Magrolimab plus azacitidine vs physician's choice for untreated TP53-mutated acute myeloid leukemia: the ENHANCE-2 study.

Autores de IIS La Fe

• Pau Montesinos Fernández

  Autor

Participantes ajenos a IIS La Fe

• Zeidner, Joshua F
• Sallman, David A
• Recher, Christian
• Daver, Naval G
• Leung, Anskar Yh
• Hiwase, Devendra K
• Subklewe, Marion
• Pabst, Thomas
• Larson, Richard A
• Wilde, Lindsay
• Enjeti, Anoop K
• Kawashima, Ichiro
• Papayannidis, Cristina
• O'Nions, Jenny
• Johnson, Lisa
• Dong, Mei
• Huang, Julie
• Bagheri, Taravat
• Hacohen-Kleiman, Gal
• Lee, Calvin
• Vyas, Paresh

Grupos

• Hematología y Hemoterapia

Abstract

Patients with TP53-mutated acute myeloid leukemia (AML) have an extremely poor prognosis, necessitating new treatments. The global, randomized, phase 3 ENHANCE-2 trial evaluated the anti-CD47 monoclonal antibody magrolimab plus azacitidine (Magro/Aza) for previously untreated TP53-mutated AML. Patients determined inappropriate for intensive therapy were randomized to receive Magro/Aza or venetoclax plus azacitidine (Ven/Aza); those appropriate for intensive therapy were randomized to receive Magro/Aza or 7+3 induction chemotherapy. Primary endpoint was overall survival (OS) in the non-intensive arm. At interim analysis, non-intensive-arm OS hazard ratio (HR) between treatment groups was 1.191 (95% CI, 0.744-1.906), meeting the study's definition for futility and resulting in study termination. At final analysis, median OS was 4.4 vs 6.6 months (HR, 1.132; 95% CI, 0.783-1.637; P = .5070) in the non-intensive arm (n = 205) and 7.3 vs 11.1 months (HR, 1.434; 95% CI, 0.635-3.239; P = .3798) in the intensive arm (n = 52) between Magro/Aza and control groups, respectively. Incidences of grade =3 adverse events (AEs) were similar across Magro/Aza and control groups (non-intensive, n = 194: 96.9% and 95.9%; intensive, n = 50: 92.6% and 95.7%), including grade =3 anemia (non-intensive: 27.1% and 23.5%; intensive: 25.9% and 21.7%). Grade =3 infections were observed in 50.0% and 53.1% of patients in the non-intensive arm and 44.4% and 65.2% of intensive arm patients. ENHANCE-2 did not meet its primary endpoint of OS in TP53-mutated AML but provides important data informing future studies in this challenging population. This trial was registered at www.clinicaltrials.gov as #NCT04778397.

Copyright © 2025 American Society of Hematology.

Keywords

• AML