By Ilana Yurkiewicz, MD
Once upon a time, there was “7+3.” Developed in the 1970s, this easy-to-remember induction chemotherapy regimen for acute myeloid leukemia (AML) went largely unchanged for decades.
But in the past few years, we have seen multiple new drug approvals, and not just for the induction phase for a pugnacious disease associated with high mortality and poor five-year overall survival. An additional therapeutic challenge is that AML is a disease of the elderly (the median age of diagnosis is approximately 68 years).
“I have patients in clinic now who are doing great on therapies that didn’t exist a couple of years ago,” said Courtney DiNardo, MD, MSc, Associate Professor in the Department of Leukemia at MD Anderson Cancer Center and chair of the Edu- cation Program session, Therapy of Acute Myeloid Leukemia: Adapting to Change. The session will run twice on Sunday, from 7:30 to 9:00 a.m. and 4:30 to 6:00 p.m. in Chapin Theater (W320), Level 3 of the Orange County Convention Center (map it)
Precision medicine — specifically, using genomic information to guide treatment decisions — has been the driving force behind these improving outcomes. Genomics has “always been important retrospectively,” Dr. DiNardo stated, as genetic mutations have historically been used in AML to help prognosticate which patients might do well and which might not. However, when we only had a one-size-fits-all approach to therapy, that information mattered less for treatment decisions. Now, “we have options to choose from,” said Dr. DiNardo.
It is the rapidity of progress that most excites Dr. DiNardo, and that includes the cutting-edge work of the two speakers with whom she will share the stage. “I heard her speak once or twice, and I learn something new each and every time,” said Dr. DiNardo about Catherine Smith, MD, of the University of California, San Francisco. Dr. DiNardo also praised Sylvie Freeman, MBChB, DPhil, of University of Birmingham as “one of the leading physicians in charge of determining the importance of [mini- mal residual disease] in AML.”
Dr. Smith will speak first, focusing her session on patients carrying an FLT3 mutation, historically associated with a poor prognosis. She will discuss recent drug approvals targeting this mutation and provide insights on modern treatment algorithms. She will also review the status of ongoing clinical trials and discuss important areas of ongoing translational research.
Dr. DiNardo will follow, summarizing the current treatment landscape of AML and discussing novel compounds under development. She will review why a comprehensive genomic evaluation is crucial. She will additionally discuss treatment options for patients considered inappropriate or refractory to standard intensive therapies.
The session will close with Dr. Freeman, who will showcase how to use minimal residual disease (MRD) assessments in AML, both from a clinical and translational standpoint. She will review the definition of MRD, when to evaluate for MRD, and whether these evaluations should influence therapeutic decision-making. When asked what she hopes attendees will take away from this education session, Dr. DiNardo focused on the clinicians in the room. “I hope they come away with a better awareness and comfort level with these new therapies so they’re better able to utilize them for their patients once they’re home.”
For those interested in increasing their comfort around AML’s sometimes precursor, myelodysplastic syndrome, be sure to check out the Education Program session titled Myelodysplastic Syndromes: From Mild-Mannered to Lurking Leukemia, which will occur on Sunday at 4:30 p.m. and Monday at 2:45 p.m. (Orange County Convention Center, Hall E2, Level 2 – map it).
Dr. Yurkiewicz indicated no relevant conflicts of interest