Nexavar for maintenance after transplant in AML – pro
The fms-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) mutation is associated with a high relapse rate for patients with acute myeloid leukemia (AML) even after allogeneic hematopoietic stem cell transplantation (HSCT). Sorafenib is a tyrosine kinase inhibitor, which inhibits the FLT3 tyrosine kinase and has shown encouraging activity in FLT3-ITD AML. The strategy of using sorafenib for maintenance after a stem cell transplant for FLT3 positive AML, is new and not yet supported by credible data. Chen et al, concludes: “Sorafenib is safe after HSCT for FLT3-ITD AML and merits further investigation for the prevention of relapse.” Antar in 2015 also conlcudes: “Sorafenib appears to be an effective maintenance therapy after allo-HCT in FLT3-ITD AML, with achievement of durable complete responses. This suggests an immunomodulatory effect of sorafenib in the posttransplantation setting and warrants a broader clinical evaluation of the use of maintenance sorafenib in FLT3-ITD AML.” NCCN and other guidelines do not recommend use of Nexvar for maintenance.
Chen B, et al, Phase I trial of maintenance sorafenib after allogeneic hematopoietic stem cell transplantation for fms-like tyrosine kinase 3 internal tandem duplication acute myeloid leukemia.Biol Blood Marrow Transplant. 2014 Dec;20(12):2042-8
Antar A et al, Sorafenib Maintenance Appears Safe and Improves Clinical Outcomes in FLT3-ITD Acute Myeloid Leukemia After Allogeneic Hematopoietic Cell Transplantation.Clin Lymphoma Myeloma Leuk. 2015 May;15(5):298-302.