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Perhaps the most compelling data regarding the synergy of APR-246 and azacitidine originates from the clinical activity in TP53 mutant MDS/AML patients, where recent data report an overall and complete remission rate of 87% and 53%, respectively ( clinicaltrials.gov identifier: NCT03072043 ).9 Similarly, preliminary results from a phase II study of APR-246 and azacitidine by the Groupe Francophone des Mylodysplasies ( clinicaltrials.gov identifier: NCT03588078 ) showed comparable response rates.10 Accordingly, the US Food and Drug Administration has recently granted breakthrough therapy designation for the treatment of patients with TP53 mutant MDS with the combination of APR-246 and azacitidine and the randomized phase III study of APR-246 and azacitidine versus azacitidine is ongoing in MDS patients ( clinicaltrials.gov identifier: NCT03745716 )

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Beyond direct damage markers, intracellular antioxidant and repair systems also exhibit corresponding changes