The Future Treatment Landscape of AML

Panelists: Harry Erba, MD, PhD, Duke University; Jorge E. Cortes, MD, MD Anderson Cancer Center; Alexander E. Perl, MD, MS, Hospital of The University of Pennsylvania; Daniel Pollyea, MD, MS, University of Colorado, Anschutz Medical Campus; Eunice Wang, MD, Roswell Park Comprehensive Cancer Center



Transcript: 

Harry Erba, MD, PhD: Let’s finish up. Jorge, just a couple of comments about what we’re excited about. What’s coming soon?

Jorge E. Cortes, MD: I’ll emphasize a couple of areas where there’s attractive new drugs and an interesting approach as part of holistic management of AML [acute myeloid leukemia]. One is targeting the microenvironment. We know that the microenvironment plays a role in protecting the cells from some of these targeted therapies. There’s been some interest in CXCR4…. There’s actually an interesting study here at ASCO [the American Society of Clinical Oncology annual meeting] with a drug called CX-01, which a randomized study of these patients, and there’s 3 arms. There’s 1 with standard chemotherapy that’s frontline, standard chemotherapy, and then standard chemotherapy with 2 different doses of these agents. And they showed that with the higher dose, there’s a very attractive improvement in response rate. It’s close to 90%. It’s a small study, preliminary but attractive. And there’s other approaches with CXCR4, DL84 and a few other drugs.

And then immunotherapy, I think it’s a broad area that’s very attractive. And here, of course, we talked a little bit about the antibody drug conjugates like gemtuzumab. You could argue that that’s not immunotherapy, but it’s a courier antibody. Still, there are many others coming along the way that look very promising. But very importantly, these bispecific monoclonal antibodies. We talked about blinatumomab in ALL [acute lymphocytic leukemia], and there are several coming that target different targets in AML. It’s been a little bit more difficult to find something that’s safe and effective in AML, but there are some targeting CD33, CD123, and some novel targets like...12A and a few others. Very attractive early data, still to be mature, but I think we’re going to see something there.

Then of course we’ve done studies with the checkpoint inhibitors, very effective in many tumors. There are some early data to suggest that they may have a role in AML, in MDS [myelodysplastic syndrome], in other hematologic malignancies. We’re still trying to figure out where, how, combining with what. But I think there is a life to these drugs, we just don’t have them quite yet ready. And in the future, CAR [chimeric antigen receptor] T cells are being developed in AML. It’s been challenging because again, there’s no specific target. But they’re on their way, and there are things that are being done to develop these drugs. So things are going to look good, and we’re going to have to integrate all of these different approaches to improve the outcome of our patients.

Harry Erba, MD, PhD: CX-01 reminds me of the data presented by Dan DeAngelo [MD, PhD,] at ASH [the American Society of Hematology meeting] last year with GMI-1271 with uproleselan.

Jorge E. Cortes, MD: That’s correct.

Harry Erba, MD, PhD: Which is an E-selectin inhibitor. Now that is being studied in the cooperative groups in previously untreated older AML patients with 7 and 3 [cytarabine/daunorubicin]. Also there’s an industry-sponsored study in the relapsed setting.

Jorge E. Cortes, MD: Yes.

Harry Erba, MD, PhD: Well, we have gone way over time, and usually we like to turn to each panelist and let them have closing remarks. But I am going to take the prerogative of the chair and maybe just make 1 broad comment. These are challenging times for us. Eight new drugs, complicated disease, and you add in on it that this is a rare disease for most oncologists. They see maybe 1 or 2 cases a year, maybe a little bit more, but not [like] breast cancer or colon cancer. And there’s all this information on diagnostics, and then you add to all of that the urgency of making the diagnosis and actually starting treatment in still an urgent amount of time. It’s not like breast cancer where you start chemotherapy 6 weeks after surgery. It’s like within a week or so.

So what I would encourage our viewers to do is that if you are not in a Center of Excellence that sees a lot of leukemia, have leukemia programs, partner with someone in your community, in your area. Find your favorite leukemia doctor, call him up, call him frequently, him or her, text them, ask questions because these are important decisions to be made for our patients. And even send them to academic centers for consideration in clinical trials. We all know that most of these patients will go back to their doctors because it’s hard to be put on a clinical trial. But I think we really need to do a better job of partnering with our community colleagues to give the best care for our patients with acute leukemia.

Jorge E. Cortes, MD: Definitely.

Eunice Wang, MD: Yes.

Harry Erba, MD, PhD: Really, that’s all you have to say? OK, we’ll stop there. So, on behalf of the panel, thank you for joining us today. We hope you found this OncLive Peer Exchange® discussion on AML to be useful and informative.

Transcript Edited for Clarity
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