Published on February 21, 2020
- Azacitidine (Vidaza) is being used as a maintenance protocol for AML patients to prolong survival and delay or prevent disease recurrence.
- In combination, (Vidaza) and venetoclex (Venclexta) have become a standard of care for older patients who are not good candidates for intensive chemotherapy.
- Moving to oral therapies is allowing more patients to receive outpatient care.
Acute myeloid leukemia experts Dr. Eunice Wang from Roswell Park Comprehensive Cancer Center and Dr. Uma Borate from Oregon Health & Science University discuss a new formulation of azacitidine (Vidaza)—an oral medication that is being used post-chemotherapy as a maintenance protocol to prolong survival and delay or prevent AML from recurring.
The experts also share response rates when using oral combination therapies as an alternative to intensive chemotherapy—a game-changer for older patients and important to all patients, as these oral therapies often allow for outpatient care. Watch now to find out more
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Transcript | New Oral Therapies Allow for Outpatient Care
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There are a lot of exciting new therapies and lot of exciting new approaches that are in development. Some of the most exciting news that I’ve seen is the development of an oral drug, that can actually be used for what we call maintenance therapy. So, patients that are getting up-front intensive chemotherapy, often times when they finish their therapy, we just stop, and unfortunately, up to half of those patients could relapse. Now there is an oral version of a drug called azacitidine (Vidaza), which has been shown, if you take it for a couple weeks out of every month, that it can dramatically prolong survival and prevent the disease from coming back, so it’s...
That’s not a new drug.
...no, it’s a new formulation. It’s an oral formation of a drug that we typically use for combination of up-front therapy for myelodysplastic syndrome, and AML. And this new pill version, convenience-wise, adherence-wise, compliance-wise is offering a way to, on a day-to-day basis, potentially delay, or prevent the disease from recurring. So, I think that is a major development, and I think we’re going to see more of that drug. I think we’re moving further and further into oral chemotherapy for our disease, away from that high, intensive chemotherapy that requires people to be in the hospital for weeks and weeks and weeks.
One of the drugs I’ve heard about, also another oral. I have chronic lymphocytic leukemia, so they came out with this drug, venetoclax (Venclexta), that’s used in AML as well, sometimes in combination with others.
Yes, so, venetoclax has astonishingly now also become a standard of care therapy for acute leukemias, based on some of the data and the safety profile from individuals like yourself, who have taken it for chronic leukemia. It has improved the results of azacitidine for acute myeloid leukemia patients. We’re now seeing about two-thirds of patients with newly diagnosed acute myeloid leukemia, particularly older individuals, 70s, 80s, patients that don’t want to get intensive chemotherapy, be able to take a pill and a shot chemotherapy together and have a response rate of 60 percent to 70 percent.
That’s a game-changer for us, and that type of chemotherapy can be continued in the outpatient setting. So, that sort of changed the way we think about it. Now, we used to think high-dose chemotherapy put you in the hospital, nausea, vomiting, low blood counts, and now we’re moving towards being able to treat older individuals safely in their own homes.
Dr. Borate, you’ve been nodding your head. So, typically people with AML are older. So, here, having these oral therapies then, as Dr. Wang was saying, it’s a game-changer as people can live a more normal life.
That’s correct, and just to elaborate a little bit of what’s already been mentioned, as Dr. Zeidan said, the first step is really testing and figuring out if you have AML, but also, what are the different genetic changes, also known as mutations, that are present in your AML? Based on the type of mutations that are present in your AML, we have different therapies that can target those mutations. The majority of them are now oral therapies, so a common mutation is an IDH1, so a lot of letters and numbers, or IDH2, and now we have two approved oral agents that you can actually give patients that they can take in their own homes.
And just as you mentioned combining this drug called azacitidine with another oral agent called venetoclax. We could combine, and there’s data presented at this meeting on combining these different oral agents that are targeted for IDH1 and IDH2 mutations, that is azacitidine. that can then even improve on the response that we’re seeing in AML patients that have these particular mutations.