Venetoclax: A New Partner in the Novel Treatment Era for Acute Myeloid Leukemia and Myelodysplastic Syndrome

Jean El-Cheikh; Ghassan Bidaoui; Mustafa Saleh; Nour Moukalled; Iman Abou Dalle; Ali Bazarbachi

doi:10.1007/s44228-023-00041-x

Venetoclax: A New Partner in the Novel Treatment Era for Acute Myeloid Leukemia and Myelodysplastic Syndrome

Clin Hematol Int. 2023 Jun;5(2-3):143-154. doi: 10.1007/s44228-023-00041-x. Epub 2023 Apr 18.

Authors

Jean El-Cheikh^{1

2}, Ghassan Bidaoui³, Mustafa Saleh^{3

4}, Nour Moukalled³, Iman Abou Dalle³, Ali Bazarbachi³

Affiliations

¹ Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. je46@aub.edu.lb.
² Department of Internal Medicine, Medical Center, Bone Marrow Transplantation Program, American University of Beirut, P.O. Box 113-6044, Beirut, Lebanon. je46@aub.edu.lb.
³ Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
⁴ Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.

Abstract

Background: Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome (MDS) are two closely related blood cancers that are more frequent in older adults. AML is the most common type of adult acute leukemia, and MDS is characterized by ineffective blood cell production and abnormalities in the bone marrow and blood. Both can be resistant to treatment, often due to dysfunction in the process of apoptosis, the body's natural mechanism for cell death. Venetoclax, an orally-administered medication that selectively targets the BCL-2 protein, has shown promise in enhancing treatment sensitivity in some hematological malignancies by reducing the apoptotic threshold. This review aims to evaluate the effectiveness of venetoclax in treating AML and MDS, as well as potential mechanisms of resistance to the medication.

Methods: A literature search was conducted utilizing PUBMED to capture all relevant research articles on the use of venetoclax as a therapy for both diseases. The MeSH terms "acute myeloid leukemia", "myelodysplastic syndrome" and "venetoclax" were searched. Furthermore, Clinicaltrials.gov was accessed to ensure the inclusion of all ongoing clinical trials.

Results: Although Venetoclax showed modest results as a single-agent therapy in AML, venetoclax-based combination therapies? mainly with hypomethylating agents or low-dose cytarabine? yielded significantly positive results. Preliminary results oN the use of venetoclax-based combination therapy with HMA, mainly azacitidine, in unfit high-risk MDS also yielded optimistic results. Identification of mutations for which various drugs have been approved has spurred active investigation of venetoclax in combination trials.

Conclusion: Venetoclax-based combination therapies have been shown to induce rapid responses and increase overall survival in AML patients unfit for intensive chemotherapy. These therapies are also yielding positive preliminary results in high-risk MDS patients in phase I trials. Resistance to venetoclax and drug-related toxicity are two main obstacles that need to be overcome to reap the full benefits of this therapy.

Keywords: Acute myeloid leukemia; Apoptosis; Bcl-2; Hypomethylating agents; Myelodysplastic syndrome; Myeloid neoplasia; Targeted therapy; Venetoclax.

Publication types

Review