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.
Most recently, in September, the FDA approved gemtuzumab ozogamicin (Mylotarg) for the treatment of adults with newly diagnosed CD33-positive AML. In the approval, the antibody-drug conjugate was also indicated for patients aged 2 years and older with CD33-positive relapsed/refractory AML.
A month prior in August, the agency granted an approval to a fixed-combination of daunorubicin and cytarabine, known as CPX-351 (Vyxeos), for adult patients with newly diagnosed therapy-related AML or disease with myelodysplasia-related changes. That same month, the FDA approved enasidenib (Idhifa) for patients with relapsed/refractory IDH2-mutated AML.
In April, the FDA granted an approval to midostaurin (Rydapt) in combination with standard cytarabine and daunorubicin induction and cytarabine consolidation for the treatment of adult patients with newly diagnosed FLT3
“This is indeed a very exciting time to be oncologists in general in acute myeloid leukemia,” according to Olga Frankfurt, MD. “There are 4 drugs that have been approved in the last several months. After about 40 years of no new drugs available for AML, now we have 4. We have to figure out how to use them and who to use them for, so it is indeed an exciting time.”
In an interview during the OncLive®
State of the Science SummitTM
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?
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
We also talked about gemtuzumab ozogamicin which, as they say, “new is the well-forgotten old.” It is a resurrected antibody against the CD33 target, with calicheamicin attached to it. It also got approved in a slightly different schedule with chemotherapy and it has been shown to be effective in that combination.
Then, we talked about enasidenib, which is a drug that is FDA approved for IDH2-positive AML. This drug really changes our concept of how we treat AML, what the expectations are, what the targets are, and it effectively transforms acute disease into a possible chronic condition, so it’s a very unusual and interesting medication.
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
-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.