibb, and Pfizer outside the submitted work. TS reports personal fees from Novartis, Bristol-Myers Squibb, Janssen-Cilag, AbbVie, and Takeda outside the submitted work. MK reports personal fees from Astellas Pharma, AbbVie, Bristol-Myers Squibb, Faron, Jazz Pharmaceuticals, Novartis and Pfizer and research funding from AbbVie outside the submitted work. The other authors have no disclosures to make.
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