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Pharmacological impact of FLT3 mutations on receptor activity and responsiveness to tyrosine kinase inhibitors

机译:FLT3突变对受体活性和对酪氨酸激酶抑制剂反应性的药理影响

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摘要

Acute myelogenous leukaemia (AML) is an aggressive blood cancer characterized by the rapid proliferation of immature myeloid blast cells, resulting in a high mortality rate. The 5-year overall survival rate for AML patients is approximately 25%. Circa 35% of all patients carry a mutation in the FLT3 gene which have a poor prognosis. Targeting FLT3 receptor tyrosine kinase has become a treatment strategy in AML patients possessing FLT3 mutations. The most common mutations are internal tandem duplications (ITD) within exon 14 and a single nucleotide polymorphism (SNP) that leads to a point mutation in the D835 of the tyrosine kinase domain (TKD). Variations in the ITD sequence and the occurrence of other point mutations that lead to ligand-independent FLT3 receptor activation create difficulties in developing personalized therapeutic strategies to overcome observed mutation-driven drug resistance. Midostaurin and quizartinib are tyrosine kinase inhibitors (TKIs) with inhibitory efficacy against FLT3-ITD, but exhibit limited clinical impact. In this review, we focus on the structural aspects of the FLT3 receptor and correlate those mutations with receptor activation and the consequences for molecular and clinical responsiveness towards therapies targeting FLT3-ITD positive AML.
机译:急性髓性白血病(AML)是一种侵略性的血液癌,其特征在于未成熟的骨髓泡泡细胞的快速增殖,导致高死亡率。 AML患者的5年整体生存率约为25%。大约35%的患者在FLT3基因中携带突变,其预后差。靶向FLT3受体酪氨酸激酶已成为具有FLT3突变的AML患者的治疗策略。最常见的突变是外显子14内的内部串联重复(ITD)和引入酪氨酸激酶结构域(TKD)的D835中的点突变。 ITD序列的变化和导致与符合邻无型的FLT3受体激活的其他点突变的发生产生困难发展个性化治疗策略以克服观察到的突变驱动的抗药性。中豚和Quizartinib是酪氨酸激酶抑制剂(TKI),具有针对FLT3-ITD的抑制效果,但表现出有限的临床影响。在本文中,我们专注于FLT3受体的结构方面,并将这些突变与受体激活的相关性和对靶向FLT3-ITD阳性AML的治疗的后果和临床反应的后果。

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