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AML Field Advances With New Agents, But More Work Remains

Gina Columbus @ginacolumbusonc
Published: Tuesday, Dec 05, 2017

Olga Frankfurt, MD
Olga Frankfurt, MD
The year 2017 saw 4 regulatory approvals in the field of acute myeloid leukemia (AML) that have made significant improvements in patient outcomes.

on Hematologic Malignancies, Frankfurt, an associate professor of medicine at the Feinberg School of Medicine, Northwestern University, discussed advances in the field of AML and challenges that lie ahead.

OncLive: We have seen much progress in the field of AML this past year. Can you highlight some of the advancements?

Frankfurt: There have been 4 drugs that have received FDA approval, which includes midostaurin, a FLT3-targeted therapy given in combination with chemotherapy. This is obviously for FLT3-expressed patients who express FLT3 mutations.

Lastly, we spoke about CPX-351, which comprises a liposomal combination of old and well-known 7+3, but it’s given in a specific ratio and it also has been shown to be more effective than 7+3 in the terrible patient population—refractory/resistant older adults with therapy-related secondary AML. 

What is the prevalence of FLT3-mutant patients?

There are different kinds of FLT3 mutations, and midostaurin is active in both of them. It depends on the study, but approximately 20% to 30% of patients express a FLT3 mutation. 

Other FLT3-targeted therapies are currently in clinical trials, so it is going to be very exciting to see 4 or 5 drugs available to choose from. We will have to see which ones are better. 

What next steps are being taken in the field to go beyond the recently approved agents?

With all those drugs becoming FDA approved, now there are all various possible combinations being explored—in different settings, with transplant, and with maintenance therapy. All of these studies are in the process. There are other drugs that are very interesting and are being studied right now. There is a BCL-2 inhibitor that is currently FDA approved for CLL; it certainly has activity in AML and it has been studied extensively in combination with hypomethylating agents. Again, I’m not a fan of low-dose cytarabine, but the combination of the 2 seems to be effective in older adults with AML. That is awesome to have that option available. 


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