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Acute Myeloid Leukemia Data From the ASCO20 Virtual Scientific Program |
Practice Community
Seattle, Washington
Practice Niche
Hematologic Malignancies – Acute Myeloid Leukemia
Hospital and Institutional Affiliations
University of Washington School of Medicine
Fred Hutchinson Cancer Center
Question Among the studies presented during the ASCO20 Virtual Scientific Program, which of those featuring novel therapies or treatment approaches in acute myeloid leukemia (AML) intrigued you the most? |
Answer In AML, a drug that receives a lot of attention is venetoclax. One of the studies that I found of interest was an update of a study of low-dose cytarabine plus or minus venetoclax.1 I did a poster discussion of this abstract. Because venetoclax has received so much attention, I think these updates are useful. |
Question In a study of the IDH1 inhibitor ivosidenib combined with venetoclax (+/- azacitidine) in IDH1-mutated myeloid malignancies, some patients experienced a composite complete response with minimal residual disease, while others experienced progressive disease in only 3 months.2 How might learning the biomarkers of response help investigators pinpoint the groups that would stand to benefit the most from this treatment approach? Why or why not? |
Answer This is relevant to the discussion about drug approvals in the previous question. Composite complete response includes complete remission (CR) with incomplete blood count recovery (CRi), CR with incomplete platelet recovery (CRp) and is now beginning to include something called CR with partial hematological recovery (CRh). What these responses have in common is that criteria for them are less stringent than the criteria for CR. How did CR get recognized as an endpoint? It was shown that people who got CR rather than other responses lived longer than people who did not with the difference due to the time spent in CR. Ten years ago I was part of a paper using data from SWOG, EGOG, and the University of Texas MD Anderson that showed CRp was associated with shorter subsequent survival and relapse-free survival than was CR although CRp was associated with better survival than being resistant to therapy. |
Question Results of a phase 3 study found that the addition of enasidenib to azacitidine in patients with newly diagnosed AML and mutated IDH2 significantly improved response rates and durations.3 Do you think the benefits seen were likely due to the upfront combination of enasidenib plus azacitidine, or as a result of the sequence of these treatments for those who crossed over to receive enasidenib after azacitidine (21% of patients)? |
Answer That is a good question that will likely require longer-follow up. If the results showed that patients receiving them together at the start seemed better than adding enasidenib, than, yes, it is better. They probably shouldn’t be as optimistic about these results as they are. |
Question Should palliative care be considered a “new standard of care” for certain patients with AML undergoing intensive induction? What is currently the standard of care for this patient subgroup? |
Answer Palliative care can have two meanings. The first is that the patient is not going to be treated. The second is that the patient will be treated, but will also have a palliative care consultation. No one can object to the latter! I have problems with the former since I think a very important way to reduce symptoms is to produce a remission. This will not happen without treatment. If standard therapies are highly unlikely to be successful I favor enrolling patients on a clinical trial. The fewer patients entered on these the slower our progress will be. |
Question Researchers reported there were complete responses seen in a phase 1 trial of an investigational bispecific T-cell engager (BiTE) product.4 These products typically require continuous infusion. Do you think this method of drug delivery could be a potential barrier to the adoption of BiTEs in AML? |
Answer The answer to this question will depend on the trade-off for the patient. If you are in a category of patients who have relapsed AML, which in the past would mean you would die within 6 months, then I don’t see how continuous infusion would be a barrier if the patient thinks such an infusion might improve their survival. In addition, now we have outpatient pumps that can provide continuous infusions, making these totally plausible in the outpatient setting. |
This interview has been edited for clarity and accuracy.
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