Skip to Navigation Skip to Search Skip to Content
Search All Centers

New Drug Options for Gene Mutations in Older AML Patients

Read Transcript
View next

Published on September 14, 2020

New Drug Options for Gene Mutations are Improving Outcomes in Older AML Patients

Mutations are present in approximately two-thirds of all acute myeloid leukemia cases. Identifying and properly treating for these mutations can lead to improved medical outcomes and quality of life. Dr. Jessica Altman, Northwestern University Feinberg School of Medicine, joins Patient Power co-founder, Andrew Schorr, to discuss the different mutations facing older AML patients and what treatments are available to those patients that are not a fit for intensive, standard of care, chemotherapy. Dr. Altman discusses the newest options and the combinations being studied including gilteritinib (Xospata) with azacitidine (Vidaza) and the potential of azacytidine (Vidaza) or decitabine (Dacogen) and venetoclax (Venclexta) and gilteritinib (Xospata) for the common FLT3 mutation.

This is a Patient Power program. We would like to thank Astellas Pharma for their support. This organization has no editorial control, and Patient Power is solely responsible for program content.

Featuring

Transcript | New Drug Options for Gene Mutations in Older AML Patients

Andrew Schorr:
Hello and welcome to Patient Power. I'm Andrew Schorr. I'm in California, but joining us from Chicago is Dr. Jessica Altman who's a noted leukemia specialist. Dr. Altman, welcome back to Patient Power.

Dr. Altman:
Andrew, thank you very much for having me.

What is the Standard of Care in Acute Myeloid Leukemia (AML)?

Andrew Schorr:
Let's talk about one of the acute leukemias, AML, and I know there've been so many changes there. What has been the standard of care traditionally in AML?

Dr. Altman:
The standard of care over the last many decades has been a combination chemotherapy of generally an anthracycline and cytarabine (Cytosar-U), or what we refer to as 7+3. And that is our standard of care for adults who are deemed fit or appropriate for intensive induction chemotherapy.

Over the last couple of years, we have made great strides. And there recently is now an approved therapy for adults who are deemed unfit or inappropriate for intensive chemotherapy and those 75 and older and that's the regimen of a hypomethylating agent or low dose Ara-C in combination with venetoclax (Venclexta).

Understanding AML Mutations & Treatments

Andrew Schorr:
One person's AML, not just based on age or fitness, but by genomics could be different. I understand they're different mutations. There's IDH1 and 2, FLT3. Help us understand why it's important for you and your patient to know what you're dealing with.

Dr. Altman:
So, in terms of a mutational profile in general, most academic centers and most centers in general, send out broad mutational profiling, a diagnosis and a patient with newly recognized acute myeloid leukemia. Within that, we're looking for specific mutations that have the potential for us to target them. For instance, we're looking specifically at the FLT3 mutation. We also look within the cytogenetics for the presence of a core binding factor mutation. Those set of genetic abnormalities are translocation (8;21) and inversion (16), or translocation (16;16). Those impact prognosis. And likewise other cytogenetic abnormalities impact prognosis.

In addition, we look at the p53 mutation, which portends an unfavorable prognosis, and other mutations in general. You mentioned the IDH mutations. Those are important because of the impact on prognosis, but more importantly, because we have targeted therapies available for them, just like we have targeted therapies that are approved for the treatment of either newly diagnosed or relapsed FLT3 mutated AML.

Andrew Schorr:
Dr. Altman, I understand about a third of the time you identified the FLT3 mutation in an AML patient. What do you do then? And particularly, what about older patients with the FLT3 mutation?

Dr. Altman:
The current standard of care continues to be azacitidine (Vidaza) or decitabine (Dacogen) and venetoclax.

So, current things that are being investigated are combining gilteritinib (Xospata) with azacitidine. there's a large company-sponsored trial that is ongoing in that space. And many centers are interested in triplet combination trials, looking at a FLT3 inhibitor in combination with azacitidine and in venetoclax. And that's the area where I think things are moving.

Andrew Schorr:
Okay. Let's try to put this together for patients and families with an acute cancer. That is, testing, genomic testing, cytogenetic testing is really important.

Dr. Altman:
Correct. It both informs prognosis and may impact initial therapy and treatment if the disease fails to respond or if the disease response and then comes back.

Andrew Schorr:
Second is, depending upon what you see as that patient's specific situation, you have more choices than ever.

Dr. Altman:
You're absolutely right. It's a very exciting time for healthcare providers and I think also for patients. Our patients are more informed and more engaged than ever. And I think the ability to access information increases and patient engagement makes things even more exciting for us as healthcare providers. And you've alluded to this, Andrew, that the importance of assessing patient's goals and understanding their lifestyle and what motivates them, helps us frame the conversation when there's choice in treatment. And we're in an era in acute myeloid leukemia therapy, where there is choice. And we haven't been in that arena before.

COVID-19 and AML

Andrew Schorr:
Dr. Altman, as we record this interview, we're doing it during the COVID-19 pandemic. There's some patients who would like to avoid if they could, coming to the clinic or they may be older and it's less convenient for them to travel, they may be 70 or 80, older even. The prospect of a three-drug combination to treat their AML is very attractive. Whether we could have an oral azacitidine, venetoclax is oral and then an oral FLT3 like gilteritinib, that would be attractive, I would think.

Dr. Altman:
Potentially. Yes. We still need to figure out, I think how to use the oral azacitidine compound upfront. But it does offer the opportunity in theory, to induce patients with an IV or subQ azacitidine or IV decitabine in a triplet combination and then in a maintenance strategy, then convert to an oral azacitidine.

And so, as I mentioned previously, I try to spend a lot of time with my patients understanding what motivates them, what their goals are, what they're interested in and have a conversation regarding response rate, toxicities and burden of therapy, as we think about the various options. I think we're in a situation now where we can think about both improving response rate and also how to best fit treatment in with a patient's goals.

Andrew Schorr:
Doing all that though, the hope is people can live longer and live better.

Dr. Altman:
Right. When I say deepening response, that in my mind, but perhaps not to everyone, translates to a deeper remission and therefore a longer time in remission and a longer life.

Andrew Schorr:
Well, that's a very hopeful message and I'm glad you have all these different tools both to see what's going on and what to do about it. Thank you so much for your leadership in the field, Dr. Jessica Altman from the Lurie Cancer Center at Northwestern. Thanks for being with us once again.

Dr. Altman:
Thank you, Andrew. It's always my pleasure.

Andrew Schorr:
I'm Andrew Schorr. Remember folks, knowledge can be the best medicine of all.


Recommended Programs:

View next