Midostaurin (Rydapt)

General information

Class/mechanism: FLT3 inhibitor, tyrosine kinase inhibitor (TKI). Midostaurin or its active metabolites CGP62221 and CGP52421 inhibit activity of wild type FLT3, FLT3 mutant kinases (ITD and TKD), KIT (wild type and D816V mutant), PDGFRα/β, VEGFR2, and members of the serine/threonine kinase PKC (protein kinase C) family. Midostaurin induced apoptosis in leukemic cells expressing ITD and TKD mutant FLT3 receptors or overexpressing wild type FLT3 and PDGF receptors. Midostaurin also causes apoptosis in mast cells and inhibits histamine release, proliferation, and KIT signaling.
Route: PO
Extravasation: n/a

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is used

• Acute myeloid leukemia, FLT3+
• Myelodysplastic syndrome
• Systemic mastocytosis

Patient drug information

• Midostaurin (Rydapt) package insert

History of changes in FDA indication

• 2017-04-28: FDA approved for the treatment of adult patients with newly diagnosed acute myeloid leukemia (AML) who are FLT3 mutation-positive (FLT3+), as detected by an FDA-approved test, in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation. (Based on RATIFY)
• 2017-04-28: FDA approved for the treatment of adults with aggressive systemic mastocytosis (SM), SM with associated hematological neoplasm, or mast cell leukemia. (Based on CPKC412D2201 and CEREMAST)

History of changes in EMA indication

• 2017-09-18: Initial authorization in combination with standard daunorubicin and cytarabine induction and high dose cytarabine consolidation chemotherapy, and for patients in complete response followed by Rydapt single agent maintenance therapy, for adult patients with newly diagnosed acute myeloid leukaemia (AML) who are FLT3 mutation positive.
• 2017-09-18: Initial authorization as monotherapy for the treatment of adult patients with aggressive systemic mastocytosis (ASM), systemic mastocytosis with associated haematological neoplasm (SM AHN), or mast cell leukaemia (MCL).

Other information

1. Heidel F, Solem FK, Breitenbuecher F, Lipka DB, Kasper S, Thiede MH, Brandts C, Serve H, Roesel J, Giles F, Feldman E, Ehninger G, Schiller GJ, Nimer S, Stone RM, Wang Y, Kindler T, Cohen PS, Huber C, Fischer T. Clinical resistance to the kinase inhibitor PKC412 in acute myeloid leukemia by mutation of Asn-676 in the FLT3 tyrosine kinase domain. Blood. 2006 Jan 1;107(1):293-300. Epub 2005 Sep 8. link to original article PubMed

Also known as

• Code name: PKC-412
• Brand names: Rydapt, Tauritmo