Breakthrough in precision medicine for treatment of acute myeloid leukaemia

Researchers at Karolinska Institutet, among others, have studied the benefit of adding an established drug as a novel targeted therapy in the treatment of acute myeloid leukaemia (AML). The results suggest that the drug hydroxyurea can increase treatment efficacy at a relatively low cost. The results, which were published in the Journal of Internal Medicine, could have significant implications for cancer treatment, including in low-income countries.

Acute myeloid leukaemia (AML) is an aggressive blood cancer with high mortality that affects around 350 people in Sweden each year. The 5-year relative survival rate after a myeloid leukaemia (AML) diagnosis is 30%. One reason for the high mortality is that responses to chemotherapy are often insufficient, and a large proportion of patients relapse a few months to several years after treatment.

SAMHD1, the protein in the leukaemia cell, has been shown to act as a resistance factor to the drug cytarabine, which is used to treat AML and other blood cancers. A translational research project, with researchers from Karolinska Institutet and Karolinska University Hospital, showed that the drug hydroxyurea, which inhibits the growth of cancer cells, also inhibits SAMHD1 and thus makes chemotherapy with cytarabine more effective.

More efficient in killing leukaemia cells

The results are based on a study that included nine patients with AML, where the standard therapy was supplemented with hydroxyurea in order to enhance the effect of cytarabine. The study was conducted between October 2020 and March 2021.

Image:

Martin Jädersten and Nikolas Herold

Caption:

(From left) Martin Jädersten and Nikolas Herold.
Photo: Josefine Franking

“The results from our study are very promising. All patients have responded remarkably well to the treatment and the addition of hydroxyurea has been well tolerated. We have in parallel also validated in the lab that the combination produced a higher concentration of the active cytotoxic agent inside the leukaemia cells, and that it was more efficient in inducing leukaemia cell death”, says the study’s first author Martin Jädersten, researcher at the Department of Medicine, Huddinge, Karolinska Institutet, and senior physician in haematology at Karolinska University Hospital Huddinge.

It can take over 15 years to develop a new drug, and it is not uncommon for a drug to have a lifespan of less than 15 years. In this case, the researchers were able to go from discovery to the publication of a clinical trial in just five years.

“Hydroxyurea has previously been used in leukaemia as a mitigating therapy, but we are using it now for a new purpose – as a modern precision medicine. Since we are able to repurpose an already existing and approved drug, the additional cost per patient will be a couple of hundred kroner, i.e. about the same as a pack of pain relievers. This also means that the treatment is available in less resource-rich countries around the world”, says the study’s last author, Nikolas Herold, researcher at the Department of Women’s and Children’s Health, Karolinska Institutet and paediatrician in paediatric oncology, Astrid Lindgren’s Children’s Hospital in Solna.

The study is an example of translational research, where the clinical problem of treatment failure is examined in a laboratory environment and the cause of the failure is mapped. In the next stage, strategies will be developed to override this resistance and study the efficacy of the therapy in clinical trials. Further studies are needed to evaluate whether the addition of hydroxyurea can become a part of the standard therapy for the treatment of AML.

The research was funded by the Center for Innovative Medicine (CIMED), the Swedish Childhood Cancer Fund, the Knut and Alice Wallenberg Foundation, the Foundation for Strategic Research, the Swedish Research Council, the Swedish Cancer Society, the Jeansson Foundation, the Märta and Gunnar V Philipson Foundation, Region Stockholm, the Sjöberg Foundation, Radiumhemmets Forskningsfonder (the Cancer Research Funds of Radiumhemmet) and the Swedish Medical Association. Two of the researchers are employed by organisations unrelated to this study. The authors declare that there is no conflict of interest.

This article is based on a Swedish press release from Karolinska University Hospital.

Publication

Targeting SAMHD1 with Hydroxyurea in First-line Cytarabine-based Therapy of Newly Diagnosed Acute Myeloid Leukaemia: Results from the HEAT-AML Trial“. Martin Jädersten, Ingrid Lilienthal, Nikolaos Tsesmetzis, Magda Lourda, Sofia Bengtzén, Anna Bohlin, Cornelia Arnroth, Tom Erkers, Brinton Seashore-Ludlow, Géraldine Giraud, Giti Shah Barkhordar, Sijia Tao, Linda Fogelstrand, Leonie Saft, Päivi Östling, Raymond F Schinazi, Baek Kim, Torsten Schaller, Gunnar Juliusson, Stefan Deneberg, Sören Lehmann, Georgios Z Rassidakis, Martin Höglund, Jan-Inge Henter, Nikolas Herold. Journal of Internal Medicine, online Aug. 7, 2022, doi: 10.1111/joim.13553.

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