Scientific Publications by FDA Staff

Clin Cancer Res 2019 Oct 15;25(20):6021-5

FDA approval summary: glasdegib for newly-diagnosed acute myeloid leukemia.

Norsworthy KJ, By K, Subramaniam S, Zhuang L, Del Valle PL, Przepiorka D, Shen YL, Sheth CM, Liu C, Leong R, Goldberg KB, Farrell AT, Pazdur R

On November 21, 2018, the Food and Drug Administration approved glasdegib (Daurismo; Pfizer, New York, NY), a small molecule Hedgehog inhibitor, in combination with low-dose cytarabine (LDAC) for treatment of newly-diagnosed acute myeloid leukemia (AML) in adults >/= 75 years or with comorbidities that preclude use of intensive induction chemotherapy. Evidence of clinical benefit came from Study BRIGHT AML 1003, a randomized trial comparing glasdegib+LDAC to LDAC alone for treatment of newly-diagnosed AML in 115 patients either >/= 75 years old or >/= 55 years old with pre-existing comorbidities. Efficacy was established by improved overall survival (OS) with the combination compared to LDAC alone (hazard ratio [HR] 0.46 [95% CI 0.30-0.71], 1-sided stratified log-rank p=0.0002). Median OS was 8.3 months with the combination and 4.3 months with LDAC alone. Common adverse reactions included cytopenias, fatigue, hemorrhage, febrile neutropenia, musculoskeletal pain, nausea, edema, dyspnea, decreased appetite, dysgeusia, mucositis, constipation, and rash. The label includes a boxed warning for embryo-fetal toxicity and a warning for QT interval prolongation. There is a limitation of use for patients with moderate-to-severe hepatic and severe renal impairment; trials studying glasdegib in these patient populations are required as a condition of this approval.