Dr Battiwalla on the Potential Roles of FLT3-ITD and Menin Inhibitors in AML Management

Minoo Battiwalla, MD, MS, director, Blood Cancer Outcomes Research, Sarah Cannon Research Institute, TriStar Medical Group, discusses the integration of FLT3-ITD inhibitors into the frontline management setting for acute myeloid leukemia (AML) and how this shift has changed the trajectory of targeted therapy for this disease. He also highlights data with the use of menin inhibitors in AML.

The integration of FLT3-ITD inhibitors into frontline management of AML has significantly shifted the paradigm of targeted therapies for this disease, Battiwalla begins. Historically, patients with AML were treated with either aggressive induction chemotherapy or venetoclax (Venclexta)–based regimens for patients needing less intensive management, he explains. However, as the understanding of AML’s molecular mutations has advanced, the ability to target specific mutations has greatly improved outcomes, Battiwalla emphasizes.

The introduction of FLT3-ITD inhibitors marked a breakthrough as the first successful targeted therapy in AML, he continues. These inhibitors are now an integral part of both frontline and maintenance treatment, according to Battiwalla. Their success has set a foundation for the development of additional targeted therapies, including inhibitors aimed at mutations in the IDH1/2 genes, further expanding treatment options for patients, Battiwalla explains.

The emergence of menin inhibitors represents another promising advancement in AML therapy, he expands. These agents are relevant for patients with NPM1 mutations or 11q23 gene rearrangements that result in MLL/KMT2Atranslocations. Early clinical trials investigating menin inhibitors, including those evaluating oral formulations of these agents, have demonstrated encouraging results, including high overall response rates, in several subsets of AML, Battiwalla adds. These promising outcomes indicate that menin inhibitors may soon become a key component of the AML treatment paradigm, he says.

Although no menin inhibitors have received FDA approval, several are nearing regulatory authorization, and it is anticipated that menin inhibitors will be incorporated into various lines of therapy, Battiwalla emphasizes. Theapproval of these agents would represent a significant shift in the AML treatment paradigm, offering new hope for patients with specific genetic mutations, Battiwalla concludes.