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Treatment Options for Newly Diagnosed AML

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Published on November 14, 2019

Key Takeaways

  • Standard of care for newly diagnosed AML patients.
  • New lines of AML therapy available.
  • Consult with an AML specialist when considering treatment options.

Patient Power host and advocate Carol Preston sits down with leading expert Dr. Gail Roboz from Weill Cornell Medicine to discuss treatment options and patient response rates for those newly diagnosed with acute myeloid leukemia (AML). Dr. Roboz provides an overview of the standard of care for AML, novel combination therapies, and how genetic mutations impact AML care. Watch now to learn more about therapies for newly diagnosed acute myeloid leukemia patients.

This program is sponsored by AbbVie, Inc., Genentech, Inc. and Adaptive Biotechnologies. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

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Transcript |

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.

Carol Preston:              

What treatments are available for newly diagnosed AML patients? And again, that’s a very broad-based question because of the subtypes. But tell us about some of the new treatments that you’re hopeful or excited about.

Dr. Roboz:                   

So, huge question. Huge. It covers a lot of…

Carol Preston:              

…well, let’s break it down and maybe just mention a couple right now.

Dr. Roboz:                   

So, conceptually making it very easy. What used to be the case was a combination regimen affectionately known as 7 and 3. 7 days of one drug and 3 days of the other. Cytarabine (Cytosar-U) and a drug called daunorubicin (Daunoxome) or idarubicin (Idamycin) has been the standard of care for newly diagnosed patients in good shape to handle intensive chemotherapy since the late 1950s. Currently, that regimen can actually be built on by the addition of newer things which might be applicable for some patients.

For example, 7 plus 3 can be combined with a FLT3 inhibitor if you actually have a FLT3 mutation. Some patients even today in 2019 will be treated with 7 and 3 and I have to say, more patients have been cured with standard chemotherapy than anything else with AML. So, don’t be put off by the fact that it’s old, because it doesn’t mean that it doesn’t work. There are many patients who boast newly enter remission with a regimen that was developed actually before I was born.

Now, that said what we’re trying to do especially for older and more frail patients is not deploy that particular combination, which is often not possible for patients well into their late 70s, 80s and beyond. And there had historically been low-intensity regimens. Things like azacitidine (Vidaza), decitobine (Dacogen), and low-dose cytarabine have typically been used. Safer for patients but much lower rates of remission. For older patients who fall into the category of not getting intensively treated, the addition of a drug called venetoclax (Venclexta) which Carol, you will know a lot about from CLL world. That drug was originally approved in CLL.

It has excellent activity in AML in combination with azacitidine, discytobine, or low dose cytarabine that is pushing the complete remission possibilities for older patients, much higher than what we’ve had before. In addition to that, there’s a lot going on with trying to add on specific inhibitors for IDH 1, IDH 2, and FLT3 mutations to learn how to mix and match those novel agents with existing backbones so that patients can be treated with the highest remission and response rates possible. Within all of that though, you’ve got to ask what’s the right one for you and there are lots of important factors that go into the making of the decision what the choice is but we have a choice now and we haven’t for many years.

In AML, we kind of had two options: less intensive and more intensive and that was the end of the story. Things are better now.

Carol Preston:              

So, that is a huge takeaway for those of you listening and watching. There are choices today that did not exist two years ago. The other takeaway that I’m hearing given the level of detail that a specialist like Dr. Roboz can go into is if you possibly can, at least one consultation with somebody who specializes in this disease. If you’re in a regional or a community hospital, see if you can get a referral or visit a major medical center that’s close to you where there is an AML specialist. There’s just so much happening in the field right now. It’s tough for your very fine community oncologists to keep up with the 10, 12 or 15 types of cancers that he may be treating.

Dr. Roboz:                   

You bring up such an important point about the second opinions. I want to just drill into one thing. AML is sometimes a disease that must, must be managed acutely and immediately and I think that there are scenarios in which patients are dangerously ill with AML, were transferred to another center or moving to another center would actually be the wrong thing to do in which case it is a great idea for family members to say, “Listen, can you call someone? Can you reach out?” And I can personally say I get calls at all hours of the night from all over the place saying, “Can I talk to you about a patient?”

So, the hope is that the doc that you’re working with recognizes that you’re really, really sick, and is checking in to see if there’s something that we can do to manage you safely where you are. Don’t run away from a center if the doctors say you’re too critically ill to move, because that could be a life-threatening mistake. That said AML is not always an emergency. In fact, it usually isn’t and there are plenty of patients with low blood counts feeling pretty good who do have an opportunity to think about the diagnosis. And we say all the time, “We want to get things right. We don’t want to necessarily get it fast.”

So, if you have a minute to think if there’s not an acute emergency, your blood counts are low, but you’ve been feeling fine. You were playing golf yesterday, you might have quite a bit of time actually to get your ducks in order, look at the data, get a couple of opinions either by phone or by a video or by checking in with experts via your doctor. You probably have a minute if there’s nothing acute going on to get that additional information.

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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