Published on April 21, 2021
Precision Medicine: What the Future Holds and Addressing Diversity
For a newly diagnosed AML patient or an AML survivor relieved by a long remission, the question is often the same: "What does the future hold?" Listen in as AML patient, reporter and patient experience advocate Loriana Hernandez-Aldama and AML expert, patient experience researcher and palliative specialist Dr. Tom LeBlanc, MD, from the Duke University School of Medicine, discuss the move to precision medicine and the new tests and treatments that are bringing better outcomes and higher qualities of life for AML patients. They also discuss the very pertinent issue of the lack of access and diversity in medical research, how it puts racial and ethnic minorities at risk, and what we can do as a community to address it.
Support for this series has been provided by AbbVie Inc. and Genentech, Inc. Patient Power maintains complete editorial control and is solely responsible for program content.
Transcript | Our AML: Hope for the Future and a Longer Life
Loriana Hernandez-Aldama: Hi, I'm Loriana Hernandez-Aldama. I'm a former news anchor, medical reporter and two-time cancer survivor, which included AML leukemia and also breast cancer. And I'm honored to be joined by Dr. Tom LeBlanc, who treats patients who have leukemia. He's an AML oncologist. Tom, thank you so much for joining us. Today we are talking about the future and being hopeful during the time with AML. I know when I was diagnosed with leukemia with AML, in 2014, I was in awe, as a former medical reporter, that I was given antiquated chemo, 40-year-old chemo, and the treatment hadn't changed in 40 years. Since then, we've made so much progress, and it's so hopeful. I would never want anyone diagnosed with AML, but if you're going to be diagnosed, 2021 is far better than the year of 2014 when I was diagnosed.
How Have Treatment Options for AML Improved?
Dr. LeBlanc: Yeah, that is absolutely true. There is so much happening right now with the science of what drives leukemias. And also, the treatments that are available to treat leukemias, even in just the last three or four years. So, starting in 2017, there was this flood of FDA approvals of new AML treatments. And I'm starting to lose count of the actual number now because there have been so many. And that is a wonderful problem. And it's still a little bit of a problem because it means now we have to figure out how to best combine them together, and which ones to give to which kinds of patients, and which one in first-line or which ones do we use for relapses.
But studies are going on and new drugs keep being developed. So now we are at a point where we are sort of fingerprinting each individual person's leukemia with these fancy tests, like myeloid next-generation sequencing panels. And understanding the individual mutations in that patient that are driving their disease, and then often personalizing their treatment to target those mutations to achieve better outcomes. And it's the kind of science that I couldn't have imagined even 10 years ago. And honestly, five years ago, we weren't doing this kind of testing as part of routine care. It was just research; it was just in laboratory. So, I wish nobody had AML, but this is a very hopeful, exciting time if you are forced to deal with it as a patient or caregiver or family member.
Loriana Hernandez-Aldama: Well, absolutely. It's been so eye-opening, and so rewarding to see a lot of the funding dollars actually get to AML and seeing these breakthrough treatments. I'm thrilled, and I had a chance to actually address the FDA and help push for that. Are patients still getting some of that antiquated chemo along with these new drugs, or have we totally broken away from that?
Precision Medicine is Giving Patients Hope for the Future
Dr. LeBlanc: Yeah, that's one of the strange things about AML care. Some of the old chemo that we started using and combinations in the early 1970s, before I was even born, are still part of the backbones for some patients' treatment. And some of the areas where we've developed the most advances now actually, are for the people who didn't have much in the way of options just a few years ago. So, people who are age 75 and older, or people who are younger than that, who may have a lot of medical problems, who aren't real physically fit to tolerate high dose chemotherapy, where we wouldn't give them that 1970s era chemo, the really high-dose kind of chemo bomb. Because we'd probably really hurt them or maybe even kill them with that treatment. They didn't have good options before the last couple years. And now they have new targeted kinds of therapies, low-intensity therapies, combination therapies, that are achieving remission rates now that are actually pretty close to or maybe even better than what we would have gotten historically with those high-dose chemos, that we couldn't even give to those patients safely. So, it's pretty exciting to see all of these new options available, and we can much more personalize and tailor the treatment to the individual sitting across from us in the exam room or the hospital bed.
Loriana Hernandez-Aldama: That's fantastic. I know that for years, people have said to me, and patients kind of cringe when people say, "Be happy you're alive." It's like, "No, I'm happy I'm alive. But we, as patients, have the right to want more and better treatment." So, to see that that is actually coming to fruition, gives me goosebumps, and it makes me so happy. And I'm glad you're able to give that to your patients, and doctors all over the world are able to do that as well.
Addressing the Lack of Diversity in AML Clinical Trials and Care
People of color make up 39% of the population in the US, but clinical trial participation from this group is 2-16%. With precision medicine, targeted drugs and gene therapies being developed, the lack of diversity in clinical trials makes it challenging to get a complete picture of a drug’s safety and efficacy.
Loriana Hernandez-Aldama: I'm Cuban American, we talk about the black and brown communities that are underserved. When I was diagnosed, they said, "We know how a German would do with this mutation. But we don't know how a Latino would do." So, in that aspect, as well, there's so much growth and potential that we have to go. And I hope that we're moving the needle, per se, and making some progress. And you give me a lot of hope when I hear about that.
Dr. LeBlanc: Talking about this is sometimes very helpful in practical ways like that, in addition to, hopefully, what some patients and families who are really dealing with AML actively will glean from this discussion today about how to get the support they need to get through it.
Loriana Hernandez-Aldama: And we need to get the registry on that topic. We need to get the registry more diverse to reflect the communities that we live in. I had my sister's DNA, thankfully. But she has this chip genetic marker which predisposes, as you know now, predisposes me to blood cancer and gave me heart disease, so there are trade-offs that they didn't know of. But they had nobody who matched me because of my ethnic background. So, I tell people, when I share my story I say, "I prehab-ed, I showed up-fit. I was well connected." Which I was blessed, and most people aren't, to be that well connected. And yet it was my ethnic background that still nearly killed me. And it shouldn't be that way. You shouldn't have to be connected to improve your patient outcome. We should help people get more wraparound services and prepare for this illness, or any illness they may face. And we need more diversity in the clinical trial, so we can properly treat them. If we can do all that and get more patient navigators, we'll be good.
Dr. LeBlanc: Absolutely. Amen to that.