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AML Combined Therapies Are Changing Outcomes

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Published on June 2, 2020

Using drug therapies in combination to target multiple pathways within an AML patient's leukemia is proving far more effective than individual drugs on their own. Watch as Dr. William Donnellan, Director, Leukemia/Myelodysplastic Syndromes Research, Sarah Cannon Research Institute, discusses current protocols when using breakthrough drugs in combination and where combination therapy is headed next.

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Transcript | AML Combined Therapies Are Changing Outcomes

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:

Hello, and welcome to Patient Power. I'm Andrew Schorr in Southern California, near San Diego. Joining me is an expert in leukemia and in leukemia research, Dr. William Donnellan, who is Director of the Leukemia Myelodysplastic Syndrome Research Program at the Sarah Cannon Research Institute based in Nashville, Tennessee. Dr. Donnellan, thanks for being with us.

Dr. Donnellan:

Andrew, thank you for having me. Glad to be here.

Andrew Schorr:

Dr. Donnellan, we've seen an explosion of new drugs and really an increasing pace of research for acute myelogenous leukemia. It offers great hope now that patients can get the care that's right for them and at the right time, doesn't it?

Dr. Donnellan:

Explosion is the right term. For decades, there were no new treatments really approved for certain types of acute leukemia, the most common in adults being acute myeloid leukemia. And then, in 2017, there were a number of new drugs approved, and that was followed by more drugs in 2018 and 2019. So, we certainly have many more therapies in the last three years than we have for a long, long time. And a lot of these therapies are really allowing us to treat patients individually based on their overall health, their type of leukemia, and then going even deeper, the specific mutations that their leukemia harbors.

Andrew Schorr:

Would you classify some of these new treatments as breakthroughs?

Dr. Donnellan:

Absolutely. I think we've been needing these breakthroughs for a long time. For many, many patients, what's been the standard of care has either not worked, or it only works for a period of time, and then it stops working. I think one of the biggest breakthroughs that we've seen in the last three years is the approval of a new drug called venetoclax (Venclexta) for acute myeloid leukemia. Now, previously, for patients diagnosed with AML or acute myeloid leukemia, there weren't a whole lot of options. You could give high-dose chemotherapy or not. And if patients were a little bit older, a little bit less healthy, there was a lot of risk of taking that high-dose chemotherapy. And so, what venetoclax has allowed us to do is to treat those older patients or patients who might have other health problems with a very effective combination. And we're seeing remission rates with venetoclax-based therapy that are almost as good, if not better, in some cases than we were seeing what the intense chemo that we've been giving for many years.

Andrew Schorr:

The name of the game has also become combination therapy. For instance, venetoclax combined with another medicine or other medicines that you have or been developing, combining them in new ways, right?

Dr. Donnellan:

Exactly. Unfortunately for AML, it's such a complicated disease. There are so many different genetic mutations that drive the disease. I wish there was a silver bullet that could take out each one of those, but that's not the case. What we're learning is to target multiple pathways within individual patient's leukemia, and then take multiple drugs and combine those. And what we're seeing is when we combine their drugs, they seem to work a lot better together than either one individually. For instance, when venetoclax was first tested, it was tested by itself. It didn't work great. The remission rate was maybe about 10 percent or 15 percent, but when we combined it with another medication, a medicine called a hypomethylating agent, we saw our remissions over 60 percent. So, definitely combination therapy is the way the field is moving.

Andrew Schorr:

Wow. Okay. Now, we're talking about approved medicines that you have, and there have been a bunch. You're in research, so where are we headed?

Dr. Donnellan:

Where we're headed, I think, is we're building on the success that we've already established. Like I mentioned, the venetoclax therapy, it's approved with another medication. Now, we're taking triplets, three drugs, combining them to see if we can get even higher response rates. The other way the field's moving, just like, I think, a lot of areas of cancer, probably the most promising breakthroughs in the last decade have been immunotherapy. Taking the patient's immune system and somehow retraining the immune system to fight the cancer, that's been highly successful in other forms of acute leukemia like acute lymphoid leukemia, which is typically seen more in younger patients, in kids. It's been very effective in lymphoma, specifically non-Hodgkin lymphoma. And so now, we're adopting some of the techniques, the type of drugs that have been successful in those diseases, and we're using it for AML and myelodysplastic syndrome.

Andrew Schorr:

Let's talk about success stories. You had some pretty tough chemo approaches and things going back just a couple of years, and now, you have some very targeted approaches and even a bit kinder and gentler, if you will. Often, for people who may be pretty old with AML, not always, but pretty old, it sounds like this is giving people back some years.

Dr. Donnellan:

Absolutely. The average age of an AML diagnosis is over the age of 70. So, we're talking about older adults. And one of the goals is, not only to achieve a remission, but to improve people's quality of life so that they're living longer, but they're also living better. In a lot of these newer medicines, these targeted therapies, they have very few side effects. They don't have the typical side effects of hair loss, nausea, vomiting that we think of when we think of chemo. In some cases, it's just a pill that patients take once a day, and they go about their way and do the things they enjoy doing.

Andrew Schorr:

Okay. Now, it's not to say that there are no side effects. These are powerful medicines. But do you feel like you can manage those?

Dr. Donnellan:

The side effects are, really, we've made progress in two areas. One is creating therapies that have less side effects, but yes, all treatments, all drugs, whether it's cancer drugs, or other drugs, they do have side effects. But the other major advance in oncology over the last 10 or 20 years is supportive care. Improving the anti-nausea medicines that are available, medications for pain, for anxiety. In a lot of clinics like mine, we integrate a supportive care team with the oncology team, with the end goal of helping people to live better lives.

Andrew Schorr:

Okay. Well, I think this is great news in AML. Families touched by this illness, maybe, they never heard of and comes on pretty strong, and then for you and other specialists that you have tools to treat it, to give people back a life and a quality of life. Thank you so much for being with us. We wish you well in your research so that you can keep staying ahead of the game of this cancer and let people live longer and better. Dr. William Donnellan from the Sarah Cannon Research Institute in Nashville. Thank you so much for being with us.

Dr. Donnellan:

Thank you, Andrew. I appreciate the opportunity. Have a good night.

Andrew Schorr:

Okay. I'm Andrew Schorr. Remember, knowledge can be the best medicine of all.

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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