This plant alkaloid originally isolated from the evergreen tree Cephalotaxus and in use for acute and chronic leukemias for over 25 years in China, will soon become available in a semisynthetic formulation (omacetaxine). This agent has now been proven to be safe and effective in patients with Chronic Myeloid Leukemia (CML) with T315I mutation. It should be noted that approximately 15% of the patients resistant to imatinib and 30% resistant to dasatinib and nilotinib harbor T315I mutation. The mechanism of action of this compound is independent of tyrosine kinase inhibiton. This drug is administered as a subcutaneous injection and is a giant leap in overcoming resistance to Tyrosine Kinase Inhibitors (TKI) in CML patients.
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