Abstract: Dr. Nigel Russell provides insights into the recent developments in the treatment landscape of Acute Myeloid Leukemia (AML). The discussion encompasses the combination of FLT3 mutation inhibitors with intensive chemotherapy, emphasizing the effectiveness and safety demonstrated by the combination of midostaurin with gemtuzumab ozogamicin. The presentation explores emerging FLT3 inhibitors like quizartinib and their potential in combination with chemotherapy. Additionally, Dr. Russell delves into a groundbreaking study involving the combination of the FLAG-Ida regimen with gemtuzumab ozogamicin for patients with NPM1-mutated AML. The study reveals significantly improved event-free and overall survival, indicating a promising therapeutic approach for this patient subgroup. Furthermore, the discussion touches upon the advancements in bispecific antibodies in AML, particularly focusing on blinatumomab’s role in targeting CD19 for patients with relapsed core-binding factor leukemia. The potential use of bispecific antibodies in eradicating minimal residual disease after intensive therapy is highlighted, offering a glimpse into a targeted therapeutic strategy for AML patients. Overall, these insights contribute to the evolving landscape of AML treatment, showcasing promising avenues for improving patient outcomes.
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Hematology Frontier: Our first question is a combination of FLT3 mutation inhibitor and intensive chemotherapy is one of the treatment options for FLT3 mutated AML. Could you please talk about the progress at this EHA congress?
Dr. Russell: Midostaurin has been a standard of care with intensive chemotherapy for a few years. We at this conference presented the data on the combination of intensive chemotherapy with gemtuzumab ozogamicin (GO) and with midostaurin. And we present some really effective data to show that the survival of these patients appears to be increased in the combination of a FLT3 inhibitor with chemotherapy, with gemtuzumab is possible and safe. I think this is a developing area and other groups in Europe are interested in using this combination. Otherwise, other FLT3 inhibitors are becoming on stream such as quizartinib. There’s been some interesting data presented recently about the combination of intensive chemotherapy and quizartinib of FLT3 mutated AML so there’s a number of lines of interests that are being developed.
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Hematology Frontier: An oral study reported by your team. The abstract 134 is for the combination of the FLAG-Ida regimen with GO to treat patient with NPM 1 mutated AML. Could you please share more details of it?
Dr. Russell: FLAG-Ida is a very commonly used intensive regimen for the treatment of relapse AML. We have combined it with gemtuzumab in a regimen called FLAG-Ida (GO) and randomized this in a large study against chemotherapy DA 3+7 plus GO and we’re particularly focusing on subgroups There were 300 patients in the analysis. And we found the patients with NPM one mutations had a significantly improved event free and overall survival with the combination of FLAG-Ida (GO) comparing to the standard of care of DA GO. This resulted in an 18 % of improvement in overall survival at 5 years. So it’s a fairly convincing benefit for this group of patients. I think this combination could become a standard of care. However, patients, particularly after the second course of therapy of FLAG-Ida (GO), do have delayed count recovery compared to standard treatment.
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Hematology Frontier: Could you please briefly talk about the latest advancing bispecific antibodies in AML?
Dr. Russell: Bispecific antibodies have not really developed in AML in the same way that they have developed in ALL that’s the first thing to say. We’ve been using blinatumomab, which is the bispecific antibody targeting CD19. We’ve been using that for patients with relapsed, core binding factor, leukemia. And we haven’t presented the data here, but we treated a number of patients with blinatumomab, and it’s been well tolerated. And in some patients, we’ve seen eradication of minimal residual disease, I think this kind of a targeted therapy using bispecific antibodies will be particularly useful in the setting of minimal residue disease. After patients have had intensive therapy, they remain MRD positive, and then use of bispecific antibody as has been used in ALL could help eradicate MRD and cure patients.
TAG: EHA 2023, Interview, Hematological Malignancy, AML
