How Newly Diagnosed AML Patients Can Access the Right Targeted Therapies

Lisa Hatfield:

Dr. Khan, targeted therapies like BCL2 inhibitors have transformed treatment options for older AML patients and those who aren’t candidates for intensive chemotherapy. However, studies indicate that underrepresented populations often have delayed access to these newer targeted treatments. How can patients and families watching proactively advocate for access to the most appropriate targeted therapies for their specific AML subtype? And what questions should they ask their care team to ensure they’re being considered for all available treatment options?

Dr. Irum Khan:

For targeted therapies in acute myeloid leukemia, it’s very important that a patient is fully aware of all the mutations that their leukemia cell carries. And this is done by testing either the abnormal white cell population in either the blood or the bone marrow for sequencing abnormalities in specific genes that can affect the outcome of the disease, and some of which are targets for certain therapies. So to know if you’re eligible for a targeted treatment, you have to know all the targets in the disease, and so I think the activation tip for this question would be for the patient and their family member to ensure that they have genetic sequencing, and this is an FDA-approved indication to do this kind of testing in acute myeloid leukemia.

And even if it requires waiting two to three weeks, which is how long it takes if your hospital has to, or your physician has to send it out and has to come back, that is okay. I think that’s one of the other things that we need to get comfortable doing, acute myeloid leukemia creates a sense of urgency. But there have been studies showing it is okay to wait and make that informed decision with the molecular data. And I think that that’s somewhere where, again, the whole community-academic partnerships are important, to let the community physician know it’s okay, you know, we’re watching the labs two to three times a week, but we need that result back before we start treatment, so we can make the best possible treatment, possibly incorporating a targeted agent. So ensuring the testing gets done, even if it means delaying treatment or using some temporizing measure, is okay.

Lisa Hatfield:

Would it be reasonable for a patient to ask their local oncologist, “Hey, I’d like to get an expert opinion, somebody who sees primarily AML patients, particularly when I’m first diagnosed, and treatment changes? Would that be reasonable to ask our community oncologist if we can do that, just so we are aware of these latest treatments and the genetic testing and what that means?

Dr. Irum Khan:

Absolutely. So I think that the academic-community partnerships are very important, bilaterally, you know, the community physicians will benefit from access to the trials that are at the academic center, a lot of which will allow for shared care, where the patient can get a lot of the care at home, but get access to some of the testing. And, you know, there’s approved testing, and there are also research tests that can sometimes provide additional information. So I think that that is very helpful for the patient, also for the community physician to know they’re doing the best for their patient.

And for the academic physicians, because, you know, at the end of the day, they’re in a glass tower, they need to reach out to people where they are, and so it’s a way for everybody to kind of be involved, and the patient to get the best possible care. And again, just like you said, I think that these second opinions are really important at certain key points in a patient’s treatment, like the initial diagnosis and treatment planning, just to make sure all the data is being considered with that initial diagnosis, and then at the time when there’s a change, the disease is not responding as well, or we need to change gears, that’s another time to consider what the possibilities are.

Lisa Hatfield:

What resources or support systems should patients proactively identify and access before starting intensive treatment to improve their chances of successful completion?

Dr. Irum Khan:

So here I am going to overlap a little but with my last question. There are social determinants of health surveys that all cancer centers are required to elicit from their patients at each encounter, really. And oftentimes, people kind of gloss over them, patients don’t want to dwell too much on them. And, you know, those kind of probe into things relating to food insecurity, rent, housing, bills, financial toxicity, etcetera. I think that being really upfront and honest for the patients and sharing that is important to allow the medical team to really engage the necessary, again, the multidisciplinary team that’s needed, whether it’s social work, whether it’s grants to help pay for medications if there are insurance gaps, things that can really set you up for a smooth transition to discharge, where, you know, you leave with everything you have to be on once you leave the hospital because that’s really often when there’s a big transition point for a leukemia patient with a new diagnosis, to leave the hospital and have to go home and cope.

So I think that that’s one major area. The [ACT]IVATION tip would be to really engage with those social determinant questions as they’re asked, because it is a mandate, so it’s something that is required of centers to inquire about, but the extent to which it gets answered is always very variable.