AML: New Drugs but New Challenges

Publication date: Available online 15 February 2020Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Alan Burnett, Richard StoneAbstractDespite the approval of 8 new drugs for AML since 2017, the disease remains challenging given the significant toxicity associated with available treatments and relatively low cure rates, especially in older adults. While advantageous for patients, self-congratulatory rejoicing about the new agents would be extremely premature. Questions abound about the need for a specific vs less specific FLT3 inhibitor (e.g midostautin) in the upfront setting and whether a single agent (gilteritnib), albeit better than chemotherapy is sufficient for relapsed disease. Is the new liposomal formulation of daunorubicin/cytarabine better than ‘3+7’ only in secondary AML? Should only those newly diagnosed patients with core binding factor AML routinely receive gemtuzumab ozogamicin?. The IDH inhibitors were approved based on non-randomized data; thus, one wonders whether single agent IDH inhibitor therapy is appropriate for relapsed patients. Glasdegib, an orally available hedgehog inhibitor, is approved in conjunction with low-dose ara-C in unfit patients but is rarely used in favour of a combination of HMA or low-dose ara-C with venetoclax, which are hopeful newly approved combinations for the older and /or unfit previously untreated. Perhaps, venetoclax-based combinations should be more widely used, but the data is currently lacking. Thus, a tempera...

Source: Clinical Lymphoma Myeloma and Leukemia - February 15, 2020 Category: Cancer & Oncology Source Type: research