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Published on January 15, 2021
Expert Explains AML Treatment Options
In the fourth episode of a nine-part podcast series, Dr. Eunice Wang, MD, Chief of Leukemia at Roswell Park Comprehensive Cancer Center, guides newly diagnosed acute myeloid leukemia patients through the different AML treatment options that are available to them. Dr. Wang explains how a patient's age, fitness, AML subtype, finances and personal preferences can inform the treatment decision.
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Transcript | What Are the Treatment Options for AML?
Dr. Wang: Hello. My name is Dr. Eunice Wang, Chief of the Clinical Leukemia Service at Roswell Park Comprehensive Cancer Center in Buffalo, New York. I am here to address a very important question for patients newly diagnosed with AML. What are the treatment options for you? What things do we look for in determining what kind of treatment you or your loved one might get and how do we support you through that treatment? Is it going to be something that requires an inpatient or an outpatient management?
How Do I Know Which AML Treatment Path Is Right for Me?
So in general, as an AML doctor that specializes in this disease, when I'm thinking about starting therapy for a patient, I generally look for two things to help me make that decision. One, I look to see how what we call fit, or how appropriate that patient is, for what we call intensive chemotherapy. And that's high dose chemotherapy infused in a hospitalized setting, where patients are going to need to stay in the hospital and have all of their blood counts go down and be managed inpatient for between four, five or six weeks.
If a patient is older or has other medical problems like heart disease or diabetes or kidney disease or liver disease, that particular individual may not tolerate or even survive that high dose chemotherapy. So for those individuals, many but not all of which are older, we would recommend potentially lower-dose chemotherapy. I think that AML is perhaps the only cancer diagnosis for which we have specific treatment regimens which have been developed for individuals 75 years of age and above.
So, looking at the overall fitness of those patients and determining that maybe they wouldn't tolerate an inpatient hospital stay makes me lean towards offering a lower dose chemo regimen, including a pill, venetoclax (Venclexta), and a shot called azacitidine (Vidaza). That venetoclax and azacitidine combination has been very well tolerated in my practice in individuals, even up until the eighties or early nineties. It's something that the first round of which needs to be carefully monitored. For some patients, they require a shorter hospital stay of two or three weeks to start that therapy, with the rest of that low-dose therapy administered as an outpatient.
Does a Patient’s AML Subtype Affect Their Treatment Options?
In addition, what we look at is the particular type of leukemia that you have, specifically, whether your leukemia is characterized by gene mutations in FLT3, IDH1 and IDH2. Those patients have the option of targeted therapies, which include oral inhibitors of mutations that are found in AML cells. Those include mutations in FLT3, IDH1 and IDH2 genes, and those oral inhibitors can even be layered on top of low or high dose chemotherapy to further improve outcomes, or they can even be added on as single agents.
So the things that we are looking for in selecting therapy include how well the patient feels, what type of therapy they would like, inpatient or outpatient, and the characteristics of their individual tumor cells and whether they would be amenable to what we call targeted therapy. Now, this requires targeted discussion with the patient, as well as with the caregivers about the individual patient, as well as the tumor type and what is the decision that is going to be beneficial for each individual patient. And that requires, potentially, a discussion between you and your oncologist as to what might be the best option for you and your family.