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A Rapidly Changing AML Treatment Landscape

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Published on January 28, 2020

Key Takeaways

  • More options are available now, where previously all patients were treated with an intensive AML chemotherapy regimen. 
  • Treatment is based on the heterogeneity of AML based on mutations.
  • Clinical trials are looking at combinations of new drugs to better treat AML patients.

Acute myeloid leukemia expert Dr. Tapan Kadia from The University of Texas MD Anderson Cancer Center, shares insight on the numerous drug approvals for AML and explains how treatment strategies are changing from AML chemotherapy. Watch as Dr. Kadia discusses the shift from treating all patients with intensive chemotherapy, to now using oral or lower-intensity regimens based on a person’s mutational status.

This is a Patient Empowerment Network program produced by Patient Power. We thank Astellas, Celgene Corporation, Daiichi Sankyo and Jazz Pharmaceuticals for their support. These organizations have no editorial control. Patient Power is solely responsible for program content.

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Transcript | A Rapidly Changing AML Treatment Landscape

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:          

Dr. Kadia, how quickly have things been changing in AML with the tools that you have and what you see coming?

Dr. Kadia:                   

Quite rapidly. Just in the last few years, we’ve had numerous drug approvals in AML. I talked earlier about the heterogeneity of AML based on the mutations, and people have worked out the biology of a lot of these mutations, and now, we understand that several of these mutations or changes in the DNA actually affect how the leukemia is driven, and so, people have developed inhibitors to these mutations.

So, things are changing rapidly. We went from previously treating everyone with one specific intensive chemotherapy regimen, 7+3, at many places around the country, to now, going to the lower-intensity regimens Dr. Desai talked about, including things like the addition of venetoclax (Venclexta) to hypomethylating agents, the addition of FLT3 inhibitors to chemotherapy. More recently, IDH-1 and -2 inhibitors, which are oral pills, which can be used either as a single agent or in combination with chemotherapy on clinical trials.

And so, things have really changed rapidly, and they’ve continued to evolve. Now that we’re becoming more comfortable with using some of these drugs, we’re now doing clinical trials looking at combinations of many of these drugs to understand how we can best match the leukemia that the patient has to the therapies that we potentially have available. So, the toolbox is quite full where, previously, we only had a couple of tools, but we’re figuring out how to add these things together.

One thing I would say, just as a caveat on a previous question, although many of these new therapies are oral medications and they’re lower intensity, I think it’s important to remember that they’re still pretty myelosuppressive drugs, and what I mean by that is your blood counts still drop pretty significantly. Some of these things can cause a syndrome called tumor lysis syndrome, where your white count or your leukemia dives rapidly, and then, certain electrolytes and blood tests can become abnormal frequent.

So, I want to emphasize the point that Dr. Desai made, that although you may be outpatient, we really follow the patients closely, almost as if they were inpatient, with either daily or every-other-day testing. In fact, at MD Anderson in Houston, even some of our older patients receiving lower-intensity therapy with these new drugs, we often hospitalize them for a period of time because that first month, that induction month, we really want to make sure that everything goes smoothly. So, they may feel well, like they’re not getting intensive chemotherapy, but there are still surrounding matters we need to address.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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