Published on March 5, 2020
Previously, elderly acute myeloid leukemia patients were told they were too old to tolerate treatment. Today, FDA-approved drugs have been developed specifically for patients 75 years old and up. Watch as experts Dr. Eunice Wang from Roswell Park Comprehensive Cancer Center and Dr. Amer Zeidan from Yale Cancer Center discuss therapies available to the older patient population, and why it’s important to seek out an AML specialist.
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Transcript | Therapies Making Treatment Possible for Older Patients
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Let me ask you, Dr. Wang. So, some people go to the emergency room. Is that flu-like symptoms?
How does it present, and then boom, you'ree upstairs in the hospital, and other people are not. So, how does it present? It varies, it seems, among people.
Yes, so, I mean this is a really rapidly moving disease. So, like Harry, you probably felt, when you think about it, you might have been feeling a little tired, a little weak, for probably a few days to weeks before this came about. So, because of the rapid rate at which the disease grows, it can be a little bit subtle, but most people present with compromise of their normal blood count. They have infection because their white count is low, or they’re really tired because their red cell count is low, or they’re bleeding because their platelets are low. Many of these individuals, you’re older. The median age is 67 to 70, many people, half of people, present over the age of 70. So, you just think, I’m just getting old, and it’s really hard to pick that up until you do some blood tests and a complete blood cell count.
Now, in the past, somebody like Harry yourself, you might have gone to the doctor and they would have said, “You have acute myeloid leukemia, and we’re not going to be able to do anything for you, because you’re too old for treatment. One of the great things and one of the major advances, I think, in the field of AML therapy is that we now have drugs and drug regimens specifically for people over the age of 75. You have to be 75 and above to really be eligible. You have to have some other problems for treatment with venetoclax (Venclexta) and azacitidine (Vidaza).
Seventy-eight, so you had your disease at just the right time. I mean really, I mean, and I think that our recognition that patients like you need treatment and can get treatment and can tolerate treatment, has, I think, really opened the field. I think if you had presented five years ago, 10 years ago, there’s a possibility that they might have said you’re too old for treatment.
Basically, go home or put your affairs in order is what had been said.
I think, also, the quick recognition, making the diagnosis, getting you to a major academic center, getting you to the specialist like Dr. Zeidan mentioned, that they were able to make that diagnosis quickly and start you on therapy, I think is outstanding by your primary care physician.
So, Dr. Zeidan, it used to be, that if someone was older with cancer, and Dr. Wang was just referring to this. That’s aging, that’s the way it goes, and the treatments we have are too hard. But now, Harry’s been treated, you seem to be doing pretty well today, that it’s tolerable even if you’re older or have other conditions. You might have diabetes, might have a heart condition, right? It’s tolerable.
Correct, and I think that’s very important, because for a long time as we just heard basically, the only option was really that strong chemo that, and patients who are older and have multiple medical problems, it can be too toxic, and we can end up doing more harm by giving those strong treatments. I think things have changed significantly, really from the mid-2000s, basically since 2004 when the first drug, the Vidaza, azacitidine was introduced. Since then I think there has been more use of this drug. However, until today, and I’ll show you some of the data we just presented in this meeting, like up to the year 2013, 40 percent of AML patients who are older in the U.S. are still not being treated with any kind of treatment, and I think some of that is related to the fact that probably some of it is lack of education, some of it is on the part of the physicians. Or some of it that those drugs don’t work particularly well, so I think getting the patients to the right specialist who can keep up with all the pace of all of those new therapies that are coming is extremely important, because things are really changing at a very rapid pace, and I think, one, we cannot cure leukemia in someone in your age, for example.
Our goal is to try to control it for as long as possible. Ultimately, I think, in an ideal world situation, to make it into a situation where it’s like diabetes, or hypertension, or someone can have it for many years, and even treat it with oral drugs. I think this is the way in which we are heading.
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