Fax: (216) 636-0636
A phase 2 trial of combination therapy with thalidomide, arsenic trioxide, dexamethasone, and ascorbic acid (TADA) in patients with overlap myelodysplastic/myeloproliferative neoplasms (MDS/MPN) or primary myelofibrosis (PMF)†
Article first published online: 16 DEC 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 16, pages 3968–3976, 15 August 2012
How to Cite
Bejanyan, N., Tiu, R. V., Raza, A., Jankowska, A., Kalaycio, M., Advani, A., Chan, J., Saunthararajah, Y., Mooney, L., Maciejewski, J. P. and Sekeres, M. A. (2012), A phase 2 trial of combination therapy with thalidomide, arsenic trioxide, dexamethasone, and ascorbic acid (TADA) in patients with overlap myelodysplastic/myeloproliferative neoplasms (MDS/MPN) or primary myelofibrosis (PMF). Cancer, 118: 3968–3976. doi: 10.1002/cncr.26741
Presented in part at the 49th Annual Meeting of the American Society of Hematology; December 8-11, 2007; Atlanta, Georgia.
- Issue published online: 3 AUG 2012
- Article first published online: 16 DEC 2011
- Manuscript Accepted: 25 OCT 2011
- Manuscript Revised: 16 OCT 2011
- Manuscript Received: 30 AUG 2011
- arsenic trioxide;
- and ascorbic acid;
- myelodysplastic/myeloproliferative neoplasms;
- primary myelofibrosis;
Primary myelofibrosis (PMF) and overlap myelodysplastic/myeloproliferative neoplasms (MDS/MPN) are clonal hematopoietic disorders that share similar clinical features and molecular abnormalities, such as the Janus kinase 2 (JAK2) valine to phenylalanine mutation at codon 617 (V617F) and the tet methylcytosine dioxygenase 2 (TET2) mutation. There are limited therapeutic options available for these diseases, and single agents have only modest efficacy. In this phase 2 study, the authors combined multiple active agents (thalidomide, arsenic trioxide, dexamethasone, and ascorbic acid [TADA]) to treat patients with these disorders.
This multicenter trial was conducted from January 2005 to July 2007. The primary endpoint was to evaluate the efficacy of TADA therapy. Patients received the combination for one 12-week cycle followed by maintenance thalidomide for an additional 3 months. Response was assessed using International Working Group criteria.
Among 28 enrolled patients, the median age was 66.5 years; 15 patients had MDS/MPN-unclassifiable, 8 patients had chronic myelomonocytic leukemia type 1, and 5 patients had PMF. Approximately 60% of the patients had normal cytogenetics. The JAK2V617F mutation was detected in 5 of 14 tested patients, and TET2 mutations were detected in 2 of 8 tested patients. Almost half of the patients had splenomegaly. With a median on-study follow-up of 5.7 months, 21 patients (75%) completed the entire 12-week course of therapy, and 6 patients (29%) responded to TADA. With a median extended follow-up of 24.1 months for 15 evaluable patients, the median progression-free survival was 14.4 months, and the median overall survival was 21.4 months.
The TADA regimen yielded clinical responses in patients with PMF and MDS/MPN. To the authors' knowledge, this study represents the first trial targeting this patient population. The results indicated that it is reasonable to incorporate multiple novel agents in the treatment of these rare diseases. Cancer 2012. © 2011 American Cancer Society.