Dr. Donnellan on Developing Combinations in AML

William B. Donnellan, MD, investigator, Hematologic Malignancies, Sarah Cannon Research Institute, Tennessee Oncology, discusses combinations in light of newly FDA-approved agents in acute myeloid leukemia (AML).

In 2017, there were many FDA approvals in the world of AML. Now, physicians are determining optimal combinations for their patients. In patients with secondary AML who also have a FLT3 mutation, the focus of research will be in determining whether there is an added benefit in combining CPX-351 (Vyxeos) with a FLT3 inhibitor like midostaurin (Rydapt), or some of the second-generation FLT3 inhibitors with the IDH2 inhibitor, enasidenib (Idhifa).

Combinations with developing drugs are also being investigated. The big story at the 2017 ASH Annual Meeting was venetoclax. In newly diagnosed AML, the agent showed high response rates when used in combination with a hypomethylating agent. Rates of response are almost 3 times what would be expected with a hypomethylating agent alone.

There's also a big phase III study that’s launching that will compare azacitidine either in combination with venetoclax or placebo. That could potentially change the treatment paradigm for elderly patients who are not fit for induction.