Mary-Beth Percival, MD, on the Current State of the AML Treatment Landscape

Transcript

Dr. Mary-Beth Percival:  Hi, everybody. My name is Mary-Beth Percival. I'm an assistant professor at the University of Washington and an assistant professor at the Fred Hutchinson Cancer Research Center in Seattle. I'm also an attending physician at the Seattle Cancer Care Alliance, which is our outpatient facility for cancer care, or primarily outpatient.

I take care of patients with acute myeloid leukemia and high-grade myelodysplastic syndrome at those institutions and do clinical research to help improve the outcomes of patients who are sitting in front of me in the clinic, and then, also, future patients who I may meet.

I think that the treatment landscape for AML has changed somewhat. We've had standard treatment for a long time with a regimen called 7+3, which is used as induction chemotherapy for patients who have a new diagnosis of leukemia. That treatment was originally studied in the early 1970s.

The fact that it's still the standard of care now suggests that, ideally, we would be able to come up with some other options for treatment that would benefit our patients.

There have been some new drugs that have been approved. There have been, now, nine drugs since 2017 after previously a 17 year drought in terms of the Food and Drug Administration prior to that.

That has been a really big change and has allowed for the capability to have targeted therapies such as ivosidenib, enasidenib, midostaurin, or gilteritinib which are targeted at particular mutational landscapes like IDH1, or IDH2, or FLT-3 mutations.

Also, some new formulations of some older drugs. For example, the drug Vyxeos, or CPX-351, uses some of the same compounds that are used in that 7+3 regimen but they are formulated in a different, which may lead to improved efficacy in patients with harder to treat AML in those who are older.

Those are some of the new standard treatments that are available for this population. There are some other drugs that I haven't mentioned yet such as Venetoclax, for example, or glasdejib, or the newest addition to this panoply of medications, which is azacitidine oral tablets, which were approved just in September 2020. There's also myelo-targeted gemtuzumab ozogamicin.

I think it's really important when patients are trying to navigate this landscape, not that they know the ins and outs of these different sorts of treatments, but that they are comfortable getting care from their oncologist.

Knowing that sometimes a second opinion or a clinical trial may be really important to explore, to try to figure out what the best way of being able to attack and potentially target their newly diagnosed or -- hopefully not -- but should their leukemia relapse, figuring out what the best thing to do is in that situation, as well.