AML treatment options are expanding, giving patients more personalized approaches than ever before. AML specialist Dr. Anand Patel explains the differences between intensive chemotherapy and newer lower-intensity therapies, and he reviews how risk categories, overall health, and treatment goals can influence AML care decisions.
Dr. Anand A. Patel is the Medical Director of the Inpatient Leukemia Service at the University of Chicago Medical Center. Learn more about Dr. Patel.
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Transcript
Katherine Banwell:
I’d like to get into the impact of test results. How do they influence treatment decisions?
Dr. Anand Patel:
So, we are living in a very dynamic time for AML treatment. So, for over 50 years, kind of the de facto standard treatment for AML was using induction chemotherapy, a regimen that we commonly refer to as 7+3, for anyone who was fit enough or well enough to receive intensive chemotherapy.
For patients who would potentially stand to be harmed more than benefited by intensive chemotherapy, they were either supported with transfusions alone or treated with a class of drugs called hypomethylating agents, mainly as a means of disease stabilization.
However, nowadays, we have a lower-intensity approach, this azacitidine (Vidaza) plus venetoclax (Venclexta) approach, where the remission rates approximate, and in some instances, could be slightly better than intensive chemotherapy, with less of a side effect burden.
So, it’s really a nuanced discussion about which treatment option should be used initially, and risk stratification plays a huge role in that nuanced discussion.
Now, an example I will use is, for patients who are well enough to receive intensive chemotherapy and that have what we call favorable risk AML, with the risk models that we use for intensive chemotherapy, they really stand to benefit from receiving that intensive chemotherapy because the goal is cure.
On the other hand, for many patients who have intermediate or adverse risk AML, they could potentially receive intensive chemotherapy with the end goal being a transplant to try and cure the disease, or they could receive this lower-intensity regimen of azacitidine, venetoclax, which is just as likely, and perhaps slightly more likely, to induce what we call a remission, and then subsequently receive a stem cell transplant, if needed.
The major thing to consider with lower-intensity therapy in patients who may not be able to proceed with a stem cell transplant is typically, they are considered indefinite therapies. So, as long as they are working, we keep delivering cycles at a frequency of anywhere from four weeks, to up to even eight to 10 weeks between cycles. Whereas with intensive chemotherapy, typically, patients will receive that induction regimen, followed by one to four cycles of this consolidation regimen, and typically, are then observed afterwards.