Dr. Wang on the Treatment Options for Unfit Patients With AML

Eunice Wang, MD, chief of Leukemia Service, the Department of Medicine, Roswell Park Comprehensive Cancer Center, discusses treatment options in unfit patients with acute myeloid leukemia (AML).

Along with venetoclax (Venclexta) and azacitidine-based therapies, new advances have been made for the treatment of unfit, older patients with AML, Wang says. When deterimining the best course of treatment, it remains vital to distinguish between the characteristics that define a fit patient vs an unfit patient, and whether there is a range between unfit and frailer patients, Wang notes.

Long-term data from the phase 3 Viale-a trial (NCT02993523) established venetoclax plus azacitidine as the standard of care for this older patient population, Wang explains. Although this venetoclax/azacitidine regimen produced a median overall survival of 14.7 months in this patient population, it is not curative in the majority of patients, Wang expands. Some patients were still alive 2 to 4 years following treatment, Wang notes.

Given the efficacy displayed by venetoclax plus azacitidine in unfit patients with AML, newer research has looked at the addition of targeted therapies to the venetoclax and azacitidine backbone. These triplet regimens can incorporate IDH inhibitors or FLT3 inhibitors, as well as other targeted therapies or immunotherapies on top of venetoclax and azacitidine, Wang says.

Novel therapies for unfit patients with AML include bispecific antibodies, adoptive T-cell therapy, checkpoint inhibitors, and a newer class of drugs known as menin inhibitors, which are gaining traction for the treatment of patients with relapsed/refractory NMP1­-mutant and KMT2A-rearranged AML, Wang says. With therapies continuing to emerge for older patients with AML, those in this patient population are no longer candidates for only short-term prolongation of survival. Instead, these patients may now be candidates for multiple lines of therapy consisting of triplets and novel targeted agents, Wang concludes.