Finding a Match for AML Therapy: How Are Genetic Test Results Used?

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Andrew Schorr:

So now the testing comes back. This next generation sequencing, which is so cool now to see your cancer genes, what cancer genes are active, what could be driving your acute myeloid leukemia, and it says this gene.  And I know they have a lot of different letters, IDH, FLT3.  You could probably name a whole bunch others that different drugs have been developed for. So it comes back with this letters and you say, ah?ha, if we have a drug that targets that we can tamp this down. Right?   

Dr. Borate:

Yep.  

Andrew Schorr:

Are these drugs infused? Are they pills?  My understanding is now you have some pills that people can take as well.  

Dr. Borate:

So I think that's one of the really cool things moving forward is most of these new targeted agents are actually oral, so medications, so pills that patients can even take at home to treat their leukemia.  

So just to back up a little bit, once we get back this genetic testing and we know their mutations and like you said IDH1, IDH2, FLT3, these are all mutations that can be targeted, we also determine a little bit??and this can be somewhat arbitrary but is determined more by the patient, their age, their ability to, you know, how able are they to do their day?to day activities?  Are they somebody who really is not even able to go to the grocery store without being really tired?  We call it, for lack of a better word, performance status.  How do they do in their everyday life?  

So we take all these factors to consider two broad categories:  Is the patient what we call fit versus, and I know this is not the kindest word, we call it unfit.  And I think those broad categories then lead us to what type of therapy should the patient get.  Should they get what we call intensive induction, meaning we still give them very broad chemotherapy to kill all the leukemia, but now we're adding targeted therapy to the chemotherapy so that you give this double?whammy?  You knock them with chemo, and you knock it also with the targeted therapy.  

However, if you happen to be 85 and you're a very functional 85, maybe, but you're not somebody whose organs can tolerate this heavy intensive chemotherapy or a transplant in the future, then we go with what we call more therapy that's what we call less intense even though it might be IV, but then we add these targeted agents which they can take at home as a pill and then they're not in the hospital as much. They get this therapy as an outpatient while they're getting treatment for their AML.  So it's very different based on our goals of care, the patient in front of us and what mutations they have.  

Andrew Schorr:

Okay.  So increasingly now you may??maybe somebody would get some chemo, working on approaches where you don't lose your hair.  

Dr. Borate:

Yes.  

Andrew Schorr:

You don't develop mouth sores. 

Dr. Borate:

Yes.  

Andrew Schorr:

Or ad nauseam.  You're working a lot on lowering the toxicity.  

Dr. Borate:

Correct.  

Andrew Schorr:

And, Don, I know you went through that you're being prepared for a transplant, heavy?duty.  But that's been ameliorated to a greet degree for many people.  

Dr. Borate:

Yes.  

Andrew Schorr:

And then somebody may be on a pill.  Now, do you have a growing range of treatments so if you try one and it doesn't work or it doesn't last you have something else?  It's kind of like an antibiotic.  The doctor says we're going to try this antibiotic.  No.  Your swollen glands and lymph nodes, it's not going away.  Let's go to this one.  

Dr. Borate:

We absolutely do.  And I think that's sort of the next frontier is what we call sequencing.  How do you sequence treatments so that you can continue to get a good response even when the patient fails a treatment and the leukemia decides or figures out how to outsmart that treatment?  And unfortunately that still happens even with targeted therapies that over time the leukemia figures out a way to survive despite a very targeted approach. And so how do you come back in with a different drug that can still work?  And how do you sequence those drugs to give them maximum effect but the least toxicity as you said, to the patient?  And those are sort of our next frontiers of clinical trials and therapy. 

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.