Will long-term use of Midostaurin cause resistance and countermeasures?

Midostaurin is an oral multi-target tyrosine kinase inhibitor, mainly used to treat FLT3 mutation-positive acute myeloid leukemia (AML) and other related tumors. Drug resistance is a common clinical problem during long-term use of targeted drugs. The resistance mechanisms of midostaurin mainly include the further evolution of FLT3 receptor mutations in tumor cells, compensatory activation of downstream signaling pathways, and changes in drug metabolism enzymes. The occurrence of drug resistance may lead to the progression of blood diseases, the inability to maintain blood cell indicators, or the weakening of therapeutic effects.

During long-term use of midostaurin, clinicians often detect signs of resistance in advance by regularly monitoringFLT3 mutation status, routine blood tests, and bone marrow assessment. Once blood disease progresses or indicators decline, the type of drug resistance should be evaluated in combination with molecular testing results. Some resistance may be related to specific secondary mutations in FLT3, while other resistance may involve activation of alternative signaling pathways. This classification helps guide subsequent treatment selection and strategy adjustments.

Strategies to deal with drug resistance mainly include drug dose optimization, combination therapy and replacement of targeted drugs. For patients with early-stage drug resistance or slow progression, doctors may appropriately adjust the dose under strict monitoring and form a combination regimen in combination with chemotherapy or other targeted drugs to delay the occurrence of drug resistance. For resistance caused by secondary mutations, it may be necessary to replace new FLT3 inhibitors that are sensitive to the mutation. In addition, combination therapies explored in clinical trials also provide new treatment options for drug-resistant patients.

While using midostaurin, patients should pay close attention to changes in their blood indicators and symptoms, such as fatigue, fever, bleeding or infection. Once abnormalities occur, they should be reported to the doctor immediately so that the treatment plan can be adjusted in a timely manner. Standardized and scientific monitoring and individualized intervention are the keys to delaying the occurrence of drug resistance and ensuring the effectiveness of treatment. With early identification and appropriate strategies, most patients can maintain blood disease control and quality of life during long-term treatment.

Reference materials:https://www.drugs.com/