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AML Treatment: Benefits of Avoiding High-Dose Chemotherapy

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Published on August 2, 2019

Should acute myeloid leukemia (AML) patients stay away from intensive chemotherapy? During this Ask the Expert segment, Dr. Daniel Pollyea, from the University of Colorado School of Medicine, discusses treatment toxicities, advances in AML research and where chemotherapy fits in today’s landscape. Watch now to learn his expert knowledge about AML chemotherapy.

This program is sponsored by AbbVie, Inc and Genentech, Inc. It is produced by Patient Power in partnership with The Leukemia & Lymphoma Society (LLS) and NeedyMeds. These organizations have no editorial control, and Patient Power is solely responsible for program content.

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Transcript | AML Treatment: Benefits of Avoiding High-Dose Chemotherapy

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.

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:        

Now, we got a lot of questions, Dr. Pollyea about the effects of chemo in many people. We've talked about older people are often not strong enough to deal with it. So, are we moving away from chemo, or you mentioned even with venetoclax (Venclexta) somebody might have a low dose of chemo, but people are concerned about the side effects, or whether they can withstand them?

Dr. Pollyea:                

That is our greatest concern, as well. I think intensive chemotherapy regiments for older patients, I shudder at the thought of that. Even the healthiest older patients, when you expose them to these intensive chemotherapy regiments can have very poor outcomes. And I often will tell patients that depending on the situation, a person has upwards of a 20 percent chance of death from the treatment, not from their disease. We really, at our institution, I know others have varying degrees of thoughts on this, but at least at our institution, we really do our best to avoid that experience, for almost all older patients, to expose them to that intensive chemotherapy. 

Now, in years past, there weren't many other viable options, and so you tolerated a great deal of risk because of the reality that there were few, if any, other treatment options. So, if you didn’t expose your patient to this horrible intensive chemotherapy regiment, then they would die of their disease. So, you made that calculation. The landscape is really different now. 

And so, we have two FDA approved therapies that are lower intensity for a newly diagnosed AML patient. One I already referred to is the venetoclax. A second is called glasdegib (Daurismo), that works a different way. And actually, as of yesterday, a third was – I alluded to this before, if you have an IDH1 mutation, and you're a newly diagnosed patient who's either older or can't tolerate intensive chemotherapy, then the FDA has said now that you can be prescribed an IDH1 inhibitor, previously that drug has only be approved in the relapse setting, but now it's available in the untreated or newly diagnosed setting. 

So, in the end, that's a long answer to the question, but the shorter answer is, yes, we need to get away from intensive chemotherapy, particularly for older patients. I would like if I could look at a crystal ball, I would like to see in five, seven, 10 years that the amount of intensive chemotherapy we're giving to any patient, younger or older is very limited, low. I would hope that that's the direction the field is going to.

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.